You are probably reading this because someone close to you is dying. You may wonder how you can comfort the person, prevent suffering, and provide the best quality of life possible in their remaining time. If the person can no longer communicate, you may be asked to make difficult decisions about their care and comfort. This can be overwhelming for family members, especially if they have not had a chance to discuss the person’s wishes ahead of time — or if multiple family members are involved and do not agree.

Addressing a person’s advance care wishes

If the person has written documents as part of an advance care plan, such as a do not resuscitate order, tell the doctor in charge as soon as possible. If end-of-life care is given at home, you will need a special out-of-hospital order, signed by a doctor, to ensure that emergency medical technicians, if called to the home, will respect the person’s wishes. Hospice staff can help determine whether a medical condition is part of the normal dying process or something that needs the attention of health care personnel.

For situations that are not addressed in a person’s advance care plan, or if the person does not have such a plan, you can consider different decision-making strategies to help determine the best approach for the person.

Decision-making strategies: Substituted judgment and best interests

Two approaches might be useful when you encounter decisions that have not been addressed in a person’s advance care plan or in previous conversations with them. One is to put yourself in the place of the person who is dying and try to choose as they would. This is called substituted judgment. Some experts believe that decisions should be based on substituted judgment whenever possible. Another approach, known as best interests, is to decide what you as their representative think is best for the dying person. This is sometimes combined with substituted judgment.

These two approaches are illustrated in the stories below.

Joseph and Leilani’s story

Joseph’s 90-year-old mother, Leilani, was in a coma after having a major stroke. The doctor said damage to Leilani’s brain was widespread and she needed to be put on a breathing machine (ventilator) or she would probably die. The doctor asked Joseph if he wanted that to be done. Joseph remembered how his mother disapproved when an elderly neighbor was put on a similar machine after a stroke. He declined, and his mother died peacefully a few hours later. This is an example of the substituted judgment approach.

Ali and Wadi’s story

Ali’s father, Wadi, is 80 years old and has lung cancer and advanced Parkinson’s disease. He is in a nursing facility and doesn’t recognize Ali when he visits. Wadi’s doctor suggested that surgery to remove part of one of Wadi’s lungs might slow down the course of the cancer and give him more time. But, Ali thought, “What kind of time? What would that time do for Dad?” Ali decided that putting his dad through surgery and recovery was not in Wadi’s best interests. After talking with Wadi’s doctors, Ali believed that surgery, which could cause additional pain and discomfort, would not improve his father’s quality of life. This is an example of the best interests decision-making approach.

If you are making decisions for someone at the end of life and are trying to use one of these approaches, it may be helpful to think about the following questions:

• Have they ever talked about what they would want at the end of life?
• Have they expressed an opinion about someone else’s end-of-life treatment?
• What were their values and what gave meaning to their life? Maybe it was being close to family and making memories together. Or perhaps they loved the outdoors and enjoyed nature. Are they still able to participate in these activities?

If you are making decisions without specific guidance from the dying person, you will need as much information as possible to help guide your actions. Remember that the decisions you are faced with and the questions you may ask the person’s medical team can vary depending on if the person is at home or in a care facility or hospital. You might ask the doctor:

• What might we expect to happen in the next few hours, days, or weeks if we continue our current course of treatment?
• Will treatment provide more quality time with family and friends?
• What if we don’t want the treatment offered? What happens then?
• When should we begin hospice care? Can they receive this care at home or at the hospital?
• If we begin hospice, will the person be denied certain treatments?
• What medicines will be given to help manage pain and other symptoms? What are the possible side effects?
• What will happen if our family member stops eating or drinking? Will a feeding tube be considered? What are the benefits and risks?
• If we try using the ventilator to help with breathing and decide to stop, how will that be done?

It is a good idea to have someone with you when discussing these issues with medical staff. That person can take notes and help you remember details. Don’t be afraid to ask the doctor or nurse to repeat or rephrase what they said if you are unclear about something they told you. Keep asking questions until you have all the information you need to make decisions. If the person is at home, make sure you know how to contact a member of the health care team if you have a question or if the dying person needs something.

It can be difficult for doctors to accurately predict how much time someone has left to live. Depending on the diagnosis, certain conditions, such as dementia, can progress unpredictably. You should talk with the doctor about hospice care if they predict your loved one has six months or less to live.

Cultural considerations at the end of life

Everyone involved in a patient’s care should understand how a person’s history and cultural and religious background may influence expectations, needs, and choices at the end of life. Different cultural and ethnic groups may have various expectations about what should happen and the type of care a person receives. The doctor and other members of the health care team may have different backgrounds than you and your family. Discuss your personal and family traditions surrounding the end of life with the health care team.

A person’s cultural background may influence comfort care and pain management at the end of life, who can be present at the time of death, who makes the health care decisions, and where they want to die.

It’s crucial that the health care team knows what is important to your family surrounding the end of life. You might say:

• In my religion, we . . . (then describe your religious traditions regarding death).
• Where we come from . . . (tell what customs are important to you at the time of death).
• In our family when someone is dying, we prefer . . . (describe what you hope to happen).

Make sure you understand how the available medical options presented by the health care team fit into your family’s desires for end-of-life care. Telling the medical staff ahead of time may help avoid confusion and misunderstandings later. Knowing that these practices will be honored could comfort the dying person and help improve the quality of care provided.

Discussing a care plan

Having a care plan in place at the end of life is important in ensuring the person’s wishes are respected as much as possible. A care plan summarizes a person’s health conditions, medications, health care providers, emergency contacts, end-of-life care wishes, such as advance directives, and other decisions. A care plan may also include your loved one’s wishes after they die, such as funeral arrangements and what will be done with their body. It’s not uncommon for the entire family to want to be involved in a person’s care plan at the end of life. Maybe that is part of your family’s cultural tradition. Or, maybe the person dying did not pick a person to make health care choices before becoming unable to do so, which is also not unusual.

If one family member is named as the decision-maker, it is a good idea, as much as possible, to have family agreement about the care plan. If family members can’t agree on end-of-life care or they disagree with the doctor, your family might consider working with a mediator. A mediator is a professional trained to bring people with different opinions to a common decision. Clinicians trained in palliative care often conduct family meetings to help address disagreements around health care decisions.

Regardless, your family should try to discuss the end-of-life care they want with the health care team. In most cases, it’s helpful for the medical staff to have one person as the main point of contact.

Here are some questions you might want to ask the medical staff when making decisions about a care plan:

• What is the best place — such as a hospital, facility, or at home — to get the type of care the dying person wants?
• What decisions should be included in our care plan? What are the benefits and risks of these decisions?
• How often should we reassess the care plan?
• What is the best way for our family to work with the care staff?
• How can I ensure I get a daily update on my family member’s condition?
• Will you call me if there is a change in his or her condition?
• Where can we find help paying for this care?

There may be other questions that arise depending on your family’s situation. It’s important to stay in contact with the health care team.

To learn more, please visit https://www.nia.nih.gov/health/end-life/making-decisions-someone-end-life.

Many older adults share a common concern: “Can I trust the health information I find online?” There are thousands of medical websites. Some provide up-to-date medical news and reliable health information, and some do not. Choosing trustworthy websites is an important step in gathering reliable health information.

Where can I find reliable health information online?

The National Institutes of Health website is a good place to start for reliable health information. The Centers for Disease Control and Prevention website is another one.

As a rule, health websites sponsored by federal government agencies are accurate sources of information. You can reach all federal websites by visiting www.usa.gov. Medical and health care organizations, hospitals, and academic medical institutions may also be reliable sources of health information.

Your health care provider can also suggest ideal sources of online information. If your doctor’s office has a website, it may include a list of recommended links.

Questions to ask before trusting a website

Searching online, you will likely find websites for multiple health organizations, including many you may not recognize. The following questions can help determine which ones are trustworthy. Many of the answers can often be found in a website’s “About Us” section.

1. What is the purpose of the website, and who owns or sponsors it?

Why was the site created? Is the purpose of the site to inform or explain, or is it trying to sell a product or service? Understanding the motive of the website can help you better judge its content. The goal of any trustworthy health information website is to provide accurate, current, and useful information versus trying to make a sale.

Knowing who pays for a website may provide you with insight into the mission or goal of the site. For example, if a business pays for the site, the health information may favor that business and its products. Sometimes, the website address (called a URL) is helpful for identifying the type of agency or organization that owns the site. For example:

• .gov identifies a U.S. government agency
• .edu identifies an educational institution, such as a school, college, or university
• .org usually identifies nonprofit organizations, such as medical or research societies and advocacy groups
• .com identifies commercial websites, such as businesses and pharmaceutical companies

While many commercial websites do provide accurate, useful health information, it can be hard to distinguish this content from marketing and promotional materials in some cases. Any advertisements on a site should be clearly marked as such. Watch out for ads designed to look like neutral health information.

2. Who wrote the information? Who reviewed it?

Website pages often, but not always, identify the authors and contributors. If the author is listed, are they an expert in the field? Look for health care professionals or scientific researchers with in-depth knowledge of the topic. Does the author work for an organization and, if so, what are the goals of that organization? A contributor’s connection to the website, and any financial stake they have regarding the information on the website, should be made clear.

If the material is not authored by an expert, has the information been reviewed by a health care professional or other credentialed specialist? Dependable health information websites will share sources and citations.

Trustworthy websites will also have contact information — an email address, phone number, and/or mailing address — that you can use to reach the site’s sponsor. Look for this information at the bottom of web pages or in a separate “About Us” or “Contact Us” page.

Be cautious about testimonials, individual blogs, and posts on discussion boards. Personal stories may be helpful and comforting, but not everyone experiences health problems the same way. Also, there is a big difference between information written by a single person interested in a topic and a website developed by professionals using researched and peer-reviewed scientific evidence.

No online information, even if it is accurate and trustworthy, should replace seeing a health care professional who can thoroughly evaluate your unique situation and provide specific advice.

3. When was the information written and updated?

Look for websites that stay current with their health information. You don’t want to make decisions about your care based on out-of-date content. Often, the date the information was created and reviewed or updated will appear at the bottom of the page. Pages on the same site may be updated at different times, and some may be updated more often than others. Older information isn’t useless, but using the most current, evidence-based information is ideal.

4. Is your privacy protected? Does the website clearly state a privacy policy?

Read the website’s privacy policy. It is usually at the bottom of the page or on a separate page titled “Privacy Policy” or “Our Policies.” If a website says it uses “cookies,” your information may not be private. Cookies are small text files that enable a website to collect and remember information about your visit. While cookies may enhance your web experience, they can also compromise your online privacy, so it is important to read about the information the website collects and how the organization will use it. Many websites will ask you ahead of time if you want to accept cookies, but others may not. If you are concerned about the potential use of information gathered by cookies, you can choose to disable the use of cookies through your internet browser settings.

5. How can I protect my health information?

If you are asked to share personal information, be sure to find out how the information will be used. Secure websites that collect personal information responsibly have an “s” after “http” in the start of their website addresses (https://) and often require that you create a username and password.

Be careful about sharing your Social Security number. Find out why your number is needed, how it will be used, and what will happen if you do not share this information. Only enter your Social Security number on secure websites. You might consider calling your doctor’s office or health insurance company to give this information over the phone rather than providing it online.

Taking these precautions may help protect your information:

• Beware of health fraud scams and pay attention when browsing the internet. Do not open unexpected links. Hover your mouse over a link to confirm that clicking it will take you to a reputable website.
• Always use a strong password. Include a variation of numbers, letters, and symbols. Some websites may allow you to use a phrase as well. Create a unique password for each website and change it frequently.
• Use two-factor authentication when you can. This security feature requires the use of two different types of personal information to log into your mobile devices or accounts.
• Don’t enter sensitive information over public Wi-Fi. Learn about how to safely use public Wi-Fi networks.
• Be careful about the information you share through social media sites. For example, don’t share personal information, such as where you live or your contact information, on a public channel.

6. Does the website offer quick and easy solutions to your health problems? Does it promise miracle cures?

• Be cautious about websites claiming any single remedy will cure many different illnesses. Also be wary of sites suggesting simple or unproven treatments for a disease. Question dramatic writing or promises of cures that seem too good to be true and look for other websites with the same information. Even if a website links to a trustworthy source, it doesn’t mean that the site has the other organization’s endorsement or support.

Health and medical apps

Mobile medical applications (“apps”) are a type of software you can install and run on your smartphone. Medical apps can support your health in many ways. For example, they can help track your eating habits or physical activity, access test results from a lab, or monitor a health condition. They can also provide helpful reminders to exercise or take medications. But anyone can develop a health app — for any reason — and apps may include inaccurate or misleading information. Before you download or use an app, make sure you know who produced it.

When you download an app, it may ask for your location, your email, or other personal information. Apps may also collect data about you as you use them. Ensure the information collected is relevant to the app, you know how the information will be used, and you feel comfortable sharing this information. Responsible app developers will make this information readily available before you download it.

Social media, health news, and health books

Social media websites and apps are online communities through which people can connect with friends, family, and strangers. Social media is one way people share health information and news stories with each other. Some of this information may be true, but too often some of it is not. Recognize that just because a post is from a friend or colleague, it does not necessarily mean that the information is accurate, complete, or applicable to your health. Check the source of the information, and make sure the original author is credible. Fact-checking websites can also help you determine if a story is reliable.

Evaluating health information in books is similar to finding reliable information on websites or on social media. Make sure to check who wrote the book, how current the information is, and where the content came from. When in doubt, ask your health care provider about what you read.

Trust yourself and talk with your doctor

Use your good judgment when gathering health information online. There are websites on nearly every health topic, and many have no rules for overseeing the quality of the information provided. Use the information you find online as one tool to become more informed. Don’t count on any one website and check your sources. Discuss what you find with your doctor before making any changes to your health care.

To learn more, please visit https://www.nia.nih.gov/health/healthy-aging/how-find-reliable-health-information-online.

A heart attack happens when the flow of blood in one or more of the coronary arteries (major blood vessels that supply blood to the heart), suddenly becomes blocked. When this happens, part of your heart can’t get enough oxygen.

A heart attack is usually caused by coronary artery disease, which happens when a sticky, waxy substance called plaque builds up inside the arteries, causing them to narrow. The plaque can break open, causing blood clots that, if they grow large enough, will block blood flow to the heart. If blood flow isn’t restored quickly, the heart muscle begins to die.

To restore blood flow, doctors may use a medicine to dissolve the blockage. Or they may place a thin flexible tube called a catheter into an artery in the top of your leg or arm to physically open the blockage. If the clot or plaque blocking blood flow is particularly long or has certain qualities, the cardiologist may use a catheter with a stent, which is a cylinder made of thin metal mesh that helps hold the artery open.

Heart attacks are very common. They can occur in both men and women. Each year, more than 800,000 people in the United States have a heart attack.

A heart attack is a life-threatening medical emergency that needs immediate attention. Knowing the warning signs of a heart attack may help save a life. The signs can include:

• Crushing chest pain or pressure in the center or left side of the chest
• Pain, numbness, and/or tingling in the shoulders, arms, neck, jaw, or back
• Shortness of breath when active, at rest, or while lying flat
• Fainting, lightheadedness, or sudden dizziness
• Rapid or irregular heartbeat
• Cold sweats
• Nausea, vomiting, or stomach upset
• Tiredness or fatigue
• Weakness
• Anxiety

The symptoms of a heart attack can be different in men and women. Women are more likely than men to experience shortness of breath; tiredness; weakness; upset stomach; anxiety; and pain in the shoulder, back, or arm. Women may also face more health problems after a heart attack, so it’s very important if you’re experiencing any symptoms or think you’re having a heart attack to seek medical assistance as soon as possible.

Although these problems can be signs of a heart attack, they can also be associated with other health conditions. Tell your doctor about any health concerns you have.

If you or someone you know might be having a heart attack, call 911 right away. Also call 911 if you are taking prescription drugs for angina (chest pain) and the pain doesn’t go away after you take the medication. You need to take an ambulance to the hospital as soon as possible. Do not try to drive yourself, and do not have someone else drive you unless there is no ambulance service where you live. The sooner you get to a hospital, the more emergency medical professionals can do to stop any heart damage and prevent deadly heart rhythm problems, heart failure, and death. If blood flow in the blocked artery can be restored quickly, it may prevent permanent damage to the heart.

The good news is that excellent treatments are available for heart attacks. These treatments — which work best when given right after symptoms begin — can save lives and help prevent disability after a heart attack.

For more information

National Heart, Lung, and Blood Institute
301-592-8573
nhlbiinfo@nhlbi.nih.gov
www.nhlbi.nih.gov

American Heart Association
800-242-8721 
inquiries@heart.org
www.heart.org

Parkinson’s disease is a brain disorder that causes unintended or uncontrollable movements, such as shaking, stiffness, and difficulty with balance and coordination.

Symptoms usually begin gradually and worsen over time. As the disease progresses, people may have difficulty walking and talking. They may also have mental and behavioral changes, sleep problems, depression, memory difficulties, and fatigue.

While virtually anyone could be at risk for developing Parkinson’s, some research studies suggest this disease affects more men than women. It’s unclear why, but studies are underway to understand factors that may increase a person’s risk. One clear risk is age: Although most people with Parkinson’s first develop the disease after age 60, about 5% to 10% experience onset before the age of 50. Early-onset forms of Parkinson’s are often, but not always, inherited, and some forms have been linked to specific alterations in genes.

What causes Parkinson’s disease?

The most prominent signs and symptoms of Parkinson’s disease occur when nerve cells in the basal ganglia, an area of the brain that controls movement, become impaired and/or die. Normally, these nerve cells, or neurons, produce an important brain chemical known as dopamine. When the neurons die or become impaired, they produce less dopamine, which causes the movement problems associated with the disease. Scientists still do not know what causes the neurons to die.

People with Parkinson’s disease also lose the nerve endings that produce norepinephrine, the main chemical messenger of the sympathetic nervous system, which controls many functions of the body, such as heart rate and blood pressure. The loss of norepinephrine might help explain some of the non-movement features of Parkinson’s, such as fatigue, irregular blood pressure, decreased movement of food through the digestive tract, and sudden drop in blood pressure when a person stands up from a sitting or lying position.

Many brain cells of people with Parkinson’s disease contain Lewy bodies, unusual clumps of the protein alpha-synuclein. Scientists are trying to better understand the normal and abnormal functions of alpha-synuclein and its relationship to genetic variants that impact Parkinson’s and Lewy body dementia.

Some cases of Parkinson’s disease appear to be hereditary, and a few cases can be traced to specific genetic variants. While genetics is thought to play a role in Parkinson’s, in most cases the disease does not seem to run in families. Many researchers now believe that Parkinson’s results from a combination of genetic and environmental factors, such as exposure to toxins.

Symptoms of Parkinson’s disease

Parkinson’s has four main symptoms:

• Tremor in hands, arms, legs, jaw, or head
• Muscle stiffness, where muscle remains contracted for a long time
• Slowness of movement
• Impaired balance and coordination, sometimes leading to falls

Other symptoms may include:

• Depression and other emotional changes
• Difficulty swallowing, chewing, and speaking
• Urinary problems or constipation
• Skin problems

The symptoms of Parkinson’s and the rate of progression differ among individuals. Early symptoms of this disease are subtle and occur gradually. For example, people may feel mild tremors or have difficulty getting out of a chair. They may notice that they speak too softly, or that their handwriting is slow and looks cramped or small. Friends or family members may be the first to notice changes in someone with early Parkinson’s. They may see that the person’s face lacks expression and animation, or that the person does not move an arm or leg normally.

People with Parkinson’s disease often develop a parkinsonian gait that includes a tendency to lean forward; take small, quick steps; and reduce swinging their arms. They also may have trouble initiating or continuing movement.

Symptoms often begin on one side of the body or even in one limb on one side of the body. As the disease progresses, it eventually affects both sides. However, the symptoms may still be more severe on one side than on the other.

Many people with Parkinson’s disease note that prior to experiencing stiffness and tremor, they had sleep problems, constipation, loss of smell, and restless legs. While some of these symptoms may also occur with normal aging, talk with your doctor if these symptoms worsen or begin to interfere with daily living.

Diagnosis of Parkinson’s disease

There are currently no blood or laboratory tests to diagnose non-genetic cases of Parkinson’s. Doctors usually diagnose the disease by taking a person’s medical history and performing a neurological examination. If symptoms improve after starting to take medication, it’s another indicator that the person has Parkinson’s.

A number of disorders can cause symptoms similar to those of Parkinson’s disease. People with Parkinson’s-like symptoms that result from other causes, such as multiple system atrophy and dementia with Lewy bodies, are sometimes said to have parkinsonism. While these disorders initially may be misdiagnosed as Parkinson’s, certain medical tests, as well as response to drug treatment, may help to better evaluate the cause. Many other diseases have similar features but require different treatments, so it is important to get an accurate diagnosis as soon as possible.

Treatments for Parkinson’s disease

Although there is no cure for Parkinson’s disease, medicines, surgical treatment, and other therapies can often relieve some symptoms.

Medicines for Parkinson’s disease

Medicines can help treat the symptoms of Parkinson’s by:

• Increasing the level of dopamine in the brain
• Having an effect on other brain chemicals, such as neurotransmitters, which transfer information between brain cells
• Helping control non-movement symptoms

The main therapy for Parkinson’s is levodopa. Nerve cells use levodopa to make dopamine to replenish the brain’s dwindling supply. Usually, people take levodopa along with another medication called carbidopa. Carbidopa prevents or reduces some of the side effects of levodopa therapy — such as nausea, vomiting, low blood pressure, and restlessness — and reduces the amount of levodopa needed to improve symptoms.

People living with Parkinson’s disease should never stop taking levodopa without telling their doctor. Suddenly stopping the drug may have serious side effects, like being unable to move or having difficulty breathing.

The doctor may prescribe other medicines to treat Parkinson’s symptoms, including:

• Dopamine agonists to stimulate the production of dopamine in the brain
• Enzyme inhibitors (e.g., MAO-B inhibitors, COMT inhibitors) to increase the amount of dopamine by slowing down the enzymes that break down dopamine in the brain
• Amantadine to help reduce involuntary movements
• Anticholinergic drugs to reduce tremors and muscle rigidity

Deep brain stimulation

For people with Parkinson’s disease who do not respond well to medications, the doctor may recommend deep brain stimulation. During a surgical procedure, a doctor implants electrodes into part of the brain and connects them to a small electrical device implanted in the chest. The device and electrodes painlessly stimulate specific areas in the brain that control movement in a way that may help stop many of the movement-related symptoms of Parkinson’s, such as tremor, slowness of movement, and rigidity.

Other therapies

Other therapies that may help manage Parkinson’s symptoms include:

• Physical, occupational, and speech therapies, which may help with gait and voice disorders, tremors and rigidity, and decline in mental functions
• A healthy diet to support overall wellness
• Exercises to strengthen muscles and improve balance, flexibility, and coordination
• Massage therapy to reduce tension
• Yoga and tai chi to increase stretching and flexibility

Support for people living with Parkinson’s disease

While the progression of Parkinson’s is usually slow, eventually a person’s daily routines may be affected. Activities such as working, taking care of a home, and participating in social activities with friends may become challenging. Experiencing these changes can be difficult, but support groups can help people cope. These groups can provide information, advice, and connections to resources for those living with Parkinson’s disease, their families, and caregivers. The organizations listed below can help people find local support groups and other resources in their communities.

To learn more, please visit https://www.nia.nih.gov/health/parkinsons-disease/parkinsons-disease-causes-symptoms-and-treatments.

Alzheimer’s disease changes the brain in ways that can affect how a person acts. Some days, the person might seem like themselves, and other days they might act in unusual ways. This variation from one day to the next is common for people with Alzheimer’s. On this page, learn about some of the common behavior changes that affect people with Alzheimer’s and how to manage these changes.

How does Alzheimer’s affect behavior?

In addition to thinking and memory problems, people with Alzheimer’s may experience symptoms such as agitation, trouble sleeping, and hallucinations. They may wander, pace, and behave in unusual ways. These problems can make your job as a caregiver harder. It’s important to remember that the disease, not the person with Alzheimer’s, causes these changes.

Common behavior changes in Alzheimer’s include:

• Showing signs of anxiety or fear
• Getting upset, worried, and angry more easily
• Acting depressed or not interested in things
• Hiding things or believing other people are hiding things
• Imagining things that aren’t there
• Feeling suspicious of or threatened by others, for little or no reason
• Pacing a lot of the time
• Showing unusual sexual behavior
• Wandering away from home
• Hitting other people
• Misunderstanding what they see or hear
• Having difficulty sleeping through the night

Other reasons for changes in behavior

In addition to changes in the brain, other things may affect how people with Alzheimer’s behave. The following are factors that may cause distressing behaviors in people with Alzheimer’s:

• Emotions such as sadness, fear, stress, confusion, or anxiety
• Health-related problems, such as pain, lack of sleep, and problems seeing or hearing
• Other physical issues, such as constipation, hunger, or thirst
• Side effects of new medications
• A noisy or stressful environment (for example, many conversations at once or a loud TV or radio)

Sudden or rapidly fluctuating changes in behavior, especially if the person has had an infection or recent medication changes, should be immediately brought to a doctor’s attention.

Caregivers may find it helpful to consider whether changes in behavior are caused by the disease itself or something else, such as the environment. But figuring out the cause of a behavior change is not always an easy task. Keeping track of common behavioral changes can help caregivers and health care providers recognize a pattern and determine the cause of the behavioral change.

Tips to manage behavior changes

Learning ways to manage behavior changes can make everyday life less stressful for a person with Alzheimer’s, their caregivers, and their loved ones. Here are some tips:

• Be patient, try not to show frustration, and avoid arguing.
• Reassure the person that you are there to help.
• Learn how to communicate with a person with Alzheimer’s.
• Redirect their attention to a new object or activity, such as listening to music, reading a book, or going for a walk.
• Create a comforting home setting by reducing noise and clutter and keeping well-loved objects (such as photos) around the home.
• Try to keep the person to a routine by bathing, dressing, and eating at the same time each day.
• Find ways for the person to be physically active, which can improve mood and sleep.

To learn more, please visit https://www.nia.nih.gov/health/alzheimers-changes-behavior-and-communication/alzheimers-caregiving-managing-personality-and.

Have you, or has someone you love, recently been diagnosed with mild cognitive impairment, early-stage Alzheimer’s disease, vascular dementia, Lewy body dementia, or a frontotemporal disorder? Do you worry about how to manage if you live alone? If so, these tips offer ways to help cope with changes in memory and thinking, prepare for the future, and stay active and engaged.

Make Everyday Tasks Easier

Many people with early-stage dementia continue to manage their everyday activities. But it’s important to look ahead to a time when performing daily tasks will be harder. The sooner you adopt new strategies to help you cope with changes, the more time you will have to adjust to them. Here are some tips:

• Organizing your days. Write down to-do lists, appointments, and events in a notebook or calendar. You can also keep track of activities with computer software or a smartphone app. Some people have an area in their home, such as an entryway table or bench, where they store important items or organize the things they need each day. You may also want to consider using a digital clock that displays the day of the week and date, in addition to the time.
• Paying bills. Setting up automated payments is an easy way to pay your bills correctly and on time without having to write checks. Many companies and banks offer this service at no extra charge. You can set up automatic payments with your utility providers, insurance companies, bank, and mortgage company or leasing office. Also consider asking someone you trust to help you pay bills. That person could review your financial statements and ask you about anything unusual.
• Shopping for meals. Many stores offer grocery delivery services, usually for a small fee. You can also order fresh or frozen meals online or by phone. Meals on Wheels America (888-998-6325) can deliver free or low-cost meals to your home, too, and this service sometimes includes a short visit and safety check. Other possible sources of meals include religious communities and senior centers. If you make your own meals at home, consider easy-to-prepare items, such as foods that you can heat in the microwave.
• Taking medications. Several products can help you manage medications. You can try a weekly pillbox, a pillbox that gives you a notification (such as an alarm or vibration) when it’s time to take medicine, or an automatic medication dispenser. You can buy these items at a drugstore or online, but you may need someone to help you set these up. Or try an electronic reminder system, such as a smartphone app or an alarm you set on your phone or computer.
• Using transportation. If you drive, you may find that you become confused, get lost, or need help with directions more often than before. Talk with your doctor about these changes. If family or friends express concerns about your driving, take their concerns seriously. Some people decide to give up driving and learn how to use public transportation or ride sharing. Neighbors, volunteers, or ride services for older adults may also be able to help with transportation.

For more suggestions on living independently, see Aging in Place: Growing Older at Home.

Scan Your Home for Safety

Making minor changes in your home can create a safer environment. For example:

• Get rid of unused items and extra furniture. If there are things you no longer use (such as clothing, appliances, decorations, and furniture), now is the time to remove them. Consider giving items to family and friends or donating items in good condition to a charity. Some organizations will pick items up from your home.
• Remove items that you may trip over. Move electrical cords, pick up throw rugs, and look for other things you might trip over. Falls can cause injury and disability that may make it difficult to live alone. Read more about fall prevention.
• Install an automatic shut-off switch on the stove. This switch can help prevent a fire from starting if the stove is left on accidentally. If necessary, have your stove disabled. Consider using a microwave or cooking device with an automatic shut-off, such as a slow cooker or rice cooker, to heat up food.
• Set the water heater at 120 °F. This setting will help you to avoid burns from scalding tap water and may help save money, too!
• Improve bathroom safety. Add nonskid mats to showers and tubs. Also consider installing grab bars in the tub or shower. Add a nightlight in the bathroom or hallway and keep a flashlight near your bed for trips to the bathroom at night.
• Carry identification with you. Medical ID bracelets and necklaces are helpful in case you get lost or need help. In an emergency, an ID can also let emergency responders know if you have allergies or special medical needs.
• Consider getting safety devices to alert others in an emergency. Personal safety devices you may want to consider include fall monitors, emergency call buttons, and GPS tracking systems. Talk to your doctor or social worker about finding an alert system to notify family and friends if you fall, become ill, or get lost.
• Make sure smoke and carbon monoxide detectors are installed and working throughout your home. These detectors should be installed in or near the kitchen and all bedrooms. Set reminders to check the batteries every six months.
• Get help with home maintenance and organization. Ask a family member or hire a professional service to help with tasks like managing clutter and making home repairs. Add labels to cabinets and drawers to make it easier to find flashlights, fire extinguishers, and other safety items quickly.

Prepare for the Future

Preparing for the future may be difficult to think about. But by starting discussions with family and friends early, everyone can help make decisions together. Talk about health and finances now, rather than later, to make sure you have a say in future decisions.

Discuss decisions about health and finances as soon as possible to ensure that others, including your doctor and family, understand your preferences for your late-stage or end-of-life decisions. Other ways to prepare for the future include:

• Get legal and financial matters in order as soon as possible. Prepare or update your will, living will, and durable powers of attorney for health care and finances. If you need legal advice, call your lawyer, or contact the National Academy of Elder Law Attorneys (703-942-5711) to find an attorney. Be sure to let someone you trust know where your documents are kept or give them a copy. Read to learn more about advance care planning.
• Understand your options for in-home care. Family members and friends may be able to help with everyday activities. If you need more help, look into options for a personal care assistant or home health care aide. Consider the costs of these services and whether any of the costs are covered by insurance. Check with your insurance provider(s) and resources like the USA.gov Benefit Finder Tool and BenefitsCheckUp to find out about benefits you may qualify for. Learn more about long-term care and how to pay for it.
• Plan for care when you can no longer live alone. There will likely come a time when you need more day-to-day care and support. Could a family member or caregiver move in with you? Or could you move in with them? Professional home care, assisted living communities, and nursing homes are other options.
• If you work, consider your options. You could share your diagnosis with your employer and discuss how to adjust your work. Under the Americans With Disabilities Act, employers with more than 15 employees are required to provide reasonable accommodations for people with disabilities. This might include changing your hours, getting reminders, or splitting up large tasks. Learn more about Alzheimer’s and employment.
• Find out about potential disability benefits if you are no longer able to work. People with dementia may be eligible for disability income through private disability insurance (if you purchased this previously), Social Security, or veterans’ benefits. A Social Security program called Compassionate Allowances ensures quick review of disability benefit claims for people with conditions including early-onset Alzheimer’s and several other types of dementia.

Strengthen Your Support System

Family members, friends, or other caregivers may be able to help in different ways. Here are some suggestions:

• Identify family and friends who can help. Talk to them about your diagnosis and ask if they can visit you regularly and be an emergency contact. Write down and save their phone numbers and other contact information in an obvious place, such as on your refrigerator door or in your wallet or mobile phone. Even family members who live far away can help. Read about long-distance caregiving.
• Consider sharing your diagnosis with neighbors you trust. Neighbors are often the first people to notice if someone is wandering or looks lost and they may be able to get help. Get tips for helping family and friends understand Alzheimer’s.
• Visit a health care provider. Your primary care doctor, neurologist, or other specialist can track changes in your memory, thinking, and ability to complete everyday tasks. Ask the doctor to provide you with a care plan and write down directions (or have a family member or friend take notes during the visit). If getting to the doctor’s office is difficult, ask your doctor about home visits or telehealth appointments. The office may also be able to recommend home health care services or a geriatric care manager, a person who helps older people find services they need.
• Learn about home- and community-based support and services. Social service agencies, local nonprofits, and Area Agencies on Aging can provide or refer you to in-home help, transportation, and meals to help you live at home. Call the Eldercare Locator (800-677-1116) to learn about services in your area. Learn more about getting help with Alzheimer’s caregiving.
• Stay connected with technology. Smartphones, computers, and tablets can connect you with family and friends through video calls, email, and social media. You may want to get products that are easy to use, such as a telephone with pictures for dialing. Whatever technology you choose, start early so you can learn the system and establish a routine. Are you unfamiliar with technology? Ask your local library or community center about classes.
• Talk with others who share your condition. Ask your doctor’s office or a social worker about support groups in your community or hosted by nonprofit organizations. For example, the Alzheimer’s Association has both online and in-person support groups and a 24-hour helpline (800-272-3900). Many NIA-supported Alzheimer’s Disease Research Centers offer programs and events for people with Alzheimer’s or a related dementia and their caregivers. Your community may also have a memory café — a place for people with dementia and their caregivers to enjoy activities and socialize.
• Get urgent help if you need it. If you are experiencing depression or have thoughts of harming yourself, immediate help is available. Call or text the 24-hour 988 Suicide & Crisis Lifeline at 988 or 800-273-TALK (800-273-8255). For TTY, use your preferred relay service or dial 711 then 988.

Take care of your physical and mental health

Eating a healthy diet, getting regular exercise, and staying connected with others offer proven benefits for well-being. Here are some tips for taking care of your mind and body if you have early-stage dementia:

• Exercise. You don’t have to join a gym or spend a lot of money to be physically active. Even light housework, gardening, and walking around the neighborhood can have benefits. Experts recommend both aerobic exercise (such as walking) and strength training (such as lifting weights). Learn more about physical activity for people with dementia.
• Eat right. Eating healthy foods helps everyone stay well, and it’s particularly important for people with dementia. Learn more about healthy eating.
• Make sleep a priority. Dementia often changes a person’s sleeping habits. But there are steps you can take to help you get a good night’s sleep, including following a regular sleep schedule.
• Be mindful. One way to help manage stress and reduce anxiety is a technique called mindfulness, which involves focusing awareness on the present moment without judgment. Learn more about the health benefits of mindfulness in daily living.
• Stay social. Spending meaningful time with others can help you cope with challenges and improve your quality of life. Join a support group, chat with family and friends regularly, or share activities you enjoy with your spouse or partner. Learn more about how to continue to participate in activities you enjoy.

To learn more, please visit https://www.nia.nih.gov/health/alzheimers-and-dementia/tips-living-alone-early-stage-dementia.

Seneca Place is proud to share Ms. Rios’s inspiring Success Story!

Ms. Rios admitted to Seneca Place for skilled therapy after a right leg amputation. At first, she required assistance with all aspects of care. With determination and the support of our therapy team and dedicated caregivers, she made incredible progress—advancing to modified independence with her daily activities and transfers.

Recently, Ms. Rios has been working on standing and pre-gait activities with Physical Therapy to prepare for her prosthetic leg. She is scheduled to discharge soon to her new apartment, where she will continue her next stage of recovery.

When asked about her experience, Ms. Rios shared that she met all her goals and had a great stay. Her advice to others beginning therapy:
“Just keep on going. Even when it is hard, keep on going. It will be better in the end.”

Congratulations to Ms. Rios and her amazing care team on this incredible achievement!

Asking questions is key to good communication with your doctor. If you don’t ask questions, he or she may assume you already know the answer or that you don’t want more information. Don’t wait for the doctor to raise a specific question or subject; he or she may not know it’s important to you. Be proactive. Ask questions when you don’t know the meaning of a word (like aneurysm, hypertension, or infarct) or when instructions aren’t clear (for example, does taking medicine with food mean before, during, or after a meal?).

Learn about medical tests

Sometimes, doctors need to do blood tests, X-rays, or other procedures to find out what is wrong or to learn more about your medical condition. Some tests, such as Pap tests, mammograms, glaucoma tests, and screenings for prostate and colorectal cancer, are done regularly to check for hidden medical problems.

Before having a medical test, ask your doctor to explain why it is important, what it will show, and what it will cost. Ask what kind of things you need to do to prepare for the test. For example, you may need to have an empty stomach, or you may have to provide a urine sample. Ask how you will be notified of the test results and how long they will take to come in.

Questions to ask your doctor before a medical test

• Why is the test being done?
• What steps does the test involve? How should I get ready?
• Are there any dangers or side effects?
• How will I find out the results? How long will it take to get the results?
• What will we know after the test?

When the results are ready, make sure the doctor tells you what they are and explains what they mean. You may want to ask your doctor for a written copy of the test results. If the test is done by a specialist, ask to have the results sent to your primary doctor.

Discuss your diagnosis and what to expect

A diagnosis identifies your disease or physical problem. The doctor makes a diagnosis based on the symptoms you are experiencing and the results of the physical exam, laboratory work, and other tests.

If you understand your medical condition, you can help make better decisions about treatment. If you know what to expect, it may be easier for you to deal with the condition.

Ask the doctor to tell you the name of the condition and why he or she thinks you have it. Ask how it may affect you and how long it might last. Some medical problems never go away completely. They can’t be cured, but they can be treated or managed.

Questions to ask your doctor about your diagnosis

• What may have caused this condition? Will it be permanent?
• How is this condition treated or managed? What will be the long-term effects on my life?
• How can I learn more about my condition?

Understand your medications

Your doctor may prescribe a drug for your condition. Make sure you know the name of the drug and understand why it has been prescribed for you. Ask the doctor to write down how often and for how long you should take it.

Make notes about any other special instructions. If you are taking other medications, make sure your doctor knows what they are, so he or she can prevent harmful drug interactions. Check with your doctor’s office before taking any over-the-counter medications.

Let the doctor know if your medicine doesn’t seem to be working or if it is causing problems. If you want to stop taking your medicine, check with your doctor first.

You may find it helpful to keep a chart of all the medicines you take and when you take them. Download, print, and copy the Medications worksheet.

Paying for medications

Don’t hesitate to ask the doctor about the cost of your medications. If they are too expensive for you, the doctor may be able to suggest less expensive alternatives. You can ask if there is a generic or other less expensive choice. You could say, for instance: “It turns out that this medicine is too expensive for me. Is there another one or a generic drug that would cost less?”

Get answers to commonly asked questions about medicines, including how to save money on medications.

For more information about questions to ask the doctor

Centers for Disease Control and Prevention
800-232-4636
cdcinfo@cdc.gov
www.cdc.gov

Medicare
800-633-4227
877-486-2048 (TTY)
www.cms.gov
www.medicare.gov

MedlinePlus
National Library of Medicine
www.medlineplus.gov

Agency for Healthcare Research and Quality
301-427-1364
info@ahrq.hhs.gov
www.ahrq.gov

Healthy Eating As You Age: Know Your Food Groups

Making smart food choices is an important part of healthy aging. Understanding the different food groups — and how much of each should make up your diet — can help you form a healthy eating pattern over time. This article describes the main food groups and other important nutrients recommended for older adults in the Dietary Guidelines for Americans (PDF, 30.6M). We also provide suggestions for how to fit occasional treats into your healthy eating pattern.

It is important to get the recommended amount of each food group without going over your daily recommended calories. Keep in mind that the amount you should eat to maintain your weight depends on your age, sex, and level of physical activity.

Main food groups

Vegetables

Vegetables come in a wide variety of colors, flavors, and textures. They contain vitamins and minerals, carbohydrates, and are an important source of fiber. The vegetable food group includes dark green vegetables, red and orange vegetables, starchy vegetables, and legumes (beans and peas).

Dark green vegetables include broccoli, collard greens, spinach, and kale. Red and orange vegetables include acorn squash, carrots, pumpkin, tomato, and sweet potato. Starchy vegetables include corn, green peas, and white potatoes. Other vegetables include eggplant, beets, cauliflower, Brussels sprouts, celery, artichokes, green beans, and onions. Legumes include black beans, garbanzo beans (chickpeas), kidney beans, soybeans, and tofu. Legumes can also be counted in the protein foods group.

1/2 cup-equivalent of vegetables equals:

• 
  1 cup uncooked spinach
• 
  6 baby carrots
• 
  1/2 cup cooked kidney beans
• 
  1/2 cup broccoli florets
• 
  1/2 large (3-inch diameter, 3-3/4 inch long) red pepper
• 
  1/2 cup cooked green beans

See more foods in the vegetable group.

Fruits

Fruits bring color, flavor, and important nutrients to your diet. There are so many choices — citrus fruits like oranges and grapefruits; different kinds of berries; fruits that grow on trees, such as apricots, cherries, peaches, and mangoes; and others like figs, grapes, and pineapples.

According to the Dietary Guidelines (PDF, 30.6M), older Americans generally do not eat enough fruit. Adding more fruit to your diet can have significant benefits for overall health. Fruits, like vegetables, contain carbohydrates and provide extra fiber that helps keep your digestive system moving. For even more fiber, eat fruits with the skin on — just make sure you wash all fruits thoroughly before eating. Although 100% fruit juice also counts toward this category, at least half of the fruits you eat should be whole fruits. When purchasing frozen, canned, or dried fruit, choose options that are lowest in added sugars.

1/2 cup-equivalent of fruit equals:

• 
  1 small piece fruit, such as a 2-inch peach or large plum
• 
  1/4 cup dried fruit
• 
  1/8 medium cantaloupe
• 
  1/2 cup 100% orange juice
• 
  1/2 medium grapefruit
• 
  1/2 cup grapes

See more foods in the fruit group.

Grains

Any food made from wheat, rye, rice, oats, cornmeal, barley, or other cereal grain is a grain product. This includes bread and pasta, breakfast cereal, grits, tortillas, and even popcorn. Grains — along with fruits, vegetables, and dairy — contain carbohydrates, the body’s main source of energy.

Read food labels to find grain choices that are low in saturated fat and added sugar. Be especially wary of options labeled “low-fat,” which can be high in added sugar.

At least half the grain foods you eat should be whole grains. Whole grains provide iron and many B vitamins, and they have fiber, too. Examples of whole grains include whole wheat, whole oats, whole bulgur (also known as cracked wheat), and whole cornmeal.

Some grain products are refined, which gives them a finer texture and a longer shelf life but removes fiber and nutrients. Most refined grains are enriched, which means that some nutrients are added back after processing. Examples of refined grain products include white flour, degermed cornmeal, white bread, and white rice.

1 ounce-equivalent of grain equals:

• 
  1 slice bread
• 
  1 small (2-1/2-inch diameter) muffin
• 
  1 cup breakfast cereal (flakes, rounds, or puffed)
• 
  1/2 cup cooked cereal, rice, or pasta
• 
  3 cups popcorn
• 
  1 small (6-inch diameter) corn or flour tortilla

See more foods in the grain group.

Protein foods

Proteins are often called the body’s building blocks. They are used to build and repair tissues, and also help your body fight infection. Your body uses extra protein for energy. Older adults should try to eat a variety of nutrient-dense proteins. Choose lean (low-fat) meats and poultry. Keep in mind that you can also get protein from seafood, eggs, beans, nuts, seeds, and soy products. Protein from plant sources tends to be lower in saturated fat, contains no cholesterol, and provides fiber and other health-promoting nutrients. Plant sources of protein, such as nuts and seeds, have different nutritional value than plant-based meat alternatives, which can be heavily processed and high in sodium.

The Dietary Guidelines (PDF, 30.6M) recommend that you eat 8 to 10 ounces per week of a variety of seafood, not only for the protein but also because seafood contains omega-3 fatty acids, such as EPA and DHA, which are good for your heart. Seafoods that are higher in EPA and DHA include salmon, anchovies, and trout. These seafoods are also lower in mercury, which can be harmful, than other types of seafood.

1 ounce-equivalent equals:

• 
  1/2 ounce nuts (12 almonds, 24 pistachios, or 7 walnut halves)
• 
  1 tablespoon peanut butter
• 
  1/2 cup split pea, lentil, or other bean soup
• 
  1/4 cup tofu
• 
  1 egg
• 
  2 tablespoons hummus

See more foods in the protein group.

Dairy

Consuming dairy helps older adults maintain strong bones and provides several vital nutrients, including calcium, potassium, and vitamin D. For your heart health, pick from the many low-fat or fat-free choices in the dairy group. These give you important vitamins and minerals, with less fat. Certain fortified dairy alternatives can provide similar nutritional content to dairy.

1 cup-equivalent of dairy equals:

• 
  1 cup yogurt
• 
  1-1/2 ounces hard cheese, such as cheddar, mozzarella, Swiss, or Parmesan
• 
  1/3 cup shredded cheese
• 
  1 cup milk or calcium-fortified soy beverage
• 
  2 cups cottage cheese
• 
  1 cup pudding made with milk

See more foods in the dairy group.

Other foods

Some foods are not in any of the main food groups. These include oils, which can be eaten regularly as part of a healthy diet, as well as unhealthy fats, sugars, and calories from drinks, which should only be consumed occasionally. There is no recommended daily intake amount in cups or ounces for these products. Limiting the calories you consume from this category can help keep your healthy eating habits on track.

Oils & solid fats

Oils are high in calories, but they are also an important source of nutrients like vitamin E. For older adults, the daily allowance of oils ranges from 5 to 8 teaspoons, depending on activity level. Oils contain monounsaturated and polyunsaturated fats, which are healthy fats that give you energy and help the body absorb certain vitamins.

Measuring your daily oils can be tricky — knowing what you add while cooking or baking is one thing, but oil is naturally a part of some foods.

Teaspoons of oil:

• 
  1/2 medium avocado has 3 teaspoons of oil
• 
  4 large ripe olives have 1/2 teaspoon of oil
• 
  1 tablespoon of peanut butter has 2 teaspoons of oil

See more oil equivalents.

In general, try to use oils instead of solid fats, such as butter or lard, which are high in saturated fat. Saturated fats occur naturally in some foods, but they are also added to foods such as baked goods and potato chips. To lower the saturated fat in your diet, eat low-fat or fat-free dairy products, choose cuts of meat with less fat, and remove the skin from chicken. Reading the Nutrition Facts label can help you keep track of how much saturated fat you consume.

Limit the consumption of foods high in added sugar, which include sweetened cereals, highly processed snack foods such as cookies and cakes, dairy desserts, and many items marketed as low-fat. Read the ingredient list to see if the food you are eating has added sugar. Some key words to look for: brown sugar, corn sweetener, corn syrup, dextrose, fructose, and high-fructose corn syrup.

Beverages

Although many beverages can be part of a healthy eating pattern, some add calories without adding nutritional value and you should avoid them. Beverages that are calorie-free — especially water — or that contribute beneficial nutrients, such as fat-free and low-fat milk and 100% juice, should be the primary beverages you consume.

Coffee and tea. Drinking coffee or tea barely provides any calories unless you add sugar or cream, which are not nutrient-dense and should be consumed in moderation. Be cautious when ordering drinks from coffee shops because these are often loaded with extra sugars and fats.

Sweetened beverages. Examples of beverages that often have added sugars are soda, fruit drinks, sports drinks, energy drinks, and sweetened waters. Most sweetened beverages do not contribute to meeting food group goals and often contain a high number of calories.

Alcohol. Alcohol is not nutrient-dense and is not part of the healthy eating patterns recommended in the Dietary Guidelines. If you consume alcohol, do so in moderation, defined as one drink or less per day for women and two drinks or less per day for men.

Calories from sugars, saturated fats, and drinks can add up quickly. As these foods provide no nutritional benefit, they should only be consumed on occasion and in limited amounts.

To learn more, please visit https://www.nia.nih.gov/health/healthy-eating-nutrition-and-diet/healthy-eating-you-age-know-your-food-groups.

No one ever plans to be sick or disabled. Yet, planning for the future can make all the difference in an emergency and at the end-of-life. Being prepared and having important documents in a single place can give you peace of mind, help ensure your wishes are honored, and ease the burden on your loved ones.

Checklist for getting your affairs in order

This list provides common steps to consider when getting your affairs in order.

1. Plan for your estate and finances. Depending on your situation, you may choose to prepare different types of legal documents to outline how your estate and finances will be handled in the future. Common documents include a will, durable power of attorney for finances, and a living trust.

• A will specifies how your estate — your property, money, and other assets — will be distributed and managed when you die. A will can also address care for children under age 18, adult dependents, and pets, as well as gifts and end-of-life arrangements, such as a funeral or memorial service and burial or cremation. If you do not have a will, your estate will be distributed according to the laws in your state.
• A durable power of attorney for finances names someone who will make financial decisions for you when you are unable to.
• A living trust names and instructs a person, called the trustee, to hold and distribute property and funds on your behalf when you are no longer able to manage your affairs.

2. Plan for your future health care. Many people choose to prepare advance directives, which are legal documents that provide instructions for medical care and only go into effect if you cannot communicate your own wishes due to disease or severe injury. The most common advance directives include a living will and a durable power of attorney for health care.

• A living will tells doctors how you want to be treated if you cannot make your own decisions about emergency treatment. You can say which common medical treatments or care you would want, which ones you would want to avoid, and under which conditions each of your choices applies. Learn how to prepare a living will.
• A durable power of attorney for health care names your health care proxy, a person who can make health care decisions for you if you are unable to communicate these yourself. Your proxy — also known as a representative, surrogate, or agent — should be familiar with your values and wishes. A proxy can be chosen in addition to or instead of a living will. Having a health care proxy helps you plan for situations that cannot be foreseen, such as a serious auto accident or stroke. Learn how to choose a health care proxy.

These documents are part of advance care planning, which involves preparing for future decisions about your medical care and discussing your wishes with your loved ones.

3. Put your important papers and copies of legal documents in one place. You can set up a file, put everything in a desk or dresser drawer, or list the information and location of papers in a notebook. For added security, you might consider getting a fireproof and waterproof safe to store your documents. If your papers are in a bank safe deposit box, keep copies in a file at home. View a list of important papers.

4. Tell someone you know and trust or a lawyer where to find your important papers. You don’t need to discuss your personal affairs, but someone you trust should know where to find your papers in case of an emergency. If you don’t have a relative or friend you trust, ask a lawyer to help.

5. Talk to your loved ones and a doctor about advance care planning. A doctor can help you understand future health decisions you may face and plan the kinds of care or treatment you may want. Discussing advance care planning with your doctor is free through Medicare during your annual wellness visit. Private health insurance may also cover these discussions. Share your decisions with your loved ones to help avoid any surprises or misunderstandings about your wishes.

6. Give permission in advance for a doctor or lawyer to talk with your caregiver as needed. If you need help managing your care, you can give your caregiver permission to talk with your doctors, your lawyer, your insurance provider, a credit card company, or your bank. You may need to sign and return a form. Giving permission for your doctor or lawyer to talk with your caregiver is different from naming a health care proxy. A health care proxy can only make decisions if you are unable to communicate them yourself.

7. Review your plans regularly. It’s important to review your plans at least once each year and when any major life event occurs, like a divorce, move, or major change in your health.

Which documents do you need to have in place?

When you’re getting your affairs in order, it’s important to prepare and organize important records and files all in one place. Typically, you will want to include personal, financial, and health information. Remember, this is a starting place. You may have other information to add. For example, if you have a pet, you will want to include the name and address of your veterinarian.

Personal information

• Full legal name
• Social Security number
• Legal residence
• Date and place of birth
• Names and addresses of spouse and children
• Location of birth and death certificates and certificates of marriage, divorce, citizenship, and adoption
• Employers and dates of employment
• Education and military records
• Names and phone numbers of religious contacts
• Memberships in groups and awards received
• Names and phone numbers of close friends, relatives, doctors, lawyers, and financial advisors

Financial information

• Sources of income and assets (pension from your employer, IRAs, 401(k)s, interest, etc.)
• Social Security information
• Insurance information (life, long-term care, home, car) with policy numbers and agents’ names and phone numbers
• Names of your banks and account numbers (checking, savings, credit union)
• Investment income (stocks, bonds, property) and stockbrokers’ names and phone numbers
• Copy of most recent income tax return
• Location of most up-to-date will with an original signature
• Liabilities, including property tax — what is owed, to whom, and when payments are due
• Mortgages and debts — how and when they are paid
• Location of original deed of trust for home
• Car title and registration
• Credit and debit card names and numbers
• Location of safe deposit box and key

Health information

• Current prescriptions (be sure to update this regularly)
• Living will
• Durable power of attorney for health care
• Copies of any medical orders or forms you have (for example, a do-not-resuscitate order)
• Health insurance information with policy and phone numbers

Who can help with getting your affairs in order?

You may want to talk with a lawyer about setting up a general power of attorney, durable power of attorney, joint account, or trust. Be sure to ask about the lawyer’s fees before you make an appointment.

You do not have to involve a lawyer in creating your advance directives for health care. Most states provide the forms for free, and you can complete them yourself. Learn more about completing an advance directive.

You should be able to find a directory of local lawyers on the internet or contact your local library, your local bar association for lawyers, or the Eldercare Locator. Your local bar association can also help you find what free legal aid options your state has to offer. An informed family member may be able to help you manage some of these issues.

What other decisions can you prepare for in advance?

Getting your affairs in order can also mean making decisions about organ donation and funeral arrangements, or what you want to happen to your body after you die. Deciding and sharing your decisions can help your loved ones during a stressful time and best ensure your wishes are understood and respected.

Organ donation and brain donation. When someone dies, their healthy organs and tissues may be donated to help someone else. You can register to be an organ donor when you renew your driver’s license or state ID at your local department of motor vehicles. You can also register online. Some people also choose to donate their brain to advance scientific research. It may be possible to donate organs for transplant as well as the brain for scientific research. Learn more about organ donation and brain donation.

Funeral arrangements. You can decide ahead of time what kind of funeral or memorial service you would like and where it will be held. You can also decide whether you would like to be buried or cremated and whether you want your body’s ashes kept by loved ones or scattered in a favorite place. Be sure and specify certain religious, spiritual, or cultural traditions that you would like to have during your visitation, funeral, or memorial service. You can make arrangements directly with a funeral home or crematory. Read these tips on planning a funeral. If you choose not to be embalmed or cremated, most states allow families to take care of transportation, preparation of the body, and other needed arrangements. Learn more about the burial options available in your state. Put your preferences in writing and give copies to your loved ones and, if you have one, your lawyer.

To learn more, please visit https://www.nia.nih.gov/health/advance-care-planning/getting-your-affairs-order-checklist-documents-prepare-future.