Healthy Aging: The Complete Guide

Key numbers at a glance

What healthy aging really means

Aging is not a disease, and many of the problems people expect to come with it are not inevitable. Muscles can still get stronger in your eighties. Balance can be trained. Hearing loss, incontinence, low mood and loneliness are common in later life but are not normal parts of it, and most can be helped. The aim of healthy aging is not to look younger; it is to keep doing the things that matter to you, in the place you want to live, for as long as possible.

What changes with age is reserve. A younger body can absorb a week in bed with flu, a new medicine, or a missed meal or two with little lasting effect. An older body has less spare capacity, so the same setback can lead to a fall, a spell of confusion or a loss of strength that is hard to win back. Much of the advice in this guide is about building that reserve back up and protecting it, so that illness or injury is a bump in the road rather than a turning point.

People also age very differently. Two people of 75 can be worlds apart in fitness, health and independence, and much of that difference comes from things that can still be changed: activity, nutrition, social connection, sleep, how well long-term conditions are managed, and whether medicines are reviewed. It is never too late to start, and the people who begin from the lowest point often gain the most.

Strength, balance and staying active

Muscle mass and strength decline gradually from midlife, and muscle power, the ability to produce force quickly, declines faster still. Power is what gets you out of a low chair, up a step and, crucially, what lets you catch yourself when you trip. Inactivity speeds the loss, and a short illness with bed rest can take away weeks of strength. The good news is that muscle responds to training at any age, including in people who are already frail.

The Physical Activity Guidelines for Americans recommend that older adults aim for at least 150 minutes a week of moderate aerobic activity, such as brisk walking, plus muscle-strengthening activity on at least 2 days a week that works all the major muscle groups. For older adults they specifically recommend multicomponent activity that combines aerobic work, strength and balance training. If health conditions mean you cannot reach these amounts, the guidelines are clear that some activity is better than none, and that you should be as active as your abilities allow.

Walking is excellent for the heart and mood but does not on its own maintain leg strength or train balance. Add exercises such as standing up from a chair without using your hands, step-ups, heel raises, and wall push-ups, and use resistance bands or weight machines, which are easy to learn safely. Balance work can be as simple as standing on one leg near a kitchen counter, walking heel to toe, or taking a tai chi class. Short sessions spread through the day all count. Many communities offer evidence-based falls-prevention and strength classes for older adults through senior centers, YMCAs and Area Agencies on Aging, and some Medicare Advantage plans include fitness benefits. Exercising with others adds social contact and makes it easier to keep going.

• Start low and build up gradually; consistency matters more than intensity
• Hold onto something stable for balance exercises until you are confident
• Ask your doctor about physical therapy if pain, a joint problem or a recent fall holds you back
• Check with your doctor before starting vigorous exercise if you have heart disease, chest pain or dizziness

Preventing falls

According to the CDC, about one in four US adults aged 65 and older falls each year, and falls are the leading cause of injury and injury-related death in this age group. A fall can lead to a broken hip, a head injury, or a loss of confidence that makes someone move less, which in turn makes another fall more likely. Many people do not tell their doctor about a fall, often because they worry about losing independence. In fact, a fall is a signal to find and fix the cause, and that usually protects independence.

Falls rarely have a single cause. Common contributors include weak legs and poor balance, medicines that cause drowsiness or dizziness, a drop in blood pressure on standing, poor vision, foot problems or unsuitable footwear, needing to rush to the bathroom at night, and hazards at home. The US Preventive Services Task Force recommends exercise for adults 65 and older who are at increased risk of falls, because it is the intervention with the strongest evidence.

Your doctor can assess your risk with a few questions and simple tests of strength, gait and balance, and the CDC's STEADI approach helps clinicians do this. At home, the most useful changes are grab bars in the bathroom, railings on both sides of stairs, good lighting including night lights on the way to the bathroom, and removing loose rugs and trailing cords. An occupational therapist can assess your home and suggest changes tailored to you, and Medicare covers this when it is medically necessary.

• Tell your doctor about any fall, even one without injury
• Have your vision checked and update glasses; take care with bifocals on stairs
• Wear well-fitting shoes with thin, firm soles indoors and out
• Get up slowly from lying or sitting, especially at night

Eating well as appetite and needs change

In later life, the bigger risk for many people is eating too little rather than too much. Appetite often falls, taste and smell dull, and dental problems, dry mouth, medicines, low mood, living alone and the effort of shopping and cooking all get in the way. Undernutrition is common, easy to miss under loose clothing, and contributes to frailty, falls, poor wound healing and slow recovery from illness. Unintended weight loss always needs a checkup.

Protein becomes more important as muscle is harder to maintain. Rather than eating most of it at dinner, aim to include a source of protein at every meal: eggs, milk, yogurt, cheese, fish, poultry, meat, beans, lentils, tofu or nut butters. If you need to gain weight or your appetite is small, small frequent meals and adding nutrition to foods you already eat, such as milk in soups or cheese on vegetables, work better than large plates. Your doctor or a registered dietitian can advise how much protein suits you, especially if you have kidney disease.

A few nutrients need particular attention. The recommended intake of vitamin D is 600 IU (15 mcg) a day for adults 51 to 70 and 800 IU (20 mcg) a day over 70, and calcium needs also rise in later life; both support bone health. Absorption of vitamin B12 from food can fall with age, partly because of lower stomach acid and some common medicines, so adults over 50 are advised to get some B12 from fortified foods or supplements. Thirst also weakens with age, so drink regularly through the day rather than waiting to feel thirsty.

The broad pattern recommended by the Dietary Guidelines for Americans still applies: vegetables, fruit, whole grains, a variety of protein foods and low-fat dairy, with less sodium, added sugar and saturated fat. Avoid starting a restrictive diet in later life without advice from your doctor or a dietitian. If you drink alcohol, less is better for health, and older adults are more sensitive to its effects and more likely to take medicines that interact with it.

Medicines: getting the benefits without the harms

Many older adults take several long-term medicines, each prescribed for a good reason, often by different clinicians. Taking several medicines at once is sometimes called polypharmacy. The more you take, the higher the chance of interactions and side effects, and older bodies process many drugs more slowly. Common results include dizziness, falls, confusion, constipation and drowsiness, which can easily be put down to age when they are in fact caused by a medicine and are reversible.

Some medicines deserve extra caution in later life. Sleep aids and sedatives, some antihistamines including those in many over-the-counter sleep and allergy products, some blood pressure medicines, and some medicines for bladder problems or mood are all linked to falls or confusion. Never stop a prescribed medicine on your own, though: some, such as steroids, beta blockers and seizure medicines, must be reduced gradually. Stopping medicines you no longer need, planned with your doctor, is called deprescribing and can be one of the most useful things a review achieves.

Ask your doctor or pharmacist for a full medication review at least once a year, and whenever a new medicine is added. Bring everything you take, including over-the-counter products, vitamins and herbal supplements, in a bag or as a written list. If you have Medicare Part D and take several medicines for chronic conditions, you may qualify for a free comprehensive medication review through a Medication Therapy Management program.

• Keep one up-to-date list of every medicine and supplement you take, with doses
• Use one pharmacy so interactions are more likely to be caught
• Ask what each medicine is for, how long you need it and what to watch for
• Use a pill organizer or blister packs if keeping track is difficult

Vaccines, screening and the Annual Wellness Visit

Infections such as flu, pneumonia, COVID-19, RSV and shingles carry much higher risks with age, and vaccines are among the simplest ways to reduce them. The CDC adult schedule recommends a flu vaccine every year, with higher-dose, adjuvanted or recombinant versions preferred at 65 and older; pneumococcal vaccination for adults 50 and older; two doses of the shingles vaccine for adults 50 and older; a single dose of RSV vaccine for adults 75 and older and for some younger adults at increased risk; and a tetanus and diphtheria booster (Td or Tdap) every 10 years. COVID-19 recommendations are updated each season, so ask what applies to you. Most of these are available at pharmacies and covered by Medicare.

Screening finds some conditions before they cause symptoms, when they are easier to treat. The US Preventive Services Task Force recommends, among others, colorectal cancer screening from 45 to 75, mammograms every 2 years for women 40 to 74, osteoporosis screening for women 65 and older, a one-time ultrasound for abdominal aortic aneurysm in men 65 to 75 who have ever smoked, and a yearly low-dose CT scan for lung cancer for adults 50 to 80 with a significant smoking history who smoke now or quit within the past 15 years. Blood pressure checks continue throughout adult life. Your doctor may also suggest checks of blood sugar and cholesterol based on your risk factors, and anyone with diabetes needs regular eye, foot and kidney checks.

Screening is not always a case of more is better. Beyond certain ages, or for people with serious health problems, the burdens of some tests can outweigh the benefits; cervical screening, for example, usually stops after 65 for women with a history of normal results. These decisions are best made with your doctor, based on your health and preferences rather than age alone.

The Medicare Annual Wellness Visit

If you have Medicare Part B, you can have a Welcome to Medicare preventive visit within your first 12 months, and then a yearly Annual Wellness Visit with no cost to you when your provider accepts assignment. This is not a full physical exam. It is a planning visit: your provider reviews your health history and medicines, checks height, weight and blood pressure, looks for signs of memory problems, asks about falls and mood, and draws up a personalized prevention plan, including a schedule for screening and vaccines. You can also discuss advance care planning. Tests or treatment for new problems raised during the visit may be billed separately.

Memory, thinking and brain health

Some changes in thinking are a normal part of aging: taking a bit longer to learn new things, occasionally forgetting a name and remembering it later, or misplacing your glasses now and then. Dementia is different. It is not a normal part of aging, and its signs include memory loss that disrupts daily life, getting lost in familiar places, repeating the same questions, difficulty managing money or following a recipe, and changes in mood, personality or judgment. Alzheimer's disease is the most common cause, but there are others.

Not every memory problem is dementia. Depression, thyroid problems, vitamin B12 deficiency, sleep problems, hearing loss, infections and medicine side effects can all affect thinking, and many are treatable. That is one reason to see your doctor rather than worry in silence. A sudden change in thinking over hours or days, called delirium, is different again: it usually points to an acute illness such as an infection, dehydration or a medicine problem and needs prompt medical care.

The habits that protect the heart also protect the brain. Keeping blood pressure, blood sugar and cholesterol under control, staying physically active, not smoking, limiting alcohol, staying socially connected, sleeping well and treating hearing loss are all linked to better brain health in later life. Learning new skills and staying mentally engaged may also help. No supplement or brain-training product has been shown to prevent dementia, so be wary of products that claim to.

Hearing, vision, teeth and feet

The senses and the small parts of the body have an outsized effect on independence. Hearing loss is common with age and often goes untreated for years. It makes conversation tiring and isolating, and it is linked to loneliness, depression and cognitive decline. Since 2022, the FDA has allowed hearing aids to be sold over the counter for adults with perceived mild to moderate hearing loss, which has made them cheaper and easier to get. For more severe loss, or hearing loss in one ear, ringing, dizziness or pain, see your doctor or an audiologist first.

Vision changes such as cataracts, glaucoma and age-related macular degeneration become more common with age, and some cause no early symptoms. Regular eye exams catch these before they cause serious loss, and good vision directly reduces fall risk. People with diabetes need a yearly diabetic eye exam, which Medicare Part B covers. Note that Original Medicare generally does not cover routine eye exams for glasses, routine dental care or hearing aids; some Medicare Advantage plans do, so check what your plan includes.

Healthy teeth and gums make it easier to eat a varied diet, and dry mouth, a common medicine side effect, raises the risk of decay. See a dentist regularly, including if you wear dentures, and ask about products for dry mouth. Foot problems such as corns, thick nails, numbness and poorly fitting shoes contribute to pain and falls. A podiatrist can help, and anyone with diabetes should check their feet daily and have any wound looked at the same day.

Mood, connection and purpose

Depression is not a normal part of aging, though it is common in later life and often missed, because it can show up as tiredness, poor sleep, aches, loss of appetite or withdrawal rather than obvious sadness. Life changes such as bereavement, retirement, illness, moving home or becoming a caregiver can all trigger it. Depression in older adults responds to treatment, including talking therapies and medicines, so see your doctor if low mood or loss of interest lasts more than two weeks.

Loneliness, the gap between the connection you have and the connection you want, and social isolation are both linked to higher risks of heart disease, stroke, depression and dementia. They can creep up after a partner dies, friends move away, driving stops or hearing worsens. Regular, structured contact tends to work better than occasional big events: a weekly class, a standing phone call, a faith community, volunteering or a club. Senior centers and your local Area Agency on Aging can tell you about programs nearby; the Eldercare Locator, at 1-800-677-1116, can connect you with them.

Having a sense of purpose, whether through family, work, volunteering, learning or creative interests, is linked to better health and well-being in later life. Purpose does not have to be grand: tending a garden, mentoring a younger person, caring for a pet or keeping a regular coffee with a neighbor all give the week shape and a reason to get out of the house. If anxiety, grief or heavy drinking is getting in the way, those deserve help too. If you have thoughts of harming yourself, call or text 988 for the 988 Suicide & Crisis Lifeline at any hour, and call 911 if you are in immediate danger.

Common conditions of later life

Bladder leakage is very common, rarely talked about, and treatable. Pelvic floor muscle exercises, also called Kegels, are the first-line treatment for stress incontinence and work best when done daily for months, ideally with guidance from a pelvic floor physical therapist. Bladder training helps urgency. Drinking less is a common response but tends to make urgency worse by concentrating urine; cutting back on caffeine and alcohol and treating constipation help more. In men, changes in urination often relate to the prostate and are worth discussing with a doctor.

Older skin is thinner, drier and slower to heal. It tears more easily, especially in people taking long-term steroids, and pressure sores can develop within hours to days in someone who cannot move much. Moisturize regularly, change position often when sitting or in bed for long periods, and check heels and the base of the spine daily if mobility is limited. Any area that stays red after pressure is relieved, or any wound that is not healing, needs prompt attention.

Frailty describes a state of low physical reserve, often with slow walking, weak grip, exhaustion, low activity and unintended weight loss. It is not an inevitable part of aging and can partly be reversed. Strength training combined with enough protein is the most effective step, and a geriatrician can carry out a comprehensive assessment that reviews health, function and medicines together. Sleep also changes with age, with lighter and more broken sleep, but older adults still need about 7 to 8 hours; persistent insomnia, loud snoring or daytime sleepiness are worth raising with your doctor.

Staying independent and planning ahead

Loss of independence often follows a fall or an acute illness, so the steps in this guide are also the steps that keep people at home. Practical help makes a difference too: an occupational therapist can suggest equipment and changes to daily routines, a home safety review can remove trip hazards, and community services can help with meals, transport and housework. Accepting a little help early often prevents needing a lot of help later. If driving is becoming harder, talk with your doctor about vision, reaction time and medicines, and plan other ways to get around before you need them.

Advance care planning means recording your wishes for medical care and naming who will make decisions for you if you cannot. A living will records the treatments you would or would not want, and a health care power of attorney names a health care proxy. Requirements vary by state, so use your state's forms. Medicare covers advance care planning conversations with your doctor, including at the Annual Wellness Visit. The most important step is talking to the people closest to you, because documents work best when the person speaking for you understands your values as well as your instructions.

Older adults can also be targets of scams, financial exploitation, neglect and abuse, often by someone they know. Warning signs include unexplained bruises, sudden changes in bank accounts or a will, unpaid bills despite enough income, a new "friend" who controls access, or someone seeming afraid of a caregiver. Be wary of unexpected calls or messages asking for money, gift cards or personal details, and hang up and call the organization back on a number you trust. If you are worried about yourself or someone else, contact Adult Protective Services in your state, which the Eldercare Locator can help you find, and call 911 if someone is in immediate danger.

Talking to your doctor and a yearly plan

Appointments are short, so prepare. Bring your medicine list, a note of your top two or three concerns, and any changes you have noticed in walking, memory, mood, weight, bladder or sleep. It is fine to bring a family member or friend to help listen and take notes. Ask what the goal of each treatment is and how it will affect daily life. Raise sensitive topics such as falls, bladder leakage, sexual health or memory directly; they are common, your doctor will have heard them many times, and many have effective treatments.

If you care for an older relative, ask them for permission to speak with their doctor and keep a shared record of medicines and appointments. Caregiving is demanding, and caregivers need support too, including breaks and help with their own health. Your local Area Agency on Aging can tell you about respite care, caregiver training and support groups, and many caregivers find it useful to ask the doctor directly what changes should prompt a call. Looking after your own sleep, activity and checkups is part of being able to keep caring.

• Once a year: Annual Wellness Visit or yearly checkup, full medication review, and a flu vaccine each fall
• Once a year: check which vaccines and screenings you are due for, and have hearing and vision checked as advised
• Every week: 150 minutes of moderate activity, strength exercises on 2 or more days, and balance practice
• Every day: protein at each meal, regular drinks, and contact with at least one other person
• Now: name a health care proxy, talk through your wishes, and walk through your home looking for fall hazards

Every guide in this topic

• Strength and Balance in Later Life: What Published Guidance Supports
• Polypharmacy: Sorting the Evidence From the Noise
• The Evidence on Vaccination in Older Adults, Without the Hype
• The Evidence on Frailty, Without the Hype
• Loneliness and Aging: Sorting the Evidence From the Noise
• Continence: Sorting the Evidence From the Noise
• Staying Independent: What the Evidence Actually Says
• Nutrition in Later Life: Sorting the Evidence From the Noise
• What the Guidance Really Says About Skin in Later Life
• Planning Ahead: What the Evidence Actually Says

Frequently asked questions

Is it too late to start exercising in my seventies or eighties?

No. Muscles respond to strength training at any age, including in people who are already frail, and balance can be improved with practice. Start gently, build up gradually and include strength and balance work as well as walking. If you have heart disease, chest pain, dizziness or a recent fall, check with your doctor first, and ask whether physical therapy could help you get started safely.

I fell but did not hurt myself. Should I tell my doctor?

Yes. A fall is often the first sign of a treatable problem, such as a medicine side effect, low blood pressure on standing, weak legs, poor vision or an infection. Your doctor can look for the cause and suggest exercise or other changes that lower your risk of another fall. Call 911 for a fall with a head injury, especially if you take a blood thinner.

How do I know if forgetfulness is normal aging or something more?

Occasionally forgetting a name or misplacing keys is common. Memory loss that disrupts daily life, such as getting lost in familiar places, repeating questions, or struggling with bills or familiar tasks, is not a normal part of aging. Many causes, including depression, thyroid problems, B12 deficiency and medicines, are treatable, so see your doctor. Sudden confusion over hours or days needs urgent care.

What happens at a Medicare Annual Wellness Visit?

It is a yearly planning visit rather than a full physical. Your provider reviews your health history and medicines, checks blood pressure and weight, looks for memory problems, asks about falls and mood, and makes a personalized prevention plan with a schedule for screening and vaccines. You can discuss advance care planning too. It has no cost to you when your provider accepts assignment, though other tests may be billed.

Which vaccines do I need after 65?

The CDC recommends a flu vaccine every year, preferably a higher-dose, adjuvanted or recombinant version; pneumococcal vaccination; two doses of the shingles vaccine if you have not had them; a single RSV dose at 75 and older, or earlier if you are at increased risk; and a Td or Tdap booster every 10 years. Ask about the current COVID-19 recommendations. Your pharmacist can check your record.

Should I take a vitamin D or other supplement?

The recommended intake of vitamin D is 600 IU (15 mcg) a day from 51 to 70 and 800 IU (20 mcg) a day over 70. Some people get enough from food, and some need a supplement; your doctor can advise. Adults over 50 are advised to get some vitamin B12 from fortified foods or supplements. Always tell your doctor and pharmacist about supplements, which can interact with medicines.

Are over-the-counter hearing aids any good?

They can be a good option for adults who notice mild to moderate hearing loss, and the FDA has allowed them to be sold without a prescription since 2022. See your doctor or an audiologist first if your hearing loss is severe, came on suddenly, affects only one ear, or comes with ear pain, discharge, ringing or dizziness. Treating hearing loss helps conversation and connection.

How can I tell if a medicine is causing problems?

Suspect a medicine if you notice new dizziness, falls, confusion, drowsiness, constipation or loss of appetite, especially after a new medicine or a dose change. Do not stop anything on your own; some medicines must be reduced gradually. Ask your doctor or pharmacist for a full medication review, bringing everything you take, including over-the-counter products and supplements.

Is bladder leakage just part of getting older?

No. It is common but not normal, and it is treatable. Pelvic floor exercises are the first-line treatment for leaking when you cough or sneeze, and bladder training helps urgency. Cut back on caffeine and alcohol rather than drinking less overall. See your doctor about any new leakage, and get urgent care for sudden inability to urinate or new leakage with back pain or leg weakness.

What is the difference between a living will and a health care power of attorney?

A living will records the medical treatments you would or would not want if you could not speak for yourself. A health care power of attorney names a person, your health care proxy, to make decisions for you. Most people benefit from both. Requirements vary by state, so use your state's forms, give copies to your doctor and proxy, and talk your wishes through.

When to speak to a doctor

See your doctor after any fall, even without injury, and for unintended weight loss, memory problems that affect daily life, low mood lasting more than two weeks, new bladder leakage, or a wound that is not healing. Get prompt care for new confusion, dizziness on standing or a sudden decline in what you can do, which often point to an infection, dehydration or a medicine problem. Call 911 for a fall with a head injury, especially if you take a blood thinner; for signs of stroke such as face drooping, arm weakness or slurred speech; and for chest pain or severe breathlessness. Call Poison Control at 1-800-222-1222 for a suspected medicine overdose. If you have thoughts of harming yourself, call or text 988, and call 911 if you are in immediate danger.

Where this comes from

• HHS — Physical Activity Guidelines for Americans, 2nd edition
• CDC — Older Adult Fall Prevention
• US Preventive Services Task Force — A and B Recommendations
• CDC — Adult Immunization Schedule by Age
• Medicare.gov — Yearly "Wellness" visits
• NIH Office of Dietary Supplements — Vitamin D Fact Sheet for Consumers
• National Institute on Aging — Safe Use of Medicines for Older Adults
• National Institute on Aging — Memory Problems, Forgetfulness, and Aging
• National Institute on Aging — Advance Care Planning: Advance Directives for Health Care
• FDA — OTC Hearing Aids: What You Should Know

How this page was put together

Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.

Medical disclaimer

This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.