Healthy Aging

Topic Overview

What is healthy aging?

Getting older is a natural part of life. How you will feel as you get older depends on many things, including what health problems run in your family and the choices you make. If you take good care of your body and learn positive ways to deal with stress now, you can slow down or even prevent problems that often come with getting older.

It's never too early or too late to change bad habits and start good ones. No matter when you start, a healthy lifestyle can make a difference in how you feel and what you can do.

What determines how healthy you will be as you get older?

The changes you'll go through as you get older depend on a number of things. One is your family history (genetics). If your family members have diseases or ongoing (chronic) health problems like high blood pressure or diabetes, then you may have a greater chance of having those problems yourself. But just because your risk is higher, it doesn't mean you will definitely have the same problems. In fact, the lifestyle choices you make can help reduce your chances of getting illnesses that run in your family. And even if you do get a family illness, choosing to be physically active, to eat healthy foods, and to learn how to deal with stress can keep the illness from destroying your ability to enjoy your golden years.

What kinds of changes should you expect as you age?

Changes as you get older are usually gradual. Certain physical changes are common. Your metabolism (how fast your body can burn calories) slows over time, which means that your body needs less food energy than before. How much and how well you sleep will likely change. Most people start needing reading glasses around age 40, and many have some hearing loss later in life. Starting in your 50s, bone aging increases. Also starting around age 50, you may notice changes in sexual function-it's normal to have a slower sexual response.

Most vital organs gradually become less efficient with age. The kidneys are less able to keep enough water in your body. And the heart can start to show signs of wear and tear. So as you get older, it's important to be physically active, drink plenty of water, and choose healthy foods. Doing these things will help your body work well for a longer period of time.

What do you need to do to feel your best as you age?

One of the most important things you can do for your health at any age is to be physically active. Physical activity keeps your body strong, and it helps with how you feel. People who stay active are less likely to get depressed. Physical activity can be anything from walking to gardening to working out at the gym. The important thing is to be active almost every day. No matter what your age or condition, there is a type of physical activity that's right for you. Always ask your doctor whether it is safe for you to start a physical activity program.

Your mental and emotional health are also important. Protect or improve your emotional health by staying in touch with friends, family, and the community. People who feel connected to others are more likely to thrive than those who do not. And try to keep stress at a minimum. In addition to getting regular physical activity, you can take charge of how stress affects you by taking 20 minutes a day to just relax.

To protect or improve your memory and mental sharpness, keep your brain active and challenged. Learn or do something new and different. For example, attend an educational workshop or learn a new card game. Depression can be a serious problem for older adults. If you think you may be depressed, seek help-antidepressant medicine and counseling can help treat depression.

Other good health habits can help you stay at your best:

• Eat a healthy, balanced diet. Avoid salty foods and foods with a lot of fat in them, such as fried foods.
• Remember that sexually transmitted infections can affect anyone at any age, so practicing safer sex is a must.
• If you smoke, try to quit.
• Always wear your seat belt.
• Don't abuse alcohol or drugs.

Normal Aging

As your body ages, you can expect gradual changes, at your body's own pace. How your body ages depends in part on your family (genetic) patterns of aging. But your lifestyle choices have a more powerful impact on how well your body ages. Fortunately, you can control your lifestyle choices.

Some of the following changes may apply to you. Others may not. A healthy lifestyle may slow many of these normal effects of aging.

Skin. With age, the skin becomes less elastic and more lined and wrinkled. Fingernail growth also slows. The oil glands gradually produce less oil, making the skin drier than before. You can slow skin aging by using moisturizer and protecting the skin from the sun with sunscreen and sun-protective clothing, such as a hat or cap.

Hair. It's normal for hair to gradually thin on the scalp, pubic area, and armpits. As hair pigment cells decline in number, gray hair growth increases.

Height. By age 80, it's common to have lost as much as 2 in. (5 cm) in height. This is often related to normal changes in posture and compression of joints, spinal bones, and spinal discs.

Hearing. Over time, changes in the ear make high-frequency sounds harder to hear and changes in tone and speech less clear. These changes tend to speed up after age 55.

Vision. Most people in their 40s develop a need for reading glasses as the lenses in the eyes become less flexible (presbyopia). It's also normal for night vision and visual sharpness to decline. Also in the later years, glare increasingly interferes with clear vision. Vision changes can affect your ability to drive safely. For more information, see:

• Healthy Aging: Is It Time to Stop Driving?

Sleep. Changes in sleep and circadian rhythm occur as you age. You will probably sleep less at night, and you may not sleep as deeply as you did when you were younger. And it's more likely that you'll wake up during the night and/or wake up earlier in the morning. For more information, see the topic Coping With Changing Sleep Patterns as You Get Older.

Bones. Throughout adulthood, men and women gradually lose some of the mineral content in their bones. The bones get less dense and strong. You can slow natural bone loss and reduce your risk of osteoporosis by getting regular, weight-bearing exercise (such as walking), getting enough calcium and vitamin D, and avoiding lifestyle choices that weaken bones (such as smoking). Your doctor may also recommend a bone-protecting medicine. For more information, see the topic Osteoporosis.

Metabolism and body composition. Over time, the body typically needs less energy, and your metabolism slows. Hormone changes in the aging body result in a shift to more body fat and less muscle mass. The best approach to managing these changes is to take in fewer calories while keeping up or increasing your physical activity. Strength training is an especially good way to build or keep your muscle mass. When your muscle mass is reduced, your metabolism slows down. Building or keeping your muscle mass allows your metabolism to remain the same or increase.

Brain and nervous system. Starting in the third decade of life, the brain's weight, the size of its nerve network, and its blood flow decrease. But the brain adapts to these changes, growing new patterns of nerve endings. Memory changes are a normal part of the aging process-it's common to have less recall of recent memories and to be slower remembering names and details. You can help keep your brain sharp. Engage in regular social activity. Challenge yourself to learn and do new things. And be physically active, to increase blood and oxygen flow to the brain.

Heart and blood circulation. The heart naturally becomes less efficient as it ages, and your heart has to work a little harder during activity than it did in the past. This makes the heart muscle a little larger. You'll notice a gradual decline in your energy or endurance from one decade to the next.

Lungs. In inactive people, the lungs become less efficient over time, supplying the body with less oxygen. Regular physical activity plays a key role in keeping your lungs strong.

Kidneys. With advancing age, the kidneys decline in size and function. They don't clear wastes and some medicines from the blood as quickly and don't help the body handle dehydration as well as in the past. This makes it increasingly important that you minimize the toxins, alcohol, and unnecessary medicine that you take in, and that you drink plenty of water.

Urinary incontinence. Age-related changes in the urinary system, decreased mobility, and some medicine side effects can all lead to urinary incontinence. This does not have to be part of normal aging, so talk to your doctor if urinary incontinence is affecting you.

Sexual function. Men and women produce lower levels of hormones starting in their 50s. Men produce less sperm, and their sexual response time slows. Women stop ovulating and have a number of menopausal changes linked to lower estrogen production. For more information, see the topic Menopause and Perimenopause.

Physical Vitality

Physical activity builds physical vitality. With every year of your life, you have more to gain from being physically active.

What are the benefits of being physically active?

On a daily basis, being physically active improves your quality of life by improving your:

• Energy level.
• Mental sharpness.
• Mood (regular aerobic exercise can help manage depression, anxiety, and stress).
• Balance, strength, and flexibility, which are key to preventing injuries and falls.
• Odds against chronic illness. Physical activity also often helps manage chronic illness with fewer medicines.

As you get older, an inactive lifestyle increases your risk of chronic disease. Conversely, getting regular aerobic exercise is one of your best defenses against diseases, such as:

• Coronary artery disease.
• Osteoarthritis.
• High blood pressure.
• Obesity.
• Osteoporosis(weight-bearing exercise is necessary).
• Type 2 diabetes.
• Cancer.

If you already have a chronic disease, becoming physically active may reduce your need for medicine to treat or control it.

I'm not physically active right now-how do I start?

If you've been inactive for awhile, you don't necessarily have to set your sights on becoming athletic-your first goal is to simply start moving more each day. Before you do, though, get off to a smart start by seeing your doctor for a full physical examination. Then you can follow his or her recommendations as well as these guidelines for becoming more physically active.

• Add more movement to your daily routine. For example, put away the TV remote control, park farther from building entrances or at the opposite side of the parking lot from where you're going, and take stairs instead of elevators. Walk a lap or two around your house or apartment, then down the street or around a nearby park. Use a phone app or pedometer and gradually increase the number of steps you take each day.
• Start with small, short-term goals. It's easiest to keep doing something new when you have early, frequent successes. For example, make a plan to walk for 10 minutes a day, 3 days a week, for 2 weeks.
• Buddy up with a friend. There's no better way to stay on track with physical activity than with a buddy you look forward to seeing, who also counts on you (especially on days when you could easily find an excuse not to be physically active).
• Change the way you think about yourself-start thinking, dressing, and eating like the active, vital person you plan to be.
• Make physical fitness a habit with such simple tasks as writing physical activity into your weekly calendar.

After a few weeks of regular physical activity, you will probably feel better than before. When you're ready for more, add some variety to your activity schedule with new ways to build flexibility, aerobic fitness, and muscle strength. Experts say to do either of these things to get and stay healthy:^{footnote 1}

• Moderate activity for at least 2½ hours a week. One way to do this is to be active 30 minutes a day, at least 5 days a week. Moderate activity means things like brisk walking, brisk cycling, or ballroom dancing. But any activities-including daily chores-that raise your heart rate can be included. You notice your heart beating faster with this kind of activity.
• Vigorous activity for at least 1¼ hours a week. One way to do this is to be active 25 minutes a day, at least 3 days a week. Vigorous activity means things like jogging, cycling fast, or cross-country skiing. You breathe rapidly and your heart beats much faster with this kind of activity.

It's fine to be active in blocks of 10 minutes or more throughout your day and week. You can choose to do one or both types of activity.

If you are just starting a fitness program or if you are age 65 or older, talk to your doctor about how often is safe for you to be physically active.

• Flexibility is increasingly important as age-related stiffness becomes a normal part of your daily life. A regular stretching or yoga routine can greatly improve your ease of movement. To help prevent injury, it's important to stretch before and after any activity that uses your joints and muscles for more than a few minutes.
• Aerobic fitness conditions your heart and lungs. Aerobic (oxygen-using) exercise is any activity that gets your heart pumping faster than when you're at rest, circulating more oxygen-carrying blood throughout your body. All kinds of daily activities can be aerobic, ranging from housecleaning, yard work, or pushing a child on a swing to walking, bicycling, or playing tennis.
• Muscle fitness includes building more powerful muscles and increasing how long you can use them (endurance). Weight lifting builds stronger muscles and strengthens bones. No matter what your age and whether you've done it before, you can gain great benefit from strength training. As you age, muscle fitness plays an increasingly important part in staying at a healthy weight, because muscle is the primary cell type that uses calories. Muscle fitness is also key to improving or preventing balance problems, falls, and therefore bone fractures. Try to do exercises to strengthen muscles at least two times each week.^{footnote 1}Examples include weight training or stair climbing on two or more days that are not in a row. For best results, use a resistance (weight) that gives you muscle fatigue after 8 to 12 repetitions of each exercise.

I'm already physically active. Is there anything more I should be doing?

Even if you're happy with your fitness routine, it's a good idea to periodically stop, think, and rework your activities and goals. As age-related issues gradually enter into your fitness equation, keep the following things in mind.

• Beyond age 60, it's important to spend as much time building strength and flexibility as you spend on aerobic fitness. Strength and flexibility help your body better handle the age-related changes, including loss of muscle and problems with balance. To maintain or improve your balance and resilience, include stretching, muscle strengthening, and such balance-building activities as yoga or tai chi in your weekly routine.
• It's normal to have to gradually adjust your expectations of how far you can push your body. If you're used to pushing yourself, accept your body's changes and tend toward moderation.
• Cross-training, or including different activities in your activity calendar, helps you build better overall fitness and helps prevent injury from overuse.
• Replacing a "lost" activity is a key to staying active. For instance, if you can no longer run, you might try walking, biking, and/or swimming.
• Injury generally takes longer to recover from as you age. If you are injured, allow your injury time to heal-yet keep the rest of your body moving. You can choose from a list of alternate activities, such as swimming, water exercises, biking, walking, yoga, Pilates, or rowing.
• To prevent injury, start a new activity gradually, avoid overusing your body, and stretch often. Drink plenty of water before, during, and after you are active. This is very important when it's hot out and when you do intense exercise.

Emotional and Mental Vitality

Emotional and mental vitality are closely tied to physical vitality-just as your mind has powerful effects on your body, so your physical state affects how you feel and think. Social contact can also make a big difference in how you feel.

Replacing a "lost" activity is a key to staying active and feeling good about yourself. For instance, if you can no longer run, you might try walking, biking, and/or swimming. And if your favorite activity was dancing, you might try something else that combines social and physical activity, such as joining a water aerobics class. Replacing lost activities can help you keep a positive attitude and sense of well-being over time, even if aging and changes in your health mean you can not do all the things you used to do.

Physical activity. Protect or improve your emotional and cognitive health with regular physical activity. While physical activity produces chemicals in the body that promote emotional well-being, inactivity can make depression, anxiety, and stress worse. Research has been done to link physical activity and the risk of Alzheimer's disease and other dementias. Adults who are physically active may be less likely to get Alzheimer's disease or dementia than adults who are not physically active.^{footnote 2}

Social activity. Protect or improve your emotional health by staying in touch with friends, family, and the greater community. Whether physically healthy or ill, people who feel connected to others are more likely to thrive than those who are socially isolated. Volunteering in your community and sharing your wisdom and talents with others is a gratifying and meaningful way to enrich your life.

Mental activity. Protect or improve your memory and mental sharpness by:

• Challenging your intellect on a daily basis. Read, learn a new musical instrument or language, do crossword puzzles, or play games of strategy with others. Just like an active body, an active brain continues to develop and thrive, while an inactive brain loses its power over time.
• Helping your memory along. Write down dates, names, and other important information that you easily forget. Use routine and repetition. For example, keep daily items such as keys and eyeglasses in a specific place. And when you meet someone new, picture that person while you repeat his or her name out loud to others or to yourself several times to commit it to memory. (No matter what your age, having too much on your mind can keep you from remembering new information. And as you age, it is normal to take longer to retrieve new information from your memory bank.)
• Preventing depression, which is a common yet treatable cause of cognitive decline in older people. In addition to getting regular physical activity and social contact, avoid the depressant effect of alcohol and sedative use, eat healthy meals and snacks, and include meaningful activity in your daily life (such as learning, creating, working, volunteering). If you think you have depression, seek professional help-antidepressant medicine or counseling or both are effective treatments for depression. For more information, see the topic Depression. If you find that a physical condition or disability is making your depressed mood worse, get the medical treatment you need.
• Not smoking. Cigarette smoking may speed mental decline. If you smoke and would like to stop, see the topic Quitting Smoking.

Stress reduction and relaxation techniques. Too much life stress can take a toll on your body, your mind, and the people who are closest to you. In addition to getting regular physical activity, you can take charge of how stress affects you by taking 20 minutes a day for relaxation time.

• Meditation focuses your attention and helps calm both mind and body. Daily meditation is used for managing a spectrum of physical and emotional conditions, including high blood pressure, anxiety, depression, and chronic pain.
• The body responds to stress with muscle tension, which can cause pain or discomfort. Progressive muscle relaxation reduces muscle tension and general anxiety and may help you get to sleep.
• The way you breathe affects your whole body. Try breathing exercises for relaxation. Full, deep breathing is a good way to reduce tension, feel relaxed, and reduce stress. For more information about reducing stress, see the topic Stress Management.

Positive thinking. Positive thinking may help you live a longer, happier life. Even if you tend to be an optimist, there are times when it takes extra effort to frame your life positively. Take the following steps to harness the power of positive thinking in your daily life.

• Open yourself to humor, friendship, and love. Go out of your way to find reasons to laugh and to spend time with people you enjoy.
• Create positive expectations of yourself, your health, and life in general. When you catch yourself using negative self-talk or predicting a bad outcome, stop. Reframe your thought into a positive one, and speak it out loud or write it down. For more information, see Stop Negative Thoughts: Choosing a Healthier Way of Thinking.

Spiritual wellness. Your spiritual beliefs can bring you comfort and give you strength for handling life's challenges. For some people, organized religion provides a faith community and a belief system. But spirituality can take many forms. Taking time to be in nature, to meditate, or to pray may help you find a sense of meaning and purpose. For more information, see Spirituality and Your Health.

Sexual Vitality

Because sexuality tends to be a private matter, it's likely that you've heard less about sexual change than any other element of aging. Fortunately, the news is good-for most healthy adults, pleasure and interest don't diminish with age. Most people are sexual throughout their lives, with or without a partner, and some feel greater sexual freedom in their later years. On the other hand, some men and women are content to be sexually inactive.

Around age 50, men and women typically begin to notice changes in their sexual drive, sexual response, or both. Like so many other physical changes that evolve over time, these aren't signs that you are losing your sexuality. Rather, these changes are simply something to adjust to and discuss openly with your partner and/or your doctor.

Normal sexual changes in men

As you age beyond your 50s, you may find that:

• Male sex drive is minimally affected by age (although health problems, certain medicines, or relationship stress can lower sex drive).
• Erections become less firm and tend to take more time than when you were younger.
• You may be able to delay ejaculation for longer than when you were younger.

Normal sexual changes in women

After menopause, estrogen and androgen levels drop, causing physical changes. You may find that:

• It can take longer to become sexually excited.
• You are less interested in sex.
• Your skin may be more sensitive and easily irritated when caressed.
• Intercourse may be painful because of thinning vaginal walls (regular sex often helps prevent this from becoming severe). If a water-based lubricant (such as Astroglide) isn't enough, talk to your doctor about vaginal estrogen cream, which reverses thinning and sensitivity. For more information, see the topics Menopause and Perimenopause and Sexual Problems in Women.

If you have noticed sexual changes that don't seem to be linked to normal aging, talk to your doctor. There are a number of medicines that can cause sexual problems, as well as health conditions that can cause sexual problems.

Adjusting to age-related sexual changes

With a little experimentation and patience, you can adjust to sexual changes and satisfy your sexual and intimacy needs. If you think your sexual interest might be affected by a medicine or health problem, work with your doctor to correct or treat it. Talk with your partner about any misgivings you might have so you can handle them together.

With your partner, take your time to set a relaxed mood and engage in foreplay. Use a lubricant if vaginal dryness or irritation is a barrier to enjoying sex. If you drink alcohol, remember that a small amount may relax you and increase your responsiveness, but too much alcohol is not likely to be helpful.

Sexually transmitted infections (STIs) are a risk no matter what age you are. Unless you and your partner have recently been tested or you are 100% sure that you both have been monogamous for many years without infection, make sure that you practice safer sex to prevent STIs. For more information, see the topic Safer Sex.

Getting the Nutrition You Need

As you get older, good nutrition plays an increasingly important role in how well you age. Eating a low-salt, low-fat diet with plenty of fruits, vegetables, and fiber can actually reduce your age-related risks of heart disease, diabetes, stroke, osteoporosis, and other chronic diseases. By eating a wide variety of foods, you can pretty easily get what your body needs, including:

• Protein, which is needed to maintain and rebuild muscles. You can get low-fat, quality protein from poultry, fish, eggs or egg substitutes, soy, and limited amounts of nuts and low-fat meat and dairy.
• Carbohydrate, which is the body's preferred source of energy. There are two main sources of dietary carbohydrates: simple sugars, such as sucrose (the refined white sugar added to sweets and desserts), fructose (the sugar contained in fruit), and lactose (milk sugar); and complex carbohydrates, which come from vegetables and grains. Unlike refined sugars, fruits contain vitamins and fiber, dairy products contain nutrients such as calcium and vitamin D, and complex carbohydrates contain vitamins, minerals, and fiber. Get most of your carbohydrate calories from vegetables, grains, and fruits. Limit drinks and foods with added sugar. And try to replace fat calories with complex carbohydrates in your diet.
• Fat, which also provides energy. To help keep your blood cholesterol levels low, get most of your limited fat intake from the polyunsaturated fats (as in liquid corn oil or soybean oil) and monounsaturated fats (in olive oil, avocados, and nuts). Limit saturated fats (beef, pork, veal, butter, shortening, and cheese). You can do this by eating these foods less often, having smaller servings, choosing less fatty cuts of meat, and by using stronger tasting cheeses so you can use just a little and still get the cheese flavor. Try to avoid the trans fats (hydrogenated fats) found in stick (hard) margarine and in many processed foods such as crackers and cookies. Trans fats are now shown on the nutrition facts labels found on most packaged foods.
• Water, to replace water lost through activity. Be sure to drink plenty of water each day.

As you take a look at your daily diet, remember that as you age:

• Your body's daily energy needs slowly decrease. So you need fewer calories a day than when you were younger. Your doctor or a registered dietitian (RD) can help you calculate your ideal calorie intake.
• Natural hormone changes make your body prone to depositing more body fat (especially around your middle) and less muscle. Eating a healthy, balanced diet and limiting your intake of saturated fat, along with increased activity and muscle strengthening (muscle cells are the major calorie burners in your body), can help you stay at a healthy weight.
• Your bones lose mineral content more rapidly than before, especially if you are a postmenopausal woman, because having less estrogen increases bone loss. As a result, you need to have calcium and vitamin D in your diet to help prevent osteoporosis. Your doctor may recommend that you take a calcium and vitamin D supplement.
• Plaque buildup (atherosclerosis) can naturally occur on the inside of the arteries that supply blood to the heart and brain. You can help slow this plaque buildup by eating heart-healthy foods such as lean meats, fruits, vegetables, and whole grains. A healthy diet can help lower cholesterol and high blood pressure and prevent heart disease and stroke.

Help for managing underweight or poor nutrition

People who are underweight or frail have low reserves for bouncing back after an illness or injury. In the later years, this can lead to permanent ill health or disability. If you have trouble keeping your weight up, it's critical that you take special measures to build your weight, energy, and resilience. Every day, follow your doctor's recommendations and:

• Eat three meals plus three snacks, and never miss a meal.
• Choose higher-calorie foods from each food group, such as whole milk instead of skim milk. But try to keep your overall saturated fat intake low-high cholesterol can affect anyone.
• Eat the highest-calorie foods in a meal first.
• Use liquid supplements, such as Ensure or Boost, between meals.

If you are having trouble getting the food you need because of transportation, financial, or health problems, ask your doctor about local meal programs. Most communities have Meals on Wheels programs that can deliver food to your door. And there are meals at churches and community centers that can nourish your needs for both food and social time.

Getting the Medical Care You Need

Medical prevention, regular checkups, and prompt treatment play a key role in your quality of life as you age.

Prevention

Your grandparents' generation had few protections from life-threatening conditions, but you now have the advantage of immunizations and regular screenings. Screenings and immunizations may help you live a longer, higher-quality life. But there comes a time when some screening tests won't be helpful, so talk to your doctor about which tests to have.

Managing your health care

Be an informed health care consumer. When you are concerned about a medical condition, read as much as you can about it and its possible treatments. Make a list of unanswered questions and talk to your doctor about them. Explore all treatment options before deciding how to treat a problem. And get at least one second opinion if you're considering a surgery, medicine with dangerous side effects, or experimental treatment.

Be your own best health advocate. Make it your goal to work in partnership with your doctors. In general, people who make health decisions with their doctors are happier with the care they receive and the results they achieve. It's important to share in every decision about your health. The decisions you make influence your overall well-being as well as the quality and cost of your care. Whenever you have a medical appointment:

• Bring your health and medicine history with you, as well as a list of questions you want answered during your appointment.
• Make sure you understand your doctor's key points about your health and any possible tests and treatments.
• You can bring along a friend or family member to support you and help you remember key information for later on. This can be especially useful when you're under a lot of physical or emotional stress.

Get organized. Feeling organized and in control of your health care can be a challenge, especially when something comes up unexpectedly. Your best approach to managing your health care is to get organized now-create a personal medical information file, including an ongoing record of your:

• Health professionals' names and numbers.
• Medicines, herbal supplements, and vitamins. For each, include the dosage, who prescribed it and why, and any side effects you have had. Use this form. (What is a PDF document?)
• Known allergies to medicines, foods, or insects (include the type of allergic reaction).
• Immunization record.
• Symptoms, health conditions, and treatments. For each, jot down dates and any details that you might easily forget. Use this form (What is a PDF document?).
• Exam and test results.
• Emergency medical information, such as pacemaker use or chronic disease diagnosis.
• Insurance policy and payment receipts.

Advance directives such as a living will and a medical power of attorney can ensure that you will get the care you want if you become physically or mentally unable to make your own medical decisions. A living will states your wishes about your medical care. A medical power of attorney gives a person you choose (your health care agent) the authority to make medical decisions for you if you become unable to make these decisions for yourself. In addition to putting your advance directives in writing, also be sure to clearly communicate your choices to all family members who might be involved in your health care in the future.