Pneumonia is an infection that inflames the air sacs on one or both lungs and may cause them to fill with fluid. It is caused by a variety of sources including bacteria, viruses, and fungi. Many of the germs that can cause pneumonia are airborne. While our bodies are generally efficient at blocking these germs; stress, lack of sleep, general depression, colds, or any weakness can allow them to sneak in. Pneumonia is the most serious for infants, people older than 65, and people with existing health challenges or weakened immune systems. It is particularly dangerous for people with heart failure or chronic lung problems. Types of Pneumonia Bacterial Pneumonia The most common form of bacterial pneumonia is pneumococcal pneumonia. Often it occurs after one has had the cold or flu. It is contagious initially but is no longer contagious after a couple days of antibiotics. Mycoplasma pneumoniae, or walking pneumonia, is a milder form of pneumonia. It is contagious and airborne. Those diagnosed often don't feel ill and are generally not hospitalized but can spread the pneumonia to others. Viral Pneumonia Viruses, including COVID-19, can cause viral pneumonia. The flu is the most common viral gateway for pneumonia. Symptoms of viral pneumonia are initially similar to those of the flu but quickly affect the lungs and breathing. Most virus generally spark only a mild form of pneumonia in health individuals. However, COVID-19 has shown that, because of its inherent propensity for lung damage, it can introduce a more severe bout with pneumonia. Older adults and people with serious illness or weak immune systems, ironically, may have fewer and milder symptoms, including a lower temperature rather than a fever. Mental acuity can be affected by a loss of oxygen to the brain, so any sudden change in mental awareness should be a cause for alarm. Fungal pneumonia Pneumonia caused by fungi is most common in people with compromised health. It is acquired through the soil or bird droppings. Ask your doctor if there are pneumonia-causing fungi in your area. ( Mayo Clinic and American Lung Association ) Symptoms of Pneumonia Chest pain when breathing or coughing Confusion or changes in mental awareness (in adults age 65 and older) Cough, which may produce phlegm Fatigue Nausea, vomiting or diarrhea Fever over 102°, sweating and shaking chills Lower than normal body temperature (in adults older than age 65 and people with weak immune systems) Bluish lips and nailbeds Shortness of breath ( Mayo Clinic ) Prevention Get vaccinated - Talk with your doctor about which might be best for your loved one. Some of the vaccines that can help include: Haemophilus influenzae type b (Hib) Influenza (flu) Measles Pertussis (whooping cough) Pneumococcal polysaccharide (recommended by the CDC for all adults over 65) Pneumococcal conjugate (recommended by the CDC for immune compromised individuals) Varicella (chickenpox) Practice good hygiene - Make sure that your loved one is washing hands and sanitizing surfaces adequately, even in their own home. Keep your immune system strong - Get enough sleep, move or exercise regularly, and eat a healthy diet. Stay away from sick people - The distancing we've all been doing is helpful but if someone in the home is sick, isolate your immuno-compromised loved ones as well. Don't smoke ( Mayo Clinic and Center for Disease Control ) Risk Factors Chronic Disease - Asthma, COPD (chronic obstructive pulmonary disease), or heart disease are primary risks. Smoking - On top of weakening the lungs, smoking generally weakens your body's natural defenses against bacteria and viruses that cause pneumonia. Compromised Immune Systems - People who have HIV/AIDS, or who have had a transplant, chemotherapy, or steroids should be aware of the risks for pneumonia. Being Hospitalized - ICU stays, especially on a ventilator, can be risky. That is not to say avoid going to the hospital if you need medical attention. Catching and treating illnesses early can help prevent a hospital stay. ( Mayo Clinic )

A good first step towards taking your loved one on a longer trip is to plan a day outing or stay-cation (overnight in your own city). Some things to take into consideration: Plan the day with ample time to allow your loved one to decompress from each activity All time for a nap, if necessary Choose locations that are quieter, with fewer people, and less waiting time. Make sure that restrooms can accommodate any limitations. Start your outing at a calmer part of the day for your loved one. Let people know about your older adult by creating business sized cards to hand to clerks or restaurant staff. They can say something like “My family member has dementia. We are giving them a fun outing but they might say or do things that are unexpected. Thank you for your understanding.” Be ready to change your plans if your loved one seems to be agitated. It is not a failure on anyone’s part if your loved one can’t handle what you’ve planned. Kudos to you for trying to give them some normalcy or fun. ( National Institute of Health ) Prepare your Family Members Before a Visit Your extended family will be excited to see their loved one but may not know how to interact. Here are some easy guidelines: Keep greetings and interactions calm. Don’t speak to your loved one as if they are a child. Respect personal space and ask permission for hugs and touch. Make eye contact and call the person by name. Don’t argue if the person seems confused. Change the subject instead. Prepare to have an activity to share – a photo album, simple game, music or a walk outside. ( Daily Caring ) If you feel that your loved one can handle an extended trip, use what you’ve learned from your day trips in planning for your extended time. Before the trip Talk with your medical team to determine if there are medications that can calm them during th travel days. Be prepared to use these only, if necessary, since a sleepy traveler can make changing planes or moving from place to place more difficult. Take advantage of available assistance at the bus terminal, train station, or airport. Bring snacks that your senior likes so that you are not reliant on restaurants or airline foods. Make sure to bring important documents including insurance information, doctors’ names and phone numbers, medication lists, and medical records. Pack items for your loved one that are familiar to them and that they like holding for comfort. If they don’t have something, get them a gift of a sensory blanket, soft stuffed toy or fidget game several weeks prior to the trip to see if any of those help calm them in difficult times. Get an ID bracelet that is difficult for them to remove in case they wander off. Ensure that you have a current photo. If you are going to visit family, spend a little time beforehand looking through photo albums and talking about the people in those albums. Once you arrive at your destination Give them the opportunity to rest in a quiet location with familiar faces. Even if you are visiting family, they may not immediately feel comfortable with people they haven’t seen in a while. Plan activities that can be stepped out of easily, if necessary. Pre-identify restroom locations. Try to keep the sleep and food schedules similar to their schedules at home. ( National Institute of Health and Special Needs Alliance ) It’s OK Not to Bring Your Loved One At the end of the day, if you are planning this trip because you would like to see family and are unsure if it’s something your loved one will enjoy, reconsider whether they need to join you. Sometimes the kindest thing you can do is to leave them in the comfort of their own home with a caregiver they trust, while you take the break that you’ve earned. If you are concerned that they’ll be missing an important family gathering such as a wedding, graduation, or reunion, they can be included through video chat without the stress of travel and larger gatherings. ( Daily Caring )

During this time of their lives, a lot of your senior’s experience may be punctuated by loss: loss of health, independence, mobility, routine, and more. The most acute loss is that of family and friends. Here are some ways to help them cope. As they grow older, your loved ones will lose friends, family and spouses through death. While they may be aware that loss will happen, that knowledge doesn’t always give them the tools to handle it. The Difference Between Grief & Depression Grief and depression have many common symptoms, but there are ways to tell the difference. Grief comes with ups and downs and involves a variety of emotions. Even when people are grieving, they will experience times of joy and happiness. With depression, however, the feelings of despair are persistent. Symptoms that may indicate depression rather than just grief include: Persistent and vague complaints Moving in a slower manner Demanding behavior Trouble concentrating Pessimism Loss of interest in things once pleasurable If you see signs of depression in anyone or experience these symptoms yourself, seek help from a medical or mental health professional. ( HelpGuide ) The Stages of Grief Swiss-American psychiatrist Elizabeth Kübler-Ross outlines five stages in the grief process: Stage 1 - Denial “This can’t be happening to me.” Stage 2 - Anger "Why is this happening? Who is to blame?" Stage 3 - Bargaining "Make this not happen and in return I will ___." Stage 4 - Depression "I'm too sad to do anything." Stage 5 - Acceptance "I'm at peace with what happened." While it is often thought that, once you’ve completed one stage, you move to the next one and never go back, this is not necessarily the case. The path is more like a roller coaster where the person grieving may experience higher and lower depts of feeling and may loop back to previous steps multiple times during the ride. This is normal. Often, memory loss and dementia can make it feel like the losses are fresh over and over. It is important to practice compassion when your senior doesn’t remember that their spouse or friend has passed. Allow them to process it anew, rather than being frustrated with them that they don’t remember. They may have to go through the stages of grief daily. Losing a spouse may leave a gap that is larger than just the person. The lost spouse may have been the one who was more upbeat, more thoughtful, more organized, more of the caregiver in the relationship. There may have been tasks they enacted throughout the relationship that the surviving spouse never had to do – paying bills, cooking, gardening, cleaning, even driving. This secondary loss can be keenly felt by the surviving spouse. Learning new skills at this point in their lives may seem overwhelming and contribute to the difficulty or moving on at each stage. Don’t discuss the loss of other friends or family in their life. Staying involved in their daily lives, even through phone conversations, will help you see who is important to your loved one and will help you know when to be there for them during an unexpected loss. ( HelpGuide ) Healthy Ways to Help Your Senior Handle Grief Share the Sorrow Allow your senior to talk about their loss if they want to. They might feel comforted to know that you are grieving as well. If it seems appropriate, suggesting a loss support group can be very helpful, as they might feel safer sharing with strangers. Don't Ignore the Pain It may feel like you can push the pain away by immersing your loved ones in other activities. Unfortunately, this only delays the pain and sometimes forces it to surface in inappropriate or unhealthy ways. Allow them to Express Grief in their Own Way Everyone expresses grief in different ways: tears, screaming, withdrawing, cleaning, caregiving, sleeping. Allow your loved one to grieve in their own way. Offer Practical Help Especially if the deceased spouse was traditionally the caregiver or the one to manage the household, the surviving spouse may be overwhelmed and stop caring for themselves. Offer to cook, clean, run errands, and take them to appointments. ( Mental Health America ) It is unavoidable that your senior will experience loss in their lives. How they process and handle that loss can be shaped by the love and caring of their caretakers, family, and friends. Depression in Seniors Grief left unacknowledged can morph into depression. Depression is a medical illness that carries with it a wealth of other health risks. Unfortunately, so often, depression is assumed as a normal component of aging – a reaction to illness, loss, and social transition as your senior faces their own mortality and vulnerability. It does not need to be. Depression is often mistaken for or lumped in with the symptoms of: Dementia Alzheimer's disease Arthritis Cancer Heart Disease Parkinson's disease Stroke Thyroid disorders While depression certainly might stem from these conditions, it needs to be treated as a separate illness with its own diagnosis. Sometimes, successfully addressing depression can lessen other symptoms of aging. Happiness or contentment can be a healing antidote, protecting the immune system, increasing social awareness, lowering heart and blood pressure, and inspiring healthier decisions. ( Healthline , NCOA )

Many seniors face inadequate nutrition. The effects of being undernourished or malnourished can be dangerous, so it is important to recognize signs of nutritional issues in aging loved ones. Common Challenges to Seniors’ Nutritional Health Typically, nutritional issues are associated with poverty or illnesses. For seniors, however, some of the most common challenges include: Difficulty getting to grocery stores, carrying groceries, and putting them away Trouble with meal planning and remembering things in the kitchen Struggling with cooking, cleaning dishes, etc. Lack of hunger due to health problems, sadness, or loneliness Forgetting to cook, eat, or get groceries Fatigue leading to convenient unhealthy food choices Problems with taste, swallowing, or digestion Some challenges are unexpected. For instance, one study found a senior woman was unplugging her refrigerator at night because it was noisy. This made the food she was consuming unsafe and caused health problems for months. ( Public Health Post and NCBI ) Malnourished or Undernourished? Seniors can be malnourished or undernourished. Knowing the difference can help you prevent and address nutritional issues. Malnourishment is when the body does not receive the nutrients needed to maintain a healthy balance. Dietary changes may restore balance, such as eating more fiber or less sugar. A body is undernourished when too few calories are consumed. This can be addressed simply by eating more. ( Merck Manuals ) Consequences of Nutrition Problems Being undernourished or malnourished can: Weaken the immune system Cause fatigue Upset digestive processes Strain the heart and mind Lead to extreme weight loss Increase risk of death Increase risk of hospitalization Delay healing times ( Mayo Clinic ) Signs of Nutrition Problems in Seniors Recognizing some nutrition problems in seniors can be simple, but others are more complex. Look for signs like these: Weight loss, whether slow or fast Lack of appetite Difficulty concentrating Feeling cold often Getting sick easily Wounds taking a long time to heal Mood changes or irritability In extreme cases or when malnourishment is a problem, symptoms might include: Shakiness or lightheartedness Difficulty breathing Sunken cheeks and features Digestive trouble Hair and skin dying out ( Medical News Today ) Home Care Tip Medications can also affect nutrition. If a senior is showing signs of nutrition problems, talk to a doctor and bring along a list of medications and health conditions. ( Family Doctor )

As we know, exercise is a key component for staying healthy. Movement is important for older adults, especially those for whom a sedentary lifestyle poses health threats. A recent study by the New England Journal of Medicine discovered that dance had the greatest protection against dementia of any of the other leisure activities studied, reducing the risk by up to 76%. Other activities studied were reading, bicycling, swimming, crossword puzzles, and golf. As brain cells die and weaken with age, the first thing to go is nouns (like the names of people) because there is only one pathway to remembering those. Dancing uses multiple pathways to movement, from coordinating steps and enjoying the music to social interactions. Therefore, there are more pathways a person's brain creates to facilitate the fun. Additionally, freestyle dancing (dancing that doesn't follow a specific set of steps) might be even better than more pattern-based dancing, like ballroom, for mental acuity. The reason is that anything that requires us to constantly think and revise on the go requires our brain to continually re-route and create new pathways for decision-making. While dancing might be the most fun and brain-diverse way to strengthen new neural pathways, anything that requires quick decisions versus a routine way of doing things can help. Freestyle dancing as a pair creates an additional need to interpret signals from a partner. Changing up the partner adds even another level of complexity. So maybe try putting on some good music and have everyone in the family dance with mom on different days? Pattern-based dancing can be relaxing and movement-rich. For improving chances against dementia, people who are proficient in ballroom dancing can move into a brain space that is more routine, which reduces the neural rerouting that can be more useful for older adults. The wonderful message in this is that dancing early and often can help our brains no matter what age we are. ( New England Journal of Medicine , Psychology Today , and Stanford University Dance ) The Benefits of Dance Improves cardiovascular health Improves balance and strength Gentle on the body Boots cognitive performance Can be done by anyone Can be a social activity Is mood boosting ( Healthline ) Dance Movement Therapy (DMT) If you aren't sure about the idea of creating a dance routine with your loved one, you have other options for introducing dance into their lives. Dance Movement Therapy (DMT) targets the specific areas in which your loved one might need improvement. Dance therapist are more dialed in to which movements will help improve specific neural pathways. They can design programs to help with balance and gait issues associated with disease like Parkinson's Disease. While some steps are taught, there is often a focus on creativity and freestyle to engage more of the senses. Dance therapy is based on the principle that movement reflects an individual's thoughts and feelings. So, watching how a person chooses to dance, paired with their physical and emotional capabilities during the process, will give the therapist insights to guide the therapy. ( National Institute of Health ) Dance as Mind-Body Intervention for Parkinson's Dance requires the practice of fluid movements and postures while maintaining full body control, which can address many motor symptoms associated with Parkinson's. In addition, dance can improve patients' emotional, cognitive, and social well-being as a result of listening to music and interacting with other people. Here's how dance may address each of the key areas identified as being important in an exercise program designed for individuals with Parkinson's. Dance is an activity performed to music. The music may serve as an external cue to facilitate movement. Dance involves the teaching of specific movement strategies. Dance incorporates balance exercises. Dance can enhance strength and/or flexibility Dance can result in improved cardiovascular functioning. ( Parkinson's News Today and National Institutes of Health )

An estimated 20 percent of people aged 55 and older experience some level of mental health challenge. These concerns include anxiety, depression, dementia, and suicidal thoughts. Yet less than 3 percent of older adults report seeking mental health solutions. Anxiety Anxiety comes in several forms and can be closely tied to medications, depression, or other health issues. • Panic Disorder includes panic attacks and feelings of intense terror that strike repeatedly and without warning, sometimes without a specific trigger. • Obsessive Compulsive Disorder is characterized by obsessions that include rituals like handwashing, counting unnecessarily cleaning, or other routines that serve to calm them. • Post-Traumatic Stress Disorder often includes nightmares, flashbacks, numbing of emotions, being easily startled, or irritability. Usually, it is in response to a traumatic event in their past. • Phobia is an extreme fear to something that doesn’t actually pose an immediate danger. Common phobias can be going outside, using the phone, certain animals, riding in a car, heights, tunnels, and flying. • Generalized Anxiety Disorder is characterized by an ongoing feeling of worry about everyday life and activities. If you see any of these symptoms of anxiety in your loved one, seek reliable medical assistance. Their family doctor may be able to determine if the symptoms are linked to a medication or medical diagnosis. A trained mental health professional can determine the appropriate way to lead them through. ( Mental Health America ) Depression Depression is the condition for which your loved one may least likely seek help. Especially in our older generations, mental health carries a stigma that makes it difficult for people to speak up. Depression can worsen health in people with conditions such as heart disease, diabetes, and stroke, as they become uninclined to care for themselves appropriately. Some indications that your loved one might be depressed are: • Persistent sadness • Recurring thoughts or mentions of self-harm or suicide • Noticeable change in appetite • Withdrawal from previously enjoyed activities • Difficulty sleeping or sleeping too much • Heavy alcohol consumption ( Centers for Disease Control and National Institute of Mental Health ) Dementia Dementia is most often characterized by deterioration in memory, thinking, behavior, and the ability to perform everyday activities. While it largely affects older citizens, dementia is not a normal part of aging. Alzheimer’s disease, the most common cause of dementia, affect 12 million people worldwide. Early diagnosis of Alzheimer’s is becoming increasing possible, due to the sensitive diagnostic tools developed by psychological and medical scientists. Early diagnosis by the doctors in your loved one’s life and understanding the challenges that this condition poses are critical for the path they will follow. Especially when they are initially still cognizant of what is happening to them, dementia can trigger anxiety, depression, or even suicidal thoughts. It is important to no just prepare for the worsening dementia but to treat the current responses and fears as well. ( World Health Organization and American Psychological Association ) Suicidal Thoughts Suicide rates are particularly high among older Americans. Older men have the highest suicide rate of any age group at 45 per 100,000, compared to the rate of 11 per 100,000 for all ages. Those suffering from depression are at greatest risk for suicide. Do not ignore remarks about death or self-harm. If your older family member seems depressed, get them the help that they need. An offhand remark is often a subtle cry for help. Report these comments to your loved one’s doctor and encourage your relative to seek treatment immediately. If there are firearms in the home, remove them as soon as possible. For more advice, call the National Suicide Prevention Lifeline at 800-273-8255. All calls are confidential. ( AARP ) Depression and Suicide Up to 20 percent of older adults and up to 37 percent of nursing home residents suffer from depression. Although older Americans make up 13 percent of the population, they account for 20 percent of the people who commit suicide. Seventy-five percent of older adults who commit suicide have seen their doctor in the past month. ( American Psychological Association ) Depression or Dementia Depression sometimes get mis-diagnosed as dementia, as the older adult with depression may exhibit dementia-like symptoms, such as forgetfulness, disorientation, or inattentiveness. A person with depression will complain about memory loss, while someone with Alzheimer’s disease or other form of dementia will try to conceal it or not even realize they have it.

If your loved one suffers from breathing challenges, they could have COPD (Chronic Obstructive Pulmonary Disease). COPD is not just one disease but an identifier for a group of disease that cause breathing-related problems, including the more commonly known emphysema and chronic bronchitis. In the past, COPD was thought of as primarily a men's disease. This is because it affected smokers and people in jobs where large amount of fumes, dust, or chemicals were inhaled, during a time when fewer women were in the workforce. With more women than men now getting COPD, this is no longer the case. In 2017, COPD became the third leading cause of death for women. If your loved on is having trouble breathing and you have not addressed this with their doctor, now is the time. In the United States, the leading cause of COPD is tobacco smoke. However, exposure to other air pollutants, genetics, and recurring respiratory infections can also play a part. While there might be a genetic component that might make you more likely to get it, it is not contagious. Because there are so many variations in the disease that manifest as COPD, there is no single test for it. There is also no cure, only treatment. Based on symptoms, your doctor will determine a course of treatment. Your medical team may include a pulmonologist and physical and respiratory therapists who will work toward treatments that work best for your loved one. COVID-19 People with COPD are not considered to be at a higher risk of COVID-19. They are, however, at a higher risk of having complications and poorer outcomes should they contract the virus. As with any at-risk community, please follow all guidelines for maximum protection. ( University of Maryland Medical System ) Why More Women than Men? In the 1960s, cigarette ads targeted women. Women's lungs are smaller and estrogen can play a role in worsening lung disease. Because it was previously more of a men's disease, doctors still often misdiagnose or under diagnose women. If you feel your female loved one has been misdiagnosed, advocate for the doctors to take a second look. Early diagnosis and treatment is key. ( American Lung Association ) Symptoms Symptoms are often mild at first, leading people to brush them off. There can be some intermittent coughing or shortness of breath. However, the symptoms will progressively worsen and become harder to ignore. it is time to see the doctor when you see one or more of the following symptoms: Shortness of breath, after even mild exercise such as walking up a flight of stairs Wheezing Chest tightness Chronic cough with or without mucus Need to clear mucus from lungs every day Frequent colds, flu, or other respiratory infections Lack of energy Swelling of the feet or ankles Unexplainable weight loss Symptoms Requiring Immediate Medical Care: Bluish or gray fingernails or lips Confusion or fairness A racing heart ( Healthline ) Treatment While COPD is incurable, it can be treated and managed with great success. Some of the things that a physician may suggest include: Quitting smoking Avoiding secondhand smoke and other pollutants Plenty of fluids Nutritional supplements and eating habits to boost overall health A monitored exercise program Pulmonary rehabilitation Medication, which might include daily and emergency inhalers An annual flu and pneumonia vaccine Quick intervention in the case of flu or other respiratory infections Supplemental oxygen ( Centers for Disease Control and Prevention and Healthline ) Benefits of Quitting Smoking If your loved one is a smoker, they will need to quit to either ward off or manage existing COPD more effectively. ( COPD.com and Medical News Today )