09 Healthy Aging and Care of Older Adults

Understanding age-related change

Aging is highly individual. Chronological age alone does not determine a person’s health, independence, or care needs. Normal aging is not the same as disease, and not everyone experiences the same changes or at the same pace.

Some people notice slower processing or recall, reduced muscle strength and flexibility, changes in sleep, or gradual changes in vision and hearing. Chronic illness, medications, lifestyle, and environment also shape function. New or rapidly worsening confusion, weakness, pain, or loss of ability should not be dismissed as “just aging.”

Assessing function and support

A Functional assessment considers what the person can do, what support they need, and whether abilities have changed from their own baseline. Ask the older adult directly and, with permission, include a knowledgeable caregiver.

Everyday function and other domains

• Activities of daily living (ADLs): bathing, dressing, toileting, transferring, eating, and continence.

• Instrumental activities of daily living (IADLs): managing medications and money, preparing meals, shopping, using transportation or a phone, and doing household tasks.

• Mobility and safety: walking, balance, falls, use of assistive devices, and ability to move around the home.

• Other important areas: cognition, mood, vision and hearing, nutrition, pain, medication use, social connection, living conditions, and the person’s goals.

A brief screen can identify concerns, but a positive finding calls for fuller evaluation rather than a diagnosis by itself. For example, difficulty managing medications may reflect vision, memory, dexterity, cost, or a confusing regimen. Identify the cause and agree on practical supports.

Individualizing prevention

Screening is intended for people without symptoms. Symptoms or known disease require appropriate diagnostic evaluation. Review preventive care periodically using current evidence-based guidance, the person’s health history and preferences, and the likely balance of benefit and harm. Areas to review include blood pressure and other chronic-disease risks, mood, tobacco and alcohol use, immunizations, and age- and risk-appropriate cancer screening.

Recommendations can differ by population and age, so decisions should be individualized:

• The USPSTF recommends osteoporosis screening for women aged 65 years or older. It finds evidence insufficient to determine the balance of benefits and harms of screening men.

• For colorectal cancer, the USPSTF recommends screening through age 75 for eligible adults. From ages 76–85, the decision is selective and considers health, prior screening, and preferences.

• Consult the current CDC adult immunization schedule for vaccines and timing. Recommendations depend on age, prior doses, health conditions, and other indications.

Preventive counseling should support regular physical activity suited to ability, nutritious food and adequate hydration, sleep, social connection, and management of chronic conditions. Review prescription medicines, over-the-counter products, and supplements for interactions, side effects, and continued need.

Reducing fall risk

Ask about falls and near-falls, fear of falling, dizziness, and the circumstances of any fall. Assess gait, balance, strength, vision, footwear, orthostatic symptoms, and medicines that may increase fall risk. CDC STEADI provides a framework that includes functional tests such as the Timed Up and Go, chair-stand, and balance tests.

Possible interventions include strength and balance activity, medication review, appropriate vision care, assistive devices, and physical or occupational therapy. Select supports in response to the person’s assessed needs.

Supporting safety at home

Review the home for hazards and tailor changes to the person’s routines and choices. Possible changes include improving lighting, securing rugs and cords, installing grab bars where useful, keeping pathways clear, and placing frequently used items within easy reach.

Discuss safe medication storage and use, emergency planning, and—when relevant—driving safety and risks of abuse or neglect. Regular review of mobility, medicines, home safety, preventive services, and desired supports can help preserve health and independence.