Finding a main doctor (often called your primary doctor or primary care doctor) who you feel comfortable talking to is the first step in good communication. How well you and your doctor talk to each other is one of the most important steps to getting good health care. This doctor gets to know you and what your health is normally like. He or she can help you make medical decisions that suit your values and daily habits and can keep in touch with the other medical specialists and healthcare providers you may need.

Taking an active role in your health care puts the responsibility for good communication on both you and your doctor. This means asking questions if the doctor’s explanations or instructions are unclear, bringing up problems even if the doctor doesn’t ask, and letting the doctor know if you have concerns about a particular treatment or change in your daily life.

If you don’t have a primary doctor or are not at ease with the one you currently see, now may be the time to find a new doctor. Whether you just moved to a new city, changed insurance providers, or had a bad experience with your doctor or medical staff, it is worthwhile to spend time finding a doctor you can trust.

People sometimes hesitate to change doctors because they worry about hurting their doctor’s feelings. But doctors understand that different people have different needs. They know it is important for everyone to have a doctor with whom they are comfortable.

Primary care physicians frequently are family practitioners, internists, or geriatricians. A geriatrician is a doctor who specializes in older people, but family practitioners and internists may also have a lot of experience with older patients. Here are some suggestions that can help you find a doctor who meets your needs.

Decide what you are looking for in a doctor

A good first step is to make a list of qualities that matter to you. Do you care if your doctor is a man or a woman? Is it important that your doctor has evening office hours, is associated with a specific hospital or medical center, or speaks your language? Do you prefer a doctor who has an individual practice or one who is part of a group so you can see one of your doctor’s partners if your doctor is not available? After you have made your list, go back over it and decide which qualities are most important and which are nice, but not essential.

Make a list of several possible doctors

Once you have a general sense of what you are looking for, ask friends and relatives, medical specialists, and other health professionals for the names of doctors with whom they have had good experiences. Rather than just getting a name, ask about the person’s experiences. For example, say: “What do you like about Dr. Smith?” and “Does this doctor take time to answer questions?” A doctor whose name comes up often may be a strong possibility.

If you belong to a managed care plan — a health maintenance organization (HMO) or preferred provider organization (PPO) — you may be required to choose a doctor in the plan or else you may have to pay extra to see a doctor outside the network. Most managed care plans will provide information on their doctors’ backgrounds and credentials. Some plans have websites with lists of participating doctors from which you can choose.

It may be helpful to develop a list of a few names you can choose from. As you find out more about the doctors on this list, you may rule out some of them. In some cases, a doctor may not be taking new patients and you may have to make another choice.

Gather information from the web

The American Medical Association’s Doctor Finder website and the American Board of Medical Specialties’ Certification Matters database can help you find doctors in your area. These websites don’t recommend individual doctors, but they do provide a list of doctors you may want to consider. MedlinePlus, a website from the National Library of Medicine at NIH, has a comprehensive list of directories, which may also be helpful. For a list of doctors who participate in Medicare, visit the Medicare.gov Physician Compare tool.

Don’t forget to call your local or State medical society to check if complaints have been filed against any of the doctors you are considering.

Collect information about the doctors you are considering

Once you have narrowed your list to two or three doctors, call their offices. The office staff is a good source of information about the doctor’s education and qualifications, office policies, and payment procedures. Pay attention to the office staff — you will have to communicate with them often!

You may want to set up an appointment to meet and talk with a doctor you are considering. He or she is likely to charge you for such a visit. After the appointment, ask yourself if this doctor is a person with whom you could work well. If you are not satisfied, schedule a visit with one of your other candidates.

When learning about a doctor, consider asking questions like:

• Do you have many older patients?
• How do you feel about involving my family in care decisions?
• Can I call or email you or your staff when I have questions? Do you charge for telephone or email time?
• What telehealth services do you offer?
• What are your thoughts about complementary or alternative treatments, such as…?

Choose a doctor

When making a decision about which doctor to choose, you might want to ask yourself questions like:

• Did the doctor give me a chance to ask questions?
• Was the doctor really listening to me?
• Could I understand what the doctor was saying? Was I comfortable asking him or her to say it again?

Once you’ve chosen a doctor, make your first actual care appointment. This visit may include a medical history and a physical exam. Be sure to bring your medical records, or have them sent from your former doctor. Bring a list of your current medicines or put the medicines in a bag and take them with you. If you haven’t already met the doctor, ask for extra time during this visit to ask any questions you have about the doctor or the practice.

To learn more, please visit https://www.nia.nih.gov/health/medical-care-and-appointments/how-choose-doctor-you-can-talk.

Which vaccines do older adults need?

As you get older, a health care provider may recommend vaccinations, also known as shots or immunizations, to help prevent certain illnesses.

Talk with a doctor or pharmacist about which of the following vaccines you need. Make sure to protect yourself as much as possible by keeping your vaccinations up to date.

COVID-19 vaccines

COVID-19 is a respiratory disease that causes symptoms such as fever, cough, and shortness of breath. Older adults are more likely than younger people to get very sick from COVID-19. The disease can lead to serious illness and death.

Studies show that COVID-19 vaccines reduce the risk of getting this disease. The vaccine will also help keep you from getting seriously ill or having to go to the hospital if you do get COVID-19. We are still learning how effective COVID-19 vaccines are against new variants of the virus. Read more about COVID-19 vaccine effectiveness.

The Centers for Disease Control and Prevention (CDC) recommends that older adults stay up to date with COVID-19 vaccines. Read more about COVID-19 vaccines from the CDC and find out the current vaccine recommendations for older adults.

Contact your local health department or visit Vaccines.gov to find out where you can get vaccinated.

Flu vaccine for older adults

Flu — short for influenza — is a virus that can cause fever, chills, sore throat, stuffy nose, headache, and muscle aches. Flu is very serious when it gets in your lungs. Older adults are at a higher risk for developing serious complications from the flu, such as pneumonia.

The flu is easy to pass from person to person. The virus also changes over time, which means you can get it again. To ensure flu vaccines remain effective, the vaccine is updated every year.

Everyone age 6 months and older should get an annual flu vaccine, but the protection from a flu vaccine can lessen with time, especially in older adults. Still, you are less likely to become seriously ill or hospitalized with the flu if you get the vaccine. A flu vaccine is especially important if you have a chronic health condition such as heart disease or diabetes.

Ideally, you should get your vaccine by the end of October each year so you are protected when the flu season starts. It takes at least two weeks for the vaccine to be effective. However, if you have not received your flu vaccine by the end of October, it’s not too late — flu season typically peaks in December or January. As long as the flu virus is spreading, getting vaccinated will help protect you.

There are flu vaccines designed specifically for older adults. The CDC recommends that people age 65 and older receive a higher-dose flu vaccine or an adjuvanted flu vaccine (one with an additional ingredient called an adjuvant that helps create a stronger immune response). These vaccines are potentially more effective than the standard flu vaccine for people in this age group. Talk with a health care provider or pharmacist about which vaccine is best for you.

Medicare will pay for the flu vaccine, and so will private health insurance plans. You can get a flu vaccine at a doctor’s office or local health department, as well as at many grocery stores, drug stores, and pharmacies. Flu shots may also be available at other community locations, such as schools, religious centers, and workplaces. The ingredients of a specific vaccine are the same wherever you receive it.

RSV vaccine for older adults

Respiratory syncytial virus (RSV) is a common virus that usually causes mild, cold-like symptoms. However, older adults have a higher risk of developing severe symptoms if they are infected with RSV. The illness can be particularly dangerous for people who have chronic diseases or a weakened immune system. Older adults who get very sick from an RSV infection may need to be hospitalized, and the illness can even be life-threatening.

RSV vaccines are available to protect older adults from the serious health problems that can occur with RSV infection. The CDC recommends that adults 60 years and older talk with their health care provider about whether they should receive the RSV vaccine. Like the flu, RSV infections are most common in the fall and winter months, so consider getting vaccinated before RSV season starts. However, you can benefit from the RSV vaccine at any time of year.

You can get the RSV vaccine at a doctor’s office, your local health department, and many pharmacies. Medicare Part D and private health insurance plans may pay some or all of the cost. Check with Medicare or your health plan for details about coverage.

Vaccines to help prevent pneumonia

Pneumococcal disease is a serious infection that spreads from person to person by air. It often causes pneumonia in the lungs and it can affect other parts of the body. Older adults are at higher risk than younger people of getting very sick or dying from pneumococcal disease.

The CDC recommends that all adults age 50 and older get pneumococcal vaccination. This vaccine helps protect you from getting a serious infection, including pneumonia. There are multiple forms of the pneumococcal vaccine: Talk to a health care provider to find out which is best for you. You can also visit the CDC’s Pneumococcal Vaccination webpage to learn more about the types of vaccines that are available.

Medicare will pay for the pneumococcal vaccine, as will many private insurance plans. You can get the vaccine at a doctor’s office, your local health department, and many pharmacies. Pneumococcal vaccines may also be available at other community locations, such as schools, religious centers, and workplaces.

Tetanus, diphtheria, and pertussis (whooping cough) vaccines

Tetanus, diphtheria, and pertussis are diseases caused by bacteria that can lead to serious illness and death.

• Tetanus (sometimes called lockjaw) is caused by bacteria found in soil, dust, and manure. It can enter the body through a deep cut or burn.
• Diphtheria is a serious illness that can affect the tonsils, throat, nose, or skin. It can spread from person to person.
• Pertussis, also known as whooping cough, causes uncontrollable, violent coughing fits that make it hard to breathe. It can spread from person to person.

Getting vaccinated is the best way to prevent tetanus, diphtheria, and pertussis. Most people get vaccinated as children, but you also need booster shots as you get older to stay protected against these diseases. The CDC recommends that adults get a Tdap (tetanus, diphtheria, and pertussis) or Td (tetanus, diphtheria) booster shot every 10 years. Ask a health care provider when you need your booster shot.

You can get the Tdap or Td vaccine at a doctor’s office, your local health department, and many pharmacies. Medicare Part D and private health insurance plans may pay some or all of the cost. Check with Medicare or your health plan for details about coverage.

Shingles vaccine for older adults

Shingles is caused by the same virus as chickenpox. If you had chickenpox, the virus is still in your body. As you get older, the virus could become active again and cause shingles.

Shingles affects the nerves. Common symptoms include burning, shooting pain, tingling, and/or itching, as well as a rash with fluid-filled blisters. Even when the rash disappears, the pain can remain. This is called post-herpetic neuralgia, or PHN.

The shingles vaccine is safe, and it may keep you from getting shingles and PHN. Healthy adults age 50 and older should get vaccinated with the shingles vaccine, Shingrix, which is given in two doses. (Zostavax, an earlier shingles vaccine, is no longer available in the United States.)

You should get a shingles vaccine even if you’ve already had chickenpox or the chickenpox vaccine, or if you don’t remember whether you had chickenpox. You should also get the shingles vaccine if you’ve already had shingles or received Zostavax. However, you should not get a vaccine if you currently have shingles, are sick or have a fever, have a weakened immune system, or have had an allergic reaction to Shingrix. Check with a health care provider if you are not sure what to do.

You can get the shingles vaccine at a doctor’s office, your local health department, and many pharmacies. Medicare Part D and private health insurance plans may pay some or all of the cost. Check with Medicare or your health plan for details about coverage.

Travel vaccines

Check with a doctor, a pharmacist, or your local health department about vaccines you need if you’re planning to travel to other countries. The vaccines that are required and recommended are based on your destination, planned activities, and medical history. Sometimes multiple vaccines or doses are needed. It’s best to get them at least four to six weeks before you travel to allow time to build up immunity and get the best protection, particularly from those that may require multiple doses.

Contact Medicare or your private health insurance plan to find out whether they cover the travel vaccines you need. You may be able to get some travel vaccines from a local health care provider. Others are available from health departments and travel medicine clinics. For more information, visit the CDC Traveler’s Health website or call its information line at 800-232-4636.

Vaccine safety and side effects

Vaccines are very safe, and they can help keep you from getting serious or life-threatening diseases. The most common side effects for all these vaccines are mild and may include pain, swelling, or redness where the vaccine was given.

Before getting any vaccine, talk with a doctor or pharmacist about your health history, including past illnesses and treatments, as well as any allergies. A health care provider can address any concerns you have.

It’s a good idea to keep your own vaccination record, listing the types and dates of your shots, along with any side effects or problems.

Learn more about vaccine safety and side effects.

The symptoms of frontotemporal dementia (FTD) and other frontotemporal disorders gradually rob people of basic abilities — thinking, talking, walking, and socializing — that most of us take for granted. FTD and other frontotemporal disorders are a common cause of early-onset dementia. They often strike people in the prime of life when they are working and raising families. Families suffer, too, as they struggle to cope with the person’s daily needs as well as changes in relationships and responsibilities.

There is currently no cure for FTD or related disorders, and no treatments to slow or stop the progression of the disease, but there are ways to help manage the symptoms. Research is improving our awareness and understanding of these challenging conditions. This progress is opening doors to better diagnosis, improved care, and eventually, new treatments.

Frontotemporal disorders result from damage to neurons primarily in the frontal and temporal lobes of the brain. As neurons die in these regions, the frontal and temporal lobes atrophy, or shrink. Gradually, this damage causes difficulties in thinking and behaviors normally controlled by these parts of the brain. Many possible symptoms can result in unusual behaviors, emotional problems, trouble communicating, difficulty with work, or difficulty with movement and walking. FTD and related disorders are rare and tend to occur at a younger age than other forms of dementia. Roughly 60% of people with FTD are 45 to 64 years old.

Frontotemporal disorders are progressive, meaning symptoms get worse over time. In the early stages, people may have just one type of symptom. As the disease progresses, other symptoms will appear as more parts of the brain are affected. It is difficult to predict how long someone with FTD will live. Some people live more than 10 years after diagnosis, while others live less than two years after they are diagnosed.

How frontotemporal disorders affect the brain

Frontotemporal disorders affect the frontal and temporal lobes of the brain. They can begin in the frontal lobe, the temporal lobe, or both. Initially, frontotemporal disorders leave other brain regions unaffected, including those that control short-term memory.

The frontal lobes, situated above the eyes and behind the forehead, direct executive functioning. This includes planning and sequencing (thinking through which steps come first, second, third, and so on), prioritizing (doing more important activities first and less important activities last), multitasking (shifting from one activity to another as needed), and monitoring and correcting errors.

When functioning well, the frontal lobes also help manage emotional responses. They help people avoid inappropriate social behaviors, such as shouting loudly in a library or at a funeral. They aid in making decisions that make sense for a given situation. When the frontal lobes are damaged, people may focus on insignificant details and ignore important aspects of a situation.

The frontal lobes are also involved in language, particularly linking words to form sentences, and in motor functions, such as moving the arms, legs, and mouth. The temporal lobes, located below and to the side of each frontal lobe on the right and left sides of the brain, contain essential areas for memory and play a major role in language and emotions. They help people understand words, speak, read, write, and connect words with their meanings. They allow people to recognize objects and to relate appropriate emotions to objects and events. When the temporal lobes aren’t working properly, people may have difficulty recognizing and responding appropriately to emotions.

Which lobe — and which part of the lobe — is affected first determines which symptoms appear initially. For example, if the disease starts in the part of the frontal lobe responsible for decision-making, then the first symptom might be trouble managing finances. If it begins in the part of the temporal lobe that connects emotions to objects, then the first symptom might be an inability to recognize potentially dangerous objects — a person might reach for a snake or plunge a hand into boiling water, for example. 

In rare cases, frontotemporal disorders can begin in a different part of the brain. For example, when a person has early movement problems, such as falls, swallowing difficulties, or muscle stiffness, the disease may be beginning in the movement parts of the brain, such as the basal ganglia or brainstem.

What are the types and symptoms of frontotemporal disorders?

Frontotemporal disorders can be grouped into three types, defined by the earliest symptoms. In the early stages, it can be hard to know which type of frontotemporal disorder a person has because symptoms and the order in which they appear can vary from one person to another. Also, the same symptoms can appear across different disorders and vary from one stage of the disease to the next as different parts of the brain are affected.

In general, changes in the frontal lobe are associated with behavioral symptoms, while changes in the temporal lobe affect language and emotions. Because it is rare and not well understood, FTD is sometimes misdiagnosed as Alzheimer’s disease or other types of dementia.

Symptoms of FTD and related disorders are often misunderstood. Family members and friends may think that a person is misbehaving, leading to anger and conflict. It is important to understand that people with these disorders cannot control their behaviors and other symptoms and (before they are diagnosed) lack any awareness of their illness.

Behavioral variant frontotemporal dementia

The most common FTD, behavioral variant frontotemporal dementia (bvFTD), involves changes in personality, behavior, and judgment. People with bvFTD can act strangely around other people, resulting in embarrassing social situations. Often, they don’t know or care that their behavior is unusual and don’t show any consideration for the feelings of others. People with this disorder may or may not have problems with cognition or memory.

Symptoms can include:

• Problems planning and sequencing
• Difficulty prioritizing tasks or activities
• Repeating the same activity or saying the same word over and over
• Acting impulsively or saying or doing inappropriate things without considering how others perceive the behavior
• Becoming uninterested in family or activities they used to care about
• Displaying flat, exaggerated, or improper emotions that seem disconnected from the situation
• Difficulty reading social signals, seeming to lack empathy
• Compulsive eating or taking food from others’ plates

Over time, language and/or movement problems may occur, and the person living with bvFTD will need more care and supervision.

Primary progressive aphasia

Primary progressive aphasia (PPA) involves changes in the ability to communicate — to use language to speak, read, write, and understand what others are saying. This includes difficulty using or understanding words (aphasia) and difficulty speaking properly (e.g., slurred speech). People with PPA may have one or both of these symptoms. They may eventually become unable to speak.

Many people with PPA develop symptoms of dementia. Problems with memory, reasoning, and judgment are not apparent at first but can develop over time. Some people with PPA may experience significant behavioral changes, similar to those seen in bvFTD, as the disease progresses.

There are three types of PPA, categorized by the language problems that appear first.

• Semantic PPA: A person slowly loses the ability to understand single words and sometimes to recognize the faces of familiar people and common objects.
• Agrammatic PPA: A person has more and more trouble speaking and may omit words that link nouns and verbs (such as to, from, and the). Eventually, the person may no longer be able to speak at all. The person may later develop movement symptoms similar to those seen in corticobasal syndrome (see below).
• Logopenic PPA: A person has trouble finding the right words during a conversation but can understand words and sentences. The person does not have problems with grammar. Logopenic PPA is usually accompanied by the hallmark brain changes seen in Alzheimer’s.

Researchers do not fully understand the biological basis of the different types of PPA. But they hope one day to link specific language problems with the changes in the brain that cause them.

Movement disorders

Two rare neurological movement disorders associated with FTD, corticobasal syndrome and progressive supranuclear palsy, occur when the parts of the brain that control movement are damaged. The disorders may affect thinking and language abilities, too.

• Corticobasal syndrome (CBS) can be caused by corticobasal degeneration — a gradual atrophy (shrinking) and loss of nerve cells in specific parts of the brain. This causes progressive loss of the ability to control movement, typically beginning around age 60. The most prominent symptom may be apraxia, the inability to use the hands or arms to perform a movement despite normal muscle strength. Apraxia leads to problems such as difficulty fastening buttons or operating small appliances. Other symptoms can include muscle rigidity and difficulty swallowing. Symptoms may appear first on one side of the body, but eventually both sides are affected. Occasionally, a person with corticobasal syndrome first has language problems or trouble orienting objects in space and later develops movement symptoms. Not everyone who has corticobasal syndrome has problems with memory, cognition, language, and behavior in addition to the loss of their ability to control their movements.
• Progressive supranuclear palsy (PSP) typically causes problems with balance and walking. People with the disorder often move slowly, experience unexplained falls, lose facial expression, and have body stiffness, especially in the neck and upper body. These symptoms are similar to those of Parkinson’s disease. A hallmark sign of this disorder is trouble with eye movements, particularly looking down. These symptoms may give the face a fixed stare. Problems with behavior, language, problem solving, and judgment can also develop.

Other movement-related types of FTD include frontotemporal dementia with parkinsonism and frontotemporal dementia with amyotrophic lateral sclerosis (FTD-ALS).

• Frontotemporal dementia with parkinsonism is usually caused by CBS or PSP, and in rare cases can be an inherited disease. Symptoms are similar to those of Parkinson’s and include slowed movement, stiffness, balance problems, and changes in behavior or language.
• FTD-ALS, also called FTD with motor neuron disease, is a combination of bvFTD and amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. In addition to the behavioral and/or language changes seen in bvFTD, people with FTD-ALS experience the progressive muscle weakness, fine jerks, and wiggling in muscles (fasciculation) seen with ALS. Symptoms of either disease may appear first, with other symptoms developing over time.

What causes frontotemporal disorders?

Scientists are beginning to understand the biological and genetic basis for the changes observed in brain cells that lead to FTD.

Scientists describe FTD using the patterns of change in the brain seen in an autopsy after death. These changes include loss of neurons and abnormal amounts or forms of proteins called tau and TDP-43. These proteins occur naturally in the body and help cells function properly. When the proteins don’t work right, for reasons not yet fully understood, neurons in specific brain regions are damaged.

People can have changes in their brain associated with multiple forms of dementia. For example, people with corticobasal syndrome or logopenic PPA may also have beta-amyloid plaques in their brain, which are associated with Alzheimer’s.

In most cases, the cause of FTD is unknown. Individuals with a family history of the disease are more likely to develop FTD.

FTD that runs in a family is often related to variants (permanent changes) in certain genes. Genes are basic units of heredity that tell cells how to make the proteins the body needs to function. Even small changes in a gene may produce an abnormal protein, which can lead to changes in the brain and, eventually, disease. An estimated one-third of FTD cases are inherited, meaning the genetic variant is passed from parent to child. These genetic variants can often be identified through genetic testing.

Scientists have discovered several different genes that, when changed or mutated, can lead to FTD. These include:

• MAPT gene — A change in this gene causes abnormalities in the tau protein, which can then form tangles inside neurons and ultimately lead to the destruction of brain cells. Inheriting a variant in this gene means a person will almost surely develop a frontotemporal disorder, usually bvFTD, but the exact age of onset and symptoms cannot be predicted.
• GRN gene — A change in this gene can lead to lower production of the protein progranulin, which in turn causes another protein, TDP-43, to go awry in brain cells. This can lead to frontotemporal disorders, with bvFTD being the most common. A change in the GRN gene can cause different symptoms in different family members, and the disease can begin at different ages.
• C90rf72 gene — An unusual variant in this gene appears to be the most common genetic abnormality in familial frontotemporal disorders and familial ALS. This variant can cause a frontotemporal disorder, ALS, or both conditions.

In recent years, researchers have discovered several other genetic changes that lead to rare familial types of frontotemporal disorders. These other variants account for less than 5% of all cases of FTD.

Scientists are continuing to study these genes and to search for other genes and proteins, as well as nongenetic risk factors, that may play a role in FTD. They are trying to understand, for example, how variants in a single gene can lead to different types of FTD in members of the same family. Environmental factors that may influence risk for developing the disorders are also being examined.

How are frontotemporal disorders diagnosed?

FTD can be hard to diagnose because the symptoms resemble those of other conditions. For example, bvFTD is sometimes misdiagnosed as a mood disorder, such as depression. To make matters more confusing, a person can have both FTD and another type of dementia, such as Alzheimer’s. Also, because these disorders are rare, physicians may be unfamiliar with the signs and symptoms.

To help diagnose FTD, a doctor may:

• Perform an exam and ask about symptoms
• Review personal and family medical history
• Use laboratory tests to help rule out other conditions, including Alzheimer’s
• Order genetic testing
• Conduct evaluations to assess behavior, memory, thinking, language skills, and physical function
• Order imaging of the brain

A psychiatric evaluation can help determine if depression or another mental health condition is causing or contributing to the condition. A diagnosis of FTD can only be confirmed by genetic tests (in familial cases) or a brain autopsy after death.

Getting the wrong diagnosis can be frustrating. Without an accurate diagnosis, people with FTD and related disorders may not get appropriate treatment to manage their symptoms. Families may not get the help they need. Learn about medical centers that can help people with FTD get diagnosis and treatment.

Read more about how FTD is treated and managed.

Researchers are studying ways to diagnose FTD earlier and more accurately, and to distinguish these conditions from other types of dementia. One area of research involves biomarkers, such as proteins or other substances in the blood or cerebrospinal fluid, which can be used to help diagnose FTD and measure disease progression. Results from biomarker tests also can help rule out other causes of dementia. For example, a blood test for Alzheimer’s could help establish whether the cause of dementia is likely to be Alzheimer’s or something else. Researchers are also exploring ways to improve brain imaging and neuropsychological testing.

To learn more, please visit https://www.nia.nih.gov/health/frontotemporal-disorders/what-are-frontotemporal-disorders-causes-symptoms-an

Not all end-of-life experiences are alike. Death can come suddenly, or a person may linger in a near-death state for days. For some older adults at the end of life, the body weakens while the mind stays clear. Others remain physically strong while cognitive function declines. It’s common to wonder what happens when someone is dying. You may want to know how to provide comfort, what to say, or what to do.

In this article, you will read about ways to help provide care and comfort to someone who is dying. Such care often involves a team: Always remember to check with the person’s health care team to make sure these suggestions are appropriate for the situation.

What is end-of-life care?

End-of-life care is the term used to describe the support and medical care given during the time surrounding death. This type of care does not happen only in the moments before breathing ceases and the heart stops beating. Older people often live with one or more chronic illness and need significant care for days, weeks, and even months before death.

The end of life may look different depending on the person’s preferences, needs, or choices. Some people may want to be at home when they die, while others may prefer to seek treatment in a hospital or facility until the very end. Many want to be surrounded by family and friends, but it’s common for some to slip away while their loved ones aren’t in the room. When possible, there are steps you can take to increase the likelihood of a peaceful death for your loved one, follow their end-of-life wishes, and treat them with respect while they are dying.

Generally speaking, people who are dying need care in four areas: physical comfort, mental and emotional needs, spiritual needs, and practical tasks. Of course, the family of the dying person needs support as well, with practical tasks and emotional distress.

End of life: Providing physical comfort

Discomfort during the dying process can come from a variety of sources. Depending on the cause of the discomfort, there are things you or a health care provider can do to help make the dying person more comfortable. For example, the person may be uncomfortable because of:

• Pain
• Breathing problems
• Skin irritation, including itching
• Digestive problems
• Temperature sensitivity
• Fatigue

Pain. Not everyone who is dying experiences pain. For those who do, experts believe that care should focus on relieving pain without worrying about possible long-term problems of drug dependence or abuse.

Struggling with severe pain can be draining and make the dying person understandably angry or short-tempered. This can make it even harder for families and other loved ones to communicate with the person in a meaningful way.

Caregivers and other family members can play significant roles in managing a dying person’s pain. But knowing how much pain someone is in can be difficult. Watch for clues, such as trouble sleeping, showing increased agitation, or crying. Don’t be afraid of giving as much pain medicine as is prescribed by the doctor.

Pain is easier to prevent than to relieve, and severe pain is hard to manage. Try to make sure that the level of pain does not get ahead of pain-relieving medicines. Tell the health care professionals if the pain is not controlled because medicines can be increased or changed. Palliative medical specialists are experienced in pain management for seriously ill patients; consider consulting with one if they’re not already involved (see What Are Palliative Care and Hospice Care?).

Breathing problems. Shortness of breath or the feeling that breathing is difficult is a common experience at the end of life. The doctor might call this dyspnea. To help ease breathing for your loved one, try raising the head of the bed, opening a window, using a humidifier, or using a fan to circulate air in the room. Sometimes, morphine or other pain medications can help relieve the sense of breathlessness.

There may be times when a dying person has an abnormal breathing pattern, known as Cheyne-Stokes breathing. The person’s breathing may alternate between deep, heavy breaths and shallow or even no breaths. Some people very near death might have noisy breathing, sometimes called a death rattle. In most cases, this noisy breathing does not upset the dying person, though it may be alarming to family and friends. You may try turning the person to rest on one side or elevating their head. Prescription medicine may also help.

Skin irritation. Skin problems can be very uncomfortable for someone when they are dying. Keep the person’s skin clean and moisturized. Gently apply alcohol-free lotion to relieve itching and dryness.

Dryness on parts of the face, such as the lips and eyes, can be a common cause of discomfort near death. These tips may help:

• Keep their lips moist with lip balm and their mouth clean with a soft, damp cloth.
• Gently dab an eye cream or gel around the eyes.
• Try placing a damp cloth over the person’s closed eyes.
• If the inside of the mouth seems dry, giving ice chips (if the person is conscious) or wiping the inside of the person’s mouth with a damp cloth, cotton ball, or specially treated swab might help.

Sitting or lying in one position can put constant pressure on sensitive skin, which can lead to painful bed sores (sometimes called pressure ulcers). When a bed sore first forms, the skin gets discolored or darker. Watch carefully for these discolored spots, especially on the heels, hips, lower back, and back of the head.

Turning the person in bed every few hours may help prevent bed sores and stiffness. Try putting a foam pad under the person’s heel or elbow to raise it off the bed and reduce pressure. Ask a member of your health care team if a special mattress or chair cushion might also help.

Digestive problems. Nausea, vomiting, constipation, and loss of appetite are common issues at the end of life. Swallowing may also be a problem. The causes and treatments for these symptoms vary, so talk to a doctor or nurse about what you’re seeing. Medicines can control nausea or vomiting or relieve constipation, all of which are common side effects of strong pain medications.

If the person loses their appetite, try gently offering favorite foods in small amounts. Serve frequent, smaller meals rather than three larger ones. Help with feeding if the person wants to eat but is too tired or weak.

But don’t force a dying person to eat. Losing one’s appetite is a common and normal part of dying. Going without food and/or water is generally not painful, and eating and drinking can add to a dying person’s discomfort. A conscious decision to give up food can be part of a person’s acceptance that death is near.

Temperature sensitivity. When a person is closer to death, their hands, arms, feet, or legs may be cool to the touch. Some parts of the body may become darker or blueish. People who are dying may not be able to tell you that they are too hot or too cold, so watch for clues. For example, someone who is too warm might repeatedly try to remove a blanket. You can remove the blanket and place a cool cloth on the person’s head.

Hunching their shoulders, pulling the covers up, and shivering can be signs the person is cold. Make sure there is no draft, raise the heat, and add another blanket. Avoid electric blankets because they can get too hot.

Fatigue. It is common for people nearing the end of life to feel tired and have little or no energy. Keep things simple. For example, a bedside commode can be used instead of walking to the bathroom. Providing a stool so the person can sit in the shower, or sponge baths in bed can also help.

End of life: Managing mental and emotional needs

End-of-life care can also include helping the dying person manage mental and emotional distress. Someone who is alert near the end of life might understandably feel depressed or anxious. It is important to treat emotional pain and suffering. You might want to contact a counselor, possibly one familiar with end-of-life issues, to encourage conversations about feelings. Medicine may help if the depression or anxiety is severe.

The dying person may also have some specific fears and concerns. He or she may fear the unknown, or worry about those left behind. Some people are afraid of being alone at the very end. These feelings can be made worse by the reactions of family, friends, and even the medical team. For example, family and friends may not know how to help or what to say, so they stop visiting, or they may withdraw because they are already grieving. Doctors may feel helpless and avoid dying patients because they cannot help them further.

And some people may experience mental confusion and may have strange or unusual behavior, making it harder to connect with their loved ones. This can add to a dying person’s sense of isolation.

Here are a few tips that may help manage mental and emotional needs:

• Provide physical contact. Try holding hands or a gentle massage.
• Set a comforting mood. Some people prefer quiet moments with fewer people. Use soft lighting in the room.
• Play music at a low volume. This can help with relaxation and lessen pain.
• Involve the dying person. If the person can still communicate, ask them what they need.
• Be present. Visit with the person. Talk or read to them, even if they can’t talk back. If they can talk, listen attentively to what they have to say without worrying about what you will say next. Your presence can be the greatest gift you can give to a dying person.

Spiritual needs at the end of life

For people nearing the end of life, spiritual needs may be as important as their physical concerns. Spiritual needs may include finding meaning in one’s life, ending disagreements with others, or making peace with life circumstances. The dying person might find comfort in resolving unsettled issues with friends or family. Visits from a social worker or a counselor may help.

Many people find solace in their faith. Others may struggle with their faith or spiritual beliefs. Praying, reading religious texts, or listening to religious music may help. The person can also talk with someone from their religious community, such as a minister, priest, rabbi, or imam.

Family and friends can talk to the dying person about the importance of their relationship. For example, adult children may share how their father has influenced the course of their lives. Grandchildren can let their grandfather know how much he has meant to them. Friends can share how they value years of support and companionship. Family and friends who can’t be present in person can send a video or audio recording of what they would like to say, or a letter to be read out loud.

Sharing memories of good times is another way some people find peace near death. This can be comforting for everyone. Some doctors think that dying people can still hear even if they are not conscious. Always talk to, not about, the person who is dying. When you come into the room, identify yourself to the person. You may want to ask someone to write down some of the things said at this time — both by and to the person who is dying. In time, these words might serve as a source of comfort to family and friends.

There may come a time when a dying person who has been confused suddenly seems to be thinking clearly. Take advantage of these moments but understand that they are likely temporary and not necessarily a sign of getting better. Sometimes, a dying person may appear to see or talk to someone who is not there. Resist temptation to interrupt or correct them, or say they are imagining things. Give the dying person the space to experience their own reality. Sometimes dying people will report having dreams of meeting deceased relatives, friends, or religious figures. The dying person may have various reactions to such dreams, but often, they are quite comforting to them.

Providing support for practical tasks

Many practical jobs need to be done at the end of life — both to relieve the person who is dying and to support the caregiver. A person who is dying might be worried about who will take care of things when they are gone. A family member or friend can offer reassurance — “I’ll make sure your African violets are watered,” “Jessica has promised to take care of Bandit,” “Dad, we want Mom to live with us from now on” — which may help provide a measure of peace. You also may remind the dying person that their personal affairs are in good hands.

Everyday tasks can also be a source of worry for someone who is dying and can overwhelm a caregiver. A family member or friend can provide the caregiver with a much-needed break by helping with small daily chores around the house such as picking up the mail, writing down phone messages, doing a load of laundry, feeding the family pet, or picking up medicine from the pharmacy.

Caregivers may also feel overwhelmed keeping close friends and family informed. A family member or friend can help set up an outgoing voicemail message, a blog, an email list, a private Facebook page, or even a phone tree to help reduce the number of calls the caregiver must make. Listed at the end of this article are some organizations that make setting up such resources easy and secure.

Providing comfort and care for someone at the end of life can be physically and emotionally exhausting. If you are a primary caregiver, ask for help when you need it and accept help when it’s offered. Don’t hesitate to suggest a specific task to someone who offers to help. Friends and family are usually eager to do something for you and the person who is dying, but they may not know what to do.

In the end, consider that there may be no “perfect” death so just do the best you can for your loved one. The deep pain of losing someone close to you may be softened a little by knowing that, when you were needed, you did what you could.

To learn more, please visit https://www.nia.nih.gov/health/end-life/providing-care-and-comfort-end-life.

Osteoarthritis is the most common form of arthritis among older adults. It is also one of the most common causes of physical disability among adults.

Osteoarthritis is a degenerative joint disease that happens when the tissues that cushion the ends of the bones within the joints break down over time. These changes usually develop slowly and worsen gradually, causing pain, stiffness, and swelling. In some cases, people living with this disease are no longer able to work or perform daily tasks.

There is no way to reverse osteoarthritis, but the symptoms of osteoarthritis can usually be managed with lifestyle changes and medications.

Who is at risk for osteoarthritis?

Anyone can get osteoarthritis, but it is more common as people age. Women are more likely than men to have osteoarthritis, especially after age 50. Other factors that may make it more likely to develop osteoarthritis include:

• Overweight or obesity
• History of injury or surgery to a joint
• Overuse from repetitive movements of the joint
• Joints that do not form correctly
• Family history of osteoarthritis

Each of these risk factors can cause tissues within the joints to break down and lead to osteoarthritis. You can decrease your chances of developing osteoarthritis by changing the risk factors you can control.

Symptoms of osteoarthritis

Osteoarthritis symptoms range from stiffness and mild pain to persistent, severe joint pain. Common signs include swelling and tenderness, stiffness after getting out of bed, and a crunching feeling or sound of bone rubbing on bone. However, not everyone with osteoarthritis feels pain.

Osteoarthritis most commonly affects the hands, lower back, neck, and weight-bearing joints such as knees, hips, and feet. Osteoarthritis in any of these joints can lead to physical disability.

Hands. Osteoarthritis of the hands seems to run in families. If you have family members who have had osteoarthritis in their hands, you’re at greater-than-average risk of having it, too. Women are more likely than men to have osteoarthritis in the hands. For most women, it develops after menopause. When osteoarthritis involves the hands, small, bony knobs may appear on the end and middle joints (those closest to the nails) of the fingers. Fingers can become enlarged and gnarled, and they may ache or be stiff and numb. The base of the thumb joint also is commonly affected by osteoarthritis.

Knees. The knees are among the joints most commonly affected by osteoarthritis. Symptoms of knee osteoarthritis include stiffness, swelling, and pain, which make it hard to walk, climb, and get in and out of chairs and bathtubs. You may hear a grinding or scraping noise when walking or moving. Over time, the knee may start to buckle.

Hips. The hips are also a common site for osteoarthritis. As with knee osteoarthritis, symptoms of hip osteoarthritis include pain and stiffness of the joint. But sometimes pain is felt in the groin, inner thigh, buttocks, or knees. Osteoarthritis of the hip may limit the ability to move and bend, making daily activities such as dressing and putting on shoes a challenge.

Spine. Osteoarthritis of the spine may show up as stiffness and pain in the neck or lower back. In some cases, arthritis-related changes in the spine can cause pressure on the nerves where they exit the spinal column, resulting in weakness, tingling, or numbness of the arms and legs. In severe cases, these changes can even affect bladder and bowel function.

Regardless of how osteoarthritis affects an individual, over time, their daily activities may become difficult, such as going up stairs, getting on or off the toilet or in and out of a chair, gripping a pen, or walking across a parking lot. Pain and other symptoms of osteoarthritis may lead a person to feel depressed, get tired easily, or have trouble sleeping. Fortunately, there are treatments to help manage the symptoms.

How is osteoarthritis diagnosed?

To make a diagnosis of osteoarthritis, most health care providers use a combination of methods and tests. Your doctor may:

• Ask about your symptoms and medical history
• Perform a physical examination
• Use X-rays and other imaging tests to look at your joints
• Order laboratory tests to rule out other problems that could be causing your symptoms

If you have questions about your diagnosis, talk to your doctor. Your primary care provider may refer you to a rheumatologist, a doctor who specializes in arthritis and other related conditions.

Osteoarthritis treatment and pain management

There is no cure for osteoarthritis, therefore, doctors focus on treatments to ease your pain, help you move better, and stop the disease from getting worse. Treatment plans often include:

Exercise. A safe, well-rounded exercise program can reduce joint pain and stiffness and increase flexibility, muscle strength, and endurance. Try stretching and balance exercises as well as low-impact activities such as walking, cycling, swimming, or tai chi. Always talk with your doctor before starting a new exercise program. Remember to start slowly and take the time to adjust to a new level of activity.

Weight control. If you are affected by overweight or obesity, managing your weight can reduce stress on the joints, which may reduce pain, prevent more injury, and increase mobility.

Medication. Over-the-counter medications, including oral pain relievers and arthritis creams, can be helpful. Your doctor may also give you a prescription for a pill or inject a medication directly into the joint to reduce inflammation and pain.

Surgery. If other treatments are not helping and the joint damage is extensive, your doctor may suggest surgery. Surgeries that help treat osteoarthritis include osteotomy, which removes a small piece of bone to relieve pressure on the affected joint, and joint-replacement surgery, which removes a part or all of the damaged joint and replaces it with a plastic, metal, or ceramic joint.

Complementary therapy. Some research shows that complementary approaches, such as massage and acupuncture, may help relieve osteoarthritis pain. Before using other therapies, talk with your doctor about the best options for your treatment.

Take steps to help manage your pain and work toward a better quality of life:

• Try heat and cold treatments to help reduce pain.
• Use a cane or walker to help move around safely. Your doctor or therapist may suggest other devices to help with other daily activities, such as jar openers.
• Practice good posture to reduce pressure on joints.
• Make several trips and keep loads small when bringing in groceries and other purchases.
• Avoid repetitive activities, such as bending at the waist, when possible.
• Reach out online and in your community for support groups.

To learn more, please visit https://www.nia.nih.gov/health/osteoarthritis/osteoarthritis.

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.