Diabetes is a serious disease that affects many older adults. Diabetes occurs when a person’s blood glucose, also called blood sugar, is too high. The good news is that you can take steps to delay or prevent type 2 diabetes, which is the most common form of the disease to develop in older adults. If you already have diabetes, there are ways to manage the condition and help prevent diabetes-related health problems.

What is diabetes?

Glucose is the body’s main source of energy. Our bodies can make glucose, and glucose also comes from the food we eat. To use glucose as energy, the body needs insulin, a hormone that helps glucose get into cells. If you have diabetes, your body may not make enough insulin, use insulin in the right way, or both. That can cause too much glucose to stay in the blood, which can cause health problems over time.

Types of diabetes

The main types of diabetes in older adults are type 1 and type 2:

• Type 1 diabetes: In this form of diabetes, the body makes little or no insulin. Although older adults can develop type 1 diabetes, it begins most often in children and young adults, who then have diabetes for life. People with type 1 diabetes need to take insulin every day.
• Type 2 diabetes: In this condition, the most common form of diabetes, the body’s cells don’t use insulin properly. It occurs most often in middle-aged and older adults, but it can also affect children. Your chance of developing type 2 diabetes is higher if you have risk factors such as overweight or obesity, an inactive lifestyle, a family history of diabetes, or a history of gestational diabetes (a type of diabetes that develops during pregnancy). People who are African American, American Indian, Asian American, Hispanic/Latino, or Pacific Islander also have a higher risk of developing type 2 diabetes than people from other backgrounds.

Prediabetes is a condition that occurs when glucose levels are higher than normal but not high enough to be diagnosed as diabetes. Millions of older Americans have prediabetes. Although people with prediabetes have a greater chance of developing type 2 diabetes, there are ways to help prevent or delay the disease. These include maintaining a healthy weight, exercising, having your glucose level checked regularly, and talking with your doctor about medications and lifestyle changes that may help reduce your risk.

Symptoms of diabetes

Symptoms of diabetes may include feeling tired, increased hunger or thirst, losing weight without trying, urinating often, and numbness or tingling in hands or feet. You may also get blurred vision and skin infections, and your body may heal more slowly from cuts and bruises.

In people with type 2 diabetes, symptoms often develop slowly and may go unnoticed for a long time. Some people with type 2 diabetes have no symptoms, and they only find out that they have the condition when other diabetes-related health problems develop.

Sometimes older adults dismiss the symptoms of diabetes as just part of “getting old,” but they can be signs of a serious problem. Talk with your doctor if you have any symptoms or are concerned about developing diabetes.

Tests for diabetes

If you have symptoms or risk factors for diabetes, it’s important to get tested. Getting an early diagnosis can help you manage your diabetes and may prevent health problems. Doctors use several blood tests to help diagnose diabetes:

• The fasting plasma glucose test measures your blood glucose at a single point in time. Most of the time, your doctor will give you the test in the morning after you have fasted (had nothing to eat or drink except water) for at least eight hours.
• The A1C test shows your average blood glucose level over the past three months. You can eat and drink before this test. The A1C test may not be accurate in people with certain other diseases and conditions, so your doctor may use other tests in addition to A1C to diagnose diabetes.
• The random plasma glucose test also measures your blood glucose at a single point in time. It is given at any time during the day and does not require fasting.
• The oral glucose tolerance test has two steps: first, your blood glucose level is tested after you have fasted overnight. Then you drink a sugary drink and have your blood glucose level tested again two hours later. if your glucose level is high, you may have diabetes.

If a blood test suggests you have diabetes, your doctor may do a second blood test to confirm the diagnosis.

Managing type 2 diabetes

A person with diabetes may need to manage the disease with lifestyle changes, medication, or both. Many people with type 2 diabetes can manage their blood glucose levels with diet and exercise alone. Others may need diabetes pills or insulin injections, along with medicines to manage other conditions like high blood pressure and high cholesterol. Ask your health care provider questions about your medications to make sure you understand how they work, how to take them, and what side effects may occur.

Managing your diabetes involves taking care of yourself each day. Your daily self-care plan to control your blood glucose may include:

• Tracking your glucose levels. Very high blood glucose levels (called hyperglycemia) or very low blood glucose levels (called hypoglycemia) can put your health at risk. Your plan will show how often you should check your glucose and how often to get the A1C test. If you are managing your diabetes without taking insulin, you may not need to check your glucose as often.
• Making healthy food choices. The food you eat affects blood glucose levels, so it’s important to learn what’s best for you to eat, how much, and when. Work with your health care team to manage your weight and to lose weight if necessary.
• Being active. Walking and other forms of daily exercise can help improve glucose levels in older people with diabetes. Set a goal to be active most days of the week and create a fitness plan that fits your schedule and abilities. Your health care team can help.
• Taking your medicines. You should take medicines as prescribed even when you feel good. Tell your doctor if you have any side effects or cannot afford your medicines. Also, let your doctor know if you have trouble taking your medicines or keeping track of your medication schedule.

Diabetes can affect many parts of your body. If diabetes is untreated or poorly managed, it can cause serious health problems over time, such as damage to the eyes, kidneys, nerves, feet, and heart. People with type 2 diabetes may also be at greater risk for cancer, depression, and dementia. Here are more strategies to stay as healthy as possible with diabetes:

• Manage your blood pressure. Get your blood pressure checked often. High blood pressure increases the risk for heart disease and can damage the eyes and kidneys.
• Manage your cholesterol. At least once a year, get a blood test to check your cholesterol and triglyceride levels. High levels may increase your risk for heart problems.
• Stop smoking. Smoking raises your risk for many health problems, including heart attack and stroke. If you smoke, take steps to quit.
• Have yearly eye exams. Finding and treating eye problems early can help keep your eyes healthy.
• Check your kidneys yearly. Because diabetes can affect your kidneys, getting recommended urine and blood tests will show if your kidneys are healthy.
• Get flu shots every year and the pneumonia vaccine. A yearly flu shot will help keep you healthy. If you’re over 65, make sure you have had the pneumonia vaccine. If you were younger than 65 when you had the pneumonia vaccine, you may need another one. Ask your doctor.
• Care for your teeth and gums. Brush your teeth and floss daily. Have your teeth and gums checked twice a year by a dentist to avoid serious problems.
• Protect your skin. Keep your skin clean and use skin moisturizers for dryness. Take care of minor cuts and bruises to prevent infections.
• Check your feet. Keep your feet clean by washing them every day and help protect your feet from damage by wearing shoes and socks at all times. Take time to look at your feet every day for any red patches. Ask someone else to check your feet if you can’t. If you have sores, blisters, breaks in the skin, infections, or calluses, see a foot doctor, called a podiatrist.
• Keep up with cancer screenings. Ask your doctor which screenings to get based on your age, sex, and other risk factors.
• Be prepared. Ensure you always have several days’ worth of supplies on hand for testing and treating your diabetes in case of an emergency.
• Talk with your doctor about your concerns. If you think you might need help with your management plan, are depressed, are worried about your memory, or have any other concerns, talk with your doctor. There may be ways to help.

When you visit your health care team, your providers will assess how well you are managing your diabetes. Your care plan may change, or you may need more information and support. A change in health, such as a new diagnosis or complication, or a change in care, such as going home from the hospital, may also lead to updates to your plan.

To learn more, please visit https://www.nia.nih.gov/health/diabetes/diabetes-older-people.

Doctors use several methods and tools to help determine if a person with thinking or memory problems has Alzheimer’s disease. To diagnose Alzheimer’s, doctors may:

• Ask the person experiencing symptoms, as well as a family member or friend, questions about overall health, use of prescription and over-the-counter medicines, diet, past medical problems, ability to carry out daily activities, and changes in behavior and personality.
• Conduct tests of memory, problem solving, attention, counting, and language.
• Order blood, urine, and other standard medical tests that can help identify other possible causes of the problem.
• Administer a psychiatric evaluation to determine if depression or another mental health condition is causing or contributing to a person’s symptoms.
• Collect cerebrospinal fluid (CSF) via a spinal tap and measure the levels of proteins associated with Alzheimer’s and related dementias.
• Perform brain scans, such as computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET), to support an Alzheimer’s diagnosis or rule out other possible causes for symptoms.

Doctors may want to repeat these tests to help best determine how the person’s memory and other cognitive functions are changing over time. The tests can also help diagnose other causes of memory problems, such as stroke, tumor, Parkinson’s disease, sleep disturbances, side effects of medication, an infection, or another type of dementia. Some of these conditions may be treatable and possibly reversible.

People with memory problems should return to the doctor every six to 12 months.

Before the early 2000s, the only sure way to know whether a person had Alzheimer’s disease was through autopsy, a procedure that is performed after death. Thanks to advances in research, lab and imaging tests are now available to help a doctor or researcher see biological signs of the disease, or biomarkers, in a living person. For example, it is now possible for many doctors, dependent on state-specific availability reflecting U.S. Food and Drug Administration guidelines, to order a blood test to measure levels of beta-amyloid, a protein that accumulates abnormally in the brains of people with Alzheimer’s. Several other blood tests are in development. At present, blood test results alone should not be used to diagnose dementia but may be taken into consideration along with other tests. However, the availability of these diagnostic tests is still limited. NIA-supported research teams continue to study options for faster, less-expensive, and less-invasive ways to diagnose Alzheimer’s.

What happens if a doctor thinks it’s Alzheimer’s disease?

If a primary care doctor suspects Alzheimer’s, he or she may refer the patient to a specialist who can provide a detailed diagnosis or further assessment. Specialists include:

• Geriatricians, who manage health care in older adults and know how the body changes as it ages and whether symptoms indicate a serious problem.
• Geriatric psychiatrists, who specialize in the mental and emotional problems of older adults and can assess memory and thinking problems.
• Neurologists, who specialize in abnormalities of the brain and central nervous system and can conduct and review brain scans.
• Neuropsychologists, who can conduct tests of memory and thinking.

Memory clinics and centers, including Alzheimer’s Disease Research Centers, offer teams of specialists who work together to diagnose the problem. In addition, these specialty clinics or centers often have access to the equipment needed for brain scans and other advanced diagnostic tests.

What are the potential benefits of an early Alzheimer’s diagnosis?

Alzheimer’s disease slowly worsens over time. People living with this disease progress at different rates, from mild Alzheimer’s, when they first notice symptoms, to severe, when they are completely dependent on others for daily, routine care such as feeding oneself.

Early, accurate diagnosis may be beneficial to some people for several reasons. While there is no cure, medicines are emerging to treat the progression of Alzheimer’s. There are also medicines available to treat some symptoms of Alzheimer’s, along with coping strategies to manage behavioral issues. Most medicines currently available work best for people in the early or middle stages of the disease. Learn more about Alzheimer’s treatments.

In addition, having an early diagnosis helps people with Alzheimer’s and their families:

• Plan for the future
• Take care of financial and legal matters
• Address potential safety issues
• Learn about living arrangements
• Develop support networks

An early diagnosis can also provide people with more opportunities to participate in clinical trials or other research studies testing possible new treatments for Alzheimer’s.

To learn more, please visit https://www.nia.nih.gov/health/alzheimers-symptoms-and-diagnosis/how-alzheimers-disease-diagnosed.

People with Alzheimer’s need to be active and do things they enjoy. However, activities they used to enjoy may become challenging for them as the disease worsens. They may have trouble deciding what to do or starting tasks. As a caregiver, you can learn how to adapt activities to make them easier and more enjoyable.

General tips

Here are some ways to make activities easier and more enjoyable for a person with Alzheimer’s:

• Match the activity with what the person with Alzheimer’s can do.
• Choose activities that can be fun for everyone.
• Help the person get started with the activity.
• Decide if they can do the activity alone or need help.
• Watch to see if the person gets frustrated.
• Make sure they feel successful and have fun.
• Let them simply watch if they seem to enjoy that more.

At home

To help keep days interesting and engaging for people with Alzheimer’s, try coming up with different activities to do each day. Here are some daily activities people with Alzheimer’s may enjoy:

• Cooking and baking: Gather materials, measure ingredients, mix and pour, or tell someone else how to prepare a recipe.
• Exercise: Take a walk together, use a stationary bike, use stretching bands, throw a soft ball or balloon back and forth, lift weights or household items such as soup cans, or follow along with exercise videos or programs for older adults.
• Music and dancing: Play music, talk about the music and the artist, ask what the person with Alzheimer’s was doing when the song was popular, sing or dance to well-known songs, or attend a concert or musical program in the community.
• Pets: Feed, groom, walk, or sit and hold a pet.
• Gardening: Take care of indoor or outdoor plants, plant flowers and vegetables, water the plants when needed, or talk about how much the plants are growing.
• Household chores: Wash dishes, set the table, prepare food, sweep the floor, dust, sort mail and clip coupons, sort socks and fold laundry, or sort recycling materials or other items.
• Visiting with children: Play a simple board game, read stories or books, visit family members who have small children, walk in the park or near schools, or go to school events. If you don’t have children to visit, talk about fond memories from childhood.

Going out

Early in the disease, people with Alzheimer’s may still enjoy the same kinds of outings they enjoyed in the past. Keep going out as long as you both are comfortable. Plan outings for the time of day when the person is at their best. Keep your time away from home from becoming too long so the person with Alzheimer’s doesn’t get too tired. Some places your loved one might enjoy visiting include a:

• Favorite restaurant
• Zoo or aquarium
• Park or nature trail
• Shopping mall
• Swimming pool (during a slow time of day at the pool)
• Museum, theater, or art exhibits for short trips

The person with Alzheimer’s may also enjoy going to a senior center. This type of “going out” could also be considered a form of respite care because it provides an activity for the person with Alzheimer’s and gives the caregiver a break.

Eating at a restaurant

Going out to eat can be a welcome change, but it also poses some challenges. Below are some tips for eating out with a person who has Alzheimer’s:

• Choose a restaurant that the person likes, is quiet, and has quick service and an understanding staff.
• Visit restaurants during “off hours” when they’re less likely to be crowded.
• Consider going to the restaurant earlier in the day so the person is not too tired. Bring supplies such as utensils, a towel, and wipes that the person uses at home.
• At the restaurant, ask for a table near the bathroom.
• Help the person choose their meal, if needed. Read parts of the menu or show the person a picture of the food. Suggest food you know the person likes.
• Ask the server to fill glasses half full or leave the drinks for you to serve.
• Order some finger food or appetizers before the main meal to hold the attention of the person with Alzheimer’s.

Traveling

Taking a person with Alzheimer’s on a trip can be a challenge because it may make the person more worried and confused. Below are some tips that you may find helpful.

• Before you leave, talk with the person’s doctor about medicines to calm someone who gets upset while traveling.
• Think about the person’s unique needs and preferences when choosing transportation, such as a plane, train, or car. Go with the option that provides the most comfort and least anxiety.
• Pack an extra set of clothing and items they enjoy looking at or holding in a carry-on bag.
• Talk to the person about travel plans in advance, but not too far ahead if traveling makes them feel anxious.
• Do not plan too many activities, and plan rest periods.
• During the trip, follow a routine like the one you use at home. Try to have the person eat, rest, and go to bed at the same time as usual.
• Be prepared to cut your visit short if necessary.
• In case the person with Alzheimer’s gets lost, make sure they wear or have something with them that tells who they are, such as an ID bracelet.

Spiritual activities

Being part of a faith community may help someone with Alzheimer’s feel connected to others and remember pleasant times. Here are some ideas to help:

• Involve the person in spiritual activities that they have known well. These might include worship services, religious or other readings, sacred music, prayer, meditation, and holiday rituals.
• Tell people in the preferred faith community about the person’s Alzheimer’s. Encourage them to talk with the person and show they still care.
• Find worship services or readings online if the person is more comfortable at home.

Holidays

Caregivers of people with Alzheimer’s may worry about the extra demands that holidays make on their time and energy. Here are some suggestions to make holidays easier:

• Understand that things will be different, and be realistic about what you can do.
• Incorporate the holiday traditions of the person with Alzheimer’s.
• Create a quiet space in case the person with Alzheimer’s needs a break. Have their favorite activities or calming music in that space.
• Ask friends and family to visit. Limit the number of visitors at any one time.
• Avoid crowds, changes in routine, and strange places that may make the person with Alzheimer’s feel confused or nervous.
• Remember to enjoy yourself. Find time for the holiday activities you like to do. Ask a friend or family member to spend time with the person while you’re out.

To learn more, please visit https://www.nia.nih.gov/health/alzheimers-caregiving/adapting-activities-people-alzheimers-disease.

Someone with Alzheimer’s disease may start rummaging or searching through cabinets, drawers, closets, the refrigerator, and other places where things are stored. They may also hide items around the house.

In some cases, there might be a logical reason for this behavior. For instance, they may be looking for something specific but not able to tell you what it is. They may be hungry or bored. Try to understand what is causing the behavior so you can fit your response to the cause.

Tips to make rummaging safer

You can take steps that allow the person with Alzheimer’s to rummage while keeping the person safe. Try these tips:

• Lock up dangerous or toxic products or place them out of the person’s sight and reach.
• Remove spoiled food from the refrigerator and cabinets. Someone with Alzheimer’s may look for snacks but lack the judgment or sense of taste to stay away from foods that have gone bad.
• Remove valuable items that could be misplaced or hidden by the person, such as important papers, checkbooks, credit cards, jewelry, cellphones, and keys.
• People with Alzheimer’s often hide, lose, or throw away mail. If this is a serious problem, consider getting a post office box. If you have a yard with a fence and a locked gate, place your mailbox outside the gate.

More tips to cope with rummaging and hiding

Here are some more suggestions to help manage rummaging and hiding behavior:

• Keep the person with Alzheimer’s from going into any unused room. This limits their rummaging and hiding things.
• Search the house to learn where the person often hides things. Once you find these places, check them often when out of sight of the person.
• Keep all trash cans covered or out of sight. People with Alzheimer’s may not remember the purpose of the container or may rummage through it.
• Check trash containers before you empty them in case something has been hidden there or thrown away by accident.

For more information

NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center
800-438-4380
adear@nia.nih.gov
www.nia.nih.gov/alzheimers
The NIA ADEAR Center offers information and publications for download (PDF) about Alzheimer’s and related dementias for families, caregivers, and health professionals. ADEAR Center staff answer telephone, email, and written requests and make referrals to local and national resources.

Alzheimers.gov
www.alzheimers.gov
Explore the Alzheimers.gov website for information and resources on Alzheimer’s and related dementias from across the federal government.

Eldercare Locator
800-677-1116
eldercarelocator@USAging.org
https://eldercare.acl.gov

Alzheimer’s Association
800-272-3900 
866-403-3073 (TTY)
info@alz.org
www.alz.org 

Alzheimer’s Foundation of America
866-232-8484
info@alzfdn.org
https://alzfdn.org

Family Caregiver Alliance
800-445-8106
info@caregiver.org
www.caregiver.org

Several prescription drugs are approved by the U.S. Food and Drug Administration (FDA) for Alzheimer’s disease to help either manage the symptoms of or to treat the disease. Most FDA-approved drugs work best for people in the early or middle stages of Alzheimer’s. There are currently no known interventions that will cure Alzheimer’s.

Medications for mild to moderate Alzheimer’s disease

Treating the symptoms of Alzheimer’s can help provide people with comfort, dignity, and independence for a longer period of time and also assist their caregivers. Galantamine, benzgalantamine, rivastigmine, and donepezil are cholinesterase inhibitors that are prescribed for mild to moderate Alzheimer’s symptoms. These drugs may help reduce or control some cognitive and behavioral symptoms.

Cholinesterase inhibitors prevent the breakdown of acetylcholine, a brain chemical believed to be important for memory and thinking. As Alzheimer’s progresses, the brain produces less acetylcholine and, over time, these medicines lose their effectiveness. Because cholinesterase inhibitors work in a similar way, switching from one to another may not produce significantly different results, but a person living with Alzheimer’s may respond better to one drug versus another.

Lecanemab and donanemab are FDA-approved immunotherapy drugs for the treatment of early Alzheimer’s. These drugs target the protein beta-amyloid to help reduce amyloid plaques, one of the hallmark brain changes in Alzheimer’s. Clinical studies to determine the effectiveness of  lecanemab and donanemab were conducted in people with early-stage Alzheimer’s or mild cognitive impairment due to the disease. These studies showed that the drugs slowed the rate of cognitive decline among some study participants over the course of 18 months and reduced the levels of amyloid in the brain. Currently, insurance may only cover these medications in specific situations. Medicare Part B covers part of the cost of these medications for patients who meet certain medical criteria.

Before prescribing lecanemab or donanemab, doctors may order PET scans or an analysis of cerebrospinal fluid to evaluate whether amyloid deposits are present in the brain. Possible side effects of these medications include amyloid-related imaging abnormalities (ARIA), which can lead to fluid buildup or bleeding in the brain. In rare instances, the side effects may be serious or life-threatening. Due to these potential risks, doctors should monitor for side effects with MRIs.

Several other medications to treat Alzheimer’s are being tested in people with mild cognitive impairment or early Alzheimer’s.

Medications for moderate to severe Alzheimer’s disease

A medication known as memantine, an N-methyl-D-aspartate (NMDA) antagonist, can be prescribed for moderate to severe Alzheimer’s. This drug is prescribed to decrease symptoms, which could enable some people to maintain certain daily functions a little longer than they would without the medication. For example, memantine may help a person in the later stages of the disease maintain their ability to use the bathroom independently for several more months, a benefit for both people with Alzheimer’s and their caregivers.

Memantine is believed to work by regulating glutamate, an important brain chemical. When produced in excessive amounts, glutamate may lead to brain cell death. Because NMDA antagonists work differently from cholinesterase inhibitors, the two types of drugs can be prescribed in combination.

The FDA has also approved donepezil, the rivastigmine patch, and a combination medication of memantine and donepezil for moderate to severe Alzheimer’s.

Brexpiprazole is an atypical antipsychotic that has been approved to treat agitation associated with Alzheimer’s. See below for more information on managing behavioral symptoms and antipsychotics.

Dosage and side effects of Alzheimer’s disease medications

Doctors usually start patients at low drug doses and gradually increase the dosage based on how well a patient tolerates it. There is some evidence that certain people may benefit from higher doses of Alzheimer’s medications. However, the higher the dose, the more likely unwanted side effects will occur.

Patients should be monitored when a drug is started. All of these medicines have possible side effects that may include nausea, vomiting, diarrhea, allergic reactions, loss of appetite, headaches, confusion, dizziness, and falls. Report any unusual symptoms to the prescribing doctor right away.

It is important to follow your doctor’s instructions when taking any medication, including vitamins and herbal supplements. Talk with your doctor before adding or changing any medications.

Managing behavioral symptoms of Alzheimer’s disease

Common behavioral symptoms of Alzheimer’s include sleeplessness, wandering, agitation, anxiety, aggression, restlessness, and depression. Scientists are learning why these symptoms occur and are studying new treatments — drug and non-drug — to manage them. Research has shown that treating behavioral symptoms can provide comfort for people with Alzheimer’s and make things easier for caregivers.

Experts agree that medicines to treat these behavior problems should be used only after other non-drug strategies have been tried. Learn more about behavioral changes in people with Alzheimer’s disease and ways to cope.

Medicines to be used with caution in people with Alzheimer’s disease

Some medicines, such as sleep aids, anti-anxiety drugs, anticonvulsants, and antipsychotics warrant extra caution for people living with Alzheimer’s. These drugs should only be considered as options after:

• A doctor has explained all the risks and side effects of the medicine
• Other, safer non-drug options have not helped treat the problem

People living with Alzheimer’s and their caregivers must watch for side effects from these medications.

Sleep aids are used to help people get to sleep and stay asleep. People with Alzheimer’s should not use these drugs regularly because they make the person more confused and more likely to fall. There are lifestyle changes people can make to improve their sleep. Learn more about getting a good night’s sleep.

Anti-anxiety drugs are used to treat agitation. Certain types of anti-anxiety drugs, such as benzodiazepines, can cause sleepiness, dizziness, falls, and confusion. For this reason, doctors recommend they only be used for short periods of time, if at all.

Anticonvulsants are drugs sometimes used to treat severe aggression. Side effects may cause sleepiness, dizziness, mood swings, and confusion.

Antipsychotics are drugs used to treat hallucinations, delusions, and paranoia, and agitation and aggression. Their side effects can be serious, including increased risk of death in some older people with dementia. These medications should only be given to people with Alzheimer’s when the doctor agrees the symptoms are severe.

The future of Alzheimer’s disease treatments

Alzheimer’s researchers continue to explore a variety of innovative approaches to treat symptoms as well as underlying disease processes. In ongoing clinical trials, they are developing and testing several new possible interventions. These include additional immunotherapy and other drug therapies, cognitive training, diet, and physical activity.

To learn more, please visit https://www.nia.nih.gov/health/alzheimers-treatment/how-alzheimers-disease-treated.

Ask yourself the five questions below to help understand your risk factors for developing Alzheimer’s disease.

How old are you?

Age is the biggest known risk factor for Alzheimer’s. Most people with Alzheimer’s develop the disease when they are 65 or older, with less than 10% of cases occurring before then. As a person ages past 65, their risk of Alzheimer’s increases. About one in 13 people age 65 to 84 and one in three people 85 and older are living with Alzheimer’s.

Does Alzheimer’s run in your family?

Family history is also an important risk factor. People with a parent or sibling diagnosed with Alzheimer’s have a higher risk of developing the disease than those who don’t have family members with the disease. Families can have many things in common, including their genes, environment, and lifestyle, that all may play a role. For example, lifestyle habits such as diet and exercise, which can be influenced by family, can affect overall health and increase risk for Alzheimer’s. Importantly, not everyone with a history of Alzheimer’s in their family will develop the disease and vice versa — not everyone who develops Alzheimer’s has a family history of the disease.

What’s your lifestyle?

There are some risk factors, like age, that you cannot change. However, there may be ways to promote better brain health and reduce your risk of Alzheimer’s by addressing certain lifestyle factors, including:

• Unmanaged chronic health issues, such as high blood pressure or hearing loss
• Physical inactivity
• Unhealthy diet
• Alcohol misuse
• Smoking
• Not getting enough sleep or not sleeping well
• Social isolation
• Lack of mental stimulation

Researchers cannot yet say for certain whether making positive changes in these areas can prevent dementia, but doing so is beneficial to living a healthier lifestyle overall. Learn more about leading a healthy lifestyle that may help address risk factors associated with Alzheimer’s and related dementias.

What medical conditions do you have?

Having certain medical conditions may increase your risk of developing Alzheimer’s. For example, cardiovascular disease, which includes conditions such as heart disease, stroke, and coronary artery disease, affects the heart and blood vessels and has been linked to Alzheimer’s.

Several risk factors associated with developing cardiovascular disease are also associated with Alzheimer’s. For example, studies have shown that managing high blood pressure reduces the risk of mild cognitive impairment and the risk of dementia. Specifically, one large clinical trial showed that lowering systolic blood pressure to below 120 mmHg reduced the risk of mild cognitive impairment, and a review of observational studies showed that managing high blood pressure with medication reduced the risk of dementia compared to people with high blood pressure who didn’t take medication. Learn more about blood pressure and Alzheimer’s and ways to control your blood pressure.

Other risk factors associated with both cardiovascular disease and Alzheimer’s include diabetes, overweight or obesity, and high LDL (“bad”) cholesterol.

In addition, other medical conditions associated with a higher risk of Alzheimer’s include:

• Hearing loss
• Depression
• Mild cognitive impairment
• Concussion or other traumatic brain injury

Getting recommended health screenings and regularly checking in with a health care provider can help you learn about and manage medical conditions. Treat high blood pressure with healthy lifestyle changes and medications if prescribed by your doctor. Protect your ears from loud sounds and use hearing restorative devices, such as hearing aids, if needed. Make healthy food choices and get regular exercise to maintain a healthy weight.

What about biomarkers?

Biomarkers are characteristics we can measure that help show what’s happening inside the body. Scientists have identified several biomarkers associated with Alzheimer’s. While testing for biomarkers can provide some information about a person’s risk, these tests can’t tell for sure whether or not someone will develop the disease. Right now, many of these biomarkers are used mostly in research settings or to help doctors in diagnosing the disease.

Genetic variants are a type of biomarker that have been associated with Alzheimer’s risk. Variants in the apolipoprotein E (APOE) gene are one example. A variant called APOE ε4 has been associated with an increased risk of Alzheimer’s in certain populations, while a variant called APOE ε2 may offer some protection against Alzheimer’s in others.

At-home tests are available for a fee to test for APOE variants. People considering such tests will benefit from talking with a doctor or genetic counselor to better understand the test and what their results may mean. Learn more about Alzheimer’s and genetics.

Other biomarkers for Alzheimer’s include levels of the proteins beta-amyloid and tau. Doctors may use brain scans and cerebrospinal fluid tests that measure these protein levels to help determine whether a person’s cognitive difficulties are caused by Alzheimer’s or not. Blood tests are also now available that can measure levels of beta-amyloid. However, none of these tests are commonly used to indicate someone’s risk outside of a research setting.

Identifying who may or may not develop Alzheimer’s is complex. Researchers continue to investigate biomarkers and other risk factors for the disease. Learn more about biomarkers that help diagnose Alzheimer’s or a related dementia.

The bottom line

Scientists are still learning about what causes Alzheimer’s and what puts some people at higher risk than others. While we know some of the factors that influence a person’s risk, there are probably many other factors that have not yet been identified. Talk with a doctor if you have concerns or questions about your risk of developing the disease. The doctor may suggest changes in memory and thinking to watch out for. They may also recommend steps for staying healthy overall to help maintain cognitive health and reduce the risk of dementia.

To learn more, please visit https://www.nia.nih.gov/health/alzheimers-causes-and-risk-factors/thinking-about-your-risk-alzheimers-disease-five.

Brain health affects many aspects of life, including how you think, feel, act, and relate to others. Many factors can affect brain health, including age-related changes in the brain, injuries such as stroke, mood disorders, substance use disorder, and diseases such as Alzheimer’s.

What is brain health?

Brain health refers to how well a person’s brain functions across several areas.

• Motor function: Controlling movements and balance
• Sensory function: Seeing, hearing, tasting, and smelling
• Tactile function: Feeling and responding to sensations of touch, including pressure, pain, and temperature
• Cognitive health: Thinking, learning, and remembering
• Emotional function: Interpreting and responding to emotions

Learn more about keeping your brain healthy as you age: www.nia.nih.gov/brain-health.

People spend about one-third of their life sleeping or trying to sleep. Being older doesn’t mean you have to be tired. Sleep is important for your body and affects your ability to function during the day. Below are some healthy habits that can help you fall and stay asleep. 

Older adults need about 7-9 hours of sleep each night. Getting a good night’s sleep supports physical health, mental health, and overall well-being. Improve your sleep with these tips.

Six Healthy Sleeping Habits for Older Adults

1. Develop a regular sleep schedule and bedtime routine
2. Avoid napping in the late afternoon or evening
3. Try to avoid electronic screens, such as cell phones and TVs, in the bedroom
4. Keep your bedroom quiet and at a comfortable temperature
5. Exercise at regular times each day, but not within three hours of bedtime
6. Avoid alcohol, caffeine, and large meals late in the day

Many factors can affect your weight, including your genes, age, sex, lifestyle, family habits, culture, sleep, and even where you live and work. Some of these factors can make it hard to maintain or achieve a healthy weight. Regardless, following a nutritious eating pattern and exercising regularly can help keep your body as healthy as possible as you age. Read on to learn why weight may change as you get older, why it’s important to aim for a healthy weight, and what you can do to help meet your goals.

Why does weight change as we age?

As we age, metabolism — how the body gets energy from food — can change. This means that some older adults must become more active or eat fewer calories to maintain or achieve their ideal weight.

Other older adults may lose weight unintentionally. This can happen if you have less of an appetite, difficulty leaving the house to buy food, pain when chewing or swallowing, or forget to eat.

Why should older adults maintain a healthy weight?

Keeping your weight in the normal range is an important part of healthy aging. As in other stages of life, elevated body mass index (BMI) in older adults can increase the likelihood of developing health problems. These include heart disease, high blood pressure, stroke, and diabetes. Losing weight or maintaining a healthy weight can help decrease these risks.

Being underweight also increases your chance of developing health problems. If you have a low BMI, you may be more likely to develop medical problems such as osteoporosis and anemia, and it may be harder to recover from an illness or infection.

How are food, exercise, and calories connected?

Being active and choosing healthy foods can help you maintain or achieve a healthy weight, feel more energetic, and decrease your chances of having other health problems. It’s important to choose foods rich in nutrients and aim for at least 150 minutes of physical activity per week.

The energy your body gets from the foods and drinks you consume is measured in calories. Your body needs a certain number of calories each day, depending on your activity level and other factors, to maintain your current weight. Visit MyPlate Plan to determine how many calories a day you need based on your age, sex, height, weight, and physical activity level.

To lose weight, exercise more or eat fewer calories than is recommended. To gain weight, increase the number of calories you eat while maintaining a moderate activity level.

Read more about making smart food choices and find recommendations of how much to eat, organized by activity level.

What should I eat to lose or gain weight?

Whether you are trying to lose or gain weight, eating healthy foods matters. Try to follow a healthy eating pattern rich in vegetables, fruits, whole grains, low-fat dairy, and lean proteins. If you’re concerned about your weight and want to change it, there are things you can do. Talk with a health care professional about how to make changes in a healthy way that’s right for you.

Trying to lose weight?

• Limit portion size to control calorie intake.
• Be as physically active as you can be.
• Swap out your usual foods for healthier alternatives.
• Stay hydrated with water and avoid drinks with added sugar.
• Set specific, realistic goals, such as three 15-minute walks per week.
• If there’s a break in your healthy eating or exercise, try to get back on track as quickly as possible.
• Keep track of what you eat in a food diary.

Trying to gain weight?

• Eat more foods with healthy fats, such as avocados and peanut butter.
• If you get full quickly, eat frequent, smaller meals throughout the day.
• Add nutrient-dense snacks such as nuts, cheese, and dried fruit to your menu.
• Dine with friends and family to make the experience more enjoyable.
• Stay active to boost your appetite.

How much physical activity do I need?

Exercise and physical activity are good for just about everyone including older adults. Aim for at least 150 minutes of moderate-intensity aerobic activity — working hard enough to raise your heart rate and break a sweat — each week. You don’t have to accomplish this all at once, rather, you can break up your activity over the course of seven days. If you can’t meet the goal right away, try to be as physically active as you can. Doing something is better than doing nothing at all.

For adults at every weight, aging is associated with muscle loss, which makes certain activities difficult. Being active can help older adults maintain muscle mass and make it easier to conduct daily activities, participate in outings, drive, keep up with grandchildren, avoid falls, and stay as independent as possible.

You don’t need to spend a lot of money joining a gym or hiring a personal trainer to get fit. Think about the kinds of physical activities that you enjoy, for example, walking, running, bicycling, gardening, swimming, and dancing. Even everyday chores such as vacuuming can provide physical activity. While you’re getting started with exercise, try to stay motivated to move your body regularly. Then increase the length of time you exercise or add another fun activity. Talk with your doctor before starting a new or more vigorous exercise program.

To learn more, please visit https://www.nia.nih.gov/health/healthy-eating-nutrition-and-diet/maintaining-healthy-weight.

While many older adults value the independence of driving, changes that happen with age may alter a person’s ability to drive safely. You may notice driving becoming more difficult over time for yourself or for your loved ones. Changes in health, including medical conditions or injuries, also may impact a person’s driving skills. Learn more about the different factors that can affect driving as you age and signs of when it may be time to stop driving.

What can change driving ability with age?

Common health conditions and medication side effects may influence your driving skills.

• Stiff joints and muscles. As you age, your joints may get stiff, and your muscles may weaken. Arthritis, which is common among older adults, might affect your ability to drive. These changes can make it harder to turn your head to look back, turn the steering wheel quickly, or brake safely. If pain, stiffness, or arthritis seem to get in the way of your driving, talk with your doctor. Think about getting hand controls for both the gas and brake pedals if you have leg problems.
• Trouble seeing. Your eyesight can change as you get older. It might be harder to see people, things, and movement outside your direct line of sight. It may also take longer to read street or traffic signs or even recognize familiar places. At night, you may have trouble seeing things clearly. Glare from oncoming headlights or streetlights can be a problem. Depending on the time of day, the sun might be blinding. Eye diseases, such as glaucoma, cataracts, and macular degeneration, as well as some medicines, can also cause vision problems. If you are 60 or older, get a dilated eye exam from your eye doctor every one to two years. If you need glasses or contact lenses to see far away while driving, make sure your prescription is up to date and correct.
• Trouble hearing. As you grow older, your hearing can change, making it harder to notice horns, sirens, or even noises coming from your own car. These sounds warn you when you may need to pull over or get out of the way, or when there is a possible mechanical issue with your vehicle. Have your hearing checked at least every three years after age 50 or more frequently if you have had chronic exposure to loud noises or have other risk factors for hearing loss. Discuss your concerns with your doctor as there may be treatments that can help.
• Medications. Some medicines can make you feel drowsy, lightheaded, or less alert than usual, which can make driving unsafe. Some drugs include a warning about driving, but even those that do not might have a negative effect. Ask your doctor or pharmacist if any of your health problems or medications might make it unsafe for you to drive.
• Slower reaction time and reflexes. As you get older, your reflexes might get slower, and you might not react as quickly as you could in the past. Stiff joints or weak muscles also can make it harder to move quickly. Loss of feeling or tingling in your fingers and feet can make it difficult to steer or use the foot pedals.
• Some medical conditions make it unsafe to drive. The uncontrollable movements and loss of coordination and balance due to Parkinson’s disease make it unsafe to drive. Similarly, many of the loss of control of limbs or other movement limitations following a stroke can mean it is no longer safe to drive.

Tips for older adults to drive safely

Maybe you already know that driving at night or in rainy weather is a problem for you. Some older drivers also have problems with certain routes or driving on busy highways, for example. Consider these tips to help you make safe choices about driving:

• Talk with your doctor. If you have any concerns about your health and driving, see your doctor. Don’t risk hurting yourself or others.
• Be physically active. This will help you keep and even improve your strength and flexibility, which may help your driving abilities.
• Consider your car. If possible, drive a car with automatic transmission, power steering, power brakes, and large mirrors. Newer cars come equipped with backup cameras, which can make parking and backing up easier, as well as other sensors that can alert a driver to a nearby object or vehicle before an accident occurs.
• Take care of your eyes and ears. Always wear your glasses or contact lenses if you need them to see clearly. If you use hearing aids, be sure to wear them while driving.
• Avoid driving certain times of day. Cut back on or stop driving at night if you have trouble seeing in the dark. Try to avoid driving during sunrise and sunset, when the sun can be directly in your line of vision.
• Check in with yourself. Don’t drive if you feel lightheaded or drowsy. Be sure to check any warnings on your medications. Try to avoid driving when you are stressed or tired.
• Don’t crowd. Leave ample space between your car and the car in front of you and start braking early when you need to stop.
• Plan your timing. Avoid heavy traffic areas or rush-hour driving when you can.
• Plan your route. Drive on streets you know and find a way to go that requires few or no left turns. Choose a route that avoids highways or other high-speed roadways. If you must drive on a fast-moving highway, drive in the right-hand lane, where traffic moves more slowly.
• When in doubt, don’t go out. Bad weather, such as rain, ice, or snow, can make it hard for anyone to drive. Try to wait until the weather is better, or use buses, taxis, ridesharing services, or other alternatives.
• Wear seat belts. Always wear your seat belt and make sure your passengers wear theirs, too.
• Limit distractions. Eating, adjusting the radio, or chatting can all be distracting. If you use your cellphone while driving (for navigation, for example), use it hands-free and use voice activation when possible. Never type on your phone while driving.
• Use window defrosters. These will help keep windows and windshields clear.

How to check and improve your driving skills

Are you concerned that your driving skills are declining or could be improved? Consider the following:

• Have your driving skills checked by a driving rehabilitation specialist, occupational therapist, or other trained professional. The American Occupational Therapy Association maintains a national database of driving specialists, or you can ask your state’s Department of Motor Vehicles or your doctor to recommend someone who can test your driving skills. Note that there may be fees associated with these types of assessments.
• The American Automobile Association’s (AAA) RoadWise Driver Course is designed to help older adults adjust to age-related physical changes to extend their safe driving career.
• Try an online self-assessment, such as this one from the National Highway Traffic Safety Administration (NHTSA), to gauge your abilities.
• Ask your family and friends for feedback about your driving, including any concerns.
• Take a driver safety course. Some car insurance companies may even lower your bill when you complete this type of class. Organizations such as AARP or your car insurance company can help you find a nearby resource.

Signs your loved one should no longer be driving

Are you worried about an older family member or friend driving? It can be hard for some people to recognize or admit when it’s no longer safe to drive. You might want to observe the person’s driving skills or ask them to consider doing a self-assessment of their driving. If it’s not possible to directly observe the person’s driving, watch for these signs:

• Multiple vehicle crashes, near misses, or new dents or scrapes on the car
• Two or more traffic tickets or warnings within the last two years
• Increases in car insurance premiums because of driving issues
• Comments from neighbors or friends about erratic, unsafe, or aggressive driving
• Anxiety about driving at night
• Health issues that might affect driving, including problems with vision, hearing, and movement
• Complaints about the speed, sudden lane changes, or actions of other drivers
• Recommendations from a doctor to modify driving habits or quit driving entirely

Having “the talk” about driving

Talking with an older person about his or her driving is often difficult. For many older adults, “giving up the keys” means a loss of freedom of choice and movement. Many people are afraid of being dependent upon someone else for getting around. They worry about losing the ability to run errands, attend appointments, and participate in activities that they did on their own for decades. They may be concerned about becoming socially isolated and missing out.

Here are some tips that might help when talking with someone about no longer driving:

• Be prepared. Learn about local community services to help someone who can no longer drive before you have the conversation with them. Identify the person’s transportation needs.
• Avoid confrontation. Use “I” messages rather than “you” messages. For example, say, “I am concerned about your safety when you are driving,” rather than, “You’re no longer a safe driver.”
• Stick to the issue. Discuss the driver’s skills, not their age.
• Focus on safety and maintaining independence. Be clear that the goal is for the older driver to continue the activities they currently enjoy while staying safe. Offer to help the person stay independent. For example, you might say, “I’ll help you figure out how to get where you want to go if driving isn’t possible.”
• Be positive and supportive. Recognize the importance of a driver’s license to the older person. Realize they may become defensive, angry, hurt, or withdrawn during your conversation. You might say, “I understand that this may be upsetting,” or “Let’s work together to find a solution.”
• Consider broaching the topic gradually. Some experts suggest a gentle introduction of the driving conversation, and then revisiting it gradually over time.

The NHTSA has a helpful guide to help concerned families and friends better understand older drivers and suggestions on how to begin discussions.

Is it time to give up driving?

We all age differently, and for this reason, there is not one recommended age to quit driving. So how does one know when to stop? To help decide, ask yourself:

• Do other drivers often honk at me?
• Have I had some accidents even if just “fender benders”?
• Am I having trouble seeing road signs, exits, or lane lines?
• Am I still flexible enough to turn my head to check mirrors and blind spots comfortably?
• Have physical conditions or medications slowed my reaction time?
• Do I get lost frequently, even on familiar roads?
• Do cars or pedestrians seem to appear out of nowhere?
• Am I often distracted while driving?
• Have family, friends, or my doctor said they’re worried about my driving?
• Am I driving less these days because I’m not as sure about my driving as I used to be?
• Do I have trouble staying in my lane?
• Do I have trouble moving my foot between the gas and the brake pedals, or do I sometimes confuse the two?
• Have I been pulled over by a police officer about my driving?

If you answered “yes” to any of these questions, it may be time to talk with your doctor or family members about your driving, or to consider a driving assessment.

How will you get around?

Are you worried you won’t be able to do the things you want and need to do if you stop driving? Many people have this concern, but there may be more ways to get around than you think. For example, some areas provide free or low-cost bus, subway, rideshare, and taxi services for older people. Some communities offer a carpool service or scheduled trips to the grocery store, mall, or doctor’s offices. Religious and civic groups sometimes have volunteers who will drive you where you want to go.

If you have a smartphone or a computer, you could consider using mobile apps available for services like meal, grocery, or prescription deliveries. Most of these are paid services but may have free or lower-cost options for some older adults.

Your local Area Agency on Aging can help you find local services. Call 800-677-1116 or search the Eldercare Locator online. You also can try searching Rides In Sight or calling 855-607-4337, a service of the nonprofit ITN America that provides information about transportation options for older adults.

You can also think about using a car or ridesharing service. While these may sound pricey, remember that owning a car can be expensive. If you no longer need to make car payments or pay for insurance, maintenance, gas, oil, tolls, and other related expenses, then you may be able to afford other transportation or to buy gas for friends and family members who provide rides.

To learn more, please visit https://www.nia.nih.gov/health/safety/safe-driving-older-adults.