You may barely notice the changes at first. Maybe you’ve found yourself reaching more often for your glasses to see up close. You might have trouble adjusting to glaring lights or reading when the light is dim. You may even have put on blue socks thinking they were black. These are some of the normal changes to your eyes and vision as you age.
As more Americans head toward retirement and beyond, scientists expect the number of people with age-related eye problems to rise dramatically. You can’t prevent all age-related changes to your eyes. But you can take steps to protect your vision and reduce your risk for serious eye disease in the future. Effective treatments are now available for many disorders that may lead to blindness or visual impairment. You can also learn how to make the most of the vision you have.
“Vision impairment and blindness are among the top 5 causes of disability in older adults,” says Dr. Cynthia Owsley, an eye researcher at the University of Alabama at Birmingham. Vision changes can make it difficult to perform everyday activities, such as reading the mail, shopping, cooking, walking safely and driving. “Losing your vision may not be life-threatening, but it certainly affects your quality of life,” Owsley says.
The clear, curved lens at the front of your eye may be one of the first parts of your body to show signs of age. The lens bends to focus light and form images on the retina at the back of your eye. This flexibility lets you see at different distances—up close or far away. But the lens hardens with age. The change may begin as early as your 20s, but it can come so gradually it may take decades to notice.
Eventually, age-related stiffening and clouding of the lens affect just about everyone. You’ll have trouble focusing on up-close objects, a condition called presbyopia. Anyone over age 35 is at risk for presbyopia.
“You might find you’re holding your book farther away to read it. You might even start thinking your arms just aren’t long enough,” says Dr. Emily Chew, a clinical researcher at NIH’s National Eye Institute. “A good and simple treatment for presbyopia is reading glasses.”
Cloudy areas in the lens, called cataracts, are another common eye problem that comes with age. More than 22 million Americans have cataracts. By age 80, more than half of us will have had them. Some cataracts stay small and have little effect on eyesight, but others become large and interfere with vision. Symptoms include blurriness, difficulty seeing well at night, lights that seem too bright and faded color vision. There are no specific steps to prevent cataracts, but tobacco use and exposure to sunlight raise your risk of developing them. Cataract surgery is a safe and common treatment that can restore good vision.
The passage of time can also weaken the tiny muscles that control your eye’s pupil size. The pupil becomes smaller and less responsive to changes in light. That’s why people in their 60s need 3 times more light for comfortable reading than those in their 20s. Smaller pupils make it more difficult to see at night.
Trouble seeing at night, coupled with a normal loss of peripheral vision as you age, can affect many daily activities, including your ability to drive safely. Loss of peripheral vision increases your risk for automobile accidents, so you need to be more cautious when driving.
“Keeping older adults active and on the road as drivers, as long as they’re safely able to do so, is considered important to their health and psychological well-being,” says
Owsley. But she notes that tests for motor vehicle licenses tend to focus on visual acuity—how well you can read the letters on an eye chart.
“Visual acuity tests may not be the best way to identify drivers at risk for crashes,” she says. “Other issues are also important, like contrast sensitivity, your peripheral vision and your visual processing speed—how quickly you can process visual information and make decisions behind the wheel.”
To find better ways to assess driver safety, Owsley and her colleagues gave 2,000 older drivers different types of vision screening tests, including tests of visual processing speed. By tracking their driving records for several years, the scientists can figure out which tests were best at predicting safe or dangerous driving, including car crashes. These findings might eventually lead to more accurate screening tests to identify potentially unsafe drivers.
If you’re not convinced you should have regular eye exams, consider that some of the more serious age-related eye diseases—like Glaucoma, age-related macular degeneration (AMD) and diabetic eye disease—may have no warning signs or symptoms in their early stages.
Glaucoma comes from increased fluid pressure inside the eye that damages the optic nerve. “Glaucoma can slowly steal your peripheral vision. You may not notice it until it’s advanced,” says Chew. It can be treated with prescription eye drops, lasers or surgery. If not treated, however, it can lead to vision loss and blindness.
AMD causes gradual loss of vision in the center of your eyesight. “AMD is the leading cause of blindness in Americans over age 65,” says Chew.
A large NIH-supported clinical study by Chew and others found that a specific combination of vitamins and minerals can prevent AMD from progressing to a more severe form. Scientists also found that people who eat diets rich in green, leafy vegetables—such as kale and spinach—or fish are less likely to have advanced AMD. A larger study of 4,000 AMD patients is now testing to see if fish oil or a vitamin/mineral combination might slow progress of the disease.
Diabetic eye disease, another leading cause of blindness, can damage the tiny blood vessels inside the retina. Keeping your blood sugar under control can help prevent or slow the problem.
The only way to detect these serious eye diseases before they cause vision loss or blindness is through a comprehensive dilated eye exam. Your eye care professional will put drops in your eyes to enlarge, or dilate, the pupils and then look for signs of disease. “Having regular comprehensive eye care gives your doctor a chance to identify a problem very early on and then treat it,” says Owsley. Annual eye exams are especially important if you have diabetes.
“Many of the healthy behaviors that help reduce your risk for long-term diseases, like heart disease and cancer, can also help to protect your eyesight,” says Owsley. These include not smoking, eating a healthy diet and controlling conditions like diabetes and high blood pressure. “It’s nice to know that healthy living not only adds years to your life, but also protects your vision as you get older,” Owsley says.
We would like to acknowledge NIH News in Health as the source
%code1% Webinar: Educating Older Americans About Their Aging Eyes
Tinnitus is commonly described as a ringing in the ears, but some people also hear it as a roaring, clicking, hissing or buzzing. It may be soft or loud, and it might affect both of your ears or only one. For some people, it’s a minor annoyance. For others, it can interfere with sleep and grow to be a source of mental and emotional anguish.
Tinnitus can also be a high-pitched tone in one or both ears and sounds like a whooshing sound. While tinnitus isn’t fully understood, it’s known to be a sign that something is wrong in the sound processing system. Something as simple as a piece of earwax blocking the ear canal can cause tinnitus, but it can also come from a number of health conditions—for example, from hearing loss after being exposed to loud noise.
Each year about 1 in 10 adults nationwide has an episode of tinnitus that lasts longer than 3 months. Tinnitus isn’t a disease. Instead, it’s a symptom that something is wrong with your auditory system. The problem may exist somewhere in your ear, in the nerve that connects the inner ear to the brain or in the parts of the brain that make sense of sounds.
Scientists still aren’t entirely sure what happens in the auditory system to cause tinnitus. But somehow, the networks of nerve cells that process sounds have been thrown out of balance in a way that creates the illusion of sound where there is none.
Because tinnitus can arise from so many conditions, ranging from hearing loss to high blood pressure to medications, diagnosing the cause or causes can be challenging. For many people, the ringing in their ears begins for no apparent reason.
Although there’s no cure for tinnitus, several treatments can make it easier to cope with. Hearing aids may help those who have hearing loss along with tinnitus. Behavioral therapy with counseling helps people learn how to live with the noise. Wearable sound generators—small electronic devices that fit in the ear—use a soft, pleasant sound to help mask the tinnitus and offer relief.
Some people with tinnitus use tabletop sound generators to help them relax or fall asleep. Antidepressants and antianxiety drugs may be prescribed to improve mood and sleep patterns. Most doctors offer a combination of these treatments, depending on the severity of the tinnitus and the daily activities it affects the most.
Researchers have been working on new ways to treat tinnitus. One NIH-sponsored study has just begun recruiting active and retired military personnel of the U.S. Armed Forces to test the effectiveness of experimental tinnitus therapy. Soldiers exposed to loud noise, including bomb blasts, can develop tinnitus due to tissue damage in hearing-related areas of the brain and ear. In fact, tinnitus is one of the most common service-related injuries among military personnel returning from Iraq and Afghanistan. The experimental treatment in this study combines educational counseling with a sound-generation device.
Called tinnitus retraining therapy, the approach has shown promise in earlier trials and appears to ease the annoyance of tinnitus and its impact on people’s lives. Learn more about the study at clinicaltrials.gov/ct2/show/NCT01177137.
Scientists were able to eliminate tinnitus—a persistent ringing in the ears—in rats by stimulating a nerve in the neck while playing various tones. The finding gives hope for a future tinnitus cure in humans.
While tinnitus isn’t fully understood, it’s known to be a sign that something is wrong in the sound processing system. Something as simple as a piece of earwax blocking the ear canal can cause tinnitus, but it can also come from a number of health conditions—for example, from hearing loss after being exposed to loud noise.
The researchers used vagus nerve stimulation (VNS), a technique known to release chemicals that encourage changes in the brain. They paired it with the playing of different tones other than the tinnitus frequency. This technique, the scientists reasoned, might induce brain cells to tune to frequencies other than the tinnitus one.
The researchers played various tones during VNS to noise-exposed rats with tinnitus 300 times a day for about 3 weeks. Both the rats’ behavior and brain activity tests showed that their tinnitus had disappeared.
“The key is that, unlike previous treatments, we’re not masking the tinnitus,” says Dr. Michael Kilgard of the University of Texas, one of the lead researchers. “We are eliminating the source of the tinnitus.”
VNS is already used to treat people with certain other conditions. The scientists are now planning to conduct clinical studies of VNS paired with tones in tinnitus patients.
Talk to your doctor if you’ve had ringing in your ears for more than 3 months. Your physician will ask about your symptoms and look into your ear to search for possible causes. You may be referred to an otolaryngologist (a doctor specializing in conditions of the ear, nose, and throat) for further evaluation.
We would like to acknowledge NIH News in Health as the source
%code1% Tinnitus and age-related hearing loss: Mayo Clinic Radio
What You Need to Know to Prevent and Treat Osteoporosis
Our bones are alive. We might not think of them that way—but to keep themselves strong and usable, our bones are always changing.
“Bone is living, growing tissue,” says Dr. Joan McGowan, a scientist at NIH. “It’s constantly breaking down and building up. It keeps refreshing itself.”
But as you get older, your bones may be at increased risk for osteoporosis (oss-tee-oh-pore-OH-sis), when the bones become weak, fragile and more likely to break. And once they break, they take longer to heal. This can be both painful and expensive.
Current estimates suggest that around 10 million people in the U.S. have osteoporosis, and 34 million more have low bone mass, which places them at increased risk.
Osteoporosis is a “silent” disease. You may not realize you have it until a sudden strain, twist or fall causes a broken bone (also called a “fracture”). With osteoporosis, even a minor tumble can be serious, requiring surgery and hospitalization.
It’s normal for bones to break in bad accidents. But if your bones are dense enough, they should be able to stand up to most falls. Bones weakened by osteoporosis, though, are more likely to break.
“It’s just like any other engineering material,” says Dr. Joan McGowan, an NIH expert on osteoporosis. If you fall and slam your weight onto a fragile bone, “it reaches a point where the structures aren’t adequate to support the weight you’re putting on them.” If the bone breaks, it’s a major hint that an older person has osteoporosis.
If you have osteoporosis, you can get a broken bone even though you haven’t fallen—by shoveling snow, for example. A spinal fracture, a break in one of the small bones in your back, may be subtle and go unnoticed. Or it may cause back pain, which you shouldn’t ignore.
“A large part of osteoporosis and fracture risk is inherited,” says McGowan. “If close relatives have suffered a fracture in their later years, this may be a clue to think carefully about your own risk. But diet and physical activity are major ways to build and maintain the best possible skeleton.”
NIH-funded research shows that childhood is the best time to build up bone tissue. Most bone is built by age 18 in girls and 20 in boys.
Start with a well-balanced diet rich in calcium and vitamin D. Most of our bone is made of a rigid protein framework. Calcium (a mineral) adds strength and hardens that framework. Vitamin D helps the intestine absorb calcium.
Calcium is found in many foods, but the most common source for Americans is milk and other dairy products. One 8-ounce glass of milk provides about one-third of the recommended intake for younger children and about one-fourth of the recommended intake for teens.
Calcium is a mineral that helps bones stay strong. It can come from the foods you eat—including milk and milk products, dark green leafy vegetables like kale and collard greens—or from dietary supplements. Women over age 50 need 1,200 mg of calcium a day. Men need 1,000 mg a day from ages 51 to 70 and 1,200 mg a day after that.
Your body makes vitamin D in the skin when you’re out in the sun. Some people get all they need from sunlight, but others need to take vitamin D pills. Talk to your doctor or see the chart at www.niams.nih.gov/health_Info/Bone/Osteoporosis/osteoporosis_ff.asp to find out how much calcium and vitamin D you should get each day.
Vitamin D helps your body absorb calcium. As you grow older, your body needs more vitamin D, which is made by your skin when you’re in the sun. You can also get vitamin D from dietary supplements and from certain foods, such as milk, eggs, fatty fish, and fortified cereals. Talk with your health care provider to make sure you’re getting a healthy amount of vitamin D. Problems can arise if you’re getting too little or too much.
Physical activity is also important for building bone. The more work bones do, the stronger they get. That’s why it’s so important for kids to run and play.
Exercise, especially weight-bearing exercise, helps bones, too. Weight-bearing exercises include jogging, walking, tennis, and dancing. The pull of muscles is a reminder to the cells in your bones that they need to keep the tissue dense.
“There is good evidence,” says McGowan, “that you can build the best skeleton by doing physical activity in childhood: jumping rope, playing basketball and running around. The trend now—of not having physical education in school and playing computer games instead of tag—may be a serious threat to bone health.”
But no matter what your age, McGowan says, “It’s never too late to promote bone health.” Increase your load-bearing exercise, like walking, and make good food choices, rich in calcium and vitamin D.
Smoking, in contrast, weakens bones. Heavy drinking does too—and makes people more likely to fall. Certain drugs may also increase the risk of osteoporosis. Having family members with osteoporosis can raise your risk for the condition as well.
Unfortunately, some factors are beyond your control. Women are more likely to have osteoporosis and related fractures, particularly Caucasian and Asian women. Osteoporosis becomes more common as you get older. Low body weight can also increase your risk. And so can certain medications (such as steroids) and certain diseases and conditions (such as anorexia nervosa, rheumatoid arthritis, gastrointestinal diseases, thyroid disease and depression).
“But even if you have osteoporosis, you can do things to prevent fractures,” McGowan says.
Talk to your doctor well before the age of 50 about your risk. One out of 2 women and 1 out of 4 men over age 50 will break a bone due to osteoporosis.
“We know that all women over the age of 65 should have a bone mineral density test,” McGowan says. The test uses a tiny amount of radiation to look at how dense your bones are. It isn’t painful, and there’s usually no need to undress. However, she says that researchers haven’t yet come up with universal recommendations about when you should get this test. That depends on your risk factors.
The hormone estrogen helps to make and rebuild bones. A woman’s estrogen levels drop after menopause, and bone loss speeds up. That’s why osteoporosis is most common among older women. But men get osteoporosis, too.
“A third of all hip fractures occur in men, yet the problem of osteoporosis in men is frequently downplayed or ignored,” says Dr. Eric Orwoll, a physician-researcher who studies osteoporosis at Oregon Health and Science University. Men tend to do worse than women after a hip fracture, Orwoll says.
Experts suggest that women start getting screened for osteoporosis at age 65. Women younger than age 65 who are at high risk for fractures should also be screened. Men should discuss screening recommendations with their health care providers.
Screening is done with a bone mineral density test at the hip and spine. The most common test is known as DXA, for dual-energy X-ray absorptiometry. It’s painless, like having an X-ray. Your results are often reported as a T-score, which compares your bone density to that of a healthy young woman. A T-score of −2.5 or lower indicates osteoporosis.
“We need to make sure that all involved in this disease—patients, physicians and scientists—maintain an awareness and progress in combating it,” says NIH-funded scientist Dr. Sundeep Khosla of the Mayo Clinic.
So ask your doctor about osteoporosis. And don’t forget to mention the medications you’re taking that might increase your risk.
Remember that osteoporosis remains silent—until there’s a fracture. “A big red flag is when a person over age 50 has a fracture of any kind,” McGowan says. “Doctors should follow up.”
The good news is, even if you already have osteoporosis, it’s not too late to start taking care of your bones. Since your bones are rebuilding themselves all the time, you can help push the balance toward more bone growth by giving them exercise, calcium, and vitamin D.
Several medications can also help fight bone loss. The most widely used are bisphosphonates. These drugs are generally prescribed to people diagnosed with osteoporosis after a DXA test, or to those who’ve had a fracture that suggests their bones are too weak. Bisphosphonates have been tested more thoroughly in women, but are approved for men too.
Researchers are trying to develop drugs that increase bone growth. For now, there’s only one available: parathyroid hormone. It’s effective at building bone and is approved for women and men with osteoporosis who are at high risk for having a fracture.
Another important way to avoid broken bones is to prevent falling and occasions for fracture in the first place. Unfortunately, more than 2 million so-called fragility fractures (which wouldn’t have happened if the bones had been stronger) occur nationwide each year. “To reduce the societal burden of fracture, it’s going to take a combined approach of not only focusing on the skeleton but focusing on fall prevention,” says Dr. Kristine Ensrud, a physician-researcher who studies aging-related disorders at the University of Minnesota and Minneapolis VA Health Care System.
Many things can affect the risk for a fall, such as how good a person’s balance is and how many trip hazards are in the environment. The kind of fall matters, too. Wrist fractures often occur when a person falls forward or backward. “It’s the active older person who trips and puts her hand out,” McGowan says. Hip fractures often arise when a person falls to the side. Your hip may be strong enough to handle weight that goes up and down, but not an impact from another direction.
“That’s why exercise that builds balance and confidence is very good at preventing fractures,” McGowan says. For example, she says, tai chi won’t provide the loads needed to build bone mass, but it can increase balance and coordination—and make you more likely to catch yourself before you topple.
NIH-funded researchers are looking for better ways to tell how strong your bones are, and how high your chances are of breaking a bone. For now, though, the DXA test is the best measure, and many seniors, even older women, don’t get it, Ensrud says. If you’re concerned about your bone health, she adds, “Ask your health care provider about the possibility of a bone density test.”
We would like to acknowledge NIH News in Health as the source
%code1% Beatrice Edwards, MD: The Best Way to Treat Osteoporosis
A Look at Vitamins, Minerals, Botanicals and More
When you reach for that bottle of vitamin C or fish oil pills, you might wonder how well they’ll work and if they’re safe. The first thing to ask yourself is whether you need them in the first place.
More than half of all Americans take one or more dietary supplements daily or on occasion. Supplements are available without a prescription and usually come in pill, powder or liquid form. Common supplements include vitamins, minerals and herbal products, also known as botanicals.
People take these supplements to make sure they get enough essential nutrients and to maintain or improve their health. But not everyone needs to take supplements.
“It’s possible to get all of the nutrients you need by eating a variety of healthy foods, so you don’t have to take one,” says Carol Haggans, a registered dietitian and consultant to NIH. “But supplements can be useful for filling in gaps in your diet.”
Some supplements may have side effects, especially if taken before surgery or with other medicines. Supplements can also cause problems if you have certain health conditions. And the effects of many supplements haven’t been tested in children, pregnant women and other groups. So talk with your health care provider if you’re thinking about taking dietary supplements.
“You should discuss with your doctor what supplements you’re taking so your care can be integrated and managed,” advises Dr. Craig Hopp, an expert in botanicals research at NIH.
Dietary supplements are regulated by the U.S. Food and Drug Administration (FDA) as foods, not as drugs. The label may claim certain health benefits. But unlike medicines, supplements can’t claim to cure, treat or prevent a disease.
“There’s little evidence that any supplement can reverse the course of any chronic disease,” says Hopp. “Don’t take supplements with that expectation.”
Evidence does suggest that some supplements can enhance health in different ways. The most popular nutrient supplements are multivitamins, calcium and vitamins B, C and D. Calcium supports bone health, and vitamin D helps the body absorb calcium. Vitamins C and E are antioxidants—molecules that prevent cell damage and help to maintain health.
Women need iron during pregnancy, and breastfed infants need vitamin D. Folic acid—400 micrograms daily, whether from supplements or fortified food—is important for all women of childbearing age.
Vitamin B12 keeps nerve and blood cells healthy. “Vitamin B12 mostly comes from meat, fish and dairy foods, so vegans may consider taking a supplement to be sure to get enough of it,” Haggans says.
Research suggests that fish oil can promote heart health. Of the supplements not derived from vitamins and minerals, Hopp says, “fish oil probably has the most scientific evidence to support its use.”
The health effects of some other common supplements need more study. These include glucosamine (for joint pain) and herbal supplements such as echinacea (immune health) and flaxseed oil (digestion).
Many supplements have mild effects with few risks. But use caution. Vitamin K, for example, will reduce the ability of blood thinners to work. Ginkgo can increase blood thinning. The herb St. John’s wort is sometimes used to ease depression, anxiety or nerve pain, but it can also speed the breakdown of many drugs—such as antidepressants and birth control pills—and make them less effective.
Just because a supplement is promoted as “natural” doesn’t necessarily mean it’s safe. The herbs comfrey and kava, for example, can seriously damage the liver.
“It’s important to know the chemical makeup, how it’s prepared, and how it works in the body—especially for herbs, but also for nutrients,” says Haggans. “Talk to a health care provider for advice on whether you need a supplement in the first place, the dose and possible interactions with medicine you’re already taking.”
For vitamins and minerals, check the % Daily Value (DV) for each nutrient to make sure you’re not getting too much. “It’s important to consider the DV and upper limit,” says Haggans. Too much of certain supplements can be harmful.
Scientists still have much to learn even about common vitamins. One recent study found unexpected evidence about vitamin E. Earlier research suggested that men who took vitamin E supplements might have a lower risk of developing prostate cancer. “But much to our surprise, a large NIH-funded clinical trial of more than 29,000 men found that taking supplements of vitamin E actually raised—not reduced—their risk of this disease,” says Dr. Paul M. Coates, director of NIH’s Office of Dietary Supplements. That’s why it’s important to conduct clinical studies of supplements to confirm their effects.
Because supplements are regulated as foods, not as drugs, the FDA doesn’t evaluate the quality of supplements or assess their effects on the body. If a product is found to be unsafe after it reaches the market, the FDA can restrict or ban its use.
Manufacturers are also responsible for the product’s purity, and they must accurately list ingredients and their amounts. But there’s no regulatory agency that makes sure that labels match what’s in the bottles. You risk getting less, or sometimes more, of the listed ingredients. All of the ingredients may not even be listed.
A few independent organizations conduct quality tests of supplements and offer seals of approval. This doesn’t guarantee the product works or is safe; it just assures the product was properly made and contains the listed ingredients.
“Products sold nationally in the stores and online where you usually shop should be fine,” Coates says. “According to the FDA, supplement products most likely to be contaminated with pharmaceutical ingredients are herbal remedies promoted for weight loss and for sexual or athletic performance enhancement.”
To make it easy to find reliable information, NIH has fact sheets on dietary supplements at ods.od.nih.gov/factsheets/list-all/. NIH also recently launched an online Dietary Supplement Label Database at www.dsld.nlm.nih.gov. This free database lets you look up the ingredients of thousands of dietary supplements. It includes information from the label on dosage, health claims and cautions.
For more personalized, on-the-go information about dietary supplements, check out NIH’s free updated app for your smart phone or tablet: My Dietary Supplements (MyDS).
The MyDS app provides the latest supplement information and lets you keep track of the vitamins, minerals, herbs and other products you take. You can even keep track of supplements taken by your parents, spouse or children.
“Deciding whether to take dietary supplements and which ones to take is a serious matter,” says Coates. “Learn about their potential benefits and any risks they may pose first. Speak to your health care providers about products of interest and decide together what might be best for you to take, if anything, for your overall health.”
Safe Use of Supplements
- Tell all of your health care providers about any dietary supplements you use. Some supplements can interact with medications or affect medical conditions.
- Read the label instructions for use.
- “Natural” doesn’t always mean safe. For up-to-date news about the safety of particular supplements, check nccam.nih.gov/news/alerts.
- Too much might be harmful. Don’t take more than the recommended dose.
We would like to acknowledge NIH News in Health as the source
%code1% Why Does Your Body Need Nutritional Supplements?
Getting older can bring many changes, both physically and mentally. Even when you’re healthy, your brain and body start slowing down. Maintaining your cognitive health—the ability to clearly think, learn, and remember—is essential for your overall well-being. Many things influence memory health. Your genes, lifestyle, and environment can all impact your thinking skills and ability to perform everyday tasks.
It’s common to experience some decline in cognitive function as you get older. That may mean occasionally losing things, forgetting words, or briefly forgetting what day it is. Or you may notice that it takes longer to learn new things. Such symptoms don’t necessarily mean that you’re developing Alzheimer’s disease or another type of dementia.
“I like to think about the brain as a computer disk for memory and thinking,” explains Dr. Marie Bernard, an aging expert at NIH. “As you get older, it gets fuller and fuller. So, it can get more difficult to retrieve data and add data to it. But you’re still able to learn and grow.”
Aging is bound to bring changes. But there are many things you can do to protect your cognitive health as you age. That includes knowing what puts your well-being at risk.
It’s not only occasional memory problems that older adults are more likely to experience. Aging can bring other changes to the way the brain works. These changes can impact your ability to deal with complex social situations. That can put you at higher risk of being scammed.
“Older adults are often targeted by scam artists,” says Dr. Patricia Boyle, who studies the aging brain at Rush University.
Older adults are also more likely than younger ones to pick up the phone without knowing who’s calling, she explains. “Simply by doing that, you’re opening yourself up to a conversation with someone who may be an unscrupulous person trying to steal from you.”
Common scams targeting older adults include identity theft, risky or fake investments, charity scams, and people posing as relatives in distress to ask for money.
Any adult can fall victim to these sorts of scams. But Boyle and her team recently found that low awareness scam artists’ tactics may be an early indicator of worsening brain function.
In their study, people with low scam awareness were about twice as likely to later develop Alzheimer’s disease as those with high scam awareness.
People should verify any investment proposal or request for money before acting, Boyle explains. Trusted family members or friends may be able to help with this. “Take the time to look into financial propositions and make sure they are legitimate,” she says.
Many things can cause memory or other thinking problems. Depression, anxiety, an infection, or even certain medications can cause cognitive changes. Sometimes these types of issues can be resolved with treatment.
If you experience a sudden change in thinking, memory, or mood, it may be caused by a new medication. Some drugs may not cause cognitive changes when taken on their own but can do so when combined with other medicines. Even common supplements or over-the-counter remedies can cause these types of interactions.
Sometimes, if you have more than one doctor, you might not know what the others prescribed. “Older adults really benefit from having a list of all their over-the-counter, herbal, and prescribed medications with them whenever they see a health care professional,” says Bernard.
Certain medications can also have dangerous or even deadly effects when combined with alcohol. And alcohol alone poses risks for the older brain. It can take less alcohol to alter judgment, coordination, balance, or sleep patterns in an older adult.
Dangerous drinking habits have been rising among older adults in the U.S. A recent NIH-funded study found that 1 in 10 Americans aged 65 or older binge drinks regularly. That means drinking four or more drinks on the same occasion for women and five or more for men.
Older adults may change their drinking habits to cope with a partner or other loved one’s death or because they’re lonely. But drinking can also be part of social activities for older adults, explains Dr. Edith Sullivan, an alcohol researcher at Stanford University.
“Older adults might feel that ‘well, I’m old now, it’s OK for me to drink,” Sullivan says. But older brains and bodies are especially vulnerable to the effects of alcohol, she adds.
A recent study by Sullivan and her team used brain imaging to see how alcohol affects the brain. They found that older adults who misused alcohol had more significant brain tissue loss than their peers who didn’t drink. This was true even if they started misusing alcohol later in life.
The good news, she explains, is that some problems with thinking or memory caused by medications or alcohol misuse can be reversed. “That’s different from classical dementia, which is a one-way street of decline,” says Sullivan.
Building Brain Power
There are many things you can do to protect your brain as you age. “Cognitive activity, physical activity, and social engagement are associated with better cognitive functioning in older adulthood,” Boyle explains.
Managing your health conditions is essential. Controlling your blood pressure, for example, reduces the risk of having a small stroke (bleeding from blood vessels in the brain). Small strokes can cause temporary or permanent cognitive problems.
Feeling a sense of purpose in one’s life also helps protect older adults from cognitive decline. A study from Boyle and her colleagues found that people who felt more purpose in life had fewer symptoms from brain changes linked to Alzheimer’s disease.
“The aging brain can accumulate Alzheimer’s changes, but if you’re stimulating your brain and strengthening it like a muscle, you may be better able to tolerate those changes,” she says.
Bernard stresses that getting older can also bring cognitive advantages you might not know about.
“Older adults have greater verbal ability than younger adults. They’re better problem solvers. And accumulated experiences are very helpful,” she says.
“Think about the positive things that come with aging,” Bernard says. “It’s a great time to become engaged in meaningful activities, maintain connections to friends and family, develop new connections, and be physically active. And in turn, all of these things can enhance one’s quality of life and one’s aging.”
How to Protect Your Brain’s Health
Good overall health can help you maintain your brain health. These tips can help you stay active and healthier physically and mentally:
- Choose healthy foods whenever possible
- Drink enough fluid
- Limit your use of alcohol
- Don’t smoke or use tobacco products
- Get enough sleep
- Make physical activity part of your routine
- Keep your mind active with learning, teaching, and volunteering
- Stay connected with loved ones, friends, and your community
- Manage chronic health problems like diabetes, high blood pressure, and high cholesterol
%code1% Ways To Keep Your Brain Sharp As You Age: | TIME
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Many of us worry from time to time. We fret over finances, feel anxious about job interviews, or get nervous about social gatherings. These feelings can be normal or even helpful. They may give us a boost of energy or help us focus. But for people with anxiety disorders, they can be overwhelming. You might feel anxious when faced with a problem at work, before taking a test, or before making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can worsen over time. The symptoms can interfere with daily activities such as job performance, school work, and relationships.
Anxiety disorders affect nearly 1 in 5 American adults each year. People with these disorders have feelings of fear and uncertainty that interfere with everyday activities and last for 6 months or more. Anxiety disorders can also raise your risk for other medical problems such as heart disease, diabetes, substance abuse, and depression.
Fear and anxiety can cause significant problems in their lives, such as social interactions, school, and work.
Generalized anxiety disorder symptoms include:
- Feeling restless, wound-up, or on-edge
- Being easily fatigued
- Having difficulty concentrating; mind going blank
- Being irritable
- Having muscle tension
- Difficulty controlling feelings of worry
- Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep
People with panic disorder have recurrent unexpected panic attacks. Panic attacks are sudden periods of intense fear that come on quickly and reach their peak within minutes. Attacks can occur unexpectedly or can be brought on by a trigger, such as a feared object or situation.
During a panic attack, people may experience:
- Heart palpitations, a pounding heartbeat, or an accelerated heart rate
- Trembling or shaking
- Sensations of shortness of breath, smothering or choking
- Feelings of impending doom
- Feelings of being out of control
People with panic disorder often worry about when the next attack will happen and actively try to prevent future attacks by avoiding places, situations, or behaviors associated with panic attacks. Worry about panic attacks and the effort spent trying to prevent attacks cause significant problems in various areas of the person’s life, including the development of agoraphobia
People with panic disorder often worry about when the next attack will happen and actively try to prevent future attacks by avoiding places, situations, or behaviors associated with panic attacks. Worry about panic attacks and the effort spent trying to avoid attacks cause significant problems in various areas of the person’s life, including the development of agoraphobia (see below).
A phobia is an intense fear of—or aversion to—specific objects or situations. Although it can be realistic to be anxious in some circumstances, the fear people with phobias feel is out of proportion to the actual danger caused by the situation or object.
People with a phobia:
- May have an irrational or excessive worry about encountering the feared object or situation
- Take active steps to avoid the feared object or situation
- Experience immediate, intense anxiety upon encountering the feared object or situation
- Endure unavoidable objects and situations with intense anxiety
There are several types of phobias and phobia-related disorders:
Specific Phobias (sometimes called simple phobias): As the name suggests, people who have a specific phobia have an intense fear of or feel intense anxiety about specific types of objects or situations. Some examples of specific phobias include the fear of:
- Specific animals, such as spiders, dogs, or snakes
- Receiving injections
Social anxiety disorder (previously called social phobia): People with social anxiety disorder have a general intense fear of, or anxiety toward, social or performance situations. They worry that actions or behaviors associated with their anxiety will be negatively evaluated by others, leading them to feel embarrassed. This worry often causes people with social anxiety to avoid social situations. Social anxiety disorder can manifest in various situations, such as within the workplace or the school environment.
Agoraphobia: People with agoraphobia have an intense fear of two or more of the following situations:
- Using public transportation
- Being in open spaces
- Being in enclosed spaces
- Standing in line or being in a crowd
- Being outside of the home alone
People with agoraphobia often avoid these situations, in part, because they think being able to leave might be difficult or impossible in the event they have panic-like reactions or other embarrassing symptoms. In the most severe form of agoraphobia, an individual can become housebound.
Separation anxiety disorder: Separation anxiety is often thought of as something that only children deal with; however, adults can also be diagnosed with a separation anxiety disorder. People who have separation anxiety disorder have fears about being parted from people they are attached to. They often worry that some sort of harm or something untoward will happen to their attachment figures while they are separated. This fear leads them to avoid being separated from their attachment figures and avoid being alone. People with separation anxiety may have nightmares about being separated from attachment figures or experience physical symptoms when separation occurs or is anticipated.
The good news is that most anxiety disorders get better with therapy. The course of treatment depends on the type of anxiety disorder. Medications, psychotherapy (“talk therapy”), or a combination of both can usually relieve troubling symptoms.
“Anxiety disorders are one of the most treatable mental health problems we see,” says Dr. Daniel Pine, an NIH neuroscientist, and psychiatrist. “Still, for reasons we don’t fully understand, most people who have these problems don’t get the treatments that could really help them.”
One of the most common anxiety disorder types is a social anxiety disorder or social phobia. It affects both women and men equally—a total of about 15 million U.S. adults. Without treatment, social phobia can last for years or even a lifetime. People with social phobia may worry for days or weeks before a social event. They’re often embarrassed, self-conscious, and afraid of being judged. They find it hard to talk to others. They may blush, sweat, tremble, or feel sick to their stomach when around other people.
Other common types of anxiety disorders include generalized anxiety disorder, which affects nearly 7 million American adults, and panic disorder, which affects about 6 million. Both are twice as common in women as in men.
People with generalized anxiety disorder worry endlessly over everyday issues—like health, money, or family problems—even if they realize there’s little cause for concern. They startle easily, can’t relax, and can’t concentrate. They find it hard to fall asleep or stay asleep. They may get headaches, muscle aches, or unexplained pains. Symptoms often get worse during times of stress.
People with panic disorder have sudden, repeated bouts of fear—called panic attacks—that last several minutes or more. During a panic attack, they may feel that they can’t breathe or have a heart attack. They may fear a loss of control or feel a sense of unreality. Not everyone who has panic attacks will develop panic disorder. But if the attacks recur without warning, creating fear of having another attack at any time, then it’s likely panic disorder.
Treatments and Therapies
Anxiety disorders are generally treated with psychotherapy, medication, or both. There are many ways to treat anxiety, and people should work with their doctor to choose the best treatment for them.
Psychotherapy or “talk therapy” can help people with anxiety disorders. To be effective, psychotherapy must be directed at the person’s specific anxieties and tailored to their needs.
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) is an example of one type of psychotherapy that can help people with anxiety disorders. It teaches people different ways of thinking, behaving, and reacting to anxiety-producing and fearful objects and situations. CBT can also help people learn and practice social skills, which is vital for treating social anxiety disorder.
Cognitive therapy and exposure therapy are two CBT methods that are often used, together or by themselves, to treat social anxiety disorder. Cognitive therapy focuses on identifying, challenging, and then neutralizing unhelpful or distorted thoughts underlying anxiety disorders. Exposure therapy focuses on confronting the fears underlying an anxiety disorder to help people engage in activities they have been avoiding. Exposure therapy is sometimes used along with relaxation exercises and/or imagery.
CBT can be conducted individually or with a group of people with similar difficulties. Often “homework” is assigned for participants to complete between sessions.
Medication does not cure anxiety disorders but can help relieve symptoms. Medication for anxiety is prescribed by doctors, such as a psychiatrist or primary care provider. Some states also allow psychologists who have received specialized training to prescribe psychiatric medications. The most common classes of medications used to combat anxiety disorders are anti-anxiety drugs (such as benzodiazepines), antidepressants, and beta-blockers.
Anti-anxiety medications can help reduce the symptoms of anxiety, panic attacks, or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines. Although benzodiazepines are sometimes used as first-line treatments for generalized anxiety disorder, they have both benefits and drawbacks.
Some benefits of benzodiazepines are that they effectively relieve anxiety and take effect more quickly than antidepressant medications often prescribed for anxiety. Some drawbacks of benzodiazepines are that people can build up a tolerance to them if they are taken over a long time and may need higher and higher doses to get the same effect. Some people may even become dependent on them.
To avoid these problems, doctors usually prescribe benzodiazepines for short periods, a practice that is especially helpful for older adults, people who have substance abuse problems, and people who become dependent on medication easily.
If people suddenly stop taking benzodiazepines, they may have withdrawal symptoms, or their anxiety may return. Therefore, benzodiazepines should be tapered off slowly. When you and your doctor have decided it is time to stop the medication, the doctor will help you slowly and safely decrease your dose.
For long-term use, benzodiazepines are often considered a second-line treatment for anxiety (with antidepressants being considered a first-line treatment) as well as an “as-needed” treatment for any distressing flare-ups of symptoms.
A different type of anti-anxiety medication is buspirone. Buspirone is a non-benzodiazepine medication specifically indicated for treating chronic anxiety, although it does not help everyone.
Antidepressants are used to treat depression, but they can also help treat anxiety disorders. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.
Antidepressants can take time to work, so it’s important to give the medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without a doctor’s help. When you and your doctor have decided it is time to stop the medication, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.
Antidepressants called selective serotonin reuptake inhibitors (SSRIs), and serotonin-norepinephrine reuptake inhibitors (SNRIs) are commonly used as first-line treatments for anxiety. Less-commonly used — but effective — treatments for anxiety disorders are older classes of antidepressants, such as tricyclic antidepressants and monoamine oxidase inhibitors (MAOIs).
Although beta-blockers are most often used to treat high blood pressure, they can also help relieve the physical symptoms of anxiety, such as rapid heartbeat, shaking, trembling, and blushing. When taken for a short period of time, these medications can help people keep physical symptoms under control. They can also be used “as needed” to reduce acute anxiety, including preventive intervention for some predictable forms of performance anxieties.
Choosing the Right Medication
Some types of drugs may work better for specific types of anxiety disorders, so people should work closely with their doctor to identify which medication is best for them. Certain substances such as caffeine, some over-the-counter cold medicines, illicit drugs, and herbal supplements may aggravate the symptoms of anxiety disorders or interact with prescribed medication. Patients should talk with their doctor to learn which substances are safe and which to avoid.
Choosing the right medication, medication dose, and treatment plan should be done under an expert’s care and based on a person’s needs and medical situation. Your doctor may try several medicines before finding the right one.
You and your doctor should discuss:
- How well medications are working or might work to improve your symptoms
- Benefits and side effects of each medication
- The risk for serious side effects based on your medical history
- The likelihood of the medications requiring lifestyle changes
- Costs of each medication
- Other alternative therapies, medications, vitamins, and supplements you are taking and how these may affect your treatment; a combination of medication and psychotherapy is the best approach for many people with anxiety disorders
- The medication should be stopped (Some drugs can’t be stopped abruptly and must be tapered off slowly under a doctor’s supervision).
For more information, please visit Mental Health Medications Health Topic webpage. Please note that any information on this website regarding medications is provided for educational purposes only and may be outdated. Diagnosis and treatment decisions should be made in consultation with your doctor. Information about medications changes frequently. Please visit the U.S. Food and Drug Administration website for the latest information on warnings, patient medication guides, or newly approved medications.
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Mental Health and Well-Being of Biomedical Researchers: Anxiety and Anxiety Disorders–NIH OITE
Adequate sleep allows your body and brain to sustain a healthy mental, physical, cognitive, and emotional existence.
Sleep is a period of rest that alternates with wakefulness. You have internal body clocks that control when you are awake and when your body is ready for sleep. These clocks have cycles of approximately 24 hours. The watches are regulated by multiple factors, including light, darkness, and sleep schedules. Once asleep, you cycle through sleep stages throughout the night in a predictable pattern.
Sleep is an essential part of your daily routine—you spend about one-third of your time doing it. Sleep is important because it affects many of your body’s systems. Not getting enough sleep or enough quality sleep raises your risk for heart and respiratory problems and affects your metabolism and ability to think clearly and focus on tasks.
Without sleep, you can’t form or maintain the pathways in your brain that let you learn and create new memories, and it’s harder to concentrate and respond quickly.
Sleep is important to several brain functions, including how nerve cells (neurons) communicate. In fact, your brain and body stay remarkably active while you sleep. Recent findings suggest that sleep plays a housekeeping role that removes toxins in your brain that build up while you are awake.
Everyone needs sleep, but its biological purpose remains a mystery. Sleep affects almost every tissue and system in the body – from the brain, heart, and lungs to metabolism, immune function, mood, and disease resistance. Research shows that a chronic lack of sleep, or getting poor quality sleep, increases the risk of disorders including high blood pressure, cardiovascular disease, diabetes, depression, and obesity.
Sleep is a complex and dynamic process that affects how you function in ways scientists are now beginning to understand. This booklet describes how your need for sleep is regulated and what happens in the brain during sleep.
Your Sleep/Wake Cycle
Many factors play a role in preparing your body to fall asleep and wake up. Your body has several internal clocks, called circadian clocks. These typically follow a 24-hour repeating rhythm, called the circadian rhythm. This rhythm affects every cell, tissue, and organ in your body and how they work. Learn more in our Circadian Rhythms Disorders Health Topic.
Your central circadian clock, located in your brain, tells you when it is time for sleep. Other circadian clocks are located in organs throughout your body. Your body’s internal clocks are in sync with certain cues in the environment. Light, darkness, and other cues help determine when you feel awake and when you feel drowsy. Artificial light and caffeine can disrupt this process by giving your body false wakefulness cues
Your body has a biological need for sleep that increases when you have been awake for a long time. This is controlled by homeostasis, the process by which your body keeps your systems, such as your internal body temperature, steady. A compound called adenosine is linked to this need for sleep. While you are awake, the level of adenosine in your brain continues to rise. The rising levels signal a shift toward sleep. Caffeine and certain drugs can interrupt this process by blocking adenosine.
Stages of Sleep
When you sleep, you cycle through two phases of sleep: rapid eye movement (REM) and non-REM sleep. The cycle starts over every 80 to 100 minutes. Usually, there are four to six cycles per night. You may wake up briefly between cycles. Sleep studies use sensors to record eye movements and brain activity, which classify sleep phases and stages.
During REM sleep, your eyes twitch, and your brain is active. Brain activity measured during REM sleep is similar to your brain’s activity during waking hours. Dreaming usually happens during REM sleep. Your muscles naturally become limp to prevent you from acting out your dreams. You typically have more REM sleep later in the night, but you do not have as much REM sleep in colder temperatures. This is because, during REM sleep, your body does not regulate its temperature properly.
How do our patterns of sleep change as we age?
The patterns and types of sleep change as people mature. For example, newborns spend more time in REM sleep. The amount of slow-wave sleep peaks in early childhood and then drops sharply in the teenage years. Slow-wave sleep continues to decrease through adulthood, and older people may not have any slow-wave sleep at all.
Importance of Sleep
Sleep plays a vital role in good health and wellbeing throughout your life. The way you feel while you are awake depends on what happens while you are sleeping. During sleep, your body supports healthy brain function and maintains your physical health. In children and teens, sleep also helps support growth and development. Getting inadequate sleep over time can raise your risk for chronic health problems. It can also affect how well you think, react, work, learn, and get along with others. Learn how sleep affects your heart and circulatory system, metabolism, respiratory system, and immune system and how much sleep is enough.
When you fall asleep and enter non-REM sleep, your blood pressure and heart rate fall. During sleep, your parasympathetic system controls your body, and your heart does not work as hard as it does when you are awake. During REM sleep and when waking, your sympathetic system is activated, increasing your heart rate and blood pressure to the normal levels when you are awake and relaxed. A sharp increase in blood pressure and heart rate upon waking has been linked to angina and heart attacks.
People who do not sleep enough or wake up frequently may have a higher risk of:
Your body makes different hormones at different times of the day. This may be related to your sleep pattern or your circadian clocks. In the morning, your body releases hormones that promote alertness, such as cortisol, which helps you wake up. Other hormones have 24-hour patterns that vary throughout your life; for example, in children, the hormones that tell the glands to release testosterone, estrogen, and progesterone are made in pulses at night, and the pulses get bigger as puberty approaches.
The way your body handles fat varies according to various circadian clocks, including those in the liver, fat, and muscle. For example, the circadian clocks make sure that your liver is prepared to help digest fats at appropriate times. Your body may handle fat differently if you eat at unusual times.
Studies have shown that not getting enough quality sleep can lead to:
- Increased levels of hormones that control hunger, including leptin and ghrelin, inside your body
- Decreased ability to respond to insulin
- Increased consumption of food, especially fatty, sweet, and salty foods
- Decreased physical activity
- Metabolic syndrome
All of these contribute to overweight and obesity.
You breathe less often and less deeply during sleep and take in less oxygen. These changes can cause problems in people with health problems such as asthma or chronic obstructive pulmonary disease (COPD). Asthma symptoms are usually worse during early morning sleep. Likewise, breathing problems in people who have lung diseases such as COPD can worsen during sleep.
Sleep also affects different parts of your immune system, which become more active at different times of the day. For example, when you sleep, a particular type of immune cell works harder. That is why people who do not sleep enough may be more likely to get colds and other infections.
Sleep helps with learning and the formation of long-term memories. Not getting enough sleep or enough high-quality sleep can lead to problems focusing on tasks and thinking clearly. Read our Sleep Deprivation and Deficiency Health Topic for more information on how lack of sleep affects daily activities’ performance, including driving and schoolwork.
Sleep promotes your overall wellbeing. Try approaching an interview, test, or important meeting without a good night’s sleep. See how your comprehensive self is depleted and how focus, concentration, problem-solving, memory decision-making, and lean ability are reduced by sacrificing a good night’s sleep.
How Much Sleep is Enough?
Experts recommend that adults sleep between 7 and 9 hours a night. Adults who sleep less than 7 hours a night may have more health issues than those who sleep 7 or more hours a night. Sleeping more than 9 hours a night is not necessarily harmful and may help young adults, people who are recovering from sleep deprivation, and sick people.
How much sleep children should get depends on their age. Sleep experts consider naps to be appropriate for children under age 7. Below you can find the recommended hours of sleep, including naps, for different ages.
- For newborns younger than 4 months, sleep patterns vary widely.
- Babies 4 months to 1 year old should sleep 12 to 16 hours per day.
- Children 1 to 2 years old should sleep 11 to 14 hours per day.
- Children 3 to 5 years old should sleep 10 to 13 hours per day.
- Children 6 to 12 years old should sleep 9 to 12 hours per day.
- Teens 13 to 18 years old should sleep 8 to 10 hours per day.
- Adults 18 to 60 years should sleep 7 or more hours per day.
- Adults 61 to 64 years should sleep 7 to 9 hours per day.
- Adults 65 years and older should sleep 7 to 8 hours per day.
Talk to your doctor or your child’s doctor if you think you or your child is sleeping too much or too little.
%CODE1% Why Sleep is Important and What Happens When You Don't Get Enough?
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