“I was avoiding going out in groups. I stopped playing cards, stopped going to Bible study, even going to church.”

Her audiologist was unable to offer Grutzmacher, a retired nurse in Elgin, Illinois, a solution. But she found her way to the cochlear implant program at Northwestern University.

There, Krystine Mullins, an audiologist who assesses patients’ hearing and counsels them about their options, explained that surgically implanting this electronic device usually substantially improved a patient’s ability to understand speech.

“I had never even thought about it,” Grutzmacher said.

That she was 84 was, in itself, immaterial. “As long as you’re healthy enough to undergo surgery, age is not a concern,” Mullins said. One recent Northwestern implant patient had been 99.

Some patients need to ponder this decision, given that after the operation, clearer hearing still requires months of practice and adaptation, and the degree of improvement is hard to predict. “You can’t try it out in advance,” Mullins said.

But Grutzmacher didn’t hesitate. “I couldn’t go on the way I was,” she said in a postimplant phone interview — one that involved frustrating repetition, but would have been impossible a few weeks earlier. “I was completely isolated.”

Hearing loss among older adults remains vastly undertreated. Federal epidemiologists have estimated that it affects about 1 in 5 people ages 65 to 74 and more than half of those over 75.

“The inner ear mechanisms weren’t built for longevity,” said Cameron Wick, an ear, nose, and throat specialist at University Hospitals in Cleveland.

Although hearing loss can contribute to depression, social disconnection, and cognitive decline, fewer than a third of people over 70 who could benefit from hearing aids have worn them.

For those who do, “if your hearing aids no longer give you clarity, you should ask for a cochlear implant assessment,” Wick said.

Twenty-five years ago, “it was a novelty to implant people over 80,” said Charles Della Santina, director of the Johns Hopkins Cochlear Implant Center. “Now, it’s pretty routine practice.”

In fact, a study published in 2023 in the journal Otology & Neurotology reported that cochlear implantation was increasing at a higher rate in patients over 80 than in any other age group.

Until recently, Medicare covered the procedure for only those with extremely limited hearing who could correctly repeat less than 40% of the words on a word recognition test. Without insurance — cochlear implantation can cost $100,000 or more for the device, surgery, counseling, and follow-up — many older people don’t have the option.

“It was incredibly frustrating, because patients on Medicare were being excluded,” Della Santina said. (Similarly, traditional Medicare doesn’t cover hearing aids, and Medicare Advantage plans with hearing benefits still leave patients paying most of the tab.)

Then, in 2022, Medicare expanded cochlear implant coverage to include older adults who could identify up to 60% of words on a speech recognition test, increasing the pool of eligible patients.

Still, while the American Cochlear Implant Alliance estimates that implants are increasing by about 10% annually, public awareness and referrals from audiologists remain low. Less than 10% of eligible adults with “moderate to profound” hearing loss receive them, the alliance says.

Cochlear implantation requires commitment. After the patient receives testing and counseling, the surgery, which is an outpatient procedure, typically takes two to three hours. Many adults undergo surgery on one ear and continue using a hearing aid in the other; some later go on to get a second implant.

The surgeon implants an internal receiver beneath the patient’s scalp and inserts electrodes, which stimulate the auditory nerve, into the inner ear; patients also wear an external processor behind the ear. (Clinical trials of an entirely internal device are underway.)

Two or three weeks later, after the swelling recedes and the patient’s stitches have been removed, an audiologist activates the device.

“When we first turn it on, you won’t like what you hear,” Wick cautioned. Voices initially sound robotic, mechanical. It takes several weeks for the brain to adjust and for patients to reliably decipher words and sentences.

“A cochlear implant is not something you just turn on and it works,” Mullins said. “It takes time and some training to get used to the new sound quality.” She assigns homework, like reading aloud for 20 minutes a day and watching television while reading the captions.

Within one to three months, “boom, the brain starts getting it, and speech clarity takes off,” Wick said. By six months, older adults will have reached most of their enhanced clarity, though some improvement continues for a year or longer.

How much improvement? That’s measured by two hearing tests: The CNC (consonant-nucleus-consonant) test, in which patients are asked to repeat individual words, and the AzBio Sentence Test, in which the words to be repeated are part of full sentences.

At Northwestern, Mullins tells older prospective patients that one year after activation, a 60% to 70% AzBio score — correctly repeating 60 to 70 words out of 100 — is typical.

A Johns Hopkins study of about 1,100 adults, published in 2023, found that after implantation, patients 65 and older could correctly identify about 50 additional words (out of 100) on the AzBio test, an increase comparable to the younger cohort’s results.

Participants over 80 showed roughly as much improvement as those in their late 60s and 70s.

“They transition from having a hard time following a conversation to being able to participate,” said Della Santina, an author of the study. “Decade by decade, cochlear implant results have gotten better and better.”

Moreover, an analysis of 70 older patients’ experiences at 13 implantation centers, for which Wick was the lead author, found not only “clinically important” hearing improvements but also higher quality-of-life ratings.

Scores on a standard cognitive test climbed, too: After six months of using a cochlear implant, 54% of participants had a passing score, compared with 36% presurgery. Studies that focus on people in their 80s and 90s have shown that those with mild cognitive impairment also benefit from implants.

Nevertheless, “we’re cautious not to overpromise,” Wick said. Usually, the longer that older patients have had significant hearing loss, the harder they must work to regain their hearing and the less improvement they may see.

A minority of patients feel dizzy or nauseated after surgery, though most recover quickly. Some struggle with the technology, including phone apps that adjust the sound. Implants are less effective in noisy settings like crowded restaurants, and since they are designed to clarify speech, music may not sound great.

For those at the upper end of Medicare eligibility who already understand roughly half of the speech they hear, implantation may not seem worth the effort. “Just because someone is eligible doesn’t mean it’s in their best interests,” Wick said.

For Grutzmacher, though, the choice seemed clear. Her initial testing found that even with hearing aids, she understood only 4% of words on the AzBio. Two weeks after Mullins turned on the cochlear implant, Grutzmacher could understand 46% using a hearing aid in her other ear.

She reported that after a few rough days, her ability to talk by phone had improved, and instead of turning the television volume up to 80, “I can hear it at 20,” she said.

So she was making plans. “This week, I’m going out to lunch with a friend,” she said. “I’m going to play cards with a small group of women. I have a luncheon at church on Saturday.”

The New Old Age is produced through a partnership with The New York Times.

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Green burials are gaining popularity as an affordable, eco-friendly alternative to traditional funerals. They avoid toxic embalming chemicals, steel caskets, and concrete vaults, letting a body naturally decompose. Methods range from the elaborate — like “human composting” and water cremation — to a simple pine box.

“The New Old Age” columnist Paula Span appeared on WAMU’s Oct. 8 “Health Hub” to talk about the environmental and economic motivations behind these alternatives to conventional burials.

Jackson Sinnenberg contributed to this report.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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As the bike toppled, he thrust out his left arm to break the fall. It didn’t seem like a serious accident, yet “I couldn’t get up,” he said.

At the emergency room, X-rays showed that he had fractured both his hip, which required surgical repair, and his shoulder. Klein, a dentist, went back to work in three weeks, using a cane. After about six months and plenty of physical therapy, he felt fine.

But he wondered about the damage the fall had caused. “A 52-year-old is not supposed to break a hip and a shoulder,” he said. At a follow-up visit with his orthopedist, “I said, ‘Maybe I should have a bone density scan.’”

As Klein suspected, the test showed he had developed osteoporosis, a progressive condition, increasing sharply with age, that thins and weakens bones and can lead to serious fractures. Klein immediately began a drug regimen and, now 70, remains on one.

Osteoporosis occurs so much more commonly in women, for whom medical guidelines recommend universal screening after age 65, that a man who was not a health care professional might not have thought about getting a scan. The orthopedist didn’t raise the prospect.

But about 1 in 5 men over age 50 will suffer an osteoporotic fracture in their remaining years, and among older adults, about a quarter of hip fractures occur in men.

When they do, “men have worse outcomes,” said Cathleen Colón-Emeric, a geriatrician at the Durham VA Health Care System and Duke University and the lead author of a recent study of osteoporosis treatment in male veterans.

“Men don’t do as well in recovery as women,” she said, with higher rates of death (25% to 30% within a year), disability and institutionalization. “A 50-year-old man is more likely to die from the complications of a major osteoporotic fracture than from prostate cancer,” she said.

(What’s “major”? Fractures of the wrist, hip, femur, humerus, pelvis or vertebra.)

In her study of 3,000 veterans ages 65 to 85, conducted at Veterans Affairs health centers in North Carolina and Virginia, only 2% of those assigned to the control group had undergone bone-density screening.

“Shockingly low,” said Douglas Bauer, a clinical epidemiologist and osteoporosis researcher at the University of California-San Francisco, who published an accompanying commentary in JAMA Internal Medicine. “Abysmal. And that’s at the VA, where it’s paid for by the government.”

But establishing a bone health service — overseen by a nurse who entered orders, sent frequent appointment reminders and explained results — led to dramatic changes in the intervention group, who had at least one risk factor for the condition.

Forty-nine percent of them said yes to a scan. Half of those tested had osteoporosis or a forerunner condition, osteopenia. Where appropriate, most of them began medications to preserve or rebuild their bones.

“We were pleasantly surprised that so many agreed to be screened and were willing to initiate treatment,” Colón-Emeric said.

After 18 months, bone density had increased modestly for those in the intervention group, who were more likely to stick to their drug regimens than osteoporosis patients of either sex in real-world conditions.

The study didn’t continue long enough to determine whether bone density increased further or fractures declined, but the researchers plan a secondary analysis to track that.

The results revive a longtime question: Given how life-altering, even deadly, such fractures can be, and the availability of effective drugs to slow or reverse bone loss, should older men be screened for osteoporosis, as women are? If so, which men and when?

Such issues mattered less when life spans were shorter, Bauer explained. Men have bigger and thicker bones and tend to develop osteoporosis five to 10 years later than women do. “Until recently, those men died of heart disease and smoking” before osteoporosis could harm them, he said.

“Now, men routinely live into their 70s and 80s, so they have fractures,” he added. By then, they have also accumulated other chronic conditions that impair their ability to recover.

With osteoporosis testing and treatment, “a man could see a clear-cut improvement in mortality and, more importantly, his quality of life,” Bauer said.

Both patients and many doctors still tend to regard osteoporosis as a women’s disease, however. “There’s a bit of a Superman idea,” said Eric Orwoll, an endocrinologist and osteoporosis researcher at Oregon Health & Science University.

“Men would like to believe they’re indestructible, so a fracture doesn’t have the implication that it should,” he added.

One patient, for example, for years resisted entreaties from his wife, a nurse, to “see someone” about his visibly rounded upper back.

Bob Grossman, 74, a retired public school teacher in Portland, blamed poor posture instead and told himself to straighten up. “I thought, ‘It can’t be osteoporosis — I’m a guy,’” he said. But it was.

Another obstacle to screening: “Clinical practice guidelines are all over the place,” Colón-Emeric said.

Professional associations like the Endocrine Society and the American Society for Bone and Mineral Research recommend that men 50 and older who have a risk factor, and all men over 70, should seek screening.

But the American College of Physicians and the U.S. Preventive Services Task Force have deemed the evidence for screening of men “insufficient.” Clinical trials have found that osteoporosis drugs increase bone density in men, as in women, but most male studies have been too small or lacked enough follow-up to show whether fractures also declined.

The task force’s position means that Medicare and many private insurers generally won’t cover screening for men who haven’t had a fracture, though they will cover care for men diagnosed with osteoporosis.

“Things have been stalled for decades,” Orwoll said.

So it may fall to older men themselves to ask their doctors about a DXA (pronounced DECKS-ah) scan, widely available at $100 to $300 out-of-pocket. Otherwise, because osteoporosis is typically asymptomatic, men (and women, who are also undertested and undertreated) don’t know their bones have deteriorated until one breaks.

“If you had a fracture after age 50, you should have a bone scan — that’s one of the key indicators,” Orwoll advised.

Other risk factors: falls, a family history of hip fractures, and a fairly long list of other health conditions including rheumatoid arthritis, hyperthyroidism and Parkinson’s disease. Smoking and excessive alcohol use increase the odds of osteoporosis as well.

“A number of medications also do a number on your bone density,” Colón-Emeric added, notably steroids and prostate cancer drugs.

When a scan reveals osteoporosis, depending on its severity, doctors may prescribe oral medications like Fosamax or Actonel, intravenous formulations like Reclast, daily self-injections of Forteo or Tymlos, or twice-annual injections of Prolia.

Lifestyle changes like exercising, taking calcium and vitamin D supplements, stopping smoking, and drinking only moderately will help but aren’t sufficient to stop or reverse bone loss, Colón-Emeric said.

Although guidelines don’t universally recommend it, at least not yet, she would like to see all men age 70 and up be screened, because the odds of disability after hip fractures are so high — two-thirds of older people will not regain their prior mobility, she noted — and the medications that treat it are effective and often inexpensive.

But informing patients and health care professionals that osteoporosis threatens men, too, has progressed “at a snail’s pace,” Orwoll said.

Klein remembers attending a seminar to instruct patients like him in using the drug Forteo. “I was the only male there,” he said.

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The team — future doctors, social workers, psychologists, and therapists — looks for such common problems as frailty, muscle weakness, and cognitive decline. The patients they evaluate, free of charge, receive printed plans to help guide their care.

Across Oregon, community health workers have enrolled in an eight-hour online training program — with sections on Medicare and Medicaid, hospice and palliative care, and communication with patients and families — to help them work with older adults.

“We need these front-line public health workers to know how to provide age-friendly care,” said Laura Byerly, the geriatrician at the Oregon Health & Science University who leads its efforts.

And in Louisville, the same federally funded program provides geriatrics training across Kentucky. Sometimes, though, it takes a less formal approach.

Sam Cotton, the social worker who directs its dementia program, recently heard from a local Methodist church whose parishioners were caring for relatives with dementia. Could someone talk to the congregation about this demanding role? Cotton, an assistant professor at the University of Louisville, said sure, she would be there.

These programs, and 39 more like them across the country, aim to address an alarming fact: The number of geriatricians and other health care providers knowledgeable about aging has failed to keep up with the burgeoning population age 65 and older.

Since 2015, therefore, Congress has authorized funding for the Geriatrics Workforce Enhancement Program, or GWEP, which trains about 70,000 people a year.

Recently, these grants to universities and hospitals, up to $1 million each this year, appeared imperiled. In July, without warning or explanation, the annual disbursements to the recipients, some of which had participated since the program began in 2015, were substantially reduced.

Instead of an expected $41.8 million, the grantees collectively received $27.5 million, a 34% shortfall, according to the Eldercare Workforce Alliance. And more cuts appeared to be coming.

The Trump administration’s proposed budget for fiscal 2026 eliminated GWEP, along with many other programs funded through the Health Resources and Services Administration, an agency of the Department of Health and Human Services.

Although the program had always drawn bipartisan support, and had been repeatedly authorized for five years, the president’s budget zeroed it out, citing “an effort to streamline the bureaucracy, reset the proper balance between federal and state responsibilities, and save taxpayer funds.”

As 10 weeks passed without clarification — was the missing money merely delayed or gone for good? — program directors frantically called their congressional representatives while contemplating painful layoffs and an uncertain future.

“This money was appropriated, signed, and sealed, so where is it?” Cotton said last month. Besides her role in the Louisville program, she serves as board president of the National Association of Geriatric Education Centers.

Grantees’ questions to HRSA, the funding agency, brought few answers. Then, on Sept. 10, the programs discovered that, as mysteriously as they had vanished, the rest of the allocated funds had suddenly materialized.

And GWEP has been restored to both the House and Senate bills funding the federal health department, though the bills could still change or be voted down — or a continuing resolution could freeze current funding.

The rescue may reflect, in part, the efforts of a powerful GWEP supporter, Republican Sen. Susan Collins of Maine, who faces reelection next year.

In a Senate floor speech on Sept. 3, Collins called the program a “modest investment that will help ensure that our older Americans have the expert care that they need, that their caregivers are provided with training, that other support employees and health care providers receive the skills that they need.”

Still, “it has been a roller coaster, to say the least,” said Marla Berg-Weger, GWEP co-director at Saint Louis University, which trains about 9,800 people annually.

The payments withheld for 10 weeks equaled the amount that each grant had earmarked for Alzheimer’s and dementia training, program directors found. The programs were required to designate $230,000 of a $1 million grant to dementia training for both professionals and community members, but some had chosen to spend more and therefore had larger shortfalls.

The GWEP at Louisiana State University, for instance, initially received just $152,000 of its expected $976,659 and halted (temporarily, the director hopes) all its geriatric rotations and internships in Louisiana and Mississippi.

What has been going on? HRSA, the federal agency funding the programs, said in an email that “all grant programs have been thoroughly reviewed to ensure alignment with administration priorities,” causing “brief delays in executing certain payments.”

“It’s surprising to me that anyone would question the value of having a workforce knowledgeable about care for older adults,” said Carole Johnson, the agency’s administrator during the Biden administration.

“Everybody in the field hoped this program would grow, not wither,” she added.

Appropriations have increased only slightly in recent years. Yet “the recipients are very resourceful,” Johnson added. “It’s a ‘big bang for the buck’ program and a smart use of federal resources.”

The number of practicing geriatricians — 6,580 this year, according to HRSA estimates — is likely to decrease slightly in the coming years, even as the need for such expertise climbs. It’s hard to attract medical students and doctors to a relatively low-paying specialty whose patients are mostly insured by Medicare, though surveys have shown high job satisfaction among geriatricians.

Most older patients receive care not from geriatricians but from primary care doctors, other medical specialists, physician assistants, nurse practitioners, social workers, pharmacists, and direct care workers.

Accordingly, GWEPs emphasize extending knowledge about care for elders — whose risks, symptoms, goals, and treatments often differ from those of younger patients — to a wide array of providers, especially in rural and underserved areas. They also educate patients themselves and family caregivers.

The Saint Louis University program, for example, recently introduced an apprenticeship for certified nursing aides, or CNAs, working at a suburban nursing home.

“The turnover of nursing home employees in general, and CNAs in particular, is very high,” Berg-Weger explained. These jobs are often poorly paid and stressful, and the 75 hours of training required for certification doesn’t delve deeply into the particular needs and characteristics of older patients.

Six women have enrolled in Saint Louis’ first apprenticeship class, designed to accommodate 10 at a time. Over a year, they’ll receive 144 hours of education on such subjects as medications, fall prevention, and dementia.

The curriculum features both in-person classes with a geriatrician and a geriatric nurse practitioner, and more than 40 short videos the GWEP team has produced. Aides “can watch on their phones during their breaks,” Berg-Weger said.

At the end of the year, graduates become certified geriatrics specialists and receive a $1,000 stipend from the program and a 12% raise from their employers. “Our plan is to offer this to other facilities,” Berg-Weger said.

And to GWEPs in other states, if they survive.

The New Old Age is produced through a partnership with The New York Times.

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Earl Vickers was accustomed to taking Molly, his shepherd-boxer-something-else mix, for strolls on the beach or around his neighborhood in Seaside, California. A few years ago, though, he started to experience problems staying upright.

“If another dog came toward us, every single time I’d end up on the ground,” recalled Vickers, 69, a retired electrical engineer. “It seemed like I was falling every other month. It was kind of crazy.”

Most of those tumbles did no serious damage, though one time he fell backward and hit his head on a wall behind him. “I don’t think I had a concussion, but it’s not something I want to do every day,” Vickers said, ruefully. Another time, trying to break a fall, he broke two bones in his left hand.

So in 2022, he told the oncologist who had been treating him for prostate cancer that he wanted to stop the cancer drug he had been taking, off and on, for four years: enzalutamide (sold as Xtandi).

Among the drug’s listed side effects are higher rates of falls and fractures among patients who took it, compared with those given a placebo. His doctor agreed that he could discontinue the drug, and “I haven’t had a single fall since,” Vickers said.

Public health experts have warned of the perils of falls for older people for decades. In 2023, the most recent year of data from the Centers for Disease Control and Prevention, more than 41,000 Americans over 65 died from falls, an opinion article in JAMA Health Forum pointed out last month.

More startling than that figure, though, was another statistic: Fall-related mortality among older adults has been climbing sharply.

The author, Thomas Farley, an epidemiologist, reported that death rates from fall injuries among Americans over 65 had more than tripled over the past 30 years. Among those over 85, the cohort at highest risk, death rates from falls jumped to 339 per 100,000 in 2023, from 92 per 100,000 in 1990.

The culprit, in his view, is Americans’ reliance on prescription drugs.

“Older adults are heavily medicated, increasingly so, and with drugs that are inappropriate for older people,” Farley said in an interview. “This didn’t occur in Japan or in Europe.”

Yet that same 30-year period saw a flurry of research and activity to try to reduce geriatric falls and their potentially devastating consequences, from hip fractures and brain bleeds to restricted mobility, persistent pain, and institutionalization.

The American Geriatrics Society adopted updated fall prevention guidelines in 2011. The CDC unveiled a program called STEADI in 2012. The United States Preventive Services Task Force recommended exercise or physical therapy for older adults at risk of falling in 2012, 2018, and again last year.

“There’ve been studies and interventions and investments, and they haven’t been particularly successful,” said Donovan Maust, a geriatric psychiatrist and researcher at the University of Michigan. “It’s a bad problem that seems to be getting worse.”

But are prescription drugs driving that increase? Geriatricians and others who research falls and prescribing practices question that conclusion.

Farley, a former New York City health commissioner who teaches at Tulane University, acknowledged that many factors contribute to falls, including the physical impairments and deteriorating eyesight associated with advancing age; alcohol abuse; and tripping hazards in people’s homes.

But “there’s no reason to think any of them have gotten three times worse in the past 30 years,” he said, pointing to studies showing declines in other high-income countries.

The difference, he believes, is Americans’ increasing use of medications — like benzodiazepines, opioids, antidepressants, and gabapentin — that act on the central nervous system.

“The drugs that increase falls’ mortality are those that make you drowsy or dizzy,” he said.

Problematic drugs are numerous enough to have acquired an acronym: FRIDs, or “fall-risk-increasing drugs,” a category that also includes various cardiac medications and early antihistamines like Benadryl.

Such medications play a major role, agreed Thomas Gill, a geriatrician and epidemiologist at Yale University and a longtime falls researcher. But, he said, “there are alternative explanations” for the increase in death rates.

He cited changes in reporting the causes of death, for instance. “Years ago, falls were considered a natural consequence of aging and no big deal,” he said.

Death certificates often attributed fatalities among older people to ailments like heart failure instead of falls, making fall mortality appear lower in the 1980s and 1990s.

Today’s over-85 cohort may also be frailer and sicker than the oldest-old were 30 years ago, Gill added, because contemporary medicine can keep people alive longer.

Their accumulating impairments, more than the drugs they take, could make them more likely to die after a fall.

Another skeptic, Neil Alexander, a geriatrician and falls expert at the University of Michigan and VA Ann Arbor Healthcare System, argued that most doctors have come to understand the dangers of FRIDs and prescribe them less often.

“Message delivered,” he said. Given the alarms sounded about opioids, about benzodiazepines and related drugs, and especially about opioids and benzos together, “a lot of primary care doctors have heard the gospel,” he said. “They know not to give older people Valium.”

Moreover, prescriptions for some fall-related drugs have already declined or hit plateaus, even as death rates because of falls have risen. Medicare data shows lower prescription opioid use beginning a decade ago, for example. Benzodiazepine prescriptions for older patients have slowed, Maust said.

On the other hand, the use of antidepressants and of gabapentin has increased.

Whether or not medication use outweighs all other factors, “nobody disputes that these agents are overused and inappropriately used” and contribute to the troubling increase in fall death rates among seniors, Gill said.

Thus, the ongoing campaign for “deprescribing” — stopping the medications whose potential harms outweigh their benefits, or reducing their dosage.

“We know a lot of these drugs can increase falls by 50 to 75%” in older patients, said Michael Steinman, a geriatrician at the University of California-San Francisco and co-director of the US Deprescribing Research Network, established in 2019.

“It’s easy to start meds, but it often takes a lot of time and effort to have patients stop taking them,” he said. Harried doctors may pay less attention to drug regimens than to health issues that seem more pressing, and patients can be reluctant to give up pills that seem to help with pain, insomnia, reflux, and other common age-related complaints.

The Beers Criteria, a directory of drugs often deemed inadvisable for older adults, recently published recommendations for alternative medications and nonpharmacological treatments for frequent problems. Cognitive behavioral therapy for sleeplessness. Exercise, physical therapy, and psychological interventions for pain.

“It’s a real tragedy when people have this life-altering event,” Steinman, co-chair of the Beers panel on alternatives, said of falls. He urged older patients to raise the issue of FRIDs themselves, if their doctors haven’t.

“Ask, ‘Do any of my medications increase the risk of falls? Is there an alternative treatment?’” he suggested. “Being an informed patient or caregiver can put this on the agenda. Otherwise, it might not come up.”

The New Old Age is produced through a partnership with The New York Times.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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And a little shopping. My grandkid wanted a few small toys. My daughter stocked up on thousand-piece jigsaw puzzles at the game store in Provincetown. I bought a pair of earrings and a couple of paperbacks.

And a gravesite.

It’s near a cluster of oaks, in a cemetery in Wellfleet, Massachusetts, where some mossy Civil War-era headstones are so weathered that you can no longer decipher who lies beneath them. The town permits nonresidents to join the locals there, and it welcomes green burials.

Regular summer visitors like us often share the fantasy of acquiring real estate on the Cape. Admittedly, most probably envision a place to use while they’re still alive, a daydream that remains beyond my means.

Buying a cemetery plot where I can have a green burial, on the other hand, proved to be surprisingly affordable and will allow my body, once no longer in use, to decompose as quickly and as naturally as possible, with minimal environmental damage. Bonus: If my descendants ever care to visit, my grave will be in a beloved place, where my daughter has come nearly every summer of her life.

“Do you see a lot of interest in green burials?” I asked the friendly town cemetery commissioner who was showing me around.

“I don’t think we’ve had a traditional burial in two years,” he said. “It’s all green.”

Nobody can count how many Americans now choose green or natural burials, but Lee Webster, former president of the Green Burial Council, is tracking the growing number of cemeteries in the United States that allow them.

The first, Ramsey Creek Preserve, began its operations in Westminster, South Carolina, in 1998. By 2016, Webster’s list included 150 cemeteries; now she counts 497. Most, like the one in Wellfleet, are hybrids accommodating both conventional and green burials.

Although a consumer survey conducted by the National Funeral Directors Association found that fewer than 10% of respondents would prefer a green burial (compared with 43% favoring cremation and 24% opting for conventional burial), more than 60% said they would be interested in exploring green and natural alternatives.

“That has to do with the baby boomers coming of age and wanting to practice what they’ve preached,” Webster said. “They’re looking for environmental consistency. They’re looking for authenticity and simplicity.”

She added, “If you nursed your babies and you recycle the cardboard in the toilet paper roll, this is going to appeal to you.” (I raise my hand.)

Aside from their environmental concerns, many survey participants attributed their interest in green burial to its lower cost. The median price of a funeral with burial in 2023 was about $10,000, including a vault but not including the cemetery plot or a monument, according to the NFDA.

Although advocates of green burials, like Webster, decry cremation’s toxic emissions and reliance on fossil fuels, the method now accounts for nearly two-thirds of body disposals in the United States, the association reports. One reason is its median cost of $6,300, without interment or a monument.

Such numbers vary considerably by location. I live in Brooklyn, where real estate is pricey even for the dead, and where Green-Wood Cemetery — a jewel and a National Historic Landmark — charges $21,000 to $30,000 for a plot. Burial in its new, green section is a comparative bargain at $15,000.

About 40 miles outside Nashville, Tennessee, though, a green burial at Larkspur Conservation costs $4,000, including the gravesite and just about everything else, except, if the family wants one, a flat, engraved native stone.

Larkspur is one of 15 conservation burial grounds in the nation operating in partnership with land trusts — The Nature Conservancy, in this case — to preserve the space. “It’s what keeps forests from becoming subdivisions,” said John Christian Phifer, Larkspur’s founder.

He listed the common elements of green burials: “No chemical embalming, no steel casket, no concrete vault. Everything that goes in the ground is compostable or biodegradable.” A small industry has evolved to produce artisanal woven caskets, linen shrouds, and other eco-friendly funerary items.

Green funerals often feel different, too. Mourners at Larkspur tend to walk the trail to the burial site wearing denim and hiking boots, not black suits.

“Instead of observing, they’re actively participating,” Phifer said. “We invite them to help lower the body into the grave with ropes, to put a handful or shovelfuls of soil into the grave,” and to mound soil, pine boughs, and flowers atop it afterward. Then, they might toast the departed with champagne or share a potluck picnic.

When Larkspur began operating in 2018, with Phifer as its only employee, 17 bodies were buried on its 161 acres. Last year, a staff of eight handled 80 burials, and the burial ground is acquiring more property.

Other alternatives to conventional burial have emerged, too. The company Earth Funeral has facilities in Nevada, Washington state, and, soon, Maryland, for so-called human composting. In this process, a body is heated with plant material for 30 to 45 days in a high-tech drum, where it all eventually turns into a cubic yard of soil.

That’s 300 pounds, more than most families can use, so local land conservancies receive the rest. The cost: $5,000 to $6,000.

Alkaline hydrolysis, which is legal in almost half of all states, dissolves bodies using chemicals and water, leaving pulverized bone fragments that can be scattered or buried and an effluent that must be disposed of.

Environmentally, when you include standard cremation, “there are ramifications for all three processes that we can avoid by simply putting a body in the soil” and letting microbes and fungi do the rest, Webster said.

Cemetery acreage near major population centers is limited, however, and increasingly expensive. “I don’t think there’s a perfect option, but we can do a hell of a lot better than the traditional methods,” said Tom Harries, founder of Earth Funeral. Debates about comparative greenness will certainly continue.

But green burial made sense to Lynne McFarland and her husband, Newell Anderson, who heard about Larkspur through their Episcopal church in Nashville. “The idea of returning to the earth sounded good to me,” McFarland said.

Her mother, Ruby Fielden, 94, was one of the first people buried at Larkspur in 2018, in an open meadow that attracts butterflies.

Last spring, Anderson, who had Alzheimer’s, died at 90 and was buried a few yards away from Fielden, in a biodegradable willow casket. A dozen family members read prayers and poems, shared stories and sang “Amazing Grace.”

Then they picked up shovels and filled the grave. It was exactly what her outdoorsy husband, a onetime Boy Scout leader, would have wanted, said McFarland, 80, who plans to be buried there, too.

I’m not sure if my survivors will undertake that much physical labor. But my daughter and son-in-law, though probably decades from their own end-of-life decisions, liked the idea of green burial in a place we all cherish. The prices in what I now think of as my cemetery were low enough — $4,235, to be precise — that I could buy a plot to accommodate myself and seven descendants, if I ever have that many.

I hope this plan, besides minimizing the impact of my death on a fragile landscape, also lessens the familial burden of making hurried arrangements. At 76, I don’t know how my future will unfold. But I know where it will conclude.

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Wanda Woods enrolled because her father advised that typing proficiency would lead to jobs. Sure enough, the federal Environmental Protection Agency hired her as an after-school worker while she was still a junior.

Her supervisor “sat me down and put me on a machine called a word processor,” Woods, now 67, recalled. “It was big and bulky and used magnetic cards to store information. I thought, ‘I kinda like this.’”

Decades later, she was still liking it. In 2012 — the first year that more than half of Americans 65 and older were internet users — she started a computer training business.

Now she is an instructor with Senior Planet in Denver, an AARP-supported effort to help older people learn and stay abreast of technology. Woods has no plans to retire. Staying involved with tech “keeps me in the know, too,” she said.

Some neuroscientists researching the effects of technology on older adults are inclined to agree. The first cohort of seniors to have contended — not always enthusiastically — with a digital society has reached the age when cognitive impairment becomes more common.

Given decades of alarms about technology’s threats to our brains and well-being — sometimes called “digital dementia” — one might expect to start seeing negative effects.

The opposite appears true. “Among the digital pioneer generation, use of everyday digital technology has been associated with reduced risk of cognitive impairment and dementia,” said Michael Scullin, a cognitive neuroscientist at Baylor University.

It’s almost akin to hearing from a nutritionist that bacon is good for you.

“It flips the script that technology is always bad,” said Murali Doraiswamy, director of the Neurocognitive Disorders Program at Duke University, who was not involved with the study. “It’s refreshing and provocative and poses a hypothesis that deserves further research.”

Scullin and Jared Benge, a neuropsychologist at the University of Texas at Austin, were co-authors of a recent analysis investigating the effects of technology use on people over 50 (average age: 69).

They found that those who used computers, smartphones, the internet, or a mix did better on cognitive tests, with lower rates of cognitive impairment or dementia diagnoses, than those who avoided technology or used it less often.

“Normally, you see a lot of variability across studies,” Scullin said. But in this analysis of 57 studies involving more than 411,000 seniors, published in Nature Human Behavior, almost 90% of the studies found that technology had a protective cognitive effect.

Much of the apprehension about technology and cognition arose from research on children, sometimes focused on adolescents, whose brains are still developing.

“There’s pretty compelling data that difficulties can emerge with attention or mental health or behavioral problems” when young people are overexposed to screens and digital devices, Scullin said.

Older adults’ brains are also malleable, but less so. And those who began grappling with technology in midlife had already learned “foundational abilities and skills,” Scullin said.

Then, to participate in a swiftly evolving society, they had to learn a whole lot more.

Years of online brain-training experiments lasting a few weeks or months have produced varying results. Often, they improve a person’s ability to perform the task in question without enhancing other skills.

“I tend to be pretty skeptical” of their benefit, said Walter Boot, a psychologist at the Center on Aging and Behavioral Research at Weill Cornell Medicine. “Cognition is really hard to change.”

The new analysis, however, reflects “technology use in the wild,” he said, with adults “having to adapt to a rapidly changing technological environment” over several decades. He found the study’s conclusions “plausible.”

Analyses like this can’t determine causality. Does technology improve older people’s cognition, or do people with low cognitive ability avoid technology? Is tech adoption just a proxy for enough wealth to buy a laptop?

“We still don’t know if it’s chicken or egg,” Doraiswamy said.

Yet when Scullin and Benge accounted for health, education, socioeconomic status, and other demographic variables, they still found significantly higher cognitive ability among older digital technology users.

What might explain the apparent connection?

“These devices represent complex new challenges,” Scullin said. “If you don’t give up on them, if you push through the frustration, you’re engaging in the same challenges that studies have shown to be cognitively beneficial.”

Even handling the constant updates, the troubleshooting, and the sometimes maddening new operating systems might prove advantageous. “Having to relearn something is another positive mental challenge,” he said.

Still, digital technology may also protect brain health by fostering social connections, known to help stave off cognitive decline. Or its reminders and prompts could partially compensate for memory loss, as Scullin and Benge found in a smartphone study, while apps help preserve functional abilities like shopping and banking.

Numerous studies have shown that while the number of people with dementia is increasing as the population ages, the proportion of older adults who develop dementia has been falling in the United States and several European countries.

Researchers have attributed the decline to a variety of factors, including reduced smoking, higher education levels, and better blood pressure treatments. Possibly, Doraiswamy said, engaging with technology has been part of the pattern.

Of course, digital technologies present risks, too. Online fraud and scams often target older adults, and while they are less apt to report fraud losses than younger people, the amounts they lose are much higher, according to the Federal Trade Commission. Disinformation poses its own hazards.

And as with users of any age, more is not necessarily better.

“If you’re bingeing Netflix 10 hours a day, you may lose social connections,” Doraiswamy pointed out. Technology, he noted, cannot “substitute for other brain-healthy activities” like exercising and eating sensibly.

An unanswered question: Will this supposed benefit extend to subsequent generations, digital natives more comfortable with the technology their grandparents often labored over? “The technology is not static — it still changes,” Boot said. “So maybe it’s not a one-time effect.”

Still, the change tech has wrought “follows a pattern,” he added. “A new technology gets introduced, and there’s a kind of panic.”

From television and video games to the latest and perhaps scariest development, artificial intelligence, “a lot of it is an overblown initial reaction,” he said. “Then, over time, we see it’s not so bad and may actually have benefits.”

Like most people her age, Woods grew up in an analog world of paper checks and paper maps. But as she moved from one employer to another through the ’80s and ’90s, she progressed to IBM desktops and mastered Lotus 1-2-3 and Windows 3.1.

Along the way, her personal life turned digital, too: a home desktop when her sons needed one for school, a cellphone after she and her husband couldn’t summon help for a roadside flat, a smartwatch to track her steps.

These days, Woods pays bills and shops online, uses a digital calendar, and group-texts her relatives. And she seems unafraid of AI, the most earthshaking new tech.

Last year, Woods turned to AI chatbots like Google Gemini and OpenAI’s ChatGPT to plan an RV excursion to South Carolina. Now, she’s using them to arrange a family cruise celebrating her 50th wedding anniversary.

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A cardiologist told Hollander that based on factors like age, sex, cholesterol, and blood pressure, she faced a moderate risk of a major cardiac event, like a heart attack, within the next 10 years.

Doctors typically counsel such patients about the importance of diet and exercise, but Hollander, now 64, a social worker in West Orange, New Jersey, didn’t have much room for improvement. She was already a serious runner, and although “I fall off the wagon once in a while,” her diet was basically healthy. Attempts to lose weight didn’t lower her cholesterol.

Her doctor explained that a coronary artery calcium test, something Hollander had never heard of, could provide a more precise estimate of her risk of atherosclerotic heart disease. A brief and painless CT scan, it would indicate whether calcifications and plaque were developing in the arteries leading to her heart.

When plaque ruptures, it can cause clots that block blood flow and trigger heart attacks. The scan would help determine whether Hollander would benefit from taking a statin, which could reduce plaque and prevent more from forming.

“The test is used by more people every year,” said Michael Blaha, co-director of the preventive cardiology program at Johns Hopkins University. Calcium scans quadrupled from 2006 to 2017, his research team reported, and Google searches for related terms have risen even more sharply.

Yet “it’s still being underused compared to its value,” he said.

One reason is that although the test is comparatively inexpensive — sometimes up to $300, but often $100 or less — patients usually must pay for it out-of-pocket. Medicare rarely covers it, though some doctors argue that it should.

Patients with a CAC score of zero — no calcification — have lower risk than their initial assessments indicate and aren’t candidates for cholesterol-lowering drugs. But Hollander’s score was in the 50s — not high but not negligible.

“It was the first indication of what was going on inside my arteries,” she said.

Though guidelines vary, cardiologists generally offer statins to patients with calcium scores over zero, and suggest higher intensity statins when scores exceed 100. At over 300, patients’ risks approach those of people who’ve already had heart attacks; they may need still more aggressive treatment.

Hollander has taken a low dose of rosuvastatin (brand name: Crestor) ever since, supplemented by a non-statin drug, a shot called evolocumab (Repatha).

This is the way calcium testing is supposed to work. It’s not a screening test for everyone. It’s intended only for selected asymptomatic patients, ages 40 to 75, who have never had a heart attack or a stroke and are not already on cholesterol drugs.

The test helps answer a pointed question: to statin, or not to statin.

If a doctor calculates the 10-year risk of atherosclerotic cardiovascular disease at 5% or lower, drugs are unnecessary for now. Over 20%, “there’s no doubt the risk is sufficiently high to justify medication,” said Philip Greenland, a preventive cardiologist at Northwestern University and co-author of a recent review in JAMA.

“It’s the in-between range where it’s more uncertain,” he said, including “borderline” risk of 5% to 7.5% and “intermediate” risk of 7.5% to 20%.

Why add another measurement to these assessments, which already incorporate risk factors like smoking and diabetes?

“A risk score is derived from a large population, with mathematical modeling,” Blaha explained. “We can say that this score describes the risk of heart disease among thousands of people. But there are lots of limitations in applying them to one individual.”

A calcium scan, however, produces an image of one individual’s arteries. Alexander Zheutlin, a cardiology fellow and researcher at Northwestern University, shows patients their images, so that they can see the lighter-colored calcifications.

Cardiologists tend to be fans of calcium testing, because they so regularly encounter patients who are reluctant to take statins. People who feel fine may hesitate to start drugs they’ll take for the rest of their lives, despite statins’ proven history of reducing heart attacks, strokes and cardiac deaths.

In 2019, a survey of almost 5,700 adults for whom statin therapy was recommended found that a quarter were not in treatment. Of those, 10% had declined a statin and 30% had started and then discontinued, primarily citing fear of side effects.

An American College of Cardiology expert consensus report recently put the rate of muscle pain, statin users’ most common complaint, at 5% to 20%. Researchers consider the fear of side effects overblown, citing studies showing that reports of muscle pain were comparable whether patients took statins or placebos.

“The actual risk is much, much lower than the perceived risk,” Zheutlin said.

That may be little comfort to people who are in pain, but cardiologists argue that reducing doses or switching to different statins usually solves the problem. Some patients will do better on a non-statin cholesterol drug.

Hollander, for example, suffered “muscle cramps that would wake me up at night.” Her doctor advised fewer doses, so Hollander now takes Crestor three days a week and self-injects Repatha twice monthly.

(Statins also carry a very low risk of a dangerous condition, rhabdomyolysis, that causes muscle breakdown, and they slightly increase the chance of diabetes.)

Some caveats: No one has undertaken a randomized clinical trial to show whether calcium testing eventually reduces heart attacks and cardiac deaths. That’s why, although several professional associations endorse calcium scans to help determine treatment, the independent U.S. Preventive Services Task Force has called the current evidence “insufficient” to recommend widespread use.

Such a trial would be expensive and difficult to mount, with many confounding variables. And pharmaceutical companies aren’t eager to underwrite one, since a successful result could mean that patients with zero scores avoid cholesterol drugs altogether.

But a recent Australian study of asymptomatic patients with family histories of coronary artery disease found that, after three years, those who had undergone calcium scans had a sustained reduction in cholesterol and a significantly lower risk of heart disease than those who had not been tested.

The test “leads to more statin prescriptions, better adherence to statins, less progression of atherosclerosis, and less plaque growth,” Greenland said of the study, in which he was not involved. “It tips the scale.”

Another concern: people age 75 and older. Most will have arterial plaque, making a scan’s benefit “less clear-cut,” said Zheutlin, lead author of a recent JAMA Cardiology article pointing out that CAC testing can be both overused and underused.

Because older adults face more chronic diseases and medical issues, cholesterol-lowering may become a lower priority. A study now enrolling participants over 75 should answer some questions about statins, calcium scans, and dementia in a few years.

Meanwhile, cardiologists see calcium scans as a persuasive tool.

“It’s incredibly frustrating,” Zheutlin said. With statins, “we have cheap, safe, effective drugs available at any pharmacy” that help prevent heart attacks. If CAC test results prove more influential than traditional risk assessments alone, he said, more patients might agree to take them.

A calcium scan helped Stephen Patrick, 70, a retired tech executive in San Francisco, reach that point. “For years, I was borderline on cholesterol, and I managed to beat it back with less cheese toast” and lots of exercise, he said. “I was on no meds, and I took pride in that.”

Last fall, with both his total and his LDL cholesterol higher than recommended, his doctor suggested a calcium scan. His score: 176.

He’s taking atorvastatin (Lipitor) daily, and his cholesterol levels have dropped dramatically. “I might have tried it anyway,” he said. “But the calcium score meant I had to pay more attention.”

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His malady was not mysterious. As a retired nurse anesthetist, Sergott knew he had anemia, a deficiency of red blood cells. In his case, it was the consequence of a hereditary condition that caused almost daily nosebleeds and depleted his hemoglobin, the protein in red blood cells that delivers oxygen throughout the body.

But in consulting doctors about his fatigue, he found that many didn’t know how to help. They advised Sergott, who lives in Westminster, Maryland, to take iron tablets, usually the first-line treatment for anemia.

But like many older people, he found a daily regimen of four to six tablets hard to tolerate. Some patients taking iron complain of severe constipation or stomach cramps. Sergott felt “nauseated all the time.” And iron tablets don’t always work.

After almost 15 years, he found a solution. Michael Auerbach, a hematologist and an oncologist who is the co-director of the Center for Cancer and Blood Disorders in Baltimore, suggested that Sergott receive iron intravenously instead of orally.

Now Sergott, 78, gets an hourlong infusion when his hemoglobin levels and other markers show that he needs one, usually three times a year. “It’s like filling the gas tank,” he said. His symptoms recede, and “I feel great.”

His story reflects, however, the frequent dismissal of a common condition, one that can not only diminish older adults’ quality of life but also lead to serious health consequences, including falls, fractures, and hospital stays.

Anemia’s symptoms — tiredness, headaches, leg cramps, coldness, decreased ability to exercise, brain fog — are often attributed to aging itself, William Ershler, a hematologist and researcher said. (Some people with anemia remain asymptomatic.)

“People say, ‘I feel weak, but everybody my age feels weak,’” Ershler said.

Even though hemoglobin levels are likely to have been included in their patients’ records, as part of the complete blood count, or CBC, routinely ordered during medical visits, doctors often fail to recognize anemia.

“The patients come to the clinic and get the blood tests, and nothing happens,” he said.

Anemia affects 12.5% of people over 60, according to the most recent survey data from the National Health and Nutrition Examination Survey, and the rate rises thereafter.

But that may be an underestimate.

In a study published in the Journal of the American Geriatrics Society, Ershler and his colleagues examined the electronic health records of almost 2,000 outpatients over 65 at Inova, the large health system based in Northern Virginia from which he recently retired.

Based on blood test results, the prevalence of anemia was much higher: About 1 in 5 patients was anemic, with hemoglobin levels below normal as defined by the World Health Organization.

Yet only about a third of those patients had anemia properly documented in their medical charts.

Anemia “deserves our attention, but it doesn’t always get it,” said George Kuchel, a geriatrician at the University of Connecticut, who wasn’t surprised by the findings.

That’s partly because anemia has so many causes, some more treatable than others. In perhaps a third of cases, it arises from a nutritional deficiency — usually a lack of iron, but sometimes of vitamin B12 or folate (called folic acid in synthetic form).

Older people may have decreased appetites or struggle to shop for food and prepare meals. But anemia can also follow blood loss from ulcers, polyps, diabetes, and other causes of internal bleeding.

Surgery can also lead to iron deficiency. Mary Dagold, 83, a retired librarian in Pikesville, Maryland, underwent three abdominal operations in 2019. She remained bedridden for weeks afterward and needed a feeding tube for months. Even after she healed, “the anemia didn’t go away,” she said.

She remembers feeling perpetually exhausted. “And I knew I wasn’t thinking the way I usually think,” she added. “I couldn’t read a novel.” Her primary care doctor and Auerbach both advised that oral iron was unlikely to help.

Iron tablets, available over the counter, are inexpensive. Intravenous iron, becoming more widely prescribed, can cost $350 to $2,400 per infusion depending on the formulation, Auerbach said.

Some patients find a single dose sufficient, while others will need regular treatment. Medicare covers it when tablets are hard to tolerate or ineffective.

For Dagold, a 25-minute intravenous iron infusion every five weeks or so has made a startling difference. “It takes a few days, and then you feel well enough to go about your daily life,” she said. She has returned to her water aerobics class four days a week.

In other cases, anemia arises from chronic conditions like heart disease, kidney failure, bone marrow disorders, or inflammatory bowel diseases.

“These people don’t lack iron, but they’re not able to process it to make red blood cells,” Kuchel said. Since iron supplements won’t be effective, doctors try to address the anemia by treating patients’ underlying illnesses.

Another reason to pay attention: “Loss of iron can be the first harbinger of colon cancer and stomach cancer,” Kuchel pointed out.

In about a third of patients, however, anemia remains frustratingly unexplained. “We’ve done everything, and we have no idea what’s causing it,” he said.

Learning more about anemia’s causes and treatments might prevent a lot of misery down the road. Besides its association with falls and fractures, anemia “can increase the severity of chronic illnesses — heart, lung, kidney, liver,” Auerbach said. “If it’s really severe and hemoglobin goes to life-threatening levels, it can cause a heart attack or stroke.”

Among the unknowns, however, is whether treating anemia early and restoring normal hemoglobin will prevent later illnesses. Still, “things are happening in this field,” Ershler said, pointing to a National Institute on Aging workshop on unexplained anemia held last year.

The American Society of Hematology has appointed a committee on diagnosing and treating iron deficiency and plans to publish new guidelines next year. The Iron Consortium at Oregon Health & Science University convened an international panel on managing iron deficiency and recently published its recommendations in The Lancet Haematology.

In the meantime, many older patients can gain access to their CBC results and thus their hemoglobin levels. The World Health Organization defines 13 grams of hemoglobin per deciliter as normal for men, and 12 for nonpregnant women (though some hematologists argue that those thresholds are too low).

Asking health care providers about hemoglobin and iron levels, or using a patient portal to check the numbers themselves, could help patients steer conversations with their doctors away from fatigue or other symptoms as inevitable results of aging.

Perhaps they’re signs of anemia, and perhaps it’s treatable.

“Chances are, you’ve had a CBC in the last six months or a year,” Kuchel said. “If your hemoglobin is fine, great.”

But, he added, “If it’s really outside the normal boundaries, or it’s changed compared to a year ago, you need to ask questions.”

The New Old Age is produced through a partnership with The New York Times.

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Her doctor and several pharmacies turned her down because she was below the recommended age at the time, which was 60. So, in 2016, she celebrated her 60th birthday at her local CVS.

“I was there when they opened,” Beckham recalled. After getting her Zostavax shot, she said, “I felt really relieved.” She has since received the newer, more effective shingles vaccine, as well as a pneumonia shot, an RSV vaccine to guard against respiratory syncytial virus, annual flu shots and all recommended covid-19 vaccinations.

Some older people are really eager to be vaccinated.

Robin Wolaner, 71, a retired publisher in Sausalito, California, has been known to badger friends who delay getting recommended shots, sending them relevant medical studies. “I’m sort of hectoring,” she acknowledged.

Deana Hendrickson, 66, who provides daily care for three young grandsons in Los Angeles, sought an additional MMR shot, though she was vaccinated against measles, mumps, and rubella as a child, in case her immunity to measles had waned.

For older adults who express more confidence in vaccine safety than younger groups, the past few months have brought welcome research. Studies have found important benefits from a newer vaccine and enhanced versions of older ones, and one vaccine may confer a major bonus that nobody foresaw.

The new studies are coming at a fraught political moment. The nation’s health secretary, Robert F. Kennedy Jr., has long disparaged certain vaccines, calling them unsafe and saying that the government officials who regulate them are compromised and corrupt.

On June 9, Kennedy fired a panel of scientific advisers to the Centers for Disease Control and Prevention, and later replaced them with some who have been skeptical of vaccines. But so far, Kennedy has not tried to curb access to the shots for older Americans.

The evidence that vaccines are beneficial remains overwhelming.

The phrase “Vaccines are not just for kids anymore” has become a favorite for William Schaffner, an infectious diseases specialist at Vanderbilt University Medical Center.

“The population over 65, which often suffers the worst impact of respiratory viruses and others, now has the benefit of vaccines that can prevent much of that serious illness,” he said.

Take influenza, which annually sends from 140,000 to 710,000 people to hospitals, most of them seniors, and is fatal to 10% of hospitalized older adults. 

For about 15 years, the CDC has approved several enhanced flu vaccines for people 65 and older. More effective than the standard formulation, they either contain higher levels of the antigen that builds protection against the virus or incorporate an adjuvant that creates a stronger immune response. Or they’re recombinant vaccines, developed through a different method, with higher antigen levels.

In a meta-analysis in the Journal of the American Geriatrics Society, “all the enhanced vaccine products were superior to the standard dose for preventing hospitalizations,” said Rebecca Morgan, a health research methodologist at Case Western Reserve University and an author of the study.

Compared with the standard flu shot, the enhanced vaccines reduced the risk of hospitalization from the flu in older adults, by at least 11% and up to 18%. The CDC advises adults 65 and older to receive the enhanced vaccines, as many already do.

More good news: Vaccines to prevent respiratory syncytial virus in people 60 and older are performing admirably.

RSV is the most common cause of hospitalization for infants, and it also poses significant risks to older people. “Season in and season out,” Schaffner said, “it produces outbreaks of serious respiratory illness that rivals influenza.”

Because the FDA first approved an RSV vaccine in 2023, the 2023-24 season provided “the first opportunity to see it in a real-world context,” said Pauline Terebuh, an epidemiologist at Case Western Reserve School of Medicine and an author of a recent study in the journal JAMA Network Open.

In analyzing electronic health records for almost 800,000 patients, the researchers found the vaccines to be 75% effective against acute infection, meaning illness that was serious enough to send a patient to a health care provider.

The vaccines were 75% effective in preventing emergency room or urgent care visits, and 75% effective against hospitalization, both among those ages 60 to 74 and those older.

Immunocompromised patients, despite having a somewhat lower level of protection from the vaccine, will also benefit from it, Terebuh said. As for adverse effects, the study found a very low risk for Guillain-Barré syndrome, a rare condition that causes muscle weakness and that typically follows an infection, in about 11 cases per 1 million doses of vaccine. That, she said, “shouldn’t dissuade people.”

The CDC now recommends RSV vaccination for people 75 and older, and for those 60 to 74 if they’re at higher risk of severe illness (from, say, heart disease).

As data from the 2024-25 season becomes available, researchers hope to determine whether the vaccine will remain a one-and-done, or whether immunity will require repeated vaccination.

People 65 and up express the greatest confidence in vaccine safety of any adult group, a KFF survey found in April. More than 80% said they were “very “or “somewhat confident” about MMR, shingles, pneumonia, and flu shots.

Although the covid vaccine drew lower support among all adults, more than two-thirds of older adults expressed confidence in its safety.

Even skeptics might become excited about one possible benefit of the shingles vaccine: This spring, Stanford researchers reported that over seven years, vaccination against shingles reduced the risk of dementia by 20%, a finding that made headlines.

Biases often undermine observational studies that compare vaccinated with unvaccinated groups. “People who are healthier and more health-motivated are the ones who get vaccinated,” said Pascal Geldsetzer, an epidemiologist at the Knight Initiative for Brain Resilience at Stanford and lead author of the study.

“It’s hard to know whether this is cause and effect,” he said, “or whether they’re less likely to develop dementia anyway.”

So the Stanford team took advantage of a “natural experiment” when the first shingles vaccine, Zostavax, was introduced in Wales. Health officials set a strict age cutoff: People who turned 80 on or before Sept. 1, 2013, weren’t eligible for vaccination, but those even slightly younger were eligible.

In the sample of nearly 300,000 adults whose birthdays fell close to either side of that date, almost half of the eligible group received the vaccine, but virtually nobody in the older group did.

“Just as in a randomized trial, these comparison groups should be similar in every way,” Geldsetzer explained. A substantial reduction in dementia diagnoses in the vaccine-eligible group, with a much stronger protective effect in women, therefore constitutes “more powerful and convincing evidence,” he said.

The team also found reduced rates of dementia after shingles vaccines were introduced in Australia and other countries. “We keep seeing this in one dataset after another,” Geldsetzer said.

In the United States, where a more potent vaccine, Shingrix, became available in 2017 and supplanted Zostavax, Oxford investigators found an even stronger effect.

By matching almost 104,000 older Americans who received a first dose of the new vaccine (full immunization requires two) with a group that had received the earlier formulation, they found delayed onset of dementia in the Shingrix group.

How a shingles vaccine might reduce dementia remains unexplained. Scientists have suggested that viruses themselves may contribute to dementia, so suppressing them could protect the brain. Perhaps the vaccine revs up the immune system in general or affects inflammation.

“I don’t think anybody knows,” said Paul Harrison, a psychiatrist at Oxford and a senior author of the study. But, he added, “I’m now convinced there’s something real here.”

Shingrix, now recommended for adults over 50, is 90% effective in preventing shingles and the lingering nerve pain that can result. In 2021, however, only 41% of adults 60 and older had received one dose of either shingles vaccine.

A connection to dementia will require further research, and Geldsetzer is trying to raise philanthropic funding for a clinical trial.

And “if you needed another reason to get this vaccine,” Schaffner said, “here it is.”

The New Old Age is produced through a partnership with The New York Times.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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