What is Healthy Aging

Stretching, Flexibility, and Relaxation

Stretching, flexibility, and relaxation exercises are an important part of your physical activity program. They give you more freedom of movement for your physical activities and for everyday activities such as getting dressed and reaching objects on a shelf. Stretching exercises can improve your flexibility but will not improve your endurance or strength. The 12 flexibility exercises which follow are:

1. neck stretch
2. shoulder stretch
3. shoulder and upper arm raise
4. upper body stretch
5. chest stretch
6. back stretch
7. ankle stretch
8. back of leg stretch
9. thigh stretch
10. hip stretch
11. lower back stretch
12. calf stretch

Do each stretching exercise 3 to 5 times at each session. Slowly stretch into the desired position, as far as possible without pain, and hold the stretch for 10 to 30 seconds. Relax, breathe, then repeat, trying to stretch farther.

You can progress in your stretching exercises. For example, as you become more flexible, try reaching farther, but not so far that it hurts.

Mediating (bringing about positive changes in) your health can have positive healthy aging effects.

Medication Use

Have you ever had a problem with your medicines? You are not alone. There are so many things to keep track of. For example, you may have asked yourself:

  • When exactly should I take my medicine?
  • Is it safe to take vitamins when I take a prescription medicine?
  • Now that I feel better, can I stop taking this medicine?

Medicine is prescribed to help you. But it can hurt if you take too much or mix medicines that don’t go together. Many people have problems each year, some serious, because of taking the wrong medicine or not taking the right medicines correctly. You can help yourself get the best results by being a part of your “health care team.” Your health care team includes:

  • The doctor, physician assistant, nurse practitioner, or other professionals who prescribe your medicine or are in charge of your care.
  • A nurse who helps you at home, a doctor’s office, or a hospital.
  • The pharmacist who fills your prescription and can answer questions about your medicines.

Healthy Eating

Following a healthy eating plan and being physically active are keys to a healthy lifestyle. Here are some recommendations for healthy eating:

  • Eat a variety of fruits and vegetables. Eating fruits and vegetables of different colors gives your body a wide range of valuable nutrients, including fiber, folate, potassium, and vitamins A and C. Some examples are green spinach, orange sweet potatoes, black beans, yellow corn, purple plums, blueberries, red watermelon, and white onions. Have them with meals or for a snack. Leave skins on your fruits and vegetables, if possible. For example, eat the skin when you have a baked potato, and snack on unpeeled apples, pears, and peaches. Don’t forget to rinse fruits and vegetables before eating.
  • Eat a diet rich in foods that contain fiber such as dry beans, fruits, vegetables, and whole-grain foods. Breakfast is a good time to enjoy foods with fiber. For example, try unsweetened, whole wheat or bran cereals, and add fruit such as berries and bananas.
  • Season your foods with lemon juice, herbs, or spices, instead of butter and salt.
  • Look for foods that are low in cholesterol and fat, especially saturated fat (mostly in foods that come from animals) and trans fats (found in many cakes, cookies, crackers, icings, margarines, and microwave popcorn). Saturated fats and trans fats can increase blood cholesterol levels.
  • Choose and prepare foods with little salt.
  • Choose lean cuts of meat and poultry. Trim away extra fat and remove the skin from chicken and turkey before cooking. Broil, roast, bake, steam, microwave, or boil foods instead of frying.
  • Reaching and maintaining a healthy weight are important for your overall health and well-being. The secret is to balance your “energy in” and “energy out” over the long run. “Energy in” is the calories from foods and beverages you have each day, and “energy out” is the calories you burn for basic body functions and during physical activity. Your weight will stay the same when the calories you eat and drink equal the calories you burn. On the other hand, you will gain weight when the calories you eat and drink are greater than those you burn. Physical activity can help you reach and keep a healthier weight.
  • Watch your portion size. Controlling portion size helps limit calorie intake, especially when eating foods that are high in calories.

Drinking Enough Fluids

It’s important to drink enough liquids to keep your body working properly. This is particularly true for older adults because they often don’t feel thirsty even if their bodies need fluids. Drinking enough fluids every day is essential for those who exercise regularly, eat large amounts of protein, use laxatives, or live in areas with high temperatures. Check with your doctor, however, if you’ve been told to limit how much you drink.

Drink plenty of liquids such as water and other drinks without added sugar. Fat-free or low-fat milk, 100% juice, coffee, and tea also are good sources of fluids, as are foods with high moisture content such as fruits, vegetables, and low-sodium broth-based soups. Those who choose to drink alcoholic beverages should do so sensibly and in moderation, which means up to one drink per day for women and up to two drinks per day for men.

Anti-Aging: Can We Prevent Aging?

People are living longer. In 1970, the average life expectancy at birth was 70.8 years; in 2000, it was 76.9 years; and by 2030 it is estimated that the “oldest-old,” age 85 and older, could grow to 10 million people.

Views on aging are also changing. It no longer necessarily means physical decline and illness— in the last two decades, the rate of disability among older people has declined dramatically.

The National Institute on Aging (NIA), part of the Federal Government’s National Institutes of Health (NIH), investigates ways to support healthy aging and prevent or delay the onset of diseases that disproportionately affect us as we age. These studies may not only increase longevity, but may also promote what is known as “active life expectancy”—the time of advancing years free of disability.

Results from NIA-sponsored and other studies are likely to improve our understanding of the benefits and risks of antioxidants, calorie restriction, hormone supplements, and other interventions to promote healthy aging. This tip sheet provides an overview of what we know about these interventions and the research needed to learn more. Until we have a better understanding, it is a good idea to be skeptical of claims that any supplements can solve your age-related problems. Instead, focus on what is known to help promote healthy aging: healthy eating and physical activity.


Antioxidants protect the body from the harmful effects of by-products, known as free radicals, made when the body changes oxygen and food into energy. The discovery of antioxidants raised hopes that people could slow aging simply by adding them to the diet. So far, studies of antioxidant-laden foods and supplements in humans have yielded little support for this premise. Further research, including large-scale epidemiological studies, might clarify whether dietary antioxidants can help people live longer, healthier lives. For now, however, the effectiveness of dietary antioxidant supplementation remains controversial.

Calorie Restriction, Intermittent Fasting, and Resveratrol

Scientists are discovering that what you eat, how frequently, and how much may have an effect on quality and years of life. Of particular interest has been calorie restriction, a diet that is lower by a specific percent of calories than the normal diet but includes all needed nutrients. Research in animals has shown calorie restriction of up to 40 percent fewer calories than normal to have an impressive effect on disease and markers of aging. It has been found to extend the life of protozoa (very small, one-celled organisms), yeast, fruit flies, mice, and rats, as well as other species. Calorie restriction studies with humans and other primates, such as monkeys, are ongoing. Early findings of the Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy (CALERIE) study show that slightly overweight adults who cut their calorie consumption by 20 to 30 percent lowered their fasting insulin levels and core body temperature. Both of these changes correlate with increased longevity in animal models. Some studies in nonhuman primates have shown that calorie restriction reduces the incidence of certain diseases such as cancer. Other studies of the effects of calorie restriction on aging and disease in primates are ongoing and have not yet reached any conclusions. Even though calorie restriction appears to work in a variety of species, its effects on longevity are far from universal. Several animal models, including wild mice, show no lifespan extension by calorie restriction. In some strains of mice, calorie restriction even appears to shorten lifespan.

Scientists do not know if long-term calorie restriction is safe or practical for humans. While a calorie-restricted diet may never be widely adopted for people, studying calorie restriction offers new insights into the aging process and biological mechanisms that could influence healthy aging. This research may also provide clues about how to prevent or delay diseases that become more prevalent with age and inform the development of treatments for such diseases.

Some studies focus on identifying chemicals that somehow mimic calorie restriction’s benefits. Resveratrol, which is found naturally in foods like grapes and nuts, is one compound of interest. In one study, scientists compared two groups of overweight mice on a high-fat diet. One group of mice was given a high dose of resveratrol together with the high-fat diet. The overweight mice receiving resveratrol were healthier and lived longer than the overweight mice that did not get resveratrol. More research is needed before scientists know if a high dose of resveratrol would be safe for humans or even have the same effect as it had in mice.

Scientists are also studying the effect of intermittent fasting or reduced meal frequency. In animal models, like mice, reduced meal frequency appears to have a protective effect on the brain and may also help with heart function and regulation of sugar content in the blood. However, the influence of intermittent fasting on human health and longevity is currently unclear.

While research into calorie restriction and intermittent fasting continues, there is already plenty of research supporting the value of a healthy, balanced diet and physical activity to help delay or prevent age-related health problems.


Hormones are chemical messengers that set in motion different processes to keep our bodies working properly. For example, they are involved in regulating our metabolism, immune function, sexual reproduction, and growth. Hormones are made by specialized groups of cells within the body’s glands. The glands—such as the pituitary, thyroid, adrenals, ovaries, and testes—release hormones into the body as needed to stimulate, regulate, and control the function of other tissues and organs involved in biological processes.

We cannot survive without hormones. As children, hormones help us grow up. In our teenage years, they drive puberty. As we get older, some hormone levels naturally decline. But what does that mean? Scientists do not know exactly. In order to learn more, NIA investigates how administering hormones to older people affects frailty and function. Many of these studies focus on hormones that naturally decline with age, including:

  • Human growth hormone
  • Testosterone
  • Estrogen and progesterone (as part of menopausal hormone therapy)
  • Dehydroepiandrosterone (DHEA)

How Hormones Work

Most hormones are typically found in very low concentrations in the bloodstream. But a hormone’s concentration will fluctuate depending on the body’s activity or time of day. Like a key that unlocks a door, a hormone molecule is released by a gland and travels through the blood until it finds a cell with the right fit, a “receptor.” The hormone latches onto a cell’s receptor and a signal is sent into the cell. These signals may instruct the cell to multiply, make proteins or enzymes, or perform other vital tasks. Some hormones can even cause a cell to release other hormones.

A hormone may fit with many types of cells but may not affect all cells in the same way. For example, one hormone may stimulate one cell to perform a task, but it might also turn off a different cell. Additionally, how a cell responds to a hormone may change throughout life.

Hormone Therapy

Levels of some hormones change naturally over the lifespan. Some hormones increase with age, like parathyroid hormone that helps regulate the amount of calcium in the blood and bone. Some tend to decrease over time, such as testosterone in men and estrogen in women. When the body fails to make enough of a hormone because of a disease or disorder, a doctor may prescribe hormone replacement drugs. These come in many forms such as pills, shots, topical (rub-on) gels, and medicated skin patches.

You may have read magazine articles or seen television programs suggesting that treatment with hormone replacement drugs can make people feel young again or can slow or prevent aging. That’s because finding a “fountain of youth” is a captivating story. The truth is that, to date, no research has shown that hormone replacement drugs add years to life or prevent age-related frailty. And, while some drugs have real health benefits for people with clinical hormone deficiencies due to a disease or disorder, they also can cause harmful side effects. That’s why people who have a diagnosed hormone deficiency should still only take hormone replacement drugs prescribed by a doctor and under a doctor’s supervision.

In some cases, the U.S. Food and Drug Administration (FDA) may have approved a hormone replacement drug for one purpose, but it is prescribed by physicians for another. This off-label use may occur when physicians believe that research, such as clinical studies, demonstrates a drug’s usefulness for another condition. However, consumers should be aware that off-label use of a drug may not have been tested and verified to the same degree as the original use of the drug.

Some Dangers of Hormone Replacement Drugs and “Anti-Aging” Supplements

Higher concentrations of hormones in your body are not necessarily better. The body maintains a delicate balance between how much hormone it produces and how much it needs to function properly. Natural hormone production fluctuates throughout the day. That means that the amount of hormone in your blood when you wake up may be different 2, 12, or 20 hours later.

If you take hormone replacement drugs or supplements, especially without medical supervision, you can adversely affect this tightly controlled, regulated system. Replacement or supplemental hormones cannot replicate your body’s natural variation. Because hormonal balance is so intricate, too much of a hormone in your system may actually cause the opposite of the intended effect. For example, taking a hormone replacement drug or supplement can cause your own hormone regulation to stop working. Or, your body may process the drugs or supplements differently than the naturally produced hormone, causing an alternate, undesired effect. It is also possible that a drug or supplement could amplify negative side effects of the hormone naturally produced by the body. Scientists may not know all the consequences.

Some hormone-like products are sold over the counter without a prescription. Using them can be dangerous. Products that are marketed as dietary supplements are not approved or regulated by the FDA. This means that companies making dietary supplements do not need to provide any proof that their products are safe and effective before selling them. There is no guarantee that the “recommended” dosage is safe, that the same amount of active ingredients is in every bottle, or that the substance is what the company claims. What you bought over the counter may not have been thoroughly studied, and potential negative side effects may not be understood or defined. In addition, these over-the-counter products may interfere with your other medications. NIA does not recommend taking any supplement touted as an “anti-aging” remedy because there is no proof of effectiveness and the health risks of short- and long-term use are largely unknown.

Human Growth Hormone

Growth hormone is important for normal growth and development, as well as for maintaining tissues and organs. It is made by the pituitary gland, a pea-sized structure located at the base of the brain.

Research supports supplemental use of human growth hormone (hGH) injections in certain circumstances. For instance, hGH injections can help children who do not produce enough growth hormone. Sometimes hGH injections may be prescribed for young adults whose obesity is the result of having had their pituitary gland surgically removed. These uses are different from taking hGH as an “anti-aging” strategy. As with other hormones, growth hormone levels often decline with age, but this decrease is not necessarily bad. At least one epidemiological study suggests that people who have high levels of naturally produced growth hormone are more apt to die at younger ages than those with lower levels of the hormone. Researchers have also studied animals with genetic disorders that suppress growth hormone production and secretion. They found that reduced growth hormone secretion actually promotes longevity in the tested species.

Although there is no conclusive evidence that hGH can prevent aging or halt age-related physical decline, some clinics market hGH for that purpose and some people spend a great deal of money on such supplements. Shots can cost more than $15,000 a year. These shots are only available by prescription and should be administered by a doctor. But, because of the unknown risks, it is hard to find a doctor who will prescribe hGH shots. Over-the-counter dietary supplements, known as human growth hormone releasers, are currently being marketed as low-cost alternatives to hGH shots. But claims of their anti-aging effects, like all those regarding hGH, are unsubstantiated.

Research is starting to paint a fuller picture of the effects of hGH, but there is still much to learn. For instance, study findings indicate that injections of hGH can increase muscle mass; however, it seems to have little impact on muscle strength or function. Questions about potential side effects, such as diabetes, joint pain, and fluid buildup leading to high blood pressure or heart failure, remain unanswered, too. A report that children who were treated with pituitary growth hormone have an increased risk of cancer created a heightened concern about the dangers of hGH injections. Whether or not older people treated with hGH for extended periods have an increased risk of cancer is unknown. To date, only small, short-term studies have looked specifically at hGH as an “anti-aging” therapy for older people. Additional research is necessary to assess the potential risks and benefits of hGH.


Testosterone is a vital sex hormone that plays an important role in puberty. In men, testosterone not only regulates sex drive (libido), it also helps regulate bone mass, fat distribution, muscle mass and strength, and the production of red blood cells and sperm. Testosterone isn’t exclusively a male hormone—women produce small amounts as well.

As men age, they often produce somewhat less testosterone, especially compared to years of peak testosterone production during adolescence and early adulthood. Normal testosterone production ranges widely, and it is unclear what amount of decline or how low a level of testosterone will cause adverse effects.

Recently, the popular press has increasingly reported about “male menopause,” a condition supposedly caused by diminishing testosterone levels in aging men. There is very little scientific evidence that this condition, also known as andropause or viropause, exists. The likelihood that an aging man will experience a major shutdown of testosterone production similar to a woman’s menopause is very remote. In fact, many of the changes that take place in older men often are incorrectly attributed to decreasing testosterone levels. For instance, some men experiencing erectile difficulty (impotence) may be tempted to blame it on lowered testosterone, but many cases of erectile problems are due to circulatory problems.

For men whose bodies make very little or no testosterone, testosterone replacement may offer benefits. FDA-approved testosterone drugs come in different forms, including patches, injections, and topical gels. Men whose testes (the reproductive glands that make testosterone and sperm) have been damaged or whose pituitary glands have been harmed or destroyed by trauma, infections, or tumors may also be prescribed testosterone. Treatment with testosterone drugs can help men with exceptionally low testosterone levels maintain strong muscles and bones and increase their sex drive. It is unclear if men who are at the lower end of the normal range for testosterone production would benefit from treatment.

More research is needed to learn what effects testosterone drug therapy may have in healthy older men without these extreme deficiencies. NIA is investigating the role of testosterone therapy in delaying or preventing frailty and helping with other age-related health issues. Results from preliminary studies involving small groups of men are inconclusive. Specifically, it remains unclear to what degree testosterone supplements can help men maintain strong muscles and sturdy bones, sustain robust sexual activity, or sharpen memory.

There are also concerns about the long-term, harmful effects that testosterone drugs might have on the aging body. Most epidemiological studies suggest that higher natural levels of testosterone are not associated with a higher incidence of prostate cancer—the second leading cause of cancer death among men. However, scientists do not know if taking testosterone drugs increases men’s risk for developing prostate cancer or promoting the growth of an existing tumor. There is also uncertainty about effects of testosterone treatment on the cardiovascular system in older men, especially men with mobility limitations and other diseases. Future studies will address this issue to ensure that older men receiving testosterone treatment are not exposed to unnecessary risks.

The bottom line: there is no scientific proof that testosterone treatment in healthy men will help them age better. Until more scientifically rigorous studies are conducted, it is not known if the possible benefits of testosterone therapy outweigh any of its potential risks. NIA continues to conduct research to gather more evidence about the effects of testosterone treatment in aging men.

Hormones in Women

Estrogen and progesterone are two hormones that play an important part in women’s menstrual cycle and pregnancy. Estrogen also helps maintain bone strength and may reduce the risk of heart disease and memory problems before menopause. Both estrogen and progesterone are produced naturally by the ovaries. However, after menopause, the ovaries make much less of these hormones. For more than 60 years, millions of women have used drugs containing estrogen to relieve their menopausal symptoms, especially hot flashes and vaginal dryness. Some women may also be prescribed estrogen drugs to prevent or treat osteoporosis—loss of bone strength—that often happens after menopause. The use of estrogen (by a woman whose uterus has been removed) or estrogen with progesterone or a progestin, a synthetic form of progesterone (by a woman with a uterus), to treat the symptoms of menopause is called menopausal hormone therapy (MHT, formerly known as hormone replacement therapy, or HRT).

There is a rich research base investigating estrogen. Many large, reliable long-term studies of estrogen and its effects on the body have been conducted. Yet, much remains unknown. In fact, the history of estrogen research demonstrates why it is important to examine both the benefits and risks of any hormone therapy before it becomes widely used. Here’s what scientists know:

  • Endometrial problems—While estrogen drugs help some women with symptom management during and after menopause, they can raise the risk of certain problems. Estrogen may cause a thickening of the lining of the uterus (endometrium) and increase the risk of endometrial cancer. To lessen these risks, doctors now prescribe progestins to women with a uterus to protect the lining.
  • Heart disease—The role of estrogen in heart disease is complex. Early studies suggested MHT could lower postmenopausal women’s risk for heart disease—the number one killer of women in the United States. But results from the NIH Women’s Health Initiative (WHI) suggest that using estrogen with or without a progestin after menopause does not protect women from heart disease and may even increase their risk.
    In 2002, WHI scientists reported that using estrogen plus progestin actually elevates some postmenopausal women’s chance of developing heart disease, stroke, blood clots, and breast cancer, but women also experienced fewer hip fractures and cases of colorectal cancer. In 2004, WHI scientists published another report, this time on postmenopausal women who used estrogen alone, which had some similar findings: women had an increased risk of stroke and blood clots, but fewer hip fractures. Then, in 2007, a closer analysis of the WHI results indicated that younger women, ages 50 to 59 at the start of the trial, who used estrogen alone, had significantly less calcified plaque in their coronary arteries than women not using estrogen. Increased plaque in coronary arteries is a risk factor for heart attacks. Scientists also noted that the risk of heart attack increased in women who started MHT more than 10 years after menopause (especially if these women had menopausal symptoms). There was no evidence of increased risk of heart attack in women who began MHT within 10 years of going through menopause.
  • Dementia—Some observational studies have suggested that estrogen may protect against Alzheimer’s disease. However, testing in clinical trials has challenged that view in older, postmenopausal women. In 2003, researchers in a substudy of the WHI, called the WHI Memory Study (WHIMS), reported that women age 65 and older who took a certain type of estrogen combined with progestin were at twice the risk for developing dementia compared to women who did not take any hormones. In 2004, WHIMS scientists reported that using the same kind of estrogen alone also increased the risk of developing dementia in women age 65 and older compared to women not taking any hormones.

Despite research thus far, there are still many unknowns about the risks and benefits of MHT. For instance, because women in their early 50’s were only a small part of the WHI, scientists do not yet know if certain risks are applicable to younger women who use estrogen drugs to relieve their symptoms during the menopausal transition.

You may also have heard about a relatively new approach to hormone therapy for women— “bioidentical hormones.” These are hormones derived from plants, such as soy or yams, that have identical chemical structures to hormones produced by the human body. The term “bioidentical hormones” is now also being applied to the practice of compounding or combining hormones such as estrogen and progesterone, theoretically based on a woman’s individual hormonal needs. Large clinical trials of these compounded hormones have not been done, and many bioidentical hormones that are available without a prescription are not regulated or approved for safety and efficacy by the FDA. FDA-regulated bioidentical hormones, such as estradiol and progesterone, are available by prescription for women considering MHT.

For middle-age and older women, the decision to take hormones is far more complex and difficult than ever before. Questions about MHT remain. Would using a different estrogen and/or progestin or different dose change the risks? Would the results be different if the hormones were given as a patch or cream, rather than a pill? Would taking progestin less often be as effective and safe? Does starting MHT around the time of menopause, compared to years later, change the risks? Can we predict which women will benefit or be harmed by using MHT? As these and other questions are addressed by research, women should continue to review the pros and cons of MHT with their doctors and assess their personal risks and benefits to make an informed decision about whether or not this therapy is right for them. NIA has additional free information on menopausal hormone therapy.


Dehydroepiandrosterone, or DHEA, is made from cholesterol by the adrenal glands, which sit on top of each kidney. It is converted by the body into two other important hormones: testosterone and estrogen. For most people, DHEA production peaks in the mid-20’s and then gradually declines with age. The effects of this decline, including its role in the aging process, are unclear. Even so, some proponents claim that over-the-counter DHEA supplements can improve energy and strength and boost immunity. Claims are also made that supplements increase muscle and decrease fat. To date, there is no conclusive scientific evidence that DHEA supplements have any of these benefits.

The conversion of naturally produced DHEA into estrogen and testosterone is highly individualized. There is no way to predict who will make more or less of these hormones. Having an excess of testosterone or estrogen in your body could be risky.

Scientists do not yet know the effects of long-term (defined as over 1 year) use of DHEA supplements. Early indications are that these supplements, even when taken briefly, may have detrimental effects on the body, including liver damage. But the picture is not clear. Two short-term studies showed that taking DHEA supplements has no harmful effects on blood, prostate, or liver function. However, these studies were too small to lead to broader conclusions about the safety or efficacy of DHEA supplementation.

Researchers are working to find more definite answers about DHEA’s effects on aging, muscles, and the immune system. In the meantime, if you are thinking about taking DHEA supplements, be aware that the effects are not fully known and might turn out to cause more harm than good.

Exercise and Physical Activity

Regular exercise and physical activity, no matter your age, are important to the physical and mental health of almost everyone, including older adults. Being physically active can help you continue to do the things you enjoy and stay independent as you age. Regular physical activity over long periods of time can produce long-term health benefits. That’s why health experts say that older adults should be active every day to maintain their health.

In addition, regular exercise and physical activity can reduce the risk of developing some diseases and disabilities that develop as people grow older. In some cases, exercise is an effective treatment for many chronic conditions. For example, studies show that people with arthritis, heart disease, or diabetes benefit from regular exercise. Exercise also helps people with high blood pressure, balance problems, or difficulty walking.

One of the great things about physical activity is that there are so many ways to be active. For example, you can be active in short spurts throughout the day, or you can set aside specific times of the day on specific days of the week to exercise. Many physical activities—such as brisk walking, raking leaves, or taking the stairs whenever you can—are free or low cost and do not require special equipment. You could also check out an exercise video from the library or use the fitness center at a local senior center.

This guide shows you many types of exercise and physical activity. It also has lots of tips to help you be active in ways that suit your lifestyle, interests, health, and budget, whether you’re just starting out, getting back to exercising after a break, or fit enough to run a 3-mile race. It’s for everyone—people who are healthy and those who live with an ongoing health problem or disability.

Sexuality in Later Life

Many people want and need to be close to others as they grow older. This includes the desire to continue an active, satisfying sex life as they grow older. But, with aging, there may be changes that can cause problems.

What Are Normal Changes?

Normal aging brings physical changes in both men and women. These changes sometimes affect the ability to have and enjoy sex. A woman may notice changes in her vagina. As a woman ages, her vagina can shorten and narrow. Her vaginal walls can become thinner and also a little stiffer. Most women will have less vaginal lubrication. These changes could affect sexual function and/or pleasure. Talk with your doctor about these problems.

As men get older, impotence (also called erectile dysfunction—ED) becomes more common. ED is the loss of ability to have and keep an erection for sexual intercourse. ED may cause a man to take longer to have an erection. His erection may not be as firm or as large as it used to be. The loss of erection after orgasm may happen more quickly, or it may take longer before another erection is possible. ED is not a problem if it happens every now and then, but if it occurs often, talk with your doctor.

What Causes Sexual Problems?

Some illnesses, disabilities, medicines, and surgeries can affect your ability to have and enjoy sex. Problems in your relationship can also affect your ability to enjoy sex.

Arthritis. Joint pain due to arthritis can make sexual contact uncomfortable. Joint replacement surgery and drugs may relieve this pain. Exercise, rest, warm baths, and changing the position or timing of sexual activity can be helpful.

Chronic pain. Any constant pain can interfere with intimacy between older people. Chronic pain does not have to be part of growing older and can often be treated. But, some pain medicines can interfere with sexual function. You should always talk with your doctor if you have unwanted side effects from any medication.

Dementia. Some people with dementia show increased interest in sex and physical closeness, but they may not be able to judge what is appropriate sexual behavior. Those with severe dementia may not recognize their spouse, but still seek sexual contact. This can be a confusing problem for the spouse. A doctor, nurse, or social worker with training in dementia care may be helpful.

Diabetes. This is one of the illnesses that can cause ED in some men. In most cases, medical treatment can help. Less is known about how diabetes affects sexuality in older women. Women with diabetes are more likely to have vaginal yeast infections, which can cause itching and irritation and make sex uncomfortable or undesirable.

Heart disease. Narrowing and hardening of the arteries can change blood vessels so that blood does not flow freely. As a result, men and women may have problems with orgasms, and men may have trouble with erections. People who have had a heart attack, or their partners, may be afraid that having sex will cause another attack. Sexual activity is often safe. Always follow your doctor’s advice.

Incontinence. Loss of bladder control or leaking of urine is more common as we grow older, especially in women. Extra pressure on the belly during sex can cause loss of urine, which may result in some people avoiding sex. This can be helped by a change in positions. The good news is that incontinence can usually be treated.

Stroke. The ability to have sex is sometimes affected by a stroke. A change in positions or medical devices may help people with ongoing weakness or paralysis to have sex. Some people with paralysis from the waist down are still able to experience orgasm and pleasure.

What Else May Cause Sexuality Problems?

Surgery. Many of us worry about having any kind of surgery—it may be even more troubling when the breasts or genital area are involved. Most people do return to the kind of sex life they enjoyed before surgery.

Hysterectomy is surgery to remove a woman’s uterus. Often, when an older woman has a hysterectomy, the ovaries are also removed. The surgery can leave both men and women worried about their sex lives. If you’re afraid that a hysterectomy will change your sex life, talk with your gynecologist or surgeon.

Mastectomy is surgery to remove all or part of a woman’s breast. This surgery may cause some women to lose their sexual desire or their sense of being desired or feeling feminine. In addition to talking with your doctor, sometimes it is useful to talk with other women who have had this surgery. Programs like the American Cancer Society’s (ACS) “Reach to Recovery” can be helpful for both women and men. If you want your breast rebuilt (reconstruction), talk to your cancer doctor or surgeon.

Prostatectomy is surgery that removes all or part of a man’s prostate because of cancer or an enlarged prostate. It may cause urinary incontinence or ED. If removal of the prostate gland (radical prostatectomy) is needed, talk to your doctor before surgery about your concerns.

Medications. Some drugs can cause sexual problems. These include some blood pressure medicines, antihistamines, antidepressants, tranquilizers, appetite suppressants, drugs for mental problems, and ulcer drugs. Some can lead to ED or make it hard for men to ejaculate. Some drugs can reduce a woman’s sexual desire or cause vaginal dryness or difficulty with arousal and orgasm. Check with your doctor. She or he may prescribe a different drug without this side effect.

Alcohol. Too much alcohol can cause erection problems in men and delay orgasm in women.

Am I Too Old To Worry About Safe Sex?

Age does not protect you from sexually transmitted diseases. Older people who are sexually active may be at risk for diseases such as syphilis, gonorrhea, chlamydial infection, genital herpes, hepatitis B, genital warts, and trichomoniasis.

Almost anyone who is sexually active is also at risk of being infected with HIV, the virus that causes AIDS. The number of older people with HIV/AIDS is growing. To protect yourself, always use a condom during sex. You are at risk for HIV/AIDS if you or your partner has more than one sexual partner or if you are having unprotected sex.

For women with vaginal dryness, lubricated condoms or a water-based lubricating jelly with condoms may be more comfortable. A man needs to have a full erection before putting on a condom. Talk with your doctor about ways to protect yourself from all sexually transmitted diseases. Go for regular check-ups and testing. Talk with your partner. You are never too old to be at risk.

Can Emotions Play a Part?

Sexuality is often a delicate balance of emotional and physical issues. How you feel may affect what you are able to do. Many older couples find greater satisfaction in their sex life than they did when they were younger. They have fewer distractions, more time and privacy, no worries about getting pregnant, and intimacy with a lifelong partner.

Some older people are concerned about sex as they age. A woman who is unhappy about how her looks are changing as she ages may think her partner will no longer find her attractive. This focus on youthful physical beauty may get in the way of her enjoyment of sex. Men may fear that ED will become a more common problem as they age. Most men have a problem with ED once in awhile. But, if you worry too much about that happening, you can cause enough stress to trigger ED.

Older couples face the same daily stresses that affect people of any age. They may also have the added concerns of age, illness, retirement, and other lifestyle changes, all of which may lead to sexual difficulties. Try not to blame yourself or your partner. You may find it helpful to talk to a therapist. Some therapists have special training in helping with sexual problems. If your male partner is troubled by ED or your female partner seems less interested in sex, don’t assume he or she is no longer interested in you or in sex. Many of the things that cause these problems can be helped.

What Can I Do?

There are things you can do on your own for an active sexual life. Make your partner a high priority. Take time to enjoy each other and to understand the changes you both are facing. Try different positions and new times, like having sex in the morning when you both may be well rested. Don’t hurry—you or your partner may need to spend more time touching to become fully aroused. Masturbation is a sexual activity that many older people, with and without a partner, find satisfying.

Some older people, especially women, may have trouble finding a romantic or sexual partner. That’s because women tend to live longer than men. To meet new people, try activities that other seniors enjoy. Some ideas include mall walking, volunteer jobs, adult education classes at a community college, or day trips sponsored by your city or county recreation department.

Don’t be afraid to talk with your doctor if you have a problem that affects your sex life. He or she may be able to suggest a treatment. For example, the most common sexual difficulty of older women is painful intercourse caused by vaginal dryness. Your doctor or a pharmacist can suggest over-the-counter vaginal lubricants or moisturizers to use. Water-based lubricants are helpful when needed to make sex more comfortable. Moisturizers are used on a regular basis, every 2 or 3 days. Or, your doctor might suggest a form of vaginal estrogen.

If ED is the problem, it can often be managed and perhaps even reversed. There are pills that can help. They should not be used by men taking medicines containing nitrates, such as nitroglycerin. The pills do have possible side effects. Other available treatments include vacuum devices, self-injection of a drug, or penile implants.

Physical problems can change your sex life as you get older. But, you and your partner may discover you have a new closeness. Talk to your partner about your needs. You may find that affection—hugging, kissing, touching, and spending time together—can make a good beginning.

Healthy Aging and Addiction

Addiction to alcohol, nicotine, and illegal substances cost Americans upwards of half a trillion dollars a year, considering their combined medical, economic, criminal, and social impact. Every year, abuse of illicit drugs and alcohol contributes to the death of more than 100,000 Americans, while tobacco is linked to an estimated 440,000 deaths per year.

People of all ages suffer the harmful consequences of drug abuse and addiction.

  • Babies exposed to legal and illegal drugs in the womb may be born premature and underweight. This drug exposure can slow the child’s intellectual development and affect behavior later in life.6
  • Adolescents who abuse drugs often act out, do poorly academically, and drop out of school. They are at risk of unplanned pregnancies, violence, and infectious diseases.
  • Parents’ drug abuse often means chaotic, stress-filled homes and child abuse and neglect. Such conditions harm the well-being and development of children in the home and may set the stage for drug abuse in the next generation.
  • Adults and Older Adults who abuse drugs often have problems thinking clearly, remembering, and paying attention. They often develop poor social behaviors as a result of their drug abuse, and their work performance and personal relationships suffer. Addiction can affect people of any age.

For more information, visit the National Institutes of Health (NIH) at www.nih.gov.