Stay healthy—you'll live longer
This section is about taking charge of your own health. It doesn't stress diseases and their cures, but rather prevention — what you can do to minimize your risk of getting sick.
Most diseases associated with old age are the result of many years of poor health habits. Good health habits can help us avoid or reduce the severity of numerous physical and mental diseases, ranging from cancer and heart disease to psychological depression. And it's never too late to start "being healthy."
Many of us know older people who seem young, and younger people who seem old. There are many reasons for this, of course, but how you take care of yourself physically and emotionally can substantially increase or decrease your "health age."
If you haven't been taking care of yourself, you can still change some of your ways and get back some of those lost years. Yes, in a sense, you can "grow younger" — not in chronological years, of course, but in your health age.
Aging and health
Aging is not a disease. If it were, all old people would be sick and that is certainly not the case. People age at different rates, though they may be the same chronological age.
Here are some facts:
- The effects of aging and disease are often confused. People die of disease, not of old age. Some experts believe that, if it were not for disease, we would probably live to be about 120.
- Mental sharpness does not necessarily decline with age.
- There is a long-term, ever-so-gradual decline in sex drive. However, many people can and do continue sexual relations into their eighties and beyond.
- Most older persons are satisfied with their lives and have no health-imposed limitations on their physical activity. About 6 out of 10 who are over age 65 enjoy full physical functioning.
Knowing about the aging process, about normal body changes, and about how to control conditions that might arise can help all of us take the steps necessary to maintain health in retirement.
Normal body changes
As we age, certain changes usually take place — very gradually — in our body, and at different rates for different people.
- Body weight (other than fat) usually decreases by about 10% over the years.
- Metabolism generally slows, so that we need about 20% fewer calories.
- Muscle tone will decrease unless we exercise regularly.
- Bones generally lose calcium content, which can cause brittle bone disease—osteoporosis. This may be offset at least in part by regular exercise, increased calcium intake, and prescription drugs.
- Ligaments of joints tend to get shorter and harder. However, this may be retarded or prevented through regular physical activity.
Many persons over age 70 begin to notice a gradual decline in sensory perception. Vision, hearing, taste and smell are all affected to one degree or another. Many people see these changes as "normal for old age" and do not seek the medical treatment that could greatly improve their lives.
- Vision may change in our 40s and 50s, necessitating bifocals. Regular checkups can detect these changes, as well as signs of cataracts and eye disease as we age.
- Hearing may decrease in later years, but this can often be offset with proper hearing aids. A hearing examination should be a regular part of health checkups.
- Taste and smell become less acute in some older people. When detected, a decline in taste and smell can be partially compensated for through awareness and enhancement of foods with spices, herbs and flavorings.
- Touch is the one sensory factor that does not change with age.
If you have gotten the impression that we can maintain good health as we age, you are correct. The problems that most of us associate with aging are generally problems of health. The secret to staying young, then, is to stay healthy.
There is no fountain of youth, but there is a lot you can do to stay young for your age. Most of us know pretty much what to do to stay healthy, but somehow we don't get around to doing it. It's the motivation that we lack.
So, consider some tips for improving your health:
1. Regular meals and proper nutrition
2. Weight in proportion to height and build
3. Sufficient physical activity
4. No smoking
5. Moderate or no alcohol usage
We are what we eat
Poor eating habits are linked to many diseases, and are a major cause of obesity. Eating healthy foods on a regular schedule is very important for mature adults. Several small meals a day rather than three large meals is an eating option that some older adults prefer.
A good diet does not have to be expensive. Vegetables, fruits, cereals and breads can make up the major part. You can save money by relying less on meat as a source of protein and more on other protein sources — such as poultry, fish, milk proteins (such as cheese), beans, peas and lentils. Snack foods (potato chips, etc.), sweets and desserts are expensive and typically have little or no nutritional value.
A good balanced diet each day consists of:
- 2 to 3 servings of protein such as lean meat or poultry, fish, beans, eggs or nuts
- 2 to 3 servings of dairy products such as (low-fat) milk, cheese or yogurt
- 3 to 5 servings of vegetables
- 2 to 4 servings of fruit
- 6 to 11 servings of bread, cereals, rice or pasta
Remember, you will be healthier if you eat:
- only sufficient calories to meet body needs and maintain desirable weight
- less saturated fat and cholesterol
- less salt and sugar
- more complex carbohydrates, such as whole grains, fruits, vegetables
- less red meat
- more fiber, as found in bran cereals and the rind of citrus fruits
Maintaining proper weight can improve appearance and add years to your life. Also, it will improve the quality of your life because you will be less likely to develop heart disease, diabetes and other illnesses that can rob you of energy and mobility.
The typical American is overweight, mostly because of too little exercise and too many calories from fattening meats, excessive starches, alcohol and sweets. Remember, mature adults need about 20% fewer calories than they did at 35. If you've been trying to lose weight without much success, keep in mind that slow change is lasting change. Make it your goal to develop new habits and drop old ones — and be patient with yourself. Fad diets and quick weight loss are hard on the body and don't really change your basic eating patterns.
- Superintendent of Documents
U.S. Government Printing Office
Washington, D.C. 20402
Making Healthy Food Choices
Suggestions for seniors on how to improve diet and health by following official dietary guidelines; includes several health-conscious recipes. Order # S/N 001-000-04662-4 ($2.75)
- American Heart Association
Recipes for Low Fat, Low Cholesterol Meals
Thirty-four pages of recipes based on fat-controlled, low cholesterol meal plans recommended as an aid to reduce an individual's risk of heart attack. (free)
Outlines food selection and preparation of food for a fat-controlled diet. (free)
- National Institutes of Health (NIH)
NIH offers a wide variety of consumer information on healthy living. For starters, visit the website for the National Heart, Lung and Blood Institute (http://www.nhlbi.nih.gov/) especially the article "Aim for a Healthy Weight."
Exercise plays an important part in slowing down the aging process and improving health. Lack of exercise can lead to reduced muscle strength (including the heart muscles) and can contribute to bone loss.
Older adults who exercise regularly (about 30-45 minutes of moderate exercise, 4 to 5 times a week) feel better, have more energy and can reduce the risk of developing certain diseases. Exercise also helps relieve stress, contributes to relaxation and improves sleeping patterns.
There are basically three kinds of exercise. Aerobic exercise can keep hearts and lungs in good working shape. Walking, swimming bicycling, vigorous sports, and dance workouts are all aerobic exercises. Exercises that strengthen and stretch muscles are also beneficial. Strengthening exercises consist of repeated contractions, such as leg lifts and sit-ups. Yoga is an excellent example of an enjoyable stretching exercise. Try to alternate vigorous aerobic exercise with the other kinds.
- See your doctor before starting an exercise program if you have not been physically active or have health concerns.
- Find a form of aerobic exercise you enjoy
- Do strengthening and stretching routines that are comfortable for you.
- Start any exercise program SLOWLY. You're in this for the long run, so build up little by little.
- If you miss a week or two of exercise, don't be discouraged, but start again slowly.
- Don't exercise when you are ill or feel faint and dizzy. (Make sure your doctor knows about all symptoms you experience.)
- Drink fluids before and after exercising, but remember to exercise at least one hour before or after eating a meal.
Other Preventive Measures
Smoking is a dangerous habit. Smoking residues enter the blood and tissues from the lungs and can not only cause lung problems but also play a role in heart problems, in diabetes, in osteoporosis, and in high blood pressure. Smoking also depletes the body of nutrients and accelerates the aging process of the skin and tissues. If you smoke, try to find a program or support group to help you stop. Why take deadly risks?
Avoid Alcohol and Drug Abuse
For good health, use alcohol moderately, if at all. Recognize that some people simply cannot drink, because of a tendency to addiction. Unfortunately, some older adults turn to alcohol to help them cope with change, loneliness, or loss. But drinking only hurts, not helps. If you, a family member, or a friend seems to be drinking too much, find a local program such as Alcoholics Anonymous and stop the destructive cycle.
Another way some older adults, especially women, cope with change and grief is to depend on drugs prescribed by doctors for relief of anxiety and stress. Be careful about taking tranquilizers. Try to relieve your stress in more healthy ways, and try to find help to solve or cope with the problems in your life. Community mental health programs can help you depend less on pills and more on positive human resources.
Both pleasant and unpleasant situations can be stressful — for example, getting married, changing your job or retiring from work produces stress. But prolonged stress can be a serious troublemaker. It may lead to chronic high blood pressure, ulcers and many other illnesses.
What can be done to handle stress in a positive way? Here are some suggestions:
- Understand the source of the stress.
- Decide on a constructive action and take it.
- Be realistic about how much you can accomplish in a given period of time.
- If it is obvious that a situation cannot be changed, learn to accept it.
- When tension builds, exercise is a great tranquilizer.
- Strike a good balance between work and recreation.
- Help someone else who has a problem. Often this can get your mind off your own troubles.
Guidelines for visiting your doctor
Good communication between you and your doctor is very important for maintaining good health or treating any existing health problems.
Before Your Next Doctor Visit:
- If you are not satisfied with your present doctor, get recommendations from friends, from local consumer groups and from the local Medical Society.
- If you are on Medicare, find out if your doctor takes "assignment," that is, Medicare-approved rates.
- Make sure you know your own and your family's medical history before you see the doctor.
- Keep a health log. Note when a problem starts and exactly how you are affected.
At the Doctor's:
- Accurately describe your symptoms to the doctor.
- Inform the doctor about any and all medications (prescription and over-the-counter) you are taking or have used recently.
- Ask the doctor to explain in simple terms your condition and its treatment.
- Ask the doctor to explain any tests he or she recommends and the reasons for them.
- Find out the names of the drugs you have to take and ask about side effects (are there alternative treatments?).
After Your Visit:
- Keep copies of all bills and papers for your records and for health insurance.
- Learn more about your problem, and any drugs used in treatment.
- Get a second opinion if you have a health problem that may require a course of treatment. This could prevent unneeded tests or surgery.
- Make sure clear instructions are on the medicine label.
- Tell your doctor about any side effects and/or body changes from the medication he or she prescribes.
Nearly all retirees are eligible for Medicare coverage at age 65. To enroll, contact your local Social Security office three or four months before your 65th birthday. You are entitled to Medicare coverage even if you continue to work after 65.
Medicare is a program of the Federal government and comes in two parts. Part A Hospital Insurance is yours if you are automatically eligible for Medicare (through your own employment or the employment of a spouse). There is no additional cost. If you are not eligible, you can enroll by paying a premium each month.
Part A covers such expenses as hospital care; post-hospital care — in either a skilled nursing home or in your own home, with services provided by skilled health professionals; hospice care; and care in a psychiatric hospital.
Part B Medical Insurance is optional, but it's such a good buy that 98% of retirees participate (the cost is subsidized by the government). It requires payment of a monthly premium: $88.50 in 2006. If you do not want Part B, you must tell the Social Security office when you apply for Medicare. Otherwise, you will automatically be enrolled in Part B. Premiums will automatically be deducted from your Social Security check each month.
Part B covers such expenses as doctor's fees, outpatient hospital care, outpatient physical and speech therapy, approved part-time skilled home-health care, and certain lab, ambulance and supply costs. The upcoming table will give you a detailed idea of exactly what costs Medicare covers for both Parts A and B. In most cases, you will have to pay an initial amount, the deductible, before Medicare picks up allowed costs. Also, in many cases you must pay a portion of these costs in the form of a co-pay.
Medicare pays less than half of the total health costs incurred by older adults. This is partly because of the deductibles and the portion of allowed costs the patient must bear (for example, patients always pay 20% of the allowed cost for doctor visits and there are significant daily co-pays for hospitalization beyond 90 days). Also, some older adults see health professionals who charge more than the "approved amount" standards set by Medicare. In these cases, the additional amount must be made up by the patient.
Take into consideration that Medicare does not cover certain services and supplies needed by many older adults. These include eye exams and eyeglasses; dental care and dentures; foot care; hearing exams and hearing aids; private duty nursing; and in-hospital personal services. The cost of long-term custodial nursing home care and unskilled home care also are not covered.
Table 1: Medicare Coverage (2006)
- "Reasonable charges" — approved amounts — are the maximum costs Medicare allows for physicians' services. If your doctor charges more, you pay the extra amount in addition to your standard 20% co-payment. (The law limits the amount doctors can charge to 15% above Medicare's approved amounts).
- Doctors who "take assignment" will charge the approved Medicare amount. Be sure to check ahead of time. Local Social Security offices will have the list of area doctors who accept assignment.
- Medicare covers home care only when a doctor recommends skilled health care services.
- Most nursing home care is not covered by Medicare.
- Current copies of the handbook, Medicare & You, are available from local Social Security offices, and can help you keep up-to-date about details about coverage and changes in the system.
- Medicare's Prospective Payment System has established standard hospital payments for specific categories of illness (known as "Diagnosis Related Groups" or DRGs). To prevent unfair treatment under the system (denying admission, discharging patients too early), Peer Review Organizations (PROs) have been set-up to review individual cases. For information on local PROs, call 1-800-Medicare or visit the Medicare website (http://www.medicare.gov/).
Medicare managed care plans
Medicare beneficiaries may opt to enroll in a Health Maintenance Organization (HMO), or similar managed care plan, instead of the traditional "fee-for-service" Medicare plan if one is available in their area. HMOs are private health plans that cover all services for a fixed, monthly fee. Patients are limited to the doctors and hospitals in the HMO network and, generally, require approval before seeing a specialist. Some HMOs offer more benefits than the traditional Medicare plan and at lower costs. However, some HMOs have been reducing their benefits and others have withdrawn coverage completely in certain geographical areas.
The availability, costs and coverage of Medicare managed care plans (known as Medicare Advantage plans) will vary depending on where you live. You can get detailed information on the plans available in your area by calling 1-800-Medicare (1-800-633-4227), or by visiting the Medicare website at www.medicare.gov.
If you are a member of a group plan at work, check with your personnel office to see if your health plan provides for continued coverage upon retirement. Many public employers continue coverage for early retirees—those retiring before age 65. Many also cover post-65 retirees, when most of these plans serve as supplements to Medicare. If your employer offers a health insurance plan, find out if it will cover deductibles, co-payments, and services not covered by Medicare. Will your employer pay all or part of the cost of the insurance premiums?
If, at retirement, you cannot continue with your group health plan, you may want to consider purchasing Medigap insurance. These plans are specifically designed to fill in the "gaps" of traditional Medicare deductibles and co-payments. These policies sometimes offer services not covered by Medicare as well. They typically do not cover eye, dental, or foot care, or nursing home custodial care.
In most states, there are 12 standard Medigap plans offering different levels of supplemental coverage. The premiums for a particular Medigap plan can vary from one company to another and from state to state. Check carefully and make sure you understand all provisions before you buy any supplemental insurance. For more information about Medigap policies, call 1-800-Medicare (1-800-633-4227).
In most cases, if you participate in an employer-sponsored group plan, you won't need additional coverage. Even if you must pay the premium yourself, a group plan will give you more for your money than an individual Medigap policy. So, stick with your employer if you can.
If Your Spouse Has Coverage...
If your spouse is also covered under an employer's retirement health care plan, and you decide to opt for your spouse's coverage rather than your own, be certain that you will continue to be insured under that group plan if your spouse should die before you. If such coverage would be terminated or reduced in that event, you may be better off taking single coverage under your own employer's plan when you retire; your spouse can remain under his/her employer's plan, or go under yours if that's an option.
Long-term care (LTC) insurance
Traditional Medicare, Medicare HMOs and Medigap insurance plans do not cover the cost of non-medical at-home care or the full cost of long-term care in a nursing home. If you have substantial assets that might have to be liquidated to pay the high cost of nursing home care, you may want to consider a private LTC insurance plan. Check the details of each plan carefully, make sure benefits increase with inflation, and avoid plans that raise the premiums as you get older. For more information, contact your state insurance office or your local Area Agency on Aging.
Prescription drug coverage
Medicare-eligible retirees who do not have drug benefits paid by an employer/union or pension fund health plan can now get limited coverage through Medicare (based on a law enacted in 2003). Known as Medicare Part D, the coverage is purchased through private insurance companies rather than Medicare itself, with as many as 50 plans competing for business in each part of the country. Premiums vary widely, but average around $25 a month. Deductibles and co-pays vary as well.
Nearly all plans have large gaps in coverage, known as the "doughnut hole." For annual drug costs between $2,250 and $5,100, the participant pays 100% of drug costs while continuing to pay monthly premiums to the plan. Once out of the "hole," the plan pays most drug costs for the remainder of the year.
Choosing a plan can be confusing — not only because costs must be compared, but also because drug lists differ from plan to plan and some lists are very limited. If you take multiple medications, you'll need to find a plan that covers them all. If this is impossible, talk to the doctor about switching some drugs to generics or alternate brands.
To compare plans — including both stand-alone Part D plans and Medicare Advantage managed care plans that incorporate Part D benefits — go to the web site, www.Medicare.gov , and locate the drug-plan finder tool. For information and counseling, call the Medicare Hotline (1-800-MEDICARE).
CAUTION: Retirees who don't sign up for a Part D plan during their initial eligibility period will end up paying a premium penalty if they join in the future: 1 percent for each month they delay. The penalty is waived, however, for retirees with drug benefits paid by employer/union or pension fund health plans. These retirees will get a notice of "creditable coverage" from their plan sponsor that says they're exempt from potential penalties because their benefits are at least as good as Part D. Call your plan sponsor if you do not get a notice or if you have any questions about your status.