Routine Health Care

Playing an active role in your own health care as you age is important. You run a greater risk for chronic disease than younger women. You may take more medications than you did 30 years ago. You also are at increased risk for certain health problems.

For all of these reasons, all women ages 65 and older should have a physical exam yearly. The exam should include certain routine screening tests, including mammography, colorectal cancer screening, and bone density screening. A screening test looks for signs of disease in people who do not have symptoms. Table 1 lists routine screening tests and immunizations that women aged 65 years and older should have.

Screening Tests Pap Test: A test in which cells are taken from the cervix and vagina and examined under a microscope. Mammography: A low-dose X-ray technique used to study the breasts. Lipid Profile Assessment: A blood test that measures the level of fatty substances in the blood (total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides). Fecal Occult Blood Test: A test of a stool sample for blood, which could be a sign of cancer of the colon or rectum. Sigmoidoscopy: A test in which a slender device is placed into the rectum and lower colon to look for cancer. Colonoscopy: An exam of the entire colon using a small, lighted instrument. Bone Density Screening: A test that checks the strength of your bones by measuring the density of minerals, including calcium, in your bones using an X-ray, computed tomography, or ultrasonography. Urinalysis: A test in which a sample of urine is studied to check for any abnormal substances. Thyroid-Stimulating Hormone Screening: A blood test used to check the levels of the hormone that triggers (stimulates) the thyroid gland to make and release more thyroid hormone. Fasting Glucose Test: A blood test used to help diagnose diabetes.

Based on your risk factors, your doctor may recommend having them more or less often. These tests and exams can help your doctor find problems early, when they can be treated more easily. In some cases, your doctor may suggest additional tests, such as:

• Hearing test to check for hearing loss
• Skin exam to check for changes in moles for early detection of cancer and precancer
• Dental exam to check for problems and to keep teeth clean
• Vision test to check eyesight

It also is important to make sure you are up-to-date on any immunizations you may need. Women older than 65 years may become very ill from influenza. Most cases of influenza are preventable with a yearly flu shot. Older women also should receive the pneumonia vaccine. This vaccine protects older women from pneumonia, a disease of the lungs caused by an infection. There is also a vaccine available for women aged 60 years and older to prevent herpes zoster (shingles). Shingles is a painful skin rash that is caused by the same virus that causes chickenpox. This risk of getting shingles increases as a person ages.

Make the most of your yearly visit. If it is your first visit with a doctor, bring a list of any medications or supplements you are taking, past surgeries, and any illnesses you may have or have had. The more your doctor knows about you the better he or she will be able to help you stay healthy.

Taking Medications

Women often need to take more medicines as they age. Some take prescribed drugs to help manage chronic health problems such as high blood pressure and diabetes. Many also take over-the-counter products such as painkillers, vitamins, minerals, and herbs.

Some medicines do not work well with each other. Some do not work well if they are taken with food. Others may have side effects, such as memory loss, dizziness, and headaches. Knowing more about the products you take and keeping track of them can help prevent problems.

Medicines and Aging

Safety First Throw out medicines after they expire. Check the date on the label or bottle. Read the label and other details about the medicine. Bring another family member with you for your doctor's visit to make sure the doctor's advice is heard and clearly understood. Be sure you know what your medicine is for and how to take it. Tell your doctor about any medicines or supplements you are taking. Tell your doctor if you have had any allergies or past problems with a medicine. Store the product as stated on the label. A dry, dark, and cool place is best for storing medicine. Do not take medicines in the dark. You might take the wrong one. Do not mix alcohol and medicine unless your doctor says it is okay.

Medicines can help you stay healthy. They can help you live longer and better. They also can help you manage chronic health problems and get well faster. However, if not used safely, medicines can cause severe health problems—and sometimes death.

Women older than 65 years are more at risk for medication problems than younger women. This is because of a combination of normal changes that occur as a woman ages, and the fact that older women often have more chronic health problems and, therefore, need to take more than one medication at the same time. This increases a woman's risk of harmful side effects.

Normal body changes cause medicines to work differently as you grow older. With age, the kidneys and liver are less able to carry excess medicines from your body. You also lose water and lean tissue (mainly muscle) and gain more fat tissue. These factors may affect how long a medicine stays in your body and how much is absorbed. Medicines in your body also are affected by:

• Alcohol
• Caffeine
• Diet
• Smoking
• Illness

Prescribed Medicines

Talk to Your Doctor Be involved in your health care. Before you leave your doctor's office, be sure you can answer these questions about your prescribed medicine: What is the name of the medicine? What does the medicine do? How often should I take it? How should I take it? (With water? With milk?) When should I take it? (Before, with, or after meals? At bedtime? As needed?) How long should I take it? What should I do if I forget to take it? Can I take it with my other medicines? What side effects could I have? Should I let the doctor know if they happen to me? Can this medicine affect the others I am taking? Should I avoid a kind of food or drink while taking this medicine? How should I store it? (In the refrigerator?) Should I avoid any activities while taking the medicine?

Some drugs must be prescribed by a doctor. A prescription tells how much of the drug you should take and how often you should take it. When you are taking a prescribed drug:

• Do not take more or less than the amount prescribed.
• Do not stop taking the drug before you discuss it with your doctor, even if you do feel better. Some drugs take longer than others to achieve complete results.
• Take your medications regularly. Even if you do not feel any different, many preventive drugs, such as those taken for osteoporosis or high blood pressure, have to be taken regularly to be effective.
• Do not share prescribed drugs with others.
• Make a list of the medicines you take and keep it with you. Discuss the list with your doctor.
• Make sure that each of your doctors (if you see more than one) has your list of medicines.
• Do not use medicine after the date it expires.

Over-the-Counter Medicines

Many over-the-counter products can help you feel better. Some of these are the same products your doctor prescribes but in lower doses. Over-the-counter medicines include:

• Aspirin, ibuprofen, acetaminophen, or other medicine for pain, headache, or fever
• Allergy, cough, or cold medicine
• Antacids
• Diet pills
• Laxatives
• Sleeping pills
• Vitamins and minerals
• Herbal or "natural" products

Side Effects

Heart Attack Warning Signs A heart attack occurs when an artery is blocked, which cuts off the heart's oxygen supply. Women older than 55 years are at greater risk of having a heart attack than younger women. You can help reduce your risk of having a heart attack by making healthy lifestyle choices, such as eating a healthy diet and maintaining a healthy weight. Many heart attacks in women go unnoticed because women's symptoms are sometimes different from men's symptoms. Most men get a crushing pain in the chest. Some women have chest pain as their first symptom. Others have nausea along with chest pain. Know the warning signs of a heart attack: Sudden, intense pressure or pain in the chest Shortness of breath Chest pain that spreads to the shoulders, neck, or arms Feelings of light-headedness, fainting, sweating, or nausea If any of these symptoms last more than 5 minutes, you could be having a heart attack. Call an ambulance and go to the hospital. While you are waiting, take an aspirin, lie down, and breathe slowly. This may help limit the damage to your heart muscle.

Medicines sometimes cause side effects, such as bloating or dry mouth. Some side effects are common and do not cause harm. Other side effects may be harmful. For instance, a medicine may make you feel dizzy or confused. As a result, you may fall or have an accident while driving.

Working With Your Pharmacy

Your pharmacist is a key member of your health care team. Working with you and your doctor, your pharmacist can help make sure your medicines are right for you. Like your doctor, your pharmacist can answer questions and help you choose over-the-counter products that will work best for you.

Try to use one pharmacy for all your prescriptions. This can help you keep track of what medicines you are taking. The pharmacist will have a complete record of your prescribed drugs and any allergies you may have. This can help you avoid problems with medicines.

Find a store where the pharmacists are willing to answer your questions about medicines. If the pharmacist's advice differs from your doctor's advice, talk to your doctor. You also may want to choose a pharmacy that offers home or mail service and discounts for seniors. If your health insurance plan covers drug costs, find out which stores you can use.

Medicines also may be ordered through the mail or over the Internet. These sources often provide a telephone number to call if you have any questions. Talk with your doctor about these sources before you place an order.

When you have a prescription filled, ask for written details about the drug. Read the details each time your prescription is filled—the information can change. If you find it hard to read small print, ask for labels with large print.

In some cases, you can request a generic drug. A generic drug is the drug's chemical name rather than the brand name. Although they contain the same active ingredients as brand-name drugs, generic drugs often are priced lower. Talk with your doctor about whether a generic drug is a good option for you. If you find it hard to open child-proof caps, ask for normal caps.

Nutrition

A well-balanced diet is key to good health, especially as you grow older. What you eat can affect your quality of life and how long you live. As you grow older, you may not feel like eating, foods may not taste the same, or you may not be able or want to cook. Still try to keep a healthy weight. Extra weight increases your chances of having health problems.

Why Eat Well?

Good nutrition is vital from childhood through your later years. Eating a well-planned, balanced diet with more fresh fruits and vegetables and fewer processed foods can help to:

• Lower your risk of heart disease, certain types of cancer, stroke, and diabetes
• Manage high blood pressure, high cholesterol, and diabetes
• Maintain a healthy weight
• Keep up your energy level
• Relieve constipation

A well-balanced diet is crucial to good health. Your body needs a regular supply of nutrients to grow, replace worn-out tissue, and provide energy. How much of each nutrient you need each day is called the recommended daily allowance (RDA) or, more recently, the dietary reference intake (DRI). You can get your DRI of nutrients from food as well as from supplements. However, most of the nutrients you need should come from the foods you eat.

Use Supplements Wisely Some people need supplements. You may take a multivitamin if you cannot eat all the nutrients you need. Supplements cannot meet all of your dietary needs. Some vitamins, such as vitamin A and selenium, can be harmful if too much is taken. Others may not work well with your medications. Some medicines also may change nutrient needs or how much a person wants to eat. Tell your doctor if you use any prescribed drugs or over-the-counter products, such as vitamins and herbs.

To be sure that your diet gives you enough nutrients, you need to know which ones are in the foods you eat. MyPyramid (www.MyPyramid.gov) can help you make healthy food choices. MyPyramid takes into account your age, sex, and how much you exercise every day. It shows the number of servings you should have each day from each of these six food groups:

1. Grains
2. Vegetables
3. Fruit
4. Oils
5. Milk
6. Meat and beans

On packaged foods, you can use the food labels to find out what nutrients they provide. A food label lists the serving size of the product and how many servings are in the package. This will help you decide how much of the product you should have for one serving.

A label also will show how much of the DRI of some of the nutrients the serving supplies. Your daily goal is to reach 100% of each nutrient that you need. One way of making healthy food choices is to compare food labels of similar products.

Reading Food Labels Most packaged foods have a Nutrition Facts label. You can use this tool to make smart food choices. The Nutrition Facts tell you if a food is a good source of nutrients. The amount of nutrients you need each day is called the Recommended Daily Allowance (RDA). The "% Daily Value" column tells you how much of each nutrient is in the food and how much of your needs (vitamin A and vitamin C, calcium, iron) it supplies. Look at the calories on the label. Compare that with the nutrients you are getting and decide whether the food is worth eating. Serving Size: Tells you how many servings are in the box, bag, or other container. If you double the servings you eat, you double the calories and nutrients. Total Fat: Tells you the amount of fat in one serving. The amount of trans fat, saturated fat, and cholesterol is listed on the label. Too much of these fats can raise cholesterol levels and increase your risk of heart disease. Nutrients: Lists some of the nutrients the product contains. Calories: Tells you the amount of energy the food supplies. Percent Daily Values: Tells you the percentage of nutrients this product provides based on the RDA. It is based on a diet of 2,000 calories, which is more than most older women need (usually about 1,600–1,800 calories) unless they are very active.

Special Needs

Every diet should include proteins, carbohydrates, vitamins, minerals, and fat. You can get most of these nutrients from a well-balanced diet. Most older women need to be sure they get enough calcium and not too much fat (saturated and trans fats), sodium, and added sugars. Some older women may need more or less than the DRI of a certain nutrient, especially those who have certain health problems, such as diabetes or high blood pressure.

Calcium

Good Sources of Calcium Milk and dairy products Cheese Ice cream Low-fat and skim milk Low-fat plain yogurt Green leafy vegetables Broccoli Kale Spinach Turnip greens Nuts Almonds Sesame seeds, dried and hulled Seafood Scallops Shrimp Other foods Chili con carne with beans Figs, dried Pudding Raisins, seedless Fortified cereals and juices Supplements

Bone is made up of calcium and protein. Bones can become thin and brittle if your diet is low in calcium and vitamin D. This may cause osteoporosis or osteopenia (low bone mass). Women aged 65 years and older need 1,500 milligrams (mg) of calcium per day. To get your DRI of calcium, you would need to drink about 6 cups of milk per day. Other dairy foods, such as yogurt and cheese, also are high in calcium. If you prefer non-dairy products or you are lactose intolerant, consider these sources of calcium:

• Dark greens (collards, spinach, turnip greens, and kale)
• Soybeans and certain other soy products
• Certain canned fish and seafood (sardines, pink salmon, blue crab, and clams)
• Cereals and juices with added calcium

It also is important to get enough vitamin D, which helps the body to absorb calcium. For this reason vitamin D often is added to milk. Exposure to sun also can help the body make vitamin D. Most women, however, should take 400–800 IU of vitamin D daily.

Iron

Osteoporosis Bones go through a constant state of loss and regrowth. As a person ages, more loss than growth can occur. This can lead to a condition called osteoporosis. The bones then become thin and fragile and can break easily. Osteoporosis can pose a special threat to women. Estrogen—a female hormone—protects against bone loss. As a woman nears menopause, her body produces less estrogen. However, bone loss begins to happen long before menopause. Often, by the time symptoms of osteoporosis show, a great deal of bone loss has already occurred. Bone loss can increase if your diet is low in calcium. Calcium slows the rate of bone loss. Exercise every day, even if you walk only a few blocks, and get enough calcium. Talk with your doctor about methods to prevent, diagnose, and treat osteoporosis.

Iron is needed to make new blood cells. If you are not getting enough iron, anemia may occur. Anemia may make you feel tired. If it becomes severe, it can make you feel weak and look pale.

If you are aged 51 years or older, you need only 8 mg of iron per day. Talk with your doctor if you are concerned that you are not getting the recommended amount of iron. One serving of most breakfast cereals with added iron should provide your DRI of iron. Other foods that are good sources of iron include:

• Spinach
• Beans (soybeans, white beans, lentils, kidney beans, chick peas)
• Clams and oysters
• Meats (beef, duck, lamb)
• Organ meats (liver, giblets)

Fat

Fat is a part of a healthy diet. It is needed to carry vitamins through the body and help manage body functions. How much and what type of fat you eat may make a difference.

There are two basic kinds of fat found in food—saturated and unsaturated. Saturated fat is solid at room temperature. An example of saturated fat is butter. Unsaturated fat is liquid at room temperature. Examples of unsaturated fat are olive oil or canola oil. Unsaturated fats are better choices than saturated fats—they do not raise your cholesterol levels as much. You can find how much fat (total fat as well as saturated and unsaturated fat) is in a product by reading its food label.

A different kind of fat—trans fat—also is listed on food labels. Trans fat is made by adding hydrogen to vegetable oils to improve their smell, taste, and shelf life. It often is found in french fries, potato chips, store-bought baked goods, and frozen meals. Trans fat also can increase your cholesterol levels. You can decrease your cholesterol levels by eating foods that are low in saturated fat, trans fat, and cholesterol. Regular exercise also can decrease your cholesterol levels.

You should limit or even remove foods that contain saturated and trans fats from your diet. If you choose to eat foods such as meat, poultry, fried goods, pastries, or milk products, look for products that are lean, low-fat, or non-fat. You also can change the way you prepare foods:

• Broil or bake instead of frying
• Skim fat from soups
• Trim all fat from meats
• Remove skin from poultry
• Cut back on butter, margarine, cream, oil, and mayonnaise made from trans fat

Sodium, or salt, is linked to the risk of high blood pressure. Typically, the more salt you eat, the higher your blood pressure gets. Choose and prepare foods with little salt. At the same time, eat potassium-rich foods, such as orange vegetables. Potassium may help lower your blood pressure. Check the salt content of a product by looking on its food label. Different brands of similar products may contain different amounts of salt. Try to choose the brand that is lower in salt.

Fiber

Fiber is an important part of a healthy diet. Fiber can help reduce the risk of heart disease, help with weight control, and lower the risk of other chronic disease. High-fiber diets also reduce constipation issues. For a diet rich in fiber, choose fiber-rich fruits, vegetables, and whole grains (such as whole wheat pasta or brown rice) often. This may cause more gas at first, but this usually improves over time.

Added Sugars

Food sugars—carbohydrates—are the body's main source of energy. Sugars can be natural or added. Natural sugars are those found in fruit, vegetables, or in milk. Added sugars are added to the food at the table (for instance, sugar in coffee or syrup on pancakes) or during processing at a factory (corn syrup added to soft drinks or baked goods). It is important to choose sugars wisely. Besides energy, many natural sugars, especially those from fruit and vegetables, are good sources of fiber. Added sugars supply calories, but few or no nutrients.

Special Concerns

Weight Control

You need to balance calories from foods with the calories you use for activities. That will keep your weight in control. To lose weight you need to take in less calories from food than you use during the day.

A healthy way to lose weight is to reduce the amount of sugar, fat, and alcohol you eat and drink. You also may want to reduce the portion size of what you eat.

You need to eat the right kinds of food to maintain a healthy weight or to lose weight. You also need to eat the right amount of food at each meal. A serving is a certain amount of food and it may be smaller than you expect:

• A serving of meat is about 3 ounces, the size of the palm of your hand or a deck of cards
• A serving of chopped vegetables or fruit is 1/2 cup or about a rounded handful.
• A serving of peanut butter is 2 tablespoons or about the size of a golf ball.

Diet and Constipation

Older people are more likely than younger people to have constipation. Eating a poor diet or drinking too little fluid can contribute to this problem. Some medicines and misuse of laxatives also may lead to this problem. Signs of constipation include:

• Swelling or bloating of the abdomen
• Straining during bowel movements
• Feeling full even after a bowel movement
• Having hard stool

• Eating more fresh produce, either cooked or raw. (Dried fruits such as apricots, prunes, and figs are high in fiber and help keep bowels regular.)
• Eating more whole-grain cereals and breads
• Eating fewer high-fat meats, dairy products, and eggs
• Cutting back on rich desserts and sweets that are high in sugar

You also may want to add small amounts of bran to your food. Start off slowly because too much bran may cause bloating and gas.

If constipation continues, you may want to use an over-the-counter laxative. The different types of laxatives work in many ways:

• Bulk-forming agents (fiber products) absorb water and expand, thus increasing the moisture in the stool and making it easier to pass (these are the safest and most natural laxatives).
• Stool softeners add liquid content to the stool to soften it.
• Stimulants provide a chemical irritant to the bowel that increases bowel activity, which moves the stool through the intestines.

Alcoholic Beverages

Alcoholic beverages supply calories but few of the basic nutrients. The hazards of heavy alcohol drinking are well known:

• Cirrhosis of the liver
• High blood pressure
• Some cancers
• Injury
• Death

• 12 ounces of regular beer
• 5 ounces of wine
• 1.5 ounces of hard liquor

Too much alcohol makes it harder to fit the good nutrients in your calorie count without gaining weight. You should not drink alcohol if:

• You cannot control how much you drink
• You take medications that interact with alcohol
• A medical condition you have gets worse with alcohol
• You are driving or taking part in an activity that requires attention

Cooking and eating often become harder for people as they age. Some find it hard to shop for food and then cook it. Others find that when they are alone, they eat quickly or rely on prepared foods that may not be healthful. If you live alone or have trouble getting around, you may want to look for ways to share meals with others and get help with making your meals. Ideas that may help you eat well:

• Invite friends, neighbors, or family to join you for meals.
• Dine out with friends and family.
• Attend meal events at your local senior center or place of worship.
• Try new foods by buying prepared foods at markets and health stores.
• Contact your local meals-on-wheels program if you cannot make your own meals or cannot get out to shop.

Planning your meals ahead of time and choosing healthful foods will help improve your diet. It also can save you money. Here are some tips for eating well on a budget:

• Make a list before you go food shopping.
• Try store brands rather than name brands. They often are a good buy. Also look for items that are on sale.
• Buy only what you can use or store.
• Buy foods that are rich in nutrients. Fresh produce, low-fat milk, eggs, dried beans, enriched pasta, oatmeal, whole-grain foods, lean meats, and fish are good choices.
• Select prepared foods with care such as sandwich meat and frozen dinners. Watch for salt content and added sugar.
• Contact your local senior center or meal program if you need help with meals.
• Try restaurants that offer a discount to seniors. Going out for lunch or to the "early bird special" often costs less than eating out at dinner time.
• Save half of your meal to take home. Many restaurants have portion sizes that are very large. Taking food home helps avoids overeating and saves money.

Staying active is one of the best ways to keep healthy as you grow older. Daily physical activity and frequent exercise offer many health benefits. For instance, an active lifestyle can improve your heart health and muscle strength. Being active also can help:

• Strengthen bones and tendons
• Control weight and blood pressure
• Lower the risk of heart disease, stroke, certain types of cancer, and adult-onset diabetes.
• Increase energy
• Promote a sense of well-being and self-esteem
• Reduce feelings of stress and depression
• Improve sleep and bowel function

Be sure to talk to your doctor before you start a fitness program. This is especially true for women with chronic health problems.

Ways to Stay Active

Being active each day can help you keep fit. You can do this by walking, working around the house, or doing yard work. To stay fit you should do a variety of exercises: endurance, strength, balance, and stretching.

Endurance Activities

Exercise: What Works for You? Your doctor or other experts can help you find ways to become more active. Only you can decide what fitness program will work for you. To get started, ask yourself these questions: What are my goals: To build endurance? Increase muscle strength? Lose weight? Sleep better? Feel better? How much time am I active each day? Can I increase the time? How can I become more active throughout the day? What are my physical limitations, if any? Do any health problems limit my activities? What time of day is best for me to exercise? Who would join me in staying active? Would I enjoy a class or group fitness program?

Endurance exercises increase your breathing and heart rate. This improves the health of your heart, lungs, and blood circulation. Better health gives you more energy. These exercises may help delay or prevent diseases such as diabetes. They also may help reduce the need for drug treatment for some diseases.

The best type of endurance exercise for you depends on your general health and fitness. It also depends on what you are able to do physically. Endurance activities include walking, swimming, cycling, tennis, and aerobics. They can be done every day of the week.

Strength Activities

You lose muscle mass as you get older. However, exercise will help you maintain muscle mass. Strength activities, such as lifting light weights, build muscles. You need this strength to do your daily tasks. Strength activities help to slow bone loss. Strength training also can increase your metabolism. This can help control your weight and blood sugar.

Start with one-pound weights and slowly work up to your comfort level. Even adding small amounts of muscle strength can have a big effect. You should do strength exercises at least 2 days per week. It is better not to work the same muscle groups 2 days in a row. You can work your upper body (arms) one day and your lower body (legs) the next day. It is never too late to begin a strength-training program. This is true if you have never exercised or have not done it for years.

Balance Activities

Balance exercises help to prevent falls. Falls are a common problem for older women. They are a major cause of broken hips, loss of independence, and even death. Many of the exercises that build strength also improve balance. Dancing, yoga and tai chi are good activities that improve balance. There may be exercise classes in your community for people in your age group. Talk to your doctor about a program that meets your needs.

Women should do balance exercises before they have a problem to keep the nerves healthy. Some balance exercises can be done anywhere at anytime, such as walking heel-to-toe, standing on one leg, and standing up from a chair without using your arms to push you up.

Stretching Activities

Stretching exercises keep you limber and help prevent joint and back aches. They stretch the muscles and tissues that hold your body's structures in place. These exercises also can help prevent injuries or help you recover from injuries. You should stretch before and after you do an endurance or strength activity. Always be sure to warm up before you stretch.

How Much Exercise Do You Need?

Some women find that walking around the block is all they can manage. Others run long-distance races. Whatever the amount, experts agree that adults should be physically active every day for at least 30 minutes.

If you cannot be active for 30 minutes at a time, spread your activity throughout the day for at least 10 minutes each time. For instance, take a brisk walk for 10 minutes in the morning, and then exercise for 20 minutes later in the day.

When you first start out, you may have trouble keeping up with the least amount of exercise. If you are active 30 minutes each day, challenge yourself to add more time or do more vigorous activities. Boosting your effort will increase the health payback. Let your body be the guide in judging how much you can do.

Getting Started

Counting Calories Staying active and eating a balanced diet go hand in hand. Your body needs energy. Calories measure energy. How many calories do you need per day? This depends on your body size, age, height, weight, activity level, and metabolism. The more you weigh, the more calories you burn. The list below includes light to moderate activities, which might include cleaning the house, weeding the garden, playing golf, or dancing. Keep track of the number of calories you burn: Calories Burned Per 30 Minutes For A 154-Pound Person Grocery shopping 100 Raking leaves 100 Sexual Intercourse 120 Walking (3.5 mph) 140 Dancing 165 Golf (walking and carrying clubs) 165 Gardening 165 Climbing stairs 200 Low-impact aerobics 200

Plan time in your day to exercise. Wear loose clothing and shoes that support your feet. Start slowly if it has been a long time since you exercised or you are not already active. Start with an exercise that you already know—walking. This makes it less likely that you will injure yourself.

Look for fitness activities in your area. Public centers, churches, and schools may offer fitness classes. If you have never exercised, find simple ways to become more active each day:

• Walk or ride a bike instead of using a car
• When you do use a car, park it some distance from where you are going so you do some walking
• Walk up and down stairs rather than taking an elevator
• Rake leaves or do other garden work
• Walk the dog
• Take a walk in the morning or after dinner or walk in the mall

Safety Tips

Warning Signs Call your doctor right away if you have any of these signs of working too hard: Chest pain Any irregular heartbeat Hard time breathing You also want to talk to your doctor about these signs that take place when you exercise: Feeling faint, very tired, or dizzy Too much muscle soreness or pain Sudden, sharp pain Unsettled stomach Vomiting A lot of perspiration (sweating) or no perspiration

These tips will help you safely begin and stay on a fitness program:

• First talk with your doctor. He or she can tell you about risks. Your doctor also may suggest a qualified exercise trainer.
• Start slowly. Doing too much too soon can cause injuries. Increase your program and your level of effort over time.
• Warm up before you exercise. Do some walking and light stretching for 10 minutes. This helps prepare your muscles for more intense activity. Hold your stretch; do not bounce. Bouncing can tear muscle tissue.
• Cool down after you exercise. Do light stretching or walking for 5–10 minutes.
• Use safety gear. Wear a helmet when riding a bike.
• Wear proper shoes. Some fitness shoes are designed for certain uses such as running, walking, or aerobics. Wearing the wrong kind of shoes can lead to injury or pain in your knees, ankles, or hips.
• Unless your doctor has advised you to limit fluids, drink fluids when doing activities even if you do not feel thirsty. As you get older, your body may become less likely to relay the urge to drink. If you wait until you are thirsty you may already be dehydrated.
• Do not hold your breath. Breathe out when you exert your muscles—when you lift a weight. Breath in when you relax your muscles—when you release the weight.
• Exercise should not cause pain. Talk with your doctor about how much to push yourself.
• When you bend forward, bend using your hips and knees, not from the waist. Keep your back straight when you bend.
• Do not work too hard. It is normal to feel a little sore or to become slightly tired. If you feel pain, stop what you are doing.
• Do not do intense exercise outside during hot, humid weather or in extreme cold.
• Wait at least 2 hours after eating before a moderate or heavy workout.
• Do not take a hot shower or use a sauna or hot tub just after exercise.

Keeping track of your progress is one way to keep your fitness program on course. Tips to stay on track include:

• Choosing activities that you enjoy
• Setting goals and rewarding yourself when you reach them
• Trying new activities
• Varying your routine
• Finding a friend to work out with you
• Signing up for a fitness program at your local senior or community center.

It is common for women older than 65 years to have concerns about their mental health. As they age, women go through life changes that can affect their mental health. A social network of friends, family, and activities is good for your mental well-being. You also are better able to handle challenges when you are in good mental health.

Some life changes may lead to depression. Depression is a medical disorder, like diabetes, high blood pressure, or heart disease. It is more than being in a "down" mood and more than being sad. It can be long lasting or short and often follows a major life event, such as:

• Retirement
• The deaths of spouse and friends
• Chronic illness
• Being alone
• Concerns about finances
• Moving

Symptoms of Depression People who are depressed have several symptoms of the illness nearly every day, all day, for at least 2 weeks. Place a check beside the lines you would answer "yes": Lack interest in things you used to enjoy Feel sad, blue, or "down in the dumps" or cry often Move in slow motion or act restlessly and not able to sit still Feel worthless or very guilty nearly every day Have a change in appetite or lose or gain weight without dieting Have thoughts of death or suicide or try to commit suicide Have problems concentrating, thinking, remembering, or making decisions Sleep too much or are not able to fall asleep or to stay asleep Lack energy and feel tired all the time If you have had at least five of these symptoms (including at least one of the first two), you may be depressed. If you are troubled by any of these symptoms, talk to your doctor.

Sometimes feelings of sadness do not last a long time and do not require treatment. For others, a low dose of a medicine for a certain period of time may work best.

Women with severe depression may appear tired, sad, or not interested in life. They often speak slowly and do not concentrate well. In these cases, treatment may be medication or counseling or both. Ask your doctor to refer you to a psychologist, psychiatrist, or social worker.

It is even harder to deal with sadness when you have other health problems. Talk about it with your doctor. See your doctor for a complete physical exam to find out if there is any physical reason for your depression.

Antidepressants help many women. Counseling works for others. Activities such as joining a patient support group, exercising regularly, and eating well balanced meals also may help to improve your mood. Let your family and friends know what is happening in your life and what you are doing to solve your problems. They can support you. Writing down your thoughts and feelings daily (keeping a journal) may be helpful if you do not easily confide in friends or family.

Abuse

Older women are sometimes the victims of abuse and domestic violence. The abuse may be mental, physical, sexual, or financial. Neglect also may take place. The abuser can be anyone, but often it is a spouse, caretaker, son or daughter, or other family member. Think about these questions:

• Has anyone at home ever hurt you?
• Has anyone taken anything of yours without asking?
• Are you afraid of anyone at home?

Sexuality

Having sex is a healthy and natural event throughout a woman's life. Although the number of times or ability to perform sexually declines slightly as a women ages, many older women remain interested in sex and intimacy.

Hormone Therapy During and after menopause the body produces less of the female hormones, estrogen and progesterone. This decrease in hormone levels can cause symptoms that may be upsetting or bothersome to some women. Hormone therapy (HT) can help reduce some of these symptoms by: Reducing hot flashes (a sudden feeling of warmth with a flush and often followed by sweating). Treating vaginal dryness and the resulting pain during intercourse Improving sleep Slowing bone loss The term hormone therapy or HT refers to treating these and other symptoms with estrogen alone or a combined estrogen and progesterone therapy. Women can experience side effects during HT. These may be minor, such as headaches, nausea, or breast pain. They also may be more serious, such as the risk of vein clots in the leg, breast cancer, uterine cancer, and heart disease. In spite of the risk, HT still has a role in treating these symptoms for many women. Review your symptoms with your doctor. Find out what course of therapy may work best for you.

Changes brought about by aging or illness can affect the sexual response in men and women. Most older women feel some decrease in sexual function and pleasure. For instance, your sexuality may be affected by your health, your partner's health, or medications you or your partner take. Some women may not be interested in sex at all.

Many problems regarding a decline in sexuality can be treated. For instance, lubricants or hormone therapy in the form of cream or lotion may help women with vaginal dryness. Medications can help men with impotence.

Some women enjoy sex more at this stage of life than they did when they were younger. Older couples may be more experienced and know how to please each other. You may have more privacy and time than you did when you were working or raising children. You may enjoy sex more at this time of your life because there is no risk of pregnancy.

The sexual performance of older women often is related to the ability of their partner. Your success depends on the health and vigor of the man as much as it does on your own health and vigor. A woman aged 65 years or older may have an interest in sex, but she may lack a partner or her partner may not be able to have sex. Because women outlive men, their choices for a partner are limited as they age. Masturbation (self-pleasure) or trying new ways of lovemaking can be good choices as people age.

Sometimes it may be a medication that interferes with your normal sexual function, arousal, and orgasm. Talk with your doctor to see if you can adjust medications to solve the problem.

For some, it may be hard to find a place that is private. Many older people live in a care facility or with family members. Ask your family or caregivers for some private time.

Keep in mind the need for safe sex does not stop. You still need to prevent sexually transmitted diseases. Use a latex condom when you have sex with a new partner and find out about your partner's sexual history.

Staying Safe

Many older women are concerned about their safety. Falls and injuries are a serious health risk for women ages 65 and older. Ask yourself these questions:

• Is my home safe from falls?
• Do I use non-skid mats in bathtubs and showers?
• Do I have handrails in bathrooms and on stairs?
• Are the rooms well lit?
• Do I have non-skid backings on throw rugs?
• Is there clutter on the stairs or on the floor?
• Are there electrical wires, extension cords, or other items that I may trip over?
• Do I need a walker, a walking stick, or a cane to help my balance?
• Am I wearing rubber-soled, low-heel shoes that support my feet and do not slip?
• Am I continuing my regular exercise program for strength, balance, and muscle tone?

The changes that aging brings are a natural part of life. Take note of the changes in your body. Talk with your doctor about them. Have routine screening tests. You are your own best resource in finding and treating problems early.

Your lifestyle plays a large part in keeping you healthy and active. Take care of yourself—mind and body—to stay healthy and active for a long time to come.

Glossary Anemia: Very low levels of blood or red blood cells in the bloodstream, often caused by lack of iron. Calories: Units of heat used to express the fuel or energy value of food. Cholesterol: A fat-like substance found in animal fats and oils. Cirrhosis: A disease caused by loss of liver cells, which are replaced by scar tissue. Constipation: Infrequent bowel movements with stools that are firm or hard to pass. Dehydration: Loss of an excessive amount of water from the body or from an organ or body part. Depression: A treatable medical disorder characterized by loss of interest in things previously enjoyed and feeling sad for periods of at least 2 weeks. Diabetes: A condition in which the levels of sugar in the blood are too high. Estrogen: A female hormone produced in the ovaries that stimulates the growth of the lining of the uterus. Hemorrhoids: Enlarged veins which cause swelling and tenderness of the tissue inside and outside the rectum. Hormone Therapy: Treatment in which estrogen, and often progesterone, is taken to relieve the symptoms caused by the low levels of hormones produced by the body. Impotence: The inability in a male to achieve an erection or to sustain it until ejaculation or until intercourse takes place. Influenza: Also called "the flu." An acute infectious respiratory disease. Symptoms include headache, fever, chills, and a cough. Kidneys: Two organs that cleanse the blood, removing liquid wastes. Lactose Intolerant: Being unable to digest dairy products. Laxatives: Products that are used to empty the bowels. Liver: An organ that cleanses the body of waste. It breaks down and filters out any harmful substances that you consume. The liver also makes bile, which helps you to digest food. Masturbation: Self-stimulation of the genitals, usually resulting in orgasm. Menopause: The process in a woman's life when ovaries stop functioning and menstruation stops. Metabolism: The physical and chemical processes that allow your body to use the energy from the food. Nutrients: Nourishing substances supplied through food, such as a vitamin or mineral. Osteoporosis: A condition in which the bones become so fragile that they break more easily. Progesterone: A female hormone that is produced in the ovaries and prepares the lining of the uterus for pregnancy. Sexually Transmitted Diseases: Diseases that are spread by sexual contact, including chlamydia, gonorrhea, genital warts, herpes, syphilis, and human immunodeficiency virus (HIV, the cause of acquired immunodeficiency syndrome [AIDS]). Stroke: A sudden interruption of blood flow to all or part of the brain, caused by blockage or bursting of a blood vessel in the brain and often resulting in loss of consciousness and temporary or permanent paralysis.

This Patient Education Booklet was developed by the American College of Obstetricians and Gynecologists. Designed as an aid to patients, it sets forth current information and opinions on subjects related to women's health. The average readability level of the series, based on the Fry formula, is grade 6–8. The Suitability Assessment of Materials (SAM) instrument rates the booklets as "superior." To ensure the information is current and accurate, the booklets are reviewed every 18 months. The information in this booklet does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice may be appropriate.

Copyright © October 2007 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

ISSN 1074-8601

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