Archives for December 2013

Effects of Exercise on Activities of Daily Living In People with Alzheimer’s Disease

Am J Occup Ther. 2014 Jan-Feb;68(1):50-6. doi: 10.5014/ajot.2014.009035.

Systematic review of the effects of exercise on activities of daily living in people with Alzheimer’s disease.

Rao AK1Chou A2Bursley B2Smulofsky J2Jezequel J2.



Alzheimer’s disease (AD) results in a loss of independence in activities of daily living (ADLs), which in turn affects the quality of life of affected people and places a burden on caretakers. Limited research has examined the influence of physical training (aerobic, balance, and strength training) on ADL performance of people with AD.


Six randomized controlled trials (total of 446 participants) fit the inclusion criteria. For each study, we calculated effect sizes for primary and secondary outcomes.


Average effect size (95% confidence interval) for exercise on the primary outcome (ADL performance) was 0.80 (p < .001). Exercise had a moderate impact on the secondary outcome of physical function (effect size = 0.53, p = .004).


Occupational therapy intervention that includes aerobic and strengthening exercises may help improve independence in ADLs and improve physical performance in people with AD. Additional research is needed to identify specific components of intervention and optimal dosage to develop clinical guidelines.


Copyright © 2014 by the American Occupational Therapy Association, Inc.


Music and Alzheimer’s: Can it Help?

(Mayo Clinic) Limited research suggests that listening to music can benefit people who have Alzheimer’s disease in various ways. For example, music can:

  • Relieve stress
  • Reduce anxiety and depression
  • Reduce agitation

Music can also benefit caregivers by reducing anxiety, lightening the mood and providing a way to connect with loved ones who have Alzheimer’s disease — especially those who have difficulty communicating.

If you’d like to use music to help a loved one who has Alzheimer’s disease, consider these tips:

  • Think about your loved one’s preferences. What kind of music does your loved one enjoy? What music evokes memories of happy times in his or her life? Involve family and friends by asking them to suggest songs or make playlists.
  • Set the mood. To calm your loved one during mealtime or a morning hygiene routine, play music or sing a song that’s soothing. When you’d like to boost your loved one’s mood, use faster paced music.
  • Avoid overstimulation. When playing music, eliminate competing noises. Turn off the TV. Shut the door. Set the volume based on your loved one’s hearing ability. Opt for music that isn’t interrupted by commercials, which can cause confusion.
  • Encourage movement. Help your loved one to clap along or tap his or her feet to the beat. If possible, dance with your loved one.
  • Pay attention to your loved one’s response. If your loved one seems to enjoy particular songs, play them often. If your loved one reacts negatively to a particular song or type of music, choose something else.

Keep in mind that music might not affect your loved one’s behavior or quality of life and that further research on music and Alzheimer’s disease is needed.


By Glenn Smith, Ph.D.

© 1998-2013 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved.


Lifelong Exercise Improves Cognitive Function

Psychological Medicine / Volume 43 / Issue 11 / November 2013, pp 2447-2458

Leisure-time physical activity over the life course and cognitive functioning in late mid-adult years: a cohort-based investigation

A. Dregana and M. C. Gulliford

King’s College London, NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, Department of Primary Care and Public Health Sciences, London, UK



The objective of the present study was to estimate the association between different leisure-time physical activity (LTPA) parameters from 11 to 50 years and cognitive functioning in late mid-adulthood.


The study used a prospective birth cohort study including participants in the UK National Child Development Study (NCDS) from age 11 to 50 years. Standardized z scores for cognitive, memory and executive functioning at age 50 represented the primary outcome measures. Exposures included self-reported LTPA at ages 11, 16, 33, 42, 46 and 50 years. Analyses were adjusted for important confounders including educational attainment and long-standing illness.


The adjusted difference in cognition score between women who reported LTPA for at least 4 days/week in five surveys or more and those who never reported LTPA for at least 4 days/week was 0.28 [95% confidence interval (CI) 0.20–0.35], 0.10 (95% CI 0.01–0.19) for memory score and 0.30 (95% CI 0.23–0.38) for executive functioning score. For men, the equivalent differences were: cognition 0.12 (95% CI 0.05–0.18), memory 0.06 (95% CI − 0.02 to 0.14) and executive functioning 0.16 (95% CI 0.10–0.23).


This study provides novel evidence about the lifelong association between LTPA and memory and executive functioning in mid-adult years. Participation in low-frequency and low-intensity LTPA was positively associated with cognitive functioning in late mid-adult years for men and women. The greatest benefit emerged from participating in lifelong intensive LTPA.


Caregivers: Is it The Blues or Depression?

(NIH) Everyone feels blue now and then. It’s part of life. But, if you no longer enjoy activities that you usually like, you may have a more serious problem. Feeling depressed without letup can change the way you think and the way you experience emotions. Doctors call this clinical depression.

Being “down in the dumps” over a period of time is not a normal part of getting older. But, it is a common problem, and medical help may be needed. For most people, depression gets better with treatment. Counseling (talk therapy), medicine, or other treatments can ease the pain of depression. You do not need to suffer.

There are many reasons why depression in older people is often missed or untreated. As a person ages, the signs of depression vary more than those of a younger person. Sometimes older people who are depressed appear to feel tired, have trouble sleeping, or seem grumpy and irritable. Confusion or attention problems caused by depression can sometimes look like Alzheimer’s disease or other brain disorders. Mood changes and signs of depression can be caused by medicines older people may take for arthritis, high blood pressure, or heart disease. The good news is that people who are depressed usually feel better with the right treatment.

What Causes Depression?

There is no one cause of depression. For some people, a single event can bring on the illness. Depression often strikes people who felt fine but who suddenly find they are dealing with a death in the family. For some people, changes in the brain can affect mood and cause depression. Sometimes, those under a lot of stress, like caregivers, can feel depressed. Others become depressed for no clear reason.

People faced with life-changing health problems, such as cancer, diabetes, heart disease, stroke, or Parkinson’s disease, may become depressed. They may worry about how the illness will change their lives. They might be tired and unable to cope with things that make them sad. Treatment can help people manage their symptoms and improve their quality of life.

Genetics, too, can play a role. Studies show that depression may run in families. Children of depressed parents may be at a higher risk for depression. Also, depression tends to be a disorder that occurs more than once. Many older people who have been depressed in the past will be at an increased risk for becoming depressed again.

What to Look For

How do you know when you need help? After all, as you age, you may have to face problems that could cause anyone to feel depressed. Perhaps you are dealing with the death of a loved one. Maybe you are having a tough time getting used to retirement and feel lonely, or are losing interest in things that used to bring you pleasure.

After a period of feeling sad, older people usually adjust and regain their emotional balance. But, if you are suffering from clinical depression and don’t get help, your depression might last for weeks, months, or even years. If you have several of the following signs of depression and they last for more than 2 weeks, see a doctor.

  • An “empty” feeling, ongoing sadness, and anxiety
  • Tiredness, lack of energy
  • Loss of interest or pleasure in everyday activities, including sex
  • Sleep problems, including trouble getting to sleep, very early morning waking, and sleeping too much
  • Eating more or less than usual
  • Crying too often or too much
  • Aches and pains that don’t go away when treated
  • A hard time focusing, remembering, or making decisions
  • Feeling guilty, helpless, worthless, or hopeless
  • Being irritable
  • Thoughts of death or suicide

If you are a family member, friend, or healthcare provider of an older person, watch for clues. Sometimes depression can hide behind a smiling face. A depressed person who lives alone may appear to feel better when someone stops by to say hello. The symptoms may seem to go away. But, when someone is very depressed, the symptoms usually come back.

Don’t ignore the warning signs. If left untreated, serious depression may lead to suicide. Listen carefully if someone of any age complains about being depressed or says people don’t care. That person may really be asking for help.

Get Immediate Help

If you are thinking about harming yourself, tell someone who can help immediately.

  • Do not isolate yourself.
  • Call your doctor.
  • Call 911 or go to a hospital emergency room to get immediate help, or ask a friend or family member to help you.
  • Call the toll-free, 24-hour National Suicide Prevention Lifeline:
    • 1-800-273-TALK (1-800-273-8255)
    • 1-800-799-4TTY (1-800-799-4889)

Getting Help

The first step is to accept that you or your family member needs help. You may not be comfortable with the subject of mental illness. Or, you might feel that asking for help is a sign of weakness. You might be like many older people, their relatives, or friends who believe that a depressed person can quickly “snap out of it” or that some people are too old to be helped. They are wrong.

A healthcare provider can help you. Once you decide to get medical advice, start with your family doctor. Your doctor should check to see if your depression could be caused by a health problem (such as hypothyroidism or vitamin B12 deficiency) or is a side effect of medicine you’re taking. After a complete exam, your doctor may suggest you talk to a mental health worker, for example, a social worker, counselor, psychologist, or psychiatrist. Doctors specially trained to treat depression in older people are called geriatric psychiatrists.

Don’t avoid getting help because you’re afraid of how much treatments might cost. Often, only short-term counseling is needed. Treatment for depression is usually covered by private insurance and Medicare. Also, some community mental health centers may offer treatment based on a person’s ability to pay.

Be aware that some family doctors may not understand about aging and depression. If your doctor is unable or unwilling to help, you may want to talk to another healthcare provider.

Do you have a friend or relative who won’t go to a doctor for treatment? Try explaining how treatment may help the person feel better. In some cases, when a depressed person can’t or won’t go to the doctor’s office, the doctor or mental health specialist can start by making a phone call. A phone call can’t take the place of the personal contact needed for a complete medical checkup, but it might motivate the person to go for treatment.

Treating Depression

Your doctor or mental health expert can often treat your depression successfully. Different therapies seem to work for different people. For instance, support groups can provide new coping skills or social support if you are dealing with a major life change. Several kinds of talk therapies are useful as well. One method might help you think in a more positive way. Always focusing on the sad things in your life or what you have lost might contribute to depression. Another method works to improve your relations with others so you will have more hope about your future.

Getting better takes time, but with support from others and with treatment, you can get a little better each day.

Antidepressant drugs (medicine to treat depression) can also help. These medications can improve your mood, sleep, appetite, and concentration. There are several types of antidepressants available. Some of these medicines are effective in a few weeks while you may need to take others for 2 or 3 months before you begin to feel better. Be sure to take your medicine the way it was prescribed for you. Your doctor may want you to continue medications for 6 months or more after your symptoms disappear.

Some antidepressants can cause unwanted side effects, although newer medicines have fewer side effects. Any antidepressant should be used with great care to avoid this problem. Remember:

  • The doctor needs to know about all prescribed and over-the-counter medica­tions, vitamins, or herbal supplements you are taking.
  • The doctor should also be aware of any other physical problems you have.
  • Be sure to take antidepressants in the proper dose and on the right schedule.

If you are still very depressed after trying therapy and/or medication, your doctor can help you choose other treat­ment options that may work for you.

Help From Family and Friends

Family and friends can play an important role in treatment. They can encourage someone who is depressed to stay with the treatment plan. Or, they may make appointments or accompany their friend or relative to see the doctor or go to a support group.

Be patient and understanding. Ask your relative or friend to go on outings with you or to go back to an activity that he or she once enjoyed. Encourage the person to be active and busy but not to take on too much at one time.

Preventing Depression

What can be done to lower the risk of depression? How can people cope? There are a few steps you can take. Try to prepare for major changes in life, such as retirement or moving from your home of many years. Stay in touch with family. Let them know when you feel sad. Friends can help ease loneliness if you lose a spouse. Consider new hobbies that help keep your mind and body active. If you are faced with a lot to do, try to break the task into smaller jobs that are easy to finish.

Regular exercise may also help prevent depression or lift your mood if you are somewhat depressed. Older people who are depressed can gain mental as well as physical benefits from mild forms of exercise like walking outdoors or in shopping malls. Gardening, dancing, and swimming are other good forms of exercise. Pick something you like to do. Begin with 10–15 minutes a day, and increase the time as you are able. Being physically fit and eating a balanced diet may help avoid illnesses that can bring on disability or depression.

Remember, with treatment, most people will begin to feel better. Expect your mood to improve slowly. Feeling better takes time. But, it can happen.

For More Information

Here are some helpful resources:

American Association for Geriatric Psychiatry 
7910 Woodmont Avenue, Suite 1050
Bethesda, MD 20814-3004

American Psychological Association 
750 First Street, NE
Washington, DC 20002-4242
1-800-374-2721 (toll-free)
1-202-336-6123 (TDD/TTY)

Depression and Bipolar Support Alliance 
730 North Franklin Street, Suite 501
Chicago, IL 60654-7225
1-800-826-3632 (toll-free)

National Alliance on Mental Illness 
3803 North Fairfax Drive, Suite 100
Arlington, VA 22203
1-800-950-6264 (toll-free)

National Institute of Mental Health 
6001 Executive Boulevard
Room 6200, MSC 9663
Bethesda, MD 20892-9663
1-866-615-6464 (toll-free)
1-866-415-8051 (TTY/toll-free)

National Library of Medicine 

Mental Health America 
2000 North Beauregard Street, 6th Floor
Alexandria, VA 22311
1-800-969-6642 (toll-free)

National Suicide Prevention Lifeline 
1-800-273-8255 (toll-free/24 hours a day)
1-800-799-4889 (TTY/toll-free)

Substance Abuse and Mental Health Services Administration 
1 Choke Cherry Road
Rockville, MD 20857
1-800-662-4357 (toll-free)
1-800-487-4889 (TDD/toll-free)

For more information on health and aging, contact:

National Institute on Aging Information Center 
P.O. Box 8057
Gaithersburg, MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free)

To sign up for regular email alerts about new publications and other information from the NIA, go to

Visit, a senior-friendly website from the National Institute on Aging and the National Library of Medicine. This website has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to make the type larger.


National Institute on Aging

National Institutes of Health

U.S. Department of Health and Human Services

Page Last Updated: October 17, 2013


7 Ways to Beat Stress

(WebMD) If stress is starting to run you ragged, take heart. There are some easy ways to keep it from overtaking your day.

No. 1: Breathe Deeply

This simple strategy is a powerful stress fighter. It helps you:

  • Lower stress hormones
  • Lower your heart rate
  • Bring down your blood pressure

Here’s how to do it:

  1. Sit quietly with one hand on your stomach, the other on your chest.
  2. Breathe in slowly and deeply through your nose, filling your lungs.
  3. Hold your breath for a few seconds.
  4. Breathe out slowly through your mouth until all the air is out of your lungs.
  5. Repeat four more times.

No. 2: Meditate

This ancient practice relaxes your mind and the body.

For several minutes each day, sit quietly and comfortably. While you do this, focus your mind on one of these things:

  • Your breathing
  • An object
  • A specific word or phrase (mantra)

As thoughts and distractions intrude, gently push them away. Return to your focus.

You can do meditation alone or with a group.

No. 3: Exercise

To get your heart rate up with an aerobic exercise:

  • Walk
  • Cycle
  • Swim

Just 20 minutes a day will calm your mind and lower stress hormones.

Exercise also boosts endorphins, brain chemicals that improve your mood. Even light exercise can relax you, though harder workouts offer greater health rewards.

No. 4: Practice Guided Imagery

This technique has the same relaxation benefits of deep breathing. Here’s how it works:

  • Sit somewhere quiet and picture yourself in a calm and peaceful place, such as a beach. Imagine walking through this place and taking in its sights, sounds, and smells.
  • While your imagination is working, breathe slowly and deeply.
  • Keep this up until you are fully relaxed.
  • Ease back slowly into the real world.

To get started, you can search online for podcasts that will talk you through the process. Nurses, counselors, therapists, or other professionals can also help you learn how to do this on your own.

No. 5: Eat Well

Foods rich in vitamin C, like oranges and grapefruits, may help lower your stress hormones. Omega-3s, like those found in salmon and other fatty fish, as well nuts and seeds, may also be calming.

In general, fueling your body well with a balanced diet can help keep your body healthy and better able to handle stress. Part of eating well means focusing on getting whole grains, vegetables, and fruits.

Want something sweet? Dark chocolate may have a calming effect by lowering stress hormones.

No. 6: Talk Positively to Yourself

Being self-critical can add to your stress. So try the opposite approach. Help yourself relax by practicing positive self-talk.

Replace negative thoughts with positive ones. In other words, be the little engine that could. Tell yourself “I think I can” rather than “I know I can’t.”

No. 7: Sleep Well

Getting a good night’s sleep can help you fight stress the next day. Go for at least 7 hours a night.

Try these tips if you’re having trouble:

  • Try to go to bed and wake up at the same time every day — even on the weekends.
  • Avoid caffeine after 3 p.m. and alcohol close to bedtime.
  • If you take naps, do so early in the day rather than too close to bedtime.
  • Exercise regularly.

Reviewed by Brunilda Nazario, MD on October 01, 2013

© 2013 WebMD, LLC. All rights reserved.


Caregiving: Treasuring This Moment in Time

(The Association for Frontotemporal Degeneration) I describe the day I heard my husband had frontotemporal dementia as my “this moment in time” day.  From this day forward our life would never be, and has not been, the same.

It’s very easy to see how people would see such news as only a negative, but I came to see an opportunity within the sadness.

“From this day forward,” said the doctor, “your life will be different. You can do anything you have done before or have wanted to do, but will do it differently.”

His statement resonated in my ears and in my mind, but even more deeply in my heart. The tornado known as FTD had hit and had carried me to an unknown and frightening land.  As I regained my composure, the paths ahead of me became clearer and I had choices to make as to which road would lead me to becoming the best FTD caregiver I could.

I have come to realize that at the moment of diagnosis, the doctor and family members present know in the deepest sense that moving forward will be profoundly difficult work.  But I also know that there are different types of difficult work and choices to make: how can I work productively to make every moment count.  Like many of us, I am fortunate to have had some people of great wisdom, clarity and empathy in my life.  This was definitely a time I needed to call forth the strengths and skills I had learned from them along the way.

Three C’s Followed by Three P’s

From one of my wise mentors I had learned a method for regaining perspective called “the three C’s:” I didn’t cause it. I can’t change it; and I can’t control it.  If ever a situation warranted embracing the three C’s, confronting frontotemporal dementia is it.  The increasing pace of research gives us hope that the future will include ways to control FTD, but at this moment its progression is relentless and the prognosis is completely devastating.

My mentor taught me to follow the negative three C’s with three P’s: pause, pray (to whomever is your higher power) and proceed.  As I paused to reflect, I knew that I faced a moment of choice.  The reality of diagnosis and prognosis were harsh, but I had to decide how to proceed on this journey.  I pictured that moment as a wooden ruler.  At one end sat the delivery of the diagnosis and at the other end, the prognosis that this will be terminal. No one can truly know the length of time in between, but between those two constants, which embody the three C’s of didn’t cause it, can’t change it, and can’t control, it is a variable about which I do have choices: how shall we live each moment?

I decided to make the difficult work productive: to make life as enjoyable, dignified, and meaningful as possible for as long as I can, with a spirit of love, empathy, and warmth, and a positive approach to this moment only.  That is what we had as I began to this unfamiliar path, and as the doctor said, we could do the same thing now, just do it differently.

Finding a Way to Proceed

The doctors advised us to start right away to form a circle of support.  Again, the magnitude of the challenges that come with FTD make this much more than a sentimental idea.  It’s essential for both the patient and those caring for him or her.  Reaching out for support can also be hard work because by default, we families carry the responsibility to tell people what FTD is and what assistance we need.

The people we have met over the past two years have formed a circle that keeps me aware of what is needed to live This Moment in Time.  Our circle includes our primary doctor, neurologist, clinical director, psychologist, caregiver support group, the good people at AFTD, and our friends and family.  If you build a support structure, then strength, courage, and endurance will follow, and life can flow in to bring you some joyous, moments.

After devouring every piece of information I could, I realized I needed a way to maximize Richard’s functioning and take care of my own needs in the new role of caregiver.  I developed a tool – we call it “the curriculum” – that works for us and is designed as a way for Richard to experience success, maintain dignity, and engage in activities that will keep his mind stimulated.  At the same time, I needed a plan for self-care to be sure I could maintain a positive outlook.  The curriculum for Richard and for myself has given me a sense of being in charge of my life again, when that feeling could have been in real danger.

Pause, pray and proceed:  it’s a mantra I rely on daily.  I do this through meditation, and my favorite is to meditate on gratitude for little things.  There are many little moments that I treasure.  I carve out bits of time for myself and my friends regularly.  I have very deliberately developed a network of men friends who I have educated about this disease and engaged to have nights out with Richard, so I can have a free night.   I attend a caregiver support group, and caregiver conferences and retreats.

Taking care of myself is the most unselfish gift I can give to my husband.  Our deliberate approach to accommodating FTD adds to my wellness and is reflected in his ability to stay active and engaged in valued activities of daily living. It doesn’t make the problems go away, but it does help us deal with some of the aspects of this terrible disease.  My wellness is a product of the choice I made at the beginning and have maintained:

This moment in time is all I have.

Choose to look at what he can still do, not the losses.

The tornado hit, nothing will ever be as it was.  As Richard and I make our way in this new strange land of FTD there are many adjustments to be made, many frustrations and unwanted challenges.  Yet, we have all that we need.  We need to see what is right before us. We need to pause to be able to access it, and see what strengths, courage, and empathy we have.  I cannot live in the past or predict what the future holds for us in this disease.  I have only This Moment in Time.  What a valuable moment, a treasure.


Written by Eleanor Vaughan, caregiver and AFTD volunteer. For more information about the curriculum, contact Eleanor Vaughan via email at

The Association for Frontotemporal Degeneration

© 2007-2013 The Association for Frontotemporal Degeneration


Medicines: Use Them Safely

(NIH) When Jerry, age 71, came home from the drug store with his latest prescription, he placed all his pill bottles on the kitchen counter and counted them. “I take five different medications, and you take four,” he said to his wife. “We need a system. We need to know what medicines we have, what they’re for, and when we should take them.

Modern medicine has made our lives better in many ways. It has helped us live longer, healthier lives. But people over 65 have to be careful when taking medications, especially when they’re taking many different drugs.

What Are Medicines? What Are Drugs?

Some people refer to the pills, liquids, creams, or sprays they take as “medicine,” and other people call them “drugs.” Both words can mean:

  • Medicines you get from a pharmacy with a doctor’s prescription
  • Pills, liquids, or creams you buy without a prescription to use now and then, for example, for aches and pains, colds, or heartburn
  • Vitamins or dietary supplements you take regularly

Drugs you get without a doctor’s prescription are called over-the-counter medicines. Because mixing certain medicines can cause problems, be sure to let your doctor know about all the prescription and over-the-counter drugs you are taking.

At Your Doctor’s Office

If you’ve gone to your doctor because you don’t feel well, the doctor might decide a medicine will help and will write a prescription. Be sure you:

  • Tell your doctor or nurse about all the medicines you take whenever a new drug is prescribed.
  • Remind your doctor or nurse about your allergies and any problems you have had with medicines, such as rashes, indigestion, dizziness, or mood changes.
  • Understand how to take the medicine before you start using it. Ask questions. It might help to write down the answers.

Questions To Ask Your Doctor About A New Medicine

  • What is the name of the medicine, and why am I taking it?
  • How many times a day should I take it? At what times? If the bottle says take “4 times a day,” does that mean 4 times in 24 hours or 4 times during the daytime?
  • Should I take the medicine with food or without? Is there anything I should not eat or drink when taking this medicine?
  • What does “as needed” mean?
  • When should I stop taking the medicine?
  • If I forget to take my medicine, what should I do?
  • What side effects can I expect? What should I do if I have a problem?

Ask Your Pharmacist

Your pharmacist is an important part of your healthcare team. If you have questions about your medicine after you leave the doctor’s office, the pharmacist can answer many of them. For example, a pharmacist can tell you how and when to take your medicine, whether a drug may change how another medicine you are taking works, and any side effects you might have. Also, the pharmacist can answer questions about over-the-counter medications.

Try to have all your prescriptions filled at the same pharmacy so your records are in one place. The pharmacist will keep track of all your medications and will be able to tell you if a new drug might cause problems. If you’re not able to use just one pharmacy, show the new pharmacist your list of medicines and over-the-counter drugs when you drop off your prescription.

When you have a prescription filled:

  • Tell the pharmacist if you have trouble swallowing pills. There may be liquid medicine available. Do not chew, break, or crush tablets without first finding out if the drug will still work.
  • Make sure you can read and understand the name of the medicine and the directions on the container and on the color-coded warning stickers on the bottle. If the label is hard to read, ask your pharmacist to use larger type.
  • Check that you can open the container. If not, ask the pharmacist to put your medicines in bottles that are easier to open.
  • Ask about special instructions on where to store a medicine. For example, should it be kept in the refrigerator or in a dry place?
  • Check the label on your medicine before leaving the pharmacy. It should have your name on it and the directions given by your doctor. If it doesn’t, don’t take it, and talk with the pharmacist.

Generic Or Brand Name?

When getting a prescription filled, sometimes you can choose between either a generic or brand-name drug. Generic and brand-name medicines are alike because they act the same way in the body. They contain the same active ingredients—the part of the medicine that makes it work. A generic drug is the same as a brand-name drug in dosage, safety, strength, quality, the way it works, the way it is taken, and the way it should be used. Generic drugs usually cost less.

If you want a generic drug, ask your healthcare provider if that’s a choice. Not all drugs are available in the generic form, and there might be medical reasons your doctor prefers the brand-name medicine.

Now, It’s Your Turn

Your doctor has prescribed a medication. The pharmacist has filled the prescription. Now it’s up to you to take the medicine safely. Here are some tips that can help:

  • Make a list of all the medicines you take, including over-the-counter products and dietary supplements. Show it to all of your healthcare providers including physical therapists and dentists. Keep one copy in your medicine cabinet and one in your wallet or pocketbook. The list should include the: name of each medicine, doctor who prescribed it, reason it was prescribed, amount you take, and time(s) you take it.
  • Read and save in one place all written information that comes with the medicine.
  • Take your medicine in the exact amount and at the time your doctor prescribes.
  • Call your doctor right away if you have any problems with your medicine or if you are worried that it might be doing more harm than good. Your doctor may be able to change your prescription to a different one that will work better for you.
  • Use a memory aid to take your medicines on time. Some people use meals or bedtime as reminders to take their medicine. Other people use charts, calendars, and weekly pill boxes. Find a system that works for you.
  • Do not skip doses of medication or take half doses to save money. Talk with your doctor or pharmacist if you can’t afford the prescribed medicine. There may be less costly choices or special programs to help with the cost of certain drugs.
  • Avoid mixing alcohol and medicine. Some medicines may not work correctly or may make you sick if taken with alcohol.
  • Take your medicine until it’s finished or until your doctor says it’s okay to stop.
  • Don’t take medicines prescribed for another person or give yours to someone else.
  • Don’t take medicine in the dark. To avoid making a mistake, turn your light on before reaching for your pills.
  • Check the expiration dates on your medicine bottles. Your pharmacist can probably tell you how to safely get rid of medicine you no longer need or that is out of date. The pharmacist might be able to dispose of it for you.
  • Make sure you store all medicines and supplements out of sight and out of reach of children. And don’t take your medicines in front of young children. They might try to copy you.

Shopping For Medicines Online

Medicines can cost a lot. If you have a drug plan through your insurance, you can probably save money by ordering yours from them rather than at your neighborhood pharmacy. Or, you might be thinking about buying yours on the Internet. But how can you tell which websites are safe and reliable? The Food and Drug Administration (see For More Information) has more information on buying medicines and medical products online.

Medicare Prescription Drug Plans

Medicare has prescription drug plans for people with Medicare to help save money on medicines. For information please call 1-800-633-4227 (1-800-MEDICARE) or visit the Medicare website at

What About Over-The-Counter Medicines?

Many of the ideas in this AgePage are also true for over-the-counter (OTC) drugs, like medicines to relieve coughs, cold, allergies, pain, and heartburn. Be careful when taking an OTC drug. For example, don’t take a cough and cold product if you only have a runny nose and no cough. And, check with your doctor before taking aspirin if you are on a blood-thinning medicine, because aspirin also slows blood clotting.

Other things to remember:

  • Measure the dose of a liquid OTC medicine as carefully as you would a prescription drug. Use a measuring spoon, since spoons you eat with vary in size.
  • Be careful—OTC medicines can have side effects.
  • Take the amount suggested on the label. If you don’t get better, see your doctor.
  • Read the label—even if you have used the OTC product in the past. Important information can change.

Remember, medicines—whether prescription or over-the-counter—can hurt you if they aren’t used the right way. Learn to be a smart consumer of medicine.

For More Information

Here are some helpful resources:

Agency for Healthcare Research and Quality 
540 Gaither Road
Rockville, MD 20850

Centers for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244-1850
1-800-633-4227 (1-800-MEDICARE/toll-free)

Food and Drug Administration
10903 New Hampshire Avenue
Silver Spring, MD 20993
1-888-463-6332 (toll-free)

Partnership for Prescription Assistance
1-888-477-2669 (toll-free)

For more information on health and aging, contact:

National Institute on Aging
Information Center 

P.O. Box 8057
Gaithersburg, MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free)

To sign up for regular email alerts about new publications and other information from the NIA, go to

Visit, a senior-friendly website from the National Institute on Aging and the National Library of Medicine. This website has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to have the text read out loud or to make the type larger.


National Institute on Aging

National Institutes of Health

U.S. Department of Health & Human Services



Nursing Homes: Making the Right Choice

(NIH) Lucille has lived in her home for 33 years. Even after her husband died 3 years ago, she was able to manage on her own. Recently, she broke her hip and now needs a walker to get around. At 85, she is no longer able to be on her own. Her children now are talking about how best to help their mom find the right care.

Sometimes, decisions about where to care for a family member need to be made quickly, for example, when a sudden injury requires a new care plan. Other times, a family has a while to look for the best place to care for an elderly relative.

What Is a Nursing Home?

A nursing home, also known as a skilled nursing facility, is a place for people who don’t need to be in a hospital but can no longer be cared for at home. This can include people with critical injuries or serious illnesses, or those needing care after surgery. Most nursing homes have aides and skilled nurses on hand 24 hours a day. Talk to your healthcare provider to find out if a nursing home is the best choice for you or a member of your family.

Nursing homes can be:

Hospital-like. This type of nursing home is often set up like a hospital. Members of the staff give medical care, as well as physical, speech, and occupational therapy. There can be a nurses’ station on each floor. As a rule, one or two people live in a room. A number of nursing homes will let couples live together. Things that make a room special, like family photos, are often welcome.

Household-like. These facilities are designed to be more like homes, and the day-to-day routine is not fixed. Teams of staff and residents try to create a relaxed feeling. Kitchens are often open to residents, decorations give a sense of home, and the staff is encouraged to develop relationships with residents.

Combination. Some nursing homes have a combination of hospital-like and household-like units.

Many nursing homes have visiting doctors who see their patients on site. Other nursing homes have patients visit the doctor’s office. Nursing homes sometimes have separate areas called “Special Care Units” for people with serious memory problems, like dementia.

Tips to Keep in Mind

If you need to go to a nursing home after a hospital stay, the hospital staff can help you find one that will provide the kind of care that’s best for you. Most hospitals have social workers who can help you with these decisions. If you are looking for a nursing home, ask your doctor’s office for some recommendations. Once you know what choices you have, it’s a good idea to:

Consider. What is important to you—nursing care, meals, physical therapy, a religious connection, hospice care, or Special Care Units for dementia patients? Do you want a place close to family and friends so they can easily visit?

Ask. Talk with friends, relatives, social workers, and religious groups to find out what places they suggest. Check with healthcare providers about which nursing homes they feel provide good care. Use their suggestions to make a list of homes that offer the types of services you want.

Call. Get in touch with each place on your list. Ask questions about how many people live there and what it costs. Find out about waiting lists.

Visit. Make plans to meet with the director and the nursing director. The Medicare Nursing Home Checklist at has some good ideas to consider when visiting. For example, look for:

  • Medicare and Medicaid certification
  • Handicap access
  • Residents who look well cared for
  • Warm interaction between staff and residents

Talk. Don’t be afraid to ask questions. For example, you can ask the staff to explain any strong odors. Bad smells might indicate a problem; good ones might hide a problem. You might want to find out how long the director and heads of nursing, food, and social services departments have worked at the nursing home. If key members of the staff change often, that could mean there’s something wrong.

Visit again. Make a second visit without calling ahead. Try another day of the week or time of day so you will meet other staff members and see different activities. Stop by at mealtime. Is the dining room attractive and clean? Does the food look tempting?

Understand. Once you select a nursing home, carefully read the contract. Question the director or assistant director about anything you don’t understand. Ask a good friend or family member to read over the contract before you sign it.

Do Nursing Homes Have to Meet Standards?

The Centers for Medicare and Medicaid Services (CMS) requires each State to inspect any nursing home that gets money from the government. Homes that don’t pass inspection are not certified. Ask to see the current inspection report and certification of any nursing home you are considering. Visit for more information.

Paying for Nursing Home Care

It’s important to check with Medicare, Medicaid, and any private insurance provider you have to find out their current rules about covering the costs of long-term care. You can pay for nursing home care in several ways. Here are some examples:

Medicare. For someone who needs special care, Medicare, a Federal program, will cover part of the cost in a skilled nursing home approved by Medicare. Check with Medicare for details.

Medicaid. Medicaid is a State/Federal program that provides health benefits to some people with low incomes. Contact your county family services department to see if you qualify.

Private pay. Some people pay for long-term care with their own savings for as long as possible. When that is no longer possible, they may apply for help from Medicaid. If you think you may need to apply for Medicaid at some point, make sure the nursing home you’re interested in accepts Medicaid payments. Not all do.

Long-term care insurance. Some people buy private long-term care insurance. It can pay part of the costs for a nursing home or other long-term care for the length of time stated in your policy. This type of insurance is sold by many different companies and benefits vary widely. Look carefully at several policies before making a choice.

When thinking about nursing home costs, keep in mind that you can have extra out-of-pocket charges for some supplies or personal care, for instance, hair appointments, laundry, and services that are outside routine care.

Resources That Can Help

The rules about programs and benefits for nursing homes can change. Medicare has some helpful resources online. Visit for information about different care options. To learn more about the Medicaid program, see

You can find nursing homes in your area that are approved by the CMS by visiting the Medicare website. You can also see summaries of recent inspection reports. To find comparisons of nursing homes near you, visit Nursing Home Compare at

The Nursing Home Checklist at the same website is a good guide to use when choosing a nursing home.

Many States have State Health Insurance Assistance Programs (SHIP). These programs can help you choose the health insurance that is right for you and your family. Visit

Each State has a Long-Term Care Ombudsman office that advocates for the rights of residents in long-term care facilities. During disputes, the ombudsman will represent the resident’s interests and will look into their complaints. The National Long-Term Care Ombudsman Resource Center has more information. Visit

A veteran in need of long-term care may be able to get help through the Department of Veterans Affairs (VA). Visit or call VA Health Care Benefits toll free at 1-877-222-8387. You can also contact a VA medical center near you.

For More Information

Here are some helpful resources:

601 E Street, NW
Washington, DC 20049
1-888-687-2277 (toll-free)
1-877-434-7598 (TTY/toll-free)
1-877-342-2277 (Spanish/toll-free)

American Health Care Association
1201 L Street, NW
Washington, DC 20005

Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore MD 21244-1850
1-800-633-4227 (toll-free)

Department of Veterans Affairs
VA Benefits: 1-800-827-1000 (toll-free)
1-800-829-4833 (TTY/toll-free)

Leading Age
2519 Connecticut Avenue, NW
Washington, DC 20008-1520

National Clearinghouse for Long Term Care Information
Administration on Aging
Washington, DC 20201

National Consumer Voice for Quality Long-Term Care
1001 Connecticut Avenue, NW
Suite 425
Washington, DC 20036

National Long-Term Care Ombudsman Resource Center
1001 Connecticut Avenue, NW
Suite 425
Washington, DC 20036

For more information on health and aging, contact:

National Institute on Aging Information Center
P.O. Box 8057
Gaithersburg, MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free)

For information on Alzheimer’s disease, contact:

Alzheimer’s Disease Education and Referral (ADEAR) Center
P.O. Box 8250
Silver Spring, MD 20907-8250
1-800-438-4380 (toll-free)

To sign up for regular email alerts about new publications and other information from the NIA, go to

Visit, a senior-friendly website from the National Institute on Aging and the National Library of Medicine. This website has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to make the type larger.


National Institute on Aging
National Institutes of Health
U.S. Department of Health and Human Services
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