Month: February 2023

Part 1 of a two-part series on making decisions about driving as we age. Read Part 2 here. 

When my grandmother repeatedly clipped the mailbox backing out of her driveway, she always had a ready explanation: "the sun was in my eyes" or "your grandfather distracted me." Our family knew we needed to take action. But no one wanted to be the one to ask her to stop driving. She was fiercely independent, didn't agree that her driving was a problem, and didn't appreciate our concerns.

Maybe there's a similar story unfolding in your family. Or maybe you're starting to wonder about your own skills. As part one in a two-part series, this post aims to help people understand red flags to watch for, and why driving abilities change as people age. It also describes a few ways to improve impaired driving, and challenges to navigate.

A second post will address ways to strike a balance that respects dignity — and safety — while providing action plans for older drivers and their families.

How safe are older drivers on the road?

Unsafe drivers can be any age, particularly when drinking is involved. But fatal traffic accidents have risen in both young drivers and older drivers, according to data from the National Safety Council:

• Fatalities occurring in crashes involving a driver ages 15 to 20 rose nearly 10% between 2020 and 2021, accounting for 5,565 deaths.
• Among drivers 65 or older, fatalities rose 15% between 2020 and 2021, accounting for more than 8,200 deaths.

While younger drivers may be inexperienced or more likely to be distracted or reckless, older drivers often overestimate their driving abilities. That may be one reason many unsafe older drivers continue to drive despite failing driving skills.

Per mile driven, the rate of motor vehicle accidents is higher for drivers ages 80 and older than for almost every other age group, according to the Insurance Institute for Highway Safety. Only the youngest drivers have higher rates. And the rate of fatal motor vehicle accidents per mile driven is higher for drivers aged 85 and older than for every other age group.

These statistics reflect the reality that an older driver may not be the only one injured or killed in a crash — occupants in one or more vehicles may be, too. And then there are pedestrians and cyclists at risk.

Clearly, the stakes are high when any unsafe driver is on the road. For older drivers with waning driving skills, it's important to recognize the problem and understand why it's happening. The following four steps are a good start.

1. Seeing any red flags?

As people get older, driving skills may decline so slowly that it's not obvious worrisome changes are happening. Even when mishaps and near-misses occur, there are so many possible contributors — especially other drivers — that it may not be clear that the older driver was at fault.

Red flags that might mean an older person is an unsafe driver include:

• concerned comments from family or friends
• reluctance of others to ride with them
• input from other drivers (why is everyone honking at me?) or traffic authorities (why am I getting all these traffic tickets?)
• getting lost on familiar roads
• consistently driving too slowly or too fast
• unexplained dents or scratches appearing on the car
• frequent accidents or near-misses.

2. Why do driving skills tend to wane with age?

While people of advanced age can safely drive (and many do!), driving skills may wane due to:

• medical conditions, such as arthritis, neuropathy, or dementia
• medications, such as sedatives or certain antidepressants
• age-related changes in reaction time
• trouble with vision or hearing
• other physical changes related to aging, such as less flexibility or strength
• difficulty processing rapidly changing information. For example, an older driver may be more likely than a younger driver to accidentally press the gas pedal instead of the brake when needing to stop suddenly.

3. What can — and can't — be reversed to improve driving?

Some changes that impair driving can be reversed or a workaround can be found. For example, if driving is impaired due to cataracts, cataract surgery can restore vision and improve driving. If night driving is difficult, it's best to drive only during the day. If memory problems are starting to arise, it may still be possible to drive safely in more limited circumstances.

Driving problems due to advanced dementia or a major stroke affecting judgment and physical skills are much less likely to improve.

4. Accept that conversations about not driving are challenging

If there is no simple way to reverse or work around declining driving skills, accept that there will be many challenges to navigate, whether you're the older driver or a family member.

Challenges facing the driver:

• It's not easy to acknowledge declining function. Driving impairment is an unsettling milestone, an indication that the future may include further loss of abilities.
• It can feel unnecessary and unreasonable. Most older folks facing a decision about whether it's safe to continue driving were good drivers not so long ago. They may still see themselves as competent drivers, and see efforts to restrict their driving as overly cautious or demeaning.
• Denial and defensiveness are common. Even when all the signs are there, it may be tempting for a poor driver to deflect blame (for example, blaming other drivers).
• Not driving is a loss of independence. Sure, there are other ways to get around and nondrivers can certainly be independent. But few alternatives rival the independence that comes with being able to drive yourself. And, depending on where you live, public transportation or other alternatives to driving may be limited.

Challenges facing the family:

• Often, the older driver doesn't share their family's concerns about driving safety. This can lead to arguments, confrontation, and resentment.
• The safety of others is at stake. The older driver with waning skills may endanger many people besides themselves: passengers in their care, other drivers and their passengers, cyclists, and pedestrians.
• It's hard to know when the time is right. Speaking up too soon may lead to unnecessary restrictions on a loved one's favored means of transportation, not to mention family strife. Waiting too long can lead to avoidable tragedy.

Finding a path forward

As for my grandmother, none of us knew what to say. Should we try to get her to agree to stop driving entirely or let her ease into the idea over time? Maybe she could stop driving at night or limit her driving to short distances. Should we bring it to the attention of her doctor and let them direct the next steps? Or should we take an even harder step and report her to the authorities?

If you're asking similar questions — or if you're starting to wonder about your own driving abilities — you may feel strongly that it's important to respect individual preferences, dignity, and independence. Yet you also want to protect everyone from harm.

What are the best ways to strike a balance? Can you test and improve how an older driver is doing behind the wheel? Can you navigate tough conversations in ways that allow room for both independence and safety? These are the subjects to be tackled in Part 2.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Small animals like turtles, iguanas, and frogs are often chosen as first-time pets for children because they are easy to interact with and low maintenance for busy households. While they can be fun, it may be best to avoid them.

The reason? “Reptiles and amphibians can carry germs that make people sick, the most common of which is the Salmonella bacteria,” says Dr. Elizabeth Hohmann, an infectious disease expert with Harvard-affiliated Massachusetts General Hospital. “These animals live in warm and wet environments where Salmonella thrives.”

Outbreaks of illness across the US

Reptiles and amphibians often carry Salmonella in their digestive tracts, although the bacteria doesn’t affect them. The risk of illness from these pets became so severe this year that the CDC warned about adopting tiny pet turtles after reported outbreaks of Salmonella illnesses and hospitalizations in 24 states. (Other small pets such as mice or hamsters, and farm animals like chickens, may also carry and spread the bacteria.)

How is the bacteria transferred from pets to children and adults?

People become exposed to Salmonella through physical contact with the animals, their droppings, food, items like toys or food dishes, and habitats such as cages, tanks, aquariums, and water.

“They get the bacteria on their hands and then inadvertently touch their mouths or nose,” says Dr. Hohmann. This is especially likely in younger children.

Once exposed to the bacteria, people can get an infection called salmonellosis.

Who is more likely to get sick?

Anyone can get salmonellosis, but children younger than age 5, adults 65 and older, and people with chronic conditions are at higher risk for severe illness and even hospitalization.

“Kids that are very young don’t always follow proper personal hygiene or understand safety protocol when handling these animals,” says Dr. Hohmann. “Older adults and people with chronic conditions like diabetes can have weakened immune systems that make them more susceptible to illnesses.” In the most serious cases, the bacteria can reach the bloodstream and from there infect other places within the body.

What are the symptoms of this infection?

The hallmarks are diarrhea, fever, and abdominal cramps. These symptoms usually appear within six hours to four days after infection and last about four to seven days.

Call your pediatrician or primary care team for advice if you have a pet that potentially carries Salmonella.

When should you seek immediate medical care?

Seek medical care immediately if you or your child have any of these severe symptoms:

• diarrhea and a fever higher than 102° F
• diarrhea for more than three days that is not improving
• bloody diarrhea
• so much vomiting that you cannot keep liquids down
• signs of dehydration such as not urinating much, dry mouth and throat, or feeling dizzy when standing up.

What if you already have a pet turtle?

If you already have a pet turtle or similar high-risk pet, make sure everyone follows these safety steps from the CDC. Children may need frequent reminders about washing hands and playing safely.

Wash hands. Always wash hands for at least 20 seconds with plenty of soap and warm water right after touching or feeding your pet, and after handling or cleaning the area where it lives and roams. “Adults should make sure to teach young children how to wash their hands properly,” says Dr. Hohmann.

Play safely. Don’t kiss or snuggle the pet, and don’t eat or drink around it. Keep it out of the kitchen and other areas where you eat, store, or prepare food.

Properly clean. Use cleaning materials like a wash tub, sponge, and scrub that are reserved only for your pet. Always clean cages, tanks, and other pet items outdoors. Avoid using a kitchen sink, as this can increase the risk of spreading germs to your food.

But perhaps the best safety advice is to simply avoid these animals as pets — or at least wait until your kids are much older, says Dr. Hohmann. “It’s probably safer to stick with dogs and cats.”

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

You may have heard recent news reports about a company that knowingly sold defective lead testing machines that tested tens of thousands of children between 2013 and 2017. Or wondered about lead in tap water after the widely reported problems with lead-contaminated water in Flint, Michigan. Reports like these are reminders that parents need to be aware of lead — and do everything they can to keep their children safe.

How is lead a danger to health?

Lead is poisonous to the brain and nervous system, even in small amounts. There really is no safe level of lead in the blood. We particularly worry about children under the age of 6. Not only are their brains actively developing, but young children commonly touch lots of things — and put their hands in their mouths. Children who are exposed to lead can have problems with learning, understanding, and behavior that may be permanent.

How do children get exposed to lead?

In the US, lead used to be far more ubiquitous than it is now, particularly in paint and gas. Yet children can be exposed to lead in many ways.

• Lead paint. In houses built before 1978, lead paint can sometimes be under other paint, and is most commonly found on windowsills or around doors. If there is peeling paint, children can sometimes ingest it. Dust from old paint can land on the floor or other surfaces that children touch with their hands (and then put their hands in their mouths). If there was ever lead paint on the outside of a house, it can sometimes be in the dirt around a house.
• Leaded gas. While leaded gas was outlawed in 1996, its use is still allowed in aircraft, farm equipment, racing cars, and marine engines.
• Water passing through lead pipes. Lead can be found in the water of older houses that have lead pipes.
• Other sources. Lead can also be found in some imported toys, candles, jewelry, and traditional medicines. Some parents may have exposure at work or through hobbies and bring it home on their hands or clothing. Examples include working in demolition of older houses, making things using lead solder, or having exposure to lead bullets at a firing range.

What can parents do to protect children from lead?

First, know about possible exposures.

• If you have an older home, get it inspected for lead if you haven’t done so already. (If you rent, federal law requires landlords to disclose known lead-based paint hazards when you sign a lease.) Inspection is particularly important if you are planning renovations, which often create dust and debris that increase the risk of exposure. Your local health department can give you information about how to do this testing. If there is lead in your home, don’t try to remove it yourself! It needs to be done carefully, by a qualified professional, to be safe.
• Talk to your local health department about getting the water in your house tested. Even if your house is new, there can sometimes be older pipes in the water system. Using a water filter and taking other steps can reduce or eliminate lead in tap water.
• If you have an older home and live in an urban area, there can be lead in the soil. You may want to have the soil around your house tested for lead. Don’t let your child play in bare soil, and be sure they take off their shoes before coming in the house and wash their hands after being outside.
• Learn about lead in foods, cosmetics, and traditional medications.
• Learn about lead in toys, jewelry, and plastics (yet another reason to limit your child’s exposure to plastic).

Second, talk to your pediatrician about whether your child should have a blood test to check for lead poisoning. The American Academy of Pediatrics recommends:

• Assessing young children for risk of exposure at all checkups between 6 months and 6 years of age, and
• Testing children if a risk is identified, particularly at 12 and 24 months. Living in an old home, or in a community with lots of older homes, counts as a risk. Given that low levels of lead exposure that can lead to lifelong problems do not cause symptoms, it’s always better to be safe than sorry. If there is any chance that your child might have an exposure, get them tested.

How is childhood lead exposure treated?

If your child is found to have lead in their blood, the most important next step is to figure out the exposure — and get rid of it. Once the child is no longer exposed, the lead level will go down, although it does so slowly.

Iron deficiency makes the body more vulnerable to lead poisoning. If your child has an iron deficiency it should be treated, but usually medications aren’t used unless lead levels are very high. In those cases, special medications called chelators are used to help pull the lead out of the blood.

For more information, visit the Centers for Disease Control and Prevention website on lead poisoning prevention.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

Once babies are a year old, those who have been drinking infant formula don’t need it anymore. By that age, they can and should get most of their nutritional needs met by solid foods. Drinking cow’s milk, or a fortified plant milk such as soy milk, is perfectly fine. And honestly, they don’t even need that much of it.

A 2023 report from the American Academy of Pediatrics (AAP) looked closely at what toddlers actually need for healthy growth and development — and toddler milks didn’t make the cut. Here are a few key takeaways for parents.

Is toddler formula more nutritious than milk?

No. But for some parents, it feels odd and uncomfortable to stop formula and give cow’s milk. They feel like formula is more nutritious and maybe even more easily digested. That may not be surprising: a lot of marketing money has encouraged people to think this way.

So it’s understandable that some parents turn to formulas marketed for toddlers. It’s especially understandable given the claims that formula companies make about the nutritional advantages of toddler formula. You may have seen — or bought — these products marketed purely as “follow-up formulas,” “transition formulas,” or “growing-up milks.” These formulas do not have a medical purpose. They simply help companies keep the customers they would otherwise lose once babies turn a year old.

Not only are toddler formulas unnecessary, some of them are actually worse than cow’s milk. That’s the main message shared by the AAP, which hopes to help parents understand what older infants and toddlers actually need — and see through the marketing claims.

Do some toddlers need specialized formulas?

Yes. Just to be clear, I am not talking about specialized formulas for children over 12 months who have digestive, metabolic, or other medical problems.

Are toddler formulas regulated in any way?

No. Because infant formulas must meet all the nutritional requirements of babies less than 12 months of age, they are regulated by the FDA. The FDA has requirements about what they must and must not contain, and it makes sure that the facilities where infant formulas are made are regularly inspected.

This is not true of toddler formulas. They are not regulated, and not required to prove any of the claims they make about their nutritional benefits.

What might make a toddler formula unhealthy?

Given the lack of regulation, it’s not surprising that there is wide variation in the composition of toddler formulas. But what is particularly worrisome, says the AAP, is that some of these products are actually unhealthy. They may have too little or too much protein, or have added sweeteners. These added sweeteners can build a child’s “sweet tooth” and set them on the path to obesity.

Additionally, toddler formulas are more expensive than cow’s milk, creating a financial burden for families — one that is definitely not worth it.

Is your toddler’s diet healthy?

Instead of reaching for a toddler formula, try to take a broader look at your child’s diet. Toddlers should eat from the same healthy food groups we all need. This includes

• fruits and vegetables
• whole grains
• protein (such as meat, fish, beans, and nut butters)
• dairy or dairy substitutes fortified with calcium and vitamin D.

Limit added sugars, and after age 2 try to limit less-healthy fats in the child’s diet as well. The best way to build healthy lifetime habits is to start early, and this is particularly true of nutrition.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

Most people want to age in place and live at home for as long as possible: according to an AARP survey, three-quarters of people 50 and older are hoping to do so.

But managing this successfully may mean hiring outside help, such as health aides who can assist you with daily activities that have become challenging. You might wonder when exactly it will make sense to seek that service. How will you know when it’s time? What can aides do for you? What are the costs and how can you make the most of their help?

Is it time to hire in-home help?

An easy way to know if it’s time for outside help is if your health takes a sudden turn for the worse — perhaps as the result of a fall that affects your mobility. But more often, the need for professional assistance at home isn’t so obvious. It develops gradually, as certain abilities — such as cooking, cleaning, or driving — become more difficult.

Even if you’re busy, happy, and able to do your own tasks and errands now, there may come a time when the balance shifts and daily activities become challenging.

“A lot of times these observations are made by family members or friends, and they start the discussion about getting help,” says Dr. Suzanne Salamon, associate chief of gerontology at Harvard-affiliated Beth Israel Deaconess Medical Center.

Start here: Ask yourself hard questions

You don’t have to wait until family and friends urge you to get outside help. Dr. Salamon recommends that you periodically assess your abilities and how well you’re managing on your own.

For example:

• Is it harder to get in and out of the bathtub because of muscle weakness or balance problems?
• Has driving become difficult because of vision changes, arthritis, or other reasons?
• Are you keeping up with your medication regimen, or are you sometimes not sure if you’ve taken pills?
• Are cooking and cleaning becoming much more of a chore than they used to be?
• Do you find grocery shopping or errands a little overwhelming?
• Do you need help bathing or getting dressed?

Be honest about the answers, and let your needs be your guide. “You might not need a home health aide yet. Maybe you only need a cleaning service to come in every other week,” Dr. Salamon says. “But if you need more assistance, it’s probably time to hire health aides.

What do health aides do?

Health aides are professional caregivers. There are two main types of aides.

• A certified nursing assistant (CNA): This is a trained, licensed professional who can provide hands-on physical care, such as helping you get up and down from a chair or bed, bathing, dressing, feeding, brushing teeth, and using the bathroom. A CNA can also perform homemaker services, such as cooking, light housework, transportation, shopping, overseeing medication routines, or sharing meaningful activities or conversation.
• A companion: This is a registered professional who can provide homemaker services but is not trained in body mechanics and cannot provide hands-on care.

The best place to find aides is through a private duty care agency, which vets and employs the aides, and takes care of their taxes and social security withholdings.

How can you find a reliable private duty care company, and what questions should you ask? Dr. Salamon suggests asking for recommendations from friends, your doctor, local senior services, or your local Area Agency on Aging.

How much does hiring health aides cost?

Private duty care is expensive. Costs average $25 to $30 per hour, typically with a three-to-four-hour minimum per week.

Those fees add up quickly. For example, if you need help two days per week for three hours per day, you’ll pay about $600 to $720 per month.

Costs are not typically covered by Medicare, but they are often covered by Veterans benefits. And they are sometimes covered fully or partially by long-term care insurance, state or local agencies on aging, or nonprofit groups.

What might hold you back from getting help you need?

Cost is a factor, of course. Even if it isn’t, you might not jump at the chance to hire home health aides. It could be that you feel you don’t need them yet, or that you’d be uncomfortable with strangers in your home.

But the sooner you can become accustomed to having professionals assist you with parts of your care as they become challenging, the better prepared you’ll be later, when you might require much more assistance. Trying services now can set you up with contacts — and caring people — you might need to lean on more often as time goes by.

How can you get over your reluctance? “Remember that you don’t have to commit to private duty care forever. Just try it for a few hours once a week. If it doesn’t go well, consider alternatives, such as eventually moving into assisted living,” Dr. Salamon says.

How far can a few hours of in-home help go?

What can an aide accomplish if you start out with just a few hours per week? Plenty.

You might want to set up a regular routine that includes doing laundry, changing bed linens, going on a walk with you, and making a large meal that can be frozen into smaller portions. Or you might want to focus on a theme for each once-a-week visit. For example, the aide can help you do errands one week, do some light house cleaning the next week, and help you cook the week after that.

“This is your opportunity to get the help you need, whether it’s with jobs around the house or basic activities of daily living,” Dr. Salamon says. “In the long run, it’s the kind of service that will keep you living on your own longer.”

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

The news these days is overwhelming in its awfulness. Acts of terrorism, wars, and heated conflicts constantly erupt throughout the world. Climate change looms, contributing to wildfires and flooding. Incomprehensible shootings occur with numbing regularity. The pandemic seems to be shifting from an immediate threat to health to an endemic illness — yet it’s still affecting us. The news has been so horrible, and so unrelenting, that it is hard to even process it.

Imagine processing it as a child?

Our first instinct is usually to shelter our children from the news and not say anything about it to them at all. That’s completely understandable, and if your child is very young or you are certain for some other reason that they aren’t going to hear about it, then not saying anything is a viable option.

But if they aren’t very young, or if you ever have the news on where they can see, or if they are ever in settings where people might have the news on or talk about it, it might not be so viable. If children are going to hear about something, they really should hear about it from you.

Also, as parents it’s important that we give our children the perspective and skills they need to navigate this scary world where, let’s be honest, bad things happen. The way you talk to children about tragedies in the news can help them cope not just now, but in the future.

The American Academy of Pediatrics has all sorts of resources to help parents talk with children about tragedies. Here are four simple things all parents can and should do:

1. Tell them what happened, in simple terms. Be honest, but skip the gory details. Answer their questions just as simply and honestly. If you think — or know — that your child has already heard something, ask them what they’ve heard. That way you can correct any misinformation, and know not only what you need to explain but also what you may need to reassure them about.

2. Be mindful of the media that your child sees. The news can be very graphic, and because the media are as much in the business of gaining viewers as of delivering news, they tend to make things as dramatic as possible and play footage over and over again. When the planes flew into the Twin Towers on 9/11, my husband and I were glued to the television, not realizing that one of our daughters, who was 3 years old at the time, thought that planes were literally flying into buildings again and again. It wasn’t until she said, “Are those planes going to come here too?” that we shut off the TV and didn’t turn it back on again until all the children were in bed.

3. Make sure your child knows that you and others are always doing everything you can to keep them safe. Talk about some of the ways you keep them safe, ways that are relevant to the tragedy you are talking about. Make a safety plan as a family for things like extreme weather or getting separated. Help them think about what they might do if they are ever in a scary situation, and who they could turn to for help. Which leads me to the most important thing to do…

4. Look for the helpers. The wonderful Fred Rogers often talked about how when he saw scary things on the news, his mother would tell him to look for the helpers, because there are always people who are helping. That may be the best thing we can do as parents: help our children look for the helpers. In all of the recent tragedies, as in all tragedies, there were so many helpers and heroes. When we concentrate on those people, not only do we give our children hope, but we may empower them to one day be helpers too.

The world can be a scary place, yet there is much we can do — from a very young age — to help children build strengths and nurture resilience, even in the face of tragedy.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD