Learn More About Sepsis Screening & Education – It Could Be a Life-Saver

By investing a few minutes, home care clinicians can make a world of difference

by Chris Chimenti, MSPT, ACCH, Senior Director of Clinical Innovation, HCR Home Care

What is sepsis? According to the Centers for Disease Control and Prevention (CDC), “Sepsis is the body’s extreme response to an infection. It is a life-threatening medical emergency! It happens when an infection you already have – in your skin, lungs, urinary tract, or somewhere else – triggers a chain reaction throughout your body. Without timely treatment, sepsis can rapidly lead to tissue damage, organ failure, and death”.¹

The figures are staggering:

• Over 1.6 million people are diagnosed with sepsis each year in the U.S.²
• The risk of death from sepsis increases by 8% every hour treatment is delayed.²
• The onset of sepsis occurs outside of a hospital setting in nearly 80 percent of cases.³

Nurses and therapists working in the home health care setting are uniquely positioned to detect sepsis, and detect it sooner than later with routine screening. Time is of the essence when sepsis begins… it’s an emergent event. Clinicians should educate patients who have an infection or are at risk of infection about the warning signs of sepsis. Family members and anyone involved in the care of the patient should be informed as well.

Who is at risk?

• Children < 1 year old
• Adults 65 and older
• Individuals with an impaired immune system
• Patients with chronic illnesses such as diabetes or cancer

What are the warning signs?

• Confusion or disorientation
• Rapid heart rate
• Shortness of breath
• Hyperthermia or hypothermia
• Shivering
• Sweaty or clammy skin
• Extreme pain

At HCR Home Care, sepsis screening is an integral part of our daily patient assessments. The Home Care Association (HCA) Sepsis Screening Tool⁴ is embedded in our electronic medical record (EMR) system. This standardized instrument streamlines the clinical assessment to promptly identify the critical signs and symptoms of sepsis. Upon completion of the three screening questions, the EMR automatically generates follow-up actions that align with established medical standards.

What are the three items included in the screening tool?

• Active infection or potential source of infection
• Fever, tachypnea, or tachycardia
• Organ dysfunction (e.g., altered mental status, hypotension)

Our nurses and therapists have conducted the standardized sepsis screens during every home visit over the past 12 months. During this time, over 175,000 individual screens have been performed. 141 patients presented with symptoms consistent with severe sepsis and required immediate transport to a local hospital emergency room. During the same time period, another 125 patients met criteria for sepsis and physician notification immediately followed.

At times, sepsis may not be included as a diagnosis in hospital discharge instructions. This may be due to the fact the symptoms associated with sepsis resolved during the hospital stay. According to the Sepsis Alliance, 62 percent of patients who develop sepsis are likely to be re-hospitalized in the subsequent 30 days.² Eliminating potentially avoidable hospitalizations is a critical focus in home health practice today. Awareness of sepsis can make a difference in keeping patients at home and out of the hospital.

Sepsis deserves to be understood, appreciated, and closely monitored. The condition can result from a simple scrape, urinary tract infection, or surgery. Early detection and prompt medical attention are needed to prevent the worst…amputation, organ failure, or death. Be prepared to ask yourself…“could this be sepsis?” You could just make a world of difference for your patient.

References:

¹ What is Sepsis? Accessed on 9/6/18.

² Sepsis Fact Sheet. Accessed on 9/6/18.

³ CDC: Most Sepsis Cases Start Outside A Hospital. Accessed on 9/5/18.

⁴ Stop Sepsis At Home. Accessed on 9/7/18.

 

Additional Resources:

Signs of Infection and Sepsis at Home (Great Plains QIN)

Sepsis Information Guides (Sepsis Alliance)

Stop Sepsis Tools & Resources (Home Care Association of New York – HCA)

Sepsis – It’s About TIME Infographic (sepsis.org)

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September is National Disaster Preparedness Month: Social Determinants, Health Care Coalitions and Disaster Preparedness

by Barbara B. Citarella, RN, MS, CHCE, NHCP-BC, President & CEO, RBC Limited Healthcare & Management Consultants

With Hurricane Florence looming in the Atlantic Ocean, the timeliness of National Preparedness Month (NPM), which is recognized each September, is more important this year than ever before for so many people along the East Coast. This national month-long observance provides an opportunity to remind us that we all must prepare ourselves and our families now and throughout the year. This September will focus on planning, with an overarching theme: Disasters Happen. Prepare Now. Learn How. Health care providers, however, fall into a unique category, much like our emergency responders. They must take care of the community as well as their own families in a disaster. But each community is defined differently and is unique.

The distinctiveness of a community is based on many factors. These factors, many of which are social determinants, affect community resilience. Health care providers, especially home care and hospice, encounter the reality of social determinants on a daily basis. But the correlation between disaster preparedness, social determinants and resilience is relatively new.

Community health care providers (home care and hospice) see and understand the real world patients live in. While responsibility, and in some cases regulations, dictates our role in developing a patient care plan that includes disaster preparedness, it is clear that when a patient is struggling with basic everyday life needs, preparedness activities are not high on the to-do list. Activities such as stockpiling food and water may be impossible for some families who are barely getting by.

What are the social determinants that impact a community’s ability to respond survive and recover from an event?

Social determinants for resiliency are social variables such as health, education, wealth, transportation, and connectivity of a community. These differences make each community unique. As all disasters are handled at the local level, the strength of each community is what impacts the response. Hurricane Katrina helped to paint a clear picture of what happens to those most vulnerable during a disaster. For many people in New Orleans prior to Hurricane Katrina, life was a challenge. It was only when the disaster occurred that those issues presented themselves in a very stark reality.

Action reports from Katrina identified problems with communicating to people who had literacy and language barriers. Many had difficulty understanding information concerning the hurricane, including what to do and where to go. The areas of the city with the weakest economy were hit the hardest. Vulnerable populations struggled to find shelters and appropriate medical care.

Last year was a particularly difficult year for people around the country, and world, with large scale events such as three major hurricanes in the United States, wildfires, earthquakes, Ebola outbreak, the Las Vegas shooting, terrorist attacks with vehicles, floods, and monsoons.

Health care providers and emergency management personnel must have knowledge of the variables in the community, such as unemployment rates, income, population demographics, various cultures, religions, church activities, community activities, crime indicators, opioid addiction statistics, housing capabilities, and yes, even awareness and location of sex offenders. This information is necessary to prepare, respond and recover. This data also helps providers to work effectively as a team with the community emergency responders and health care coalitions. Collaboration like this is imperative to help move people in, up, down and through the impacted area as physical, mental, and social needs change.

Often in the past home care and hospice providers were not a part of the community preparedness activities. During the last few years there has been a significant change. The basis for the change comes in the form of health care coalitions. Health Care Coalitions (HCC) are groups of individual health care and response organizations in a defined geographic location that serve as multi-agency coordinating groups and support and integrate with public health and medical services activities. HCCs play a critical role in developing health care delivery system preparedness and response capabilities. Coalitions have recognized the value of community health workers especially in their ability to provide short term surge capacity as well as location and identification of vulnerable populations. Community health care providers know the geographic area well and can easily move around when roads are blocked. Additionally, their personnel are readily accepted by the community and recognized as providing needed and supportive services to those most fragile and at risk.

As an entity, health care coalitions are involved in strategic planning, operational planning and response, information sharing, resource coordination, and management. Coalitions have the capability to identify the social determinants for their specific geographic location. This is done by engaging all community providers and support groups in a collaborative effort to work together without bias for the betterment of the community. It is only through collaborative leadership that communities will be successful in preparedness, mitigation, response and recovery. All health care providers should reach out to the coalition in their location. You can access a list of all the health care coalitions in the country here.

Health care providers play an essential role in preparedness and response. Remember: Disasters Happen. Prepare Now. Learn How.  

 

Additional Emergency Preparedness Resources:

• Emergency Preparedness Rule website (CMS) includes guidance, examples, FAQs…
  • Emergency Preparedness Rule – Federal Register (CMS)
• Ready.gov
• Hurricane Information Sheet (FEMA)
• Wildfire Information Sheet (FEMA)
• Flood Information Sheet (FEMA)
• Extreme Heat Information Sheet (FEMA)
• Emergency Preparedness Basic Surveyor Training Course (CMS)
• Preparing for Winter Weather: What to Have in Case of Emergency  (MyHHQI Blog)

National Immunization Awareness Month – The Importance of Adult Vaccination

written by the Centers for Disease Control and Prevention

Vaccines provide protection for everyone!

August is National Immunization Awareness Month. As a health professional, it’s an opportune time to remind adults about getting their vaccines. Each year thousands of adults in the US get sick from diseases that could be prevented by vaccines. Unfortunately, adult vaccination rates are low.

What vaccines do adults need?

The Centers for Disease Control and Prevention (CDC) recommends several vaccines for adults based on age, health condition, occupation, lifestyle, and other risk factors.

• Seasonal influenza (flu) – for all adults
• Tdap (Tetanus, diphtheria, and pertussis)
  • For health care professionals and anyone having close contact with a baby younger than 12 months
  • Pregnant women should get a dose of Tdap during every pregnancy
  • A Td booster should be given to adults every 10 years after Tdap vaccination.
• Pneumococcal disease – for adults 65 years and older, and adults younger than 65 with certain conditions that weaken their immune system
• Shingles – for adults 50 years and older

Adults may also need vaccines to protect against human papillomavirus (HPV)— which can cause certain cancers, meningococcal disease, hepatitis A, hepatitis B, measles, mumps and rubella (MMR).

When traveling internationally, CDC recommends adults receive the recommended vaccines based on their destination.

The flu vaccine remains the best protection from flu

Most people who get the flu will have mild illness, will not need medical care or antiviral drugs, and will recover in less than two weeks. Some people, however, are more likely to get flu complications that can result in hospitalization and sometimes death. Pneumonia, bronchitis, sinus infections and ear infections are examples of flu-related complications. Vaccination can keep people from getting sick with flu, and it may also make illness milder for people who do get the flu. A 2017 study showed that flu vaccination reduced deaths, intensive care unit (ICU) admissions, ICU length of stay, and overall duration of hospitalization among hospitalized flu patients. 2017-2018 was a high severity flu season with record-breaking levels of influenza-like illness and hospitalization rates. CDC estimates that the 2017-2018 flu vaccine reduced the risk of getting sick and having to see a doctor from flu by about one-third.

Promote the new shingles vaccine for adults!

Shingles is a painful rash illness which sometimes leads to long-term nerve pain. CDC recommends adults age 50 or older get vaccinated with the new shingles vaccine, Shingrix.

There are several reasons to get vaccinated with Shingrix:

• Previous infection with chickenpox puts adults at risk for shingles.
• More than 99 percent of Americans born before 1980 have had chickenpox, even if they don’t remember it.
• About 1 in 10 people who get shingles develop nerve pain that lasts for months or years after the rash goes away. This is called postherpetic neuralgia and is the most common complication of shingles.
• Shingles may lead to other serious complications involving the eye, including blindness. Very rarely it can also lead to pneumonia, hearing problems, brain inflammation (encephalitis) or death.
• The risk of shingles and its complications increases with age.

Adults 50 years and older need two doses of Shingrix. They should receive the second dose two to six months after getting the first dose. They may have already received a different shingles vaccine called Zostavax. If they did, they still need two doses of Shingrix.

Shingrix is more than 90 percent effective at preventing shingles and long-term nerve pain. You may experience some short-term side effects because Shingrix causes a strong response in your immune system. The pain from shingles can last a lifetime, while the side effects from the shot should only last a few days.

Recommend pneumococcal disease vaccine for your older patients and coworkers

Each year in the United States, pneumococcal disease causes thousands of infections, such as meningitis, bloodstream infections, pneumonia, and ear infections. Most pneumococcal deaths in the U.S. occur in adults, yet 8 out of 10 adults with increased risk conditions remain unvaccinated. Four out of 10 adults age 65 or older are unvaccinated. The best way to prevent pneumococcal disease is to get the vaccine. Recommend pneumococcal vaccination for all adults 65 years or older and adults younger than 65 with chronic illnesses or conditions that weaken the immune system.

The importance of vaccination for people with chronic health conditions

Adults with certain chronic conditions are more likely to develop complications, including long-term illness, hospitalization and even death, from certain vaccine-preventable diseases. Here are vaccine recommendations for adults with these chronic conditions:

• Heart Disease – CDC recommends people with heart disease get a yearly flu vaccine. They should also get a pneumococcal vaccine once as an adult before 65 years of age and then two more doses at 65 years or older.
• Lung Disease – CDC recommends people with asthma, COPD, or other conditions that affect the lungs get a yearly flu vaccine. They should also receive a pneumococcal vaccine once as an adult before 65 years of age and then two more doses at 65 years or older.
• Diabetes – CDC recommends people with diabetes get a yearly flu vaccine and a hepatitis B vaccine series if they’re between the ages of 19 and 59. If they are 60 years or older, they should consult their doctor to see if they should receive hepatitis B vaccine. Pneumococcal vaccines are also recommended for people with diabetes once as an adult before 65 years of age and then two more doses at 65 years or older.

What are some recommendations for improving adult vaccination rates?

Most adults are not aware that they need vaccines. As a health care professional, a strong recommendation is a critical factor that affects whether your patients get vaccinated. CDC suggests using the SHARE method to make a strong vaccine recommendation and provide important information to help patients and coworkers make informed decisions about vaccinations:

• S: SHARE the reasons why vaccines is are an important defense against certain preventable diseases.
• H: HIGHLIGHT positive experiences with vaccines (personal or in your practice), as appropriate, to reinforce the benefits and strengthen confidence in vaccination.
• A: ADDRESS patient questions and any concerns about vaccines, including side effects, safety and vaccine effectiveness in plain and understandable language.
• R: REMIND patients that vaccines can protect them and their loved ones from serious illness and disease-related complications.
• E: EXPLAIN the potential costs of getting certain illnesses, including serious health effects, time lost (such as missing work or family obligations) and financial costs.

Did you know health care workers are at risk for exposure to serious, sometimes deadly diseases?

Health professionals who handle materials that could potentially spread infection should get the recommended and appropriate vaccines to reduce the chance of getting or spreading vaccine-preventable diseases. Health care workers can protect themselves, their patients and family members by making sure they are up-to-date with recommended vaccines.

Each year, thousands of adults needlessly suffer illness, are hospitalized, and even die as a result of vaccine-preventable diseases. As a health professional, you can increase awareness about the importance of adult immunization and encourage vaccination. Share fact sheets that can help adults understand why vaccination is so important, and which vaccines are recommended for them. CDC also has posters and flyers that can be used to encourage adult vaccination. With your help, we can improve vaccination rates and ensure that adults have the best protection against many diseases.

 

RESOURCE ALERT!

The Home Health Quality Improvement (HHQI) National Campaign provides many tools and resources to support immunizations, including:

• Immunization & Infection Best Practice Intervention Package
• 10 Common Flu Myths
• Immunization:  Your Strongest Defense (patient video)

Summer Heat and the Risks for Seniors

by Misty Kevech, HHQI RN Project Coordinator

As we enter into the “Dog Days of Summer,” we have seen triple-digit temperatures across a large portion of the U.S. Seniors are at high risk for heat stress, especially related to sudden changes in temperatures. Summer heat also produces violent storms that can disrupt electricity resulting in the lack of air conditioning or fans for cooling.

(CDC, 2017)

The Centers for Disease Control and Prevention (CDC) recommends keeping seniors cool and hydrated. Work with patient and family to have an emergency action plan for excessive heat days or power outages.

• Stay in air-conditioned buildings. Teach patients that fans don’t work well in the heat as their main cooling system.
  • Have a backup location list, if needed, such as:
    • Home of a friend or family member
    • Local cooling shelter
  • Discuss transportation needs, if applicable.
• Be proactive in drinking non-caffeine fluids even before feeling thirsty, unless patient is on fluid-restrictions.
  • Ask practitioner about specifics for fluid restriction during hot weather.
• Avoid using the stove or oven for cooking.
  • Consider microwave, cold foods, or if able, have food delivered from restaurant.
• Wear loose, lightweight, light colored clothing like cottons.
  • Try to wear shoes that are well-ventilated and socks that repel perspiration.
  • Foot powders and antiperspirants can also assist with sweating even the feet
• Take cool showers or baths.
  • If unable, use cool washcloths to exposed body parts.
• Avoid a lot of activity and get plenty of rest.
• Arrange a system for the patient to be checked on either by family, friends, or neighbors.
  • This could be a phone call.
  • Engage the patient to check on his/her friend and they can do the same in return.

Medications are a concern in the summer heat too. The elderly have other medical problems and medications that can affect the body’s response to the hot temperatures.

• Antihistamines and anticholinergics, often found in allergy and cold medicines, can decrease the body’s ability to sweat and cool the body’s temperature.
• Antipsychotics affects the brain center where body temperature is regulated.
  • Patient brochure: Summer Health and Sun Risks for Antipsychotic Medication Users (State of NJ Division of Mental Health and Addiction services)
• Beta-blockers, ace receptor blockers, ace inhibitors, and calcium channel blockers slow the heart beat and reduce blood pressure. This makes it more difficult for the body to rid the skin of heat.
• Ephedrine, amphetamines, and cocaine increase the body’s metabolism and internal body temperature, as well as constricting the blood vessels.
• Other medications such as diuretics can cause dehydration.

Medication storage should be evaluated during the hot weather. Drug manufacturers recommend that most prescribed and over-the-counter medications should be stored in a temperature controlled room between 58 and 86 degrees. Heat and moisture can alter the effectiveness of the medication.

Smith-Caldwell Drug Store provides a few tips on summer storage:

• Store your medication in a low-humidity, low temperature location and also out of reach of children.
  • Consider:
    • Cabinet in kitchen not near the stove or oven
    • Linen closet
    • If traveling with medication, keep in a purse or a small cooler or tote
  • Avoid:
    • Medicine cabinets in the bathroom (too much humidity)
    • Cabinets near the stove and oven
    • On top of the refrigerator (motor generates heat)
    • Leaving medication in a car

Take actions by educating seniors on the signs of heat stress or heat stroke and what to do about it. Consider providing a copy of the CDC’s Warning Signs & Symptoms of Heat-Related Illness handout for your elderly patients, family, or friends. This tool is similar to a ZONE tool with a column of signs and symptoms and then a column for actions. Involve patient’s families to check on their relatives often during this time of the year, and know what to look for and what to do.

Help seniors enjoy or survive the “Dog-days of summer.” Be safe and cool!

 

Resources: 

• American Heart Association (AHA). (2017). Protect your Heart in the Heat.
• Centers for Disease Control and Prevention (CDC). (2017). Heat and Older Adults.
• CDC. (2017). Tips for Preventing Heat-Related Illness.
• health enews (2016). Some widely used medications may put you at risk for heat stroke.
• Smith-Caldwell Drug Store. (2015). Storing medications:  Why you have to take special precautions during the summer.

Preventing Strokes in the Elderly

by Matthew Boyle, COO, Landmark Senior Living

In part two of my blog focused on stroke education, I will discuss things people can do to reduce their chance of stroke.

While you can’t reverse the advancement of age, you can take several precautionary measures to ensure that risk of stroke is severely lessened. If you know that you may be more susceptible to a specific cause of strokes, you should work with a licensed medical professional to develop a plan that addresses this.

Here are the most common causes and preventative measures for strokes:

• High Blood Pressure
• Frequent Tobacco Usage
• Heart Disease
• Diabetes
• High Weight and Infrequent Exercise
• Blood Thinning Medication
• Old Age
• Family History

Preventative Measures: Strokes are a reality for many over the age of 65, but not inevitable. Here are several ways you can significantly reduce your chances of stroke as an elderly person.

Lower Blood Pressure: High blood pressure is the number one leading contributor to strokes in adults. Doctors recommend maintaining a blood pressure of less than 135/85 to be safe. If this is too aggressive, a goal closer to 140/90 may be suitable. Having a lower blood pressure not only reduces your chance of stroke, but increases your overall heart health significantly. You can reduce your blood pressure by reducing salt intake, avoiding high cholesterol foods, eating fruits and veggies, getting more exercise, and quitting smoking.

Lose Weight: Obesity is a significant factor directly related to strokes. If you’re overweight, losing as few as 10 pounds can have a real impact on your risk of stroke. Following a better health and fitness for seniors regimen  is the first step to lowering your weight. However, having a balanced, moderated diet is the best way to ensure you lose weight. Doctors recommend eating no more than 1500-2000 calories per day, and making exercise, even if its low intensity, a daily habit.

Avoid Drinking: Drinking alcohol in extreme moderation is good for you, but as most people know, anything outside of 1-2 per day does nothing good for your health. Your goal for lowering risk of stroke should be to aim for little to no alcohol consumption. If you do drink, pick up the red wine, and keep it to 1-2 glasses per day. For reference, a standard sized drink is a 5 ounce glass of wine, 12 ounce beer, or 1.5 ounce of hard liquor.

Quit Smoking: Smoking raises your risk of stroke because it contributes to plaque build up and thickens the blood. Quitting smoking can also raise your overall health and fitness, which will contribute to lowering your chance of stroke. Quitting smoking is one of the best options to preventing a stroke in the elderly.

At Landmark Senior Living, our goal is to create the utmost in independent living for every one of our senior housing residents. Our independent living program is tailored to each individual’s needs and includes robust daily exercise, yoga, & strength training classes available for seniors to become as healthy as possible. Our broad range of activities and events will help you to take care of your mental and physical health.

 

To read part one of this blog, Stroke 101: What is a Stroke and What Are the Signs, please click here.

Stroke 101: What is a Stroke and What Are the Signs

by Matthew Boyle, COO, Landmark Senior Living

Currently in the United States, every 40 seconds someone suffers from a stroke. This translates to nearly 800,000 people per year, of which 140,000 result in death. Given our country’s propensity for fast food and bingeable TV programs, this isn’t that surprising. However, we should be considering that this speaks volumes about our healthcare and culture. Strokes are now the third leading cause of death in the country, but it’s also one of the most preventable. Strokes are usually induced by people who have high blood pressure, smoke or chew tobacco, or who have diabetes.

However, the most at risk population for strokes are our elderly. Nearly three quarters of all strokes occur in people over the age of 65. In fact, risk of stroke increases twofold every decade after the age of 55. In honor of National Stroke Awareness month, we’d like to share some helpful information on what a stroke is, what causes strokes, and how to prevent a stroke from happening for an elderly person.

What is a Stroke?

A stroke is what occurs when the blood flow to the brain gets cut off. Similar to a heart attack, you can think of strokes like “brain attacks”. When the brain cells that need oxygen are deprived of this vital blood flow, will shut off and die. A stroke is a serious occurrence because the death of brain cells can immobilize the victim and possibly result in permanent brain damage. There are two types of strokes.

Ischemic Stroke

An ischemic stroke is similar to a heart attack in that a clot forms in the blood vessels surrounding the brain. These can also occur when too much plaque from fatty deposits and cholesterol block blood vessels. Ischemic are the most common type of stroke and account for 80% of all strokes.

Hemorrhagic Stroke

This type of stroke occurs when a blood vessel in the brain breaks open. This rupture leads to blood seeping on to brain tissue, which can cause damage to brain cells. Hemorrhagic strokes typically occur because of high blood pressure, or aneurysm, which is a thinness in the walls of a blood vessel.

The effects of the stroke depend on where the stroke occurs in the brain. Some areas control motor function and some control memory, so stroke victims may experience temporary or permanent loss of mobility in a portion of their body, or lose the ability to speak. Some people recover from strokes without permanent damage, but more than ⅔ of stroke victims continue with some sort of disability. It’s important to recognize the signs of a stroke so you can treat it as quickly as possible.

Signs of a Stroke

Knowing the signs of a stroke can save a life and prevent lasting brain damage. The sooner you can get treatment for a stroke, the better chances you have of saving brain cells and preventing further damage to the brain. A helpful acronym for knowing when to call emergency services is FAST.

Other common signs and characteristics are:

1. Onset weakness or paralysis of half or part of the body
2. Numbness on one half or part of the body
3. Sudden change in level of awareness
4. Partial vision loss
5. Double vision
6. Sudden severe headache with no known cause
7. Difficulty speaking or understanding speech
8. Unbalance and vertigo

If you suspect or are unsure if someone may be having a stroke, it is wise to call 9-1-1 anyway. However, the safest method is to use preventative guidelines to make sure you never have a stroke in the first place. There are plenty of healthy tips and tricks you can use to reduce your chances of stroke, but there is no guarantee that you will never have one, especially if you have a family history of high blood pressure or strokes.

Visit the MyHHQI Blog page for part two of this blog,  Preventing Strokes in the Elderly, to learn more about preventative measures seniors can take to reduce their chance of stroke.

During National Women’s Health Week, Honor Your Own Health

10 Tips for Good Health in Later Life

by HealthinAging.org

National Women’s Health Week (May 13-19, 2018) is a perfect reminder to female healthcare providers to practice what we preach. As caregivers and as women who serve our communities’ health, we all too often focus on the health needs of others before our own. In the immortal words of every flight attendant, “Put on your oxygen mask before assisting others.” Meaning, of course, that if you’re neglecting your own well-being, it will be difficult for you to help your clients and loved ones.

And as we age, it becomes increasingly important to monitor our health. That’s because older women are more likely than men to have chronic health conditions, including arthritis, high blood pressure and osteoporosis.

Happily, a great deal of what it takes to boost your chances for staying physically and mentally healthy is within your power. Below is what the experts with the American Geriatrics Society’s Health in Aging Foundation recommend.

See your healthcare provider regularly. Even if you feel perfectly healthy, get a check-up at least once a year, or as often as your provider recommends.

Take medications, vitamins and supplements only as directed. When you visit your provider, bring all the pills and other supplements you take—even those you buy over the counter without a prescription. Your provider should check all of your pills to make sure they’re safe for you, and you should check with her before taking any new medication or supplement.

Let your provider know right away if a medication or supplement seems to be causing a problem or a side effect.

Get screened. Certain screening tests can help diagnose health problems early. Ask your healthcare provider which tests are right for you.

Get vaccinated. Check with your healthcare provider to make sure you’re getting:

• A flu shot every year in late summer or early fall before the flu season begins.
• Pneumonia vaccine: there are two types available now, called pneumococcal conjugate vaccine (PCV) 13 and pneumococcal polysaccharide vaccine (PPSV) 23. Talk to your healthcare provider.
• A tetanus shot every 10 years.
• The shingles (herpes zoster) vaccine: once after age 50 or older.

Reduce falls and fracture risks. Take 1,200 to 1,500 mg of calcium and 800 to 1,000 IU of vitamin D daily. Do weight-bearing exercises such as walking, jogging, and aerobic dancing. If you’ve fallen in the past, ask your healthcare provider about exercise programs in your area that include strength training, balance and stretching exercises.

Use sunscreen daily. As skin ages, it becomes more susceptible to sun damage—and that boosts risks for skin cancer. Use sunscreen all year round on exposed skin, and wear a wide-brimmed hat for added protection.

Quit smoking. Tell your healthcare provider about your smoking habits and enlist his/her aid to help you stop. For additional help, call 1-800-QUITNOW. It’s never too late to stop smoking.

Eat a rainbow. Later in life you need healthy foods but fewer calories. Visit the USDA’s updated Choose My Plate for older adults to learn what a healthy diet looks like. Suggestions include:

• Eat at least five servings of fruits and vegetables daily (less than 1/3 of older adults do this). Select a variety and choose the deepest colors—dark green leafy vegetables, orange fruits and vegetables, and blue and purple vegetables, too. Choose fiber-rich whole grain breads, pasta and rice instead of the white stuff. Pick lean meats and avoid processed meats and cold cuts.
• To keep your bones strong, enjoy two daily servings of low-fat milk, cheese and yogurt.
• Try to eat twice-weekly servings of heart-healthy fish, like tuna, salmon, sardines or mackerel.
• Use healthier fats, such as extra virgin olive oil or canola oil instead of butter or lard.
• Drink responsibly. Some—but not all—women may benefit from one alcoholic drink a day. Check with your healthcare provider to make sure this is right for you. Remember, one drink equals 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of hard liquor.

Exercise your mind and body. Regular exercise is essential for good health at any age. It improves heart health and circulation, strengthens bones, helps keep the pounds off, lifts your mood and can help ease depression. Talk to your doctor about an exercise program that’s right for you.

Get involved. Social involvement is a key to staying healthy and happy as we age. Sign up for a class, do puzzles, find an interesting hobby or club. Challenge your brain by trying new things.

For more information and tips for staying healthy as we age, visit HealthinAging.org, a website created and managed by the American Geriatrics Society’s Health in Aging Foundation.