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Dementia occurs more often among older people with higher levels of hearing loss than among those with normal hearing. A new study found that wearing hearing aids reduced the risk for dementia in people who had significant hearing loss.n “,”content”:”n

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Are you having a little trouble hearing conversations? If so, you’re not alone. An estimated 23% of Americans ages 12 and older have hearing loss. Although most of those people have mild hearing loss, for people ages 80 years and older, it’s more common for hearing loss to be moderate to severe than mild.

But not only is moderate to severe hearing loss disruptive to one’s life, it also makes you more likely to develop dementia. A new study helps explain why — and what you can do about it.

What did the new study look at and find?

A study published in JAMA focused on a sample of adults in the United States from the National Health and Aging Trends Study, which follows Medicare beneficiaries. The participants sampled were 70 or older.

The researchers found that about 33% of participants had normal hearing, 37% had mild hearing loss, and 30% had moderate to severe hearing loss. Dementia occurred least often among those with normal hearing (6%), more often among those with mild hearing loss (9%), and most often among those with moderate to severe hearing loss (17%). That’s a large increase in risk, particularly for those whose hearing loss is moderate to severe.

What else to know about this study

The study sample was selected to make it possible to analyze subgroups by age and apply findings to a diverse population. The sample included additional participants ages 90 years and older, and additional participants who identified as Black. Of the 2,413 total participants, 53% were ages 80 years and older, 56% were female, 19% were non-Hispanic Black, 4.5% were Hispanic, and 74% were non-Hispanic white.

Also, unlike previous research, this study looked objectively at hearing loss and dementia. Prior research had shown that hearing loss is thought to account for about 8% of all dementia cases worldwide. Exactly why the connection exists is not known.

It’s important to note that most large studies that found this link were based on questionnaires that people fill out. In other words, no one actually measured the hearing of those participating in the study to make sure that they had hearing loss — or that their hearing was really normal.

In this new study, however, the investigative team used an electronic tablet-based audiometer to evaluate participants’ hearing for four pure tone frequencies that are most important for understanding speech. So, for the first time in a large study, there was objective measurement of hearing loss.

How do hearing aids reduce the risk of dementia?

If you have hearing loss, does that mean you’re doomed to develop dementia? Not at all. This study found that those with moderate to severe hearing loss could significantly reduce their risk of dementia simply by using hearing aids.

This research helps us understand why hearing loss causes dementia. Here’s the connection:

There is increasing evidence that the more the brain is stimulated, the less likely it is that dementia will develop. When there is hearing loss, auditory stimulation is reduced. This, by itself, likely increases dementia risk. But even more important is that when an individual suffers from moderate to severe hearing loss, they are less likely to participate in social activities. Perhaps they are embarrassed about their hearing loss. Or they may simply find it unrewarding to attend a social event when they cannot hear what is going on.

It turns out that social activities are one of the best ways to stimulate the brain, as there is evidence that our brains evolved to facilitate social behavior. Given all this information, you won’t be surprised to learn that reduced social activity has been linked to cognitive decline. Thus, this new study provides additional evidence that the reason hearing loss increases the risk of dementia is because hearing loss reduces brain stimulation — both directly and through reduced social interaction.

What to do if you have hearing loss

Don’t let hearing loss raise your risk of dementia.

Keep your ears clean. (But remember, never put anything in your ears smaller than your elbow. Ask your doctor if you’re not sure how to clean your ears.)

If you can’t hear and you don’t have hearing aids, get them. Hearing aids now available over the counter can help many people with mild to moderate hearing loss.

If you have hearing aids, wear them.

If your hearing aids aren’t working, get them fixed.

Don’t be passive — ramp up your social life and other activities.

All these things will help to reduce your risk of dementia. And you might just find that, despite some hearing loss, you’re enjoying life more.

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n “,”description”:null,”author”:null,”slug”:”want-to-reduce-your-risk-of-dementia-get-your-hearing-checked-today-202302162891″,”sort_date”:”2023-02-16T05:00:00.000000Z”,”contentable_type”:”AppModelsMarketingBlogPost”,”contentable_id”:2891,”replacement_content_id”:null,”landing_page_landing_page_group_id”:null,”ucr_content_id”:”BL021623″,”publication_date”:”2023-02-16T15:30:00.000000Z”,”last_review_date”:null,”imported_at”:”2023-04-23T09:00:17.000000Z”,”last_import_type”:”update”,”last_modified_date”:”2023-04-22T04:00:00.000000Z”,”active”:1,”created_at”:”2023-02-16T10:00:03.000000Z”,”updated_at”:”2023-04-23T09:00:17.000000Z”,”deleted_at”:null,”images_remapped”:0,”old_product_id”:null,”old_content_id”:null,”hide_ads”:0,”primary_content_topic_id”:37,”ecommerce_type”:”CATALOG”,”authors”:[{“id”:209,”cr_id”:538,”featured”:1,”hhp_staff”:0,”hidden”:0,”name”:”Andrew E. Budson, MD”,”title”:null,”first_name”:”Andrew”,”middle_name”:”E.”,”last_name”:”Budson”,”suffix”:”MD”,”slug”:”andrew-e-budson-md”,”byline”:”Contributor; Editorial Advisory Board Member, Harvard Health Publishing”,”description”:”

Dr. Andrew E. Budson is chief of cognitive & behavioral neurology at the Veterans Affairs Boston Healthcare System, lecturer in neurology at Harvard Medical School, and chair of the Science of Learning Innovation Group at the Harvard Medical School Academy. Graduating cum laude from Harvard Medical School in 1993, he has given over 750 local, national, and international grand rounds and other talks; published over 125 scientific papers, reviews, and book chapters; and co-authored or edited eight books.

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His book Seven Steps to Managing Your Memory: What’s Normal, What’s Not, and What to Do About It explains how individuals can distinguish changes in memory due to Alzheimer’s versus normal aging; what medications, vitamins, diets, and exercise regimens can help; and the best habits, strategies, and memory aids to use; it is being translated into Chinese and Korean. His book Memory Loss, Alzheimer’s Disease, and Dementia: A Practical Guide for Clinicians has been translated into Spanish, Portuguese, and Japanese. His book Six Steps to Managing Alzheimer’s Disease and Dementia: A Guide for Families teaches caregivers how they can manage all the problems that come with dementia — and still take care of themselves. His latest book, Why We Forget and How to Remember Better: The Science Behind Memory, explains the science of memory and how to use that knowledge to improve our ability to remember in daily life.
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rnTwitter: @abudson

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Thousands of miles of veins throughout the body bring blood to the lungs to pick up oxygen and nutrients, and get rid of carbon dioxide before returning to the heart to be pumped out again. How do veins work, what problems can occur, and how can you keep these vital blood vessels healthy?

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Blood circulation is vital to our health. Our arteries deliver oxygen, energy-rich nutrients, hormones, immune cells, and other essentials throughout the body. When deliveries are cut off, organs and tissue can be irreversibly damaged within minutes.

But a second part of blood circulation is also vitally important: the return trip. After our arteries deliver the goods, our blood must return to the lungs to pick up more oxygen, stock up on nutrients, get rid of carbon dioxide, and head back to the heart to be pumped out again. In this way, blood is in continuous motion, ensuring organs and tissues get what they need while waste products are removed.

The vessels designed for the return trip are your veins. Read on for answers to questions about how veins work, what can interfere with their ability to work smoothly, and five ways to keep thousands of miles of these blood vessels healthy.

What are veins and what do they do?

Perhaps you haven’t thought much about your veins. Or if you have, maybe you focused on varicose veins, those swollen, unsightly purplish vessels that may be visible just beneath the skin of the legs. Or perhaps you had a blood test and the person taking the blood had a hard time finding a “good vein.” But these are just a small part of vein world.

Veins make up a network of connecting tubes throughout the human body, ranging in size from 1 mm (about the size of a pencil point) to 2 cm (about the size of a quarter), that bring blood low in oxygen back to the lungs to reload with oxygen. Then four pulmonary veins carry oxygen-rich blood from the lungs to the heart. (Fun fact: some people have three or five pulmonary veins, but most of us have four.)

Often, major veins are found alongside similarly named arteries, like a highway with cars moving in opposite directions: in the upper arm, for example, the axillary vein lies next to the axillary artery; in the kidney, the renal vein runs alongside the renal artery.

How do veins help keep blood flowing?

Let’s start by picturing tiny red blood cells loaded up with oxygen. Now imagine you’re a red blood cell that has just traveled from the heart through the arteries to a calf muscle of someone who is jogging. After you drop off the much-needed oxygen and pick up waste products like carbon dioxide, you need to get back to the heart — fast! — because exercising muscles need extra oxygen.

But wait. As you head back to the lungs to load up on more oxygen and release carbon dioxide, there’s a steep climb straight up. How can you make it back to the lungs without help?

Fortunately, veins have tiny valves within them that allow blood to flow in only one direction. When muscles contract near larger veins, they pump blood toward the lungs. In addition, taking in a breath creates a sort of suction that pulls blood toward the lungs. Without these forces encouraging blood to flow in the right direction through the veins, blood flowing into the legs would pool there, causing dangerously high pressure and swelling.

Why are veins blue?

Actually, they aren’t. People think they’re blue because that’s often how they appear in diagrams and illustrations. But that’s just to set them apart from the bright red arteries.

The veins on the back of your hand may appear blue if you have light-colored skin. That’s an illusion due to the way light is absorbed by the skin. In people with darker skin tones, veins tend to blend in more.

If you could look at veins directly, without any skin in the way, they’d appear pale because they are naturally colorless, or dark red due to the blood inside them.

What sort of problems can occur in veins?

Blood clots, varicose veins, and venous insufficiency are some of the most common health conditions affecting the veins:

Deep vein thrombosis (DVT) occurs when a blood clot forms in a deep vein, blocking blood flow. This condition is potentially serious because clots in deep veins can travel to the lungs, causing a life-threatening pulmonary embolism by blocking an artery that delivers blood to part of the lungs.

Superficial thrombophlebitis is a blood clot in a small vein just under the skin. This causes inflammation and pain.

Varicose veins are small veins under the skin that swell and twist. While these may be harmless, they can cause pain and are occasionally complicated by blood clots.

Venous insufficiency occurs when the valves in veins are damaged — due to aging or prior blood clots, for example. The blood flow through the veins may be impaired, leading to leg swelling, increased pressure, inflamed skin, and poor healing.

One far more rare condition goes by the impressive name of phlegmasia cerulea dolens. It is a serious complication of DVT in which the obstruction of blood flow through a deep vein leads to blocked blood flow through nearby arteries. That can cause gangrene and the need for amputation.

All of these conditions can affect circulation temporarily or in a lasting way. Treatments are aimed at restoring circulation, if possible.

Top 5 ways to improve vein health

Healthy veins help the heart, brain, and every other part of your body. Here are five ways to improve vein health, even if you already have vein disease:

Be active. Exercise regularly and avoid prolonged standing or sitting.

Choose healthy foods, such as those in a plant-based, heart-healthy diet.

Maintain a healthy weight.

Don’t smoke.

Wear compression stockings if you already have vein disease such as venous insufficiency.

And of course, seek medical care for unexplained swelling, inflammation, or ulcers on your legs, ankles, or feet.

The bottom line

Our veins are busy around the clock, shuttling blood from distant sites back to the lungs and heart, which pumps enriched blood out again. Without veins, blood circulation could not happen. They’re a good example of how many parts of your amazing body are easy to overlook until something goes wrong.

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n “,”description”:null,”author”:null,”slug”:”veins-are-a-key-player-in-the-body-heres-why-202311292997″,”sort_date”:”2023-11-29T05:00:00.000000Z”,”contentable_type”:”AppModelsMarketingBlogPost”,”contentable_id”:2997,”replacement_content_id”:null,”landing_page_landing_page_group_id”:null,”ucr_content_id”:”BL112923″,”publication_date”:”2023-11-29T15:30:00.000000Z”,”last_review_date”:null,”imported_at”:”2023-12-01T10:00:03.000000Z”,”last_import_type”:”update”,”last_modified_date”:”2023-11-30T05:00:00.000000Z”,”active”:1,”created_at”:”2023-11-29T10:00:02.000000Z”,”updated_at”:”2023-12-01T10:00:03.000000Z”,”deleted_at”:null,”images_remapped”:0,”old_product_id”:null,”old_content_id”:null,”hide_ads”:0,”primary_content_topic_id”:44,”ecommerce_type”:”CATALOG”,”authors”:[{“id”:23,”cr_id”:2,”featured”:1,”hhp_staff”:1,”hidden”:0,”name”:”Robert H. Shmerling, MD”,”title”:null,”first_name”:”Robert”,”middle_name”:”H.”,”last_name”:”Shmerling”,”suffix”:”MD”,”slug”:”robert-h-shmerling-md”,”byline”:”Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing”,”description”:”

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. As a practicing rheumatologist for over 30 years, Dr. Shmerling engaged in a mix of patient care, teaching, and research. His research interests center on diagnostic studies in patients with musculoskeletal symptoms, and rheumatic and autoimmune diseases. He has published research regarding infectious arthritis, medical ethics, and diagnostic test performance in rheumatic disease. Having retired from patient care in 2019, Dr. Shmerling now works as a senior faculty editor for Harvard Health Publishing.

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At a year old, babies who have been drinking formula don’t need it anymore, but formula companies are marketing transitional products to keep customers longer. These products are unnecessary and costly, don’t offer any nutritional advantages, and are sometimes even unhealthy.

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

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

Is toddler formula more nutritious than milk?

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

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

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

Do some toddlers need specialized formulas?

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

Are toddler formulas regulated in any way?

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

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

What might make a toddler formula unhealthy?

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

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

Is your toddler’s diet healthy?

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

fruits and vegetables

whole grains

protein (such as meat, fish, beans, and nut butters)

dairy or dairy substitutes fortified with calcium and vitamin D.

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

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The holidays are supposed to be filled with love, laughter, and good cheer. Unfortunately, joyous celebration often deteriorates into discord when family and friends gather during the season. But you don’t have to get drawn into arguments if you plan ahead and stay alert for potential triggers.

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The holidays, as painted by idealists, are hardly the time for disagreements. They’re supposed to be filled with love, laughter, good cheer, and those tiny sparkly lights that make the mood feel festive. Unfortunately, joyous celebration often deteriorates into epic discord when family and friends gather during the season. But you don’t have to get drawn into arguments if you plan ahead and stay alert for potential triggers.

Why do we fight at the holidays?

In many ways, we are primed for holiday arguments. “It’s a stressful time. Buying gifts can lead to financial worries. The weather is colder. Days are darker. We’re trying to juggle work and get time off,” says Justin Gillis, a clinical therapist at Harvard-affiliated McLean Hospital. “The holidays can also elicit painful memories or make us face unfortunate realities in our lives, such as a lack of family or close support.”

As a result, we are often emotionally vulnerable during the holidays, Gillis says. It’s hard to manage intense feelings, express ourselves accurately, or be open and nonjudgmental.

“When we increase emotional arousal, it impacts our reasoning and subsequent behaviors. So we may be more defensive, or express ourselves in ways that result in conflict,” Gillis says.

Drinking alcohol at holiday gatherings can also fuel arguments, since alcohol lowers inhibitions and makes it harder to remain calm or maintain composure. In a 2021 survey from the American Addiction Centers, 57% of 3,400 respondents said they had at least one family member who becomes argumentative at holiday gatherings after imbibing too much.

Plan ahead to help defuse emotions and arguments

It’s challenging to control emotions in a heated moment. A bit of planning can help you avoid potential arguments or take appropriate action if angry words start flying. Here are some helpful tips.

Set a time limit. If you’re hosting the event, let your guests know in advance what time the festivities will end. If you’re attending the event, tell the host in advance when you’ll have to leave. “Stick to the plan, even if things are going well, so you can end on a high note,” Gillis says.

Ask for help. To help you rein in reactivity, ask someone you trust to give you a sign if a conversation appears to be risky or escalating. “They can chime in and ask you to do something, which is code for, ‘Back out or take a break.’ Doing that will ensure that you separate from the discussion,” Gillis says.

Schedule breaks. Think about when and how you’ll be able to take breaks during a gathering. This gives you an opportunity to check in with your emotions. “You might go into another room and take a moment to breathe deeply, volunteer to help set the table or clean up, or excuse yourself to make a phone call, even if nothing is wrong,” Gillis suggests. “These can be welcome distractions that limit the chance for conflict.”

Prepare words of deflection. If you know loved ones might ask questions that will lead to conflict, have a prepared answer and practice it. “Make a statement acknowledging the person’s feelings and letting them know it’s best for the topic to change,” Gillis says. He suggests using a version of the following statements.

“I appreciate your thoughts, but let’s talk about something we agree on or share.”

“I care about you, but I’m starting to feel sad and I don’t want to continue a negative conversation.”

“I appreciate and respect your passion about this, but I don’t think I can talk about this anymore.”

How to de-escalate arguments

If you find that heated debates or arguments are brewing — or boiling over — you can still take a few steps to defuse the situation. Use the deflection statements you practiced, or excuse yourself from the conversation to go do another activity.

Other tips to keep in mind:

Don’t take the bait. Don’t answer nosy questions if you don’t want to. “Change the subject. Move the focus back onto the other person and ask how they’re doing,” Gillis says. And if someone asks a loaded question (such as, “I suppose you voted for that candidate?”), use humor if appropriate (“Let’s talk about the Bruins instead”) and change the subject or the activity.

Adjust your mindset. “We have to accept that there are perspectives we don’t like and that engaging in conflict isn’t likely to change anyone’s perspective,” Gillis says. “You can choose not to participate in an unhealthy conversation.”

Respond with kindness. “If someone is angry with you, that suggests they really care what you think. Remember that and try to maintain a compassionate stance and response,” Gillis advises.

Remember why you’re there. The goal of the gathering is celebrating, not solving painful or controversial issues. “It’s the holiday. It doesn’t have to be the day when everyone puts their cards on the table to work out problems,” Gillis says. “Make it festive and enjoyable so you can feel that you created a pleasant holiday memory together.”

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n “,”description”:null,”author”:null,”slug”:”holiday-arguments-brewing-heres-how-to-defuse-them-202212142866″,”sort_date”:”2022-12-14T05:00:00.000000Z”,”contentable_type”:”AppModelsMarketingBlogPost”,”contentable_id”:2866,”replacement_content_id”:null,”landing_page_landing_page_group_id”:null,”ucr_content_id”:”BL121422″,”publication_date”:”2022-12-14T15:30:00.000000Z”,”last_review_date”:null,”imported_at”:”2023-12-01T10:00:05.000000Z”,”last_import_type”:”update”,”last_modified_date”:”2023-05-18T04:00:00.000000Z”,”active”:1,”created_at”:”2022-12-14T14:16:20.000000Z”,”updated_at”:”2023-12-01T10:00:05.000000Z”,”deleted_at”:null,”images_remapped”:0,”old_product_id”:null,”old_content_id”:null,”hide_ads”:0,”primary_content_topic_id”:37,”ecommerce_type”:”CATALOG”,”authors”:[{“id”:31,”cr_id”:117,”featured”:0,”hhp_staff”:0,”hidden”:0,”name”:”Heidi Godman”,”title”:null,”first_name”:”Heidi”,”middle_name”:null,”last_name”:”Godman”,”suffix”:null,”slug”:”heidi-godman”,”byline”:”Executive Editor, Harvard Health Letter“,”description”:”

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow of the American Academy of Neurology, and has been honored by the Associated Press, the American Heart Association, the Wellness Community, and other organizations for outstanding medical reporting. Heidi holds a bachelor of science degree in journalism from West Virginia University.

“,”image_url”:”https://d2icykjy7h7x7e.cloudfront.net/authors/jmHxTqYhe8m1bTrPQJnvY8odf8gsq1y1Q0i6Wp6Y.jpg”,”twitter_username”:null,”sort_order”:0,”created_at”:”2021-05-11T10:08:08.000000Z”,”updated_at”:”2022-08-03T17:04:41.000000Z”,”deleted_at”:null,”pivot”:{“content_id”:17727,”author_id”:31,”sort_order”:1}}],”contentable”:{“id”:2866,”comments_open”:1,”created_at”:”2022-12-14T14:16:20.000000Z”,”updated_at”:”2022-12-14T20:45:31.000000Z”,”deleted_at”:null,”media”:[]},”content_type”:{“id”:18,”name”:”blog”,”slug”:”blog”,”created_at”:”2021-05-11T08:30:32.000000Z”,”updated_at”:”2021-05-11T08:30:32.000000Z”,”deleted_at”:null},”media”:[{“id”:13340,”model_type”:”AppModelsMarketingContent”,”model_id”:17727,”uuid”:”f2a1f762-e970-4920-883e-8023ceb2cc85″,”collection_name”:”contents”,”name”:”1380ed22-af68-4a71-88d7-57be377b5d5e”,”file_name”:”1380ed22-af68-4a71-88d7-57be377b5d5e.jpg”,”mime_type”:”image/jpeg”,”disk”:”s3″,”conversions_disk”:”s3″,”size”:33136,”manipulations”:[],”custom_properties”:{“alt”:”A round black time bomb with an illustrated brown striped, curvy fuse and yellow and orange paper flames at the end showing that it’s been lit”},”generated_conversions”:{“micro”:true,”thumb”:true},”responsive_images”:[],”order_column”:13311,”created_at”:”2022-12-14T14:16:20.000000Z”,”updated_at”:”2022-12-14T14:16:23.000000Z”,”full_url”:”https://domf5oio6qrcr.cloudfront.net/medialibrary/13340/1380ed22-af68-4a71-88d7-57be377b5d5e.jpg”}],”primary_content_topic”:{“id”:37,”name”:”Mind & Mood”,”slug”:”mind-and-mood”,”is_primary”:1,”canonical”:”https://www.health.harvard.edu/topics/mind-and-mood”}},{“id”:18472,”content_source_id”:2,”content_type_id”:18,”content_access_type_id”:1,”title”:”What does a birth doula do?”,”short_title”:””,”subheading”:”Doulas can be an extra support and advocate during pregnancy and labor — and sometimes in early months after childbirth.”,”summary”:”n

In the US, more people seem to be seeking out the assistance of a doula when preparing to give birth. While such services may not be covered by insurance, a professional doula can provide emotional and physical support during pregnancy and throughout the birthing process.

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Childbirth — painful, messy, unpredictable — has been part of humankind for time immemorial. And in the US, which has surprisingly high rates of avoidable complications and maternal deaths, more people seem to be seeking out doulas for additional care during pregnancy and birth, says Natalia Richey, interim chief midwife in the Department of Obstetrics and Gynecology at Massachusetts General Hospital.

Some research suggests that doula care may benefit both mother and baby. But what does a birth doula do? While neither a midwife nor a doctor, a professional doula can provide emotional and physical support to women during pregnancy and throughout the birthing process.

Here’s what to know if you’re considering doula care.

What’s the difference between doulas and midwives?

Midwives and doulas tend to have a few overlapping duties. But there’s a key difference: midwives provide medical care and doulas don’t.

Midwives: Their primary responsibility is to maintain the physical health of a woman and her baby throughout childbirth. Certified nurse-midwives like Richey are also trained nurses, but most midwives have undergone some type of medical training. This may vary depending on state laws.

Doulas: Unlike midwives, doulas don’t perform any medical tasks. Their main role is to help laboring women remain comfortable and calm using various methods, including suggesting comfort measures and optimal positions for labor and pushing.

“Many women hire doulas if they’re trying to have an unmedicated birth,” Richey says. “Doulas are really good at knowing what techniques — such as walking, showering, massage, or aromatherapy — can help a woman through the pain. It’s like having a coach.”

Are doulas trained or licensed?

Be aware that doula training varies widely. There are no formal rules requiring licensing or certification. Many doulas, however, seek certification from the more than 100 independent organizations that offer some type of doula training and credentials, according to the National Health Law Program.

Is doula care covered by insurance?

Private insurers often do not cover doula care, which can cost several thousand dollars when arranged for privately.

However, some employers — including Walmart — will help pay for doula care. And some hospital systems, particularly in low-income or medically underserved areas, have doula programs aimed at improving maternal care during and after pregnancy. Others may arrange doula support for people with limited resources who might otherwise be alone during the later stages of pregnancy and birth.

As of February 2023, 10 states and the District of Columbia provided Medicaid coverage for doula services. Other states are in the midst of implementing coverage. Most of the states that provide Medicaid coverage for doula care require doulas to be trained or certified by an approved organization.

Can working with a doula improve birth outcomes?

A 2023 analysis in the journal Cureus reviewed 16 individual studies done over 22 years. It found doula support was linked with better birth outcomes, such as fewer C-sections and premature deliveries, and shorter length of labor.

Additionally, the emotional support provided by doulas was associated with less anxiety and stress in birthing mothers. Among low-income women, doula support was shown to improve breastfeeding success.

“It’s impressive,” Richey says. “I think those improved outcomes are due to having an expert in the labor process who isn’t a medical person but is just there for you from moment to moment.”

How do people collaborate with doulas?

Agreements about care vary. Typically, doulas meet with women every few months through their pregnancy to discuss their goals for birth (such as skipping pain medication, for example), and to build rapport with both the expectant person and their spouse or partner.

Like obstetricians, doulas are on call 24/7 to support clients who have gone into labor or who have their labor induced. Doulas stay throughout the birth process.

“Having someone there who’s seen quite a few births, who can support and advocate for them, can be a huge comfort,” says Richey.

This may be especially important to women with limited resources, particularly those who might otherwise be alone during the later stages of pregnancy and birth. “Doulas remind women that they’re okay and can get through this process — all the things many of us take for granted,” Richey says.

How might a doula work with the OB/GYN team?

Usually, this is a seamless process, Richey says. If a hospital arranges for a woman’s doula, OB/GYN team members may meet the doula a couple of times before childbirth. Meanwhile, a doula who’s been hired privately will usually only meet the larger OB/GYN team when the woman arrives at the hospital to give birth.

When everyone sticks to their assigned roles, all goes smoothly. For a doula, that may mean suggesting nonpharmacological ways to ease pain and help labor progress. Boundaries are important, though, when medical intervention is needed.

“If the baby’s heart rate is down, for instance, the expertise needs to be left to the midwife or doctor,” Richey explains.

What questions should you ask if you’re interested in working with a doula?

Richey suggests starting by asking yourself:

What are my hopes and goals for the childbirth process? Might a doula enhance my ability to achieve them?

How do I envision my support team during delivery? Do I have a partner, a mom, or a friend I want there? Would a doula add to any support I already have?

Do I have friends or family members who have used doulas in the past? What were their impressions of the experience? Can they recommend a doula?

If you contact a doula to explore your options, ask about:

their training and certification

how many births they’ve attended

how they believe they can help you during your pregnancy and during labor

how they will collaborate with your partner or spouse and the medical team

whether they provide support after a birth — if so, what type of support and for how long?

“Take the time to meet with any doula you’re considering and make sure they’re a good fit,” Richey advises, “because this is someone who will be there during one of the most vulnerable times of your life. Having someone there who doesn’t make you feel safe and comfortable can affect birth in a major way.”

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n “,”description”:null,”author”:null,”slug”:”what-does-a-birth-doula-do-202311222995″,”sort_date”:”2023-11-22T05:00:00.000000Z”,”contentable_type”:”AppModelsMarketingBlogPost”,”contentable_id”:2995,”replacement_content_id”:null,”landing_page_landing_page_group_id”:null,”ucr_content_id”:”BL112223″,”publication_date”:”2023-11-22T15:30:00.000000Z”,”last_review_date”:null,”imported_at”:”2023-11-22T10:00:03.000000Z”,”last_import_type”:”insert”,”last_modified_date”:”2023-11-21T05:00:00.000000Z”,”active”:1,”created_at”:”2023-11-22T10:00:03.000000Z”,”updated_at”:”2023-11-22T10:00:04.000000Z”,”deleted_at”:null,”images_remapped”:0,”old_product_id”:null,”old_content_id”:null,”hide_ads”:0,”primary_content_topic_id”:46,”ecommerce_type”:”CATALOG”,”authors”:[{“id”:420,”cr_id”:779,”featured”:0,”hhp_staff”:0,”hidden”:0,”name”:”Maureen Salamon”,”title”:null,”first_name”:”Maureen”,”middle_name”:null,”last_name”:”Salamon”,”suffix”:null,”slug”:”maureen-salamon”,”byline”:”Executive Editor, Harvard Women's Health Watch“,”description”:”

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has appeared in The New York Times, The Atlantic, CNN.com, WebMD, Medscape and HealthDay, among other major outlets. Maureen earned a BA in print journalism from Penn State University.

“,”image_url”:”https://d2icykjy7h7x7e.cloudfront.net/authors/MWQyHwiFAPooqhDKsjTfFjCCCoIooqQNLj1M7LRO.jpg”,”twitter_username”:null,”sort_order”:0,”created_at”:”2022-02-24T21:39:38.000000Z”,”updated_at”:”2022-07-17T15:04:53.000000Z”,”deleted_at”:null,”pivot”:{“content_id”:18472,”author_id”:420,”sort_order”:1}}],”contentable”:{“id”:2995,”comments_open”:1,”created_at”:”2023-11-22T10:00:03.000000Z”,”updated_at”:”2023-11-22T10:00:03.000000Z”,”deleted_at”:null,”media”:[]},”content_type”:{“id”:18,”name”:”blog”,”slug”:”blog”,”created_at”:”2021-05-11T08:30:32.000000Z”,”updated_at”:”2021-05-11T08:30:32.000000Z”,”deleted_at”:null},”media”:[{“id”:14566,”model_type”:”AppModelsMarketingContent”,”model_id”:18472,”uuid”:”3a171f60-7aa0-4bdd-9b7d-b0a98e2fc613″,”collection_name”:”contents”,”name”:”4363d72b-26d0-4308-8327-d9122eb1fe4d”,”file_name”:”4363d72b-26d0-4308-8327-d9122eb1fe4d.jpg”,”mime_type”:”image/jpeg”,”disk”:”s3″,”conversions_disk”:”s3″,”size”:71831,”manipulations”:[],”custom_properties”:{“alt”:”A birth doula in blue top smiles at a pregnant woman seen from the side wearing a hospital gown”},”generated_conversions”:{“micro”:true,”thumb”:true},”responsive_images”:[],”order_column”:14512,”created_at”:”2023-11-22T10:00:04.000000Z”,”updated_at”:”2023-11-22T10:00:06.000000Z”,”full_url”:”https://domf5oio6qrcr.cloudfront.net/medialibrary/14566/4363d72b-26d0-4308-8327-d9122eb1fe4d.jpg”}],”primary_content_topic”:{“id”:46,”name”:”Women’s Health”,”slug”:”womens-health”,”is_primary”:1,”canonical”:”https://www.health.harvard.edu/topics/womens-health”}},{“id”:18428,”content_source_id”:2,”content_type_id”:18,”content_access_type_id”:1,”title”:”Cellulitis: How long does it take to heal on legs?”,”short_title”:””,”subheading”:”When this common skin infection affects the lower leg, symptoms can persist for days after successful antibiotic treatment.”,”summary”:”n

Cellulitis, a skin infection that often occurs on the lower leg, develops when bacteria enter the body through a cut, bite, or other wound. A new study shows key aspects of healing typically occur within 10 days of treatment, but symptoms can linger for some time after that.

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Cellulitis is an infection of the deep layers of the skin. It develops when bacteria enter through a cut, bite, or wound — including tiny breaks in cracked, dry skin. Common skin-dwelling bacteria, Staphylococcus or Streptococcus, are the usual culprits. Although cellulitis can occur anywhere on the body, the most common location is the lower leg.

Dr. Arash Mostaghimi, a dermatologist at Brigham and Women’s Hospital and associate professor of medicine at Harvard Medical School, weighs in on new research that explores important questions about how long it takes to fully heal.

What are the symptoms of cellulitis?

The body’s natural immune response to this bacterial invasion triggers a painful rash that appears red on lighter skin and dark purple on darker skin. The affected area also may be swollen and feel warm.

How is cellulitis treated?

The typical treatment is five to 10 days of antibiotic pills. More serious cases may require intravenous antibiotics.

How quickly can antibiotics help cellulitis resolve?

After starting antibiotic treatment, people usually notice improvement within a few days. However, the area may remain swollen, warm, and painful even after 10 days.

Does that mean the antibiotic treatment was ineffective? Not necessarily, according to a recent study of people with cellulitis in the lower leg that described the natural history of the healing stages following antibiotics.

“The healing process has two parts, which is why a full recovery takes longer than you might think,” says Dr. Mostaghimi.

First, the antibiotics and your white blood cells work together to kill the bacteria. But your body’s immune response against the bacteria may take a while to shut down. As a result, this second stage of the healing process may include some residual symptoms, he explains.

What did the study find?

The study included 247 people with mild to moderate cellulitis of the lower leg who received antibiotics for seven to 10 days. By day 10:

Their swelling had lessened by 50%, and the size of the affected area had shrunk by about 55%.

A blood marker of inflammation, C-reactive protein, dropped during treatment and reached near-normal levels in all the participants.

Still, more than half continued to report discomfort in the affected leg, with 14% ranking their pain as 5 or greater on a scale of 1 to 10.

This pattern of discomfort isn’t unusual, especially with leg infections, says Dr. Mostaghimi. As people are recovering from leg cellulitis, they’re often advised to elevate the leg, which helps to ease the swelling. (Putting a warm, moist washcloth on the area may also help.)

But after they feel better and start walking more, fluid shifts back down into the legs. So it’s not surprising that the area might feel a little swollen and uncomfortable again once they’re back on their feet, he says.

Who is at greatest risk for cellulitis?

Remember, cellulitis typically occurs when bacteria normally present on our skin manage to breach that shield to enter the body.

Some people who develop cellulitis have no obvious injury or skin damage to explain the infection, which can occur in people who are generally healthy. However, people with certain health problems are more prone to cellulitis. This includes people who are overweight or have diabetes, a weakened immune system, poor circulation, or chronic edema (swollen limbs).

Additionally, skin conditions such as eczema and athlete’s foot can create small cracks in the skin that make it easier for bacteria to penetrate deeper into the skin, Dr. Mostaghimi says. Scratching a bug bite until it bleeds is another possible entry point for bacteria.

What happens if cellulitis goes untreated?

Untreated cellulitis can be very serious. The rash may spread, be surrounded with blisters, and become increasingly painful. Nearby lymph nodes may become tender and swollen, followed by fever and chills. Seek medical care right away if you experience these symptoms.

The bottom line

“It’s important for people with leg cellulitis to realize that it may take a bit longer after finishing your antibiotics for all of your symptoms to completely resolve,” says Dr. Mostaghimi. You’ll probably start to feel better within a few days, but always finish all the pills in your antibiotic prescription. However, having residual symptoms once you’re done does not mean you need another course of antibiotics or a different antibiotic, he says.

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n “,”description”:null,”author”:null,”slug”:”cellulitis-how-long-does-it-take-to-heal-on-legs-202311202994″,”sort_date”:”2023-11-20T05:00:00.000000Z”,”contentable_type”:”AppModelsMarketingBlogPost”,”contentable_id”:2994,”replacement_content_id”:null,”landing_page_landing_page_group_id”:null,”ucr_content_id”:”BL112023″,”publication_date”:”2023-11-20T15:30:00.000000Z”,”last_review_date”:null,”imported_at”:”2023-11-20T10:00:04.000000Z”,”last_import_type”:”insert”,”last_modified_date”:”2023-11-19T05:00:00.000000Z”,”active”:1,”created_at”:”2023-11-20T10:00:04.000000Z”,”updated_at”:”2023-11-20T10:00:04.000000Z”,”deleted_at”:null,”images_remapped”:0,”old_product_id”:null,”old_content_id”:null,”hide_ads”:0,”primary_content_topic_id”:28,”ecommerce_type”:”CATALOG”,”authors”:[{“id”:14,”cr_id”:157,”featured”:1,”hhp_staff”:0,”hidden”:0,”name”:”Julie Corliss”,”title”:null,”first_name”:”Julie”,”middle_name”:null,”last_name”:”Corliss”,”suffix”:null,”slug”:”julie-corliss”,”byline”:”Executive Editor, Harvard Heart Letter“,”description”:”

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She is co-author of Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep it Off. Julie earned a BA in biology from Oberlin College and a master’s certificate in science communication from the University of California at Santa Cruz.

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The holiday season is probably the hardest time of year to resist rich, indulgent foods, but too many salty, fatty, sugary choices can harm your health. Instead, try adding natural flavor to holiday foods with herbs and spices, many of which contain substances that have a beneficial effect on health.

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The holiday season is one of the hardest times of the year to resist salty, fatty, sugary foods. Who doesn’t want to enjoy the special dishes and treats that evoke memories and meaning — especially during the pandemic? Physical distancing and canceled gatherings may make you feel that indulging is a way to pull some joy out of the season.

But stay strong. While it’s okay to have an occasional bite or two of marbled roast beef, buttery mashed potatoes, or chocolate pie, gorging on them frequently can lead to weight gain, and increased blood pressure, blood sugar, and “bad” LDL cholesterol.

Instead, skip the butter, cream, sugar, and salt, and flavor your foods with herbs and spices.

The bounty of nature’s flavor-makers go beyond enticing tastes, scents, and colors. Many herbs and spices contain antioxidants, flavonoids, and other beneficial compounds that may help control blood sugar, mood, and inflammation.

Amp up holiday foods with herbs and spices

Try flavoring your foods with some of the herbs and spices in the list below. Play food chemist and experiment with combinations you haven’t tried before. The more herbs and spices you use, the greater the flavor and health rewards. And that’s a gift you can enjoy all year through.

Allspice: Use in breads, desserts, and cereals; pairs well with savory dishes, such as soups, sauces, grains, and vegetables.

Basil: Slice into salads, appetizers, and side dishes; enjoy in pesto over pasta and in sandwiches.

Cardamom: Good in breads and baked goods, and in Indian dishes, such as curry.

Cilantro: Use to season Mexican, Southwestern, Thai, and Indian foods.

Cinnamon: Stir into fruit compotes, baked desserts, and breads, as well as Middle Eastern savory dishes.

Clove: Good in baked goods and breads, but also pairs with vegetable and bean dishes.

Cumin: Accents Mexican, Indian, and Middle Eastern dishes, as well as stews and chili.

Dill weed: Include in potato dishes, salads, eggs, appetizers, and dips.

Garlic: Add to soups, pastas, marinades, dressings, grains, and vegetables.

Ginger: Great in Asian and Indian sauces, stews, and stir-fries, as well as beverages and baked goods.

Marjoram: Add to stews, soups, potatoes, beans, grains, salads, and sauces.

Mint: Flavors savory dishes, beverages, salads, marinades, and fruits.

Nutmeg: Stir into fruits, baked goods, and vegetable dishes.

Oregano: Delicious in Italian and Mediterranean dishes; it suits tomato, pasta, grain dishes, and salads.

Parsley: Enjoy in soups, pasta dishes, salads, and sauces.

Pepper (black, white, red): Seasons soups, stews, vegetable dishes, grains, pastas, beans, sauces, and salads.

Rosemary: Try it in vegetables, salads, vinaigrettes, and pasta dishes.

Sage: Enhances grains, breads, dressings, soups, and pastas.

Tarragon: Add to sauces, marinades, salads, and bean dishes.

Thyme: Excellent in soups, tomato dishes, salads, and vegetables.

Turmeric: Essential in Indian foods; pairs well with soups, beans, and vegetables.

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n “,”description”:null,”author”:null,”slug”:”21-spices-for-healthy-holiday-foods-2020120421550″,”sort_date”:”2020-12-04T05:00:00.000000Z”,”contentable_type”:”AppModelsMarketingBlogPost”,”contentable_id”:2338,”replacement_content_id”:null,”landing_page_landing_page_group_id”:null,”ucr_content_id”:”BL120420″,”publication_date”:”2020-12-04T05:00:00.000000Z”,”last_review_date”:”2022-11-16T05:00:00.000000Z”,”imported_at”:”2023-12-01T10:00:05.000000Z”,”last_import_type”:”update”,”last_modified_date”:”2023-11-16T05:00:00.000000Z”,”active”:1,”created_at”:”2020-12-04T11:30:13.000000Z”,”updated_at”:”2023-12-01T10:00:05.000000Z”,”deleted_at”:null,”images_remapped”:0,”old_product_id”:null,”old_content_id”:21550,”hide_ads”:0,”primary_content_topic_id”:15,”ecommerce_type”:”CATALOG”,”authors”:[{“id”:31,”cr_id”:117,”featured”:0,”hhp_staff”:0,”hidden”:0,”name”:”Heidi Godman”,”title”:null,”first_name”:”Heidi”,”middle_name”:null,”last_name”:”Godman”,”suffix”:null,”slug”:”heidi-godman”,”byline”:”Executive Editor, Harvard Health Letter“,”description”:”

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Many people experience a decline in their driving skills as they age. While some choose to stop driving, others resist. Whether it’s you or a loved one, planning ahead can help you tackle fixable issues, make transitions easier, and avoid harming yourself or someone else.

n “,”content”:”

n n

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

It’s a simple but unfortunate fact: driving skills can wane over time.

Eventually, driving can become unsafe for an older driver, their passengers, and others on the road. If you notice a decline in driving abilities in a loved one, or in yourself, what’s the best way to handle this?

If you’re an older driver: Create an action plan

If you’re an older driver, don’t wait for a near-miss or an accident to think about the next steps. Planning ahead can help you tackle fixable issues, make necessary transitions easier, and avoid harming yourself or someone else.

Here are six measures you can take right now:

Have a frank conversation with a trusted friend or family member. After driving with them as a passenger, ask whether they are worried about your driving. Don’t disregard their comments, even if they share things you don’t want to hear.

See your doctor and talk about your driving. Is it harder to see at night? Are you finding you’re slower to react? Ask your doctor about medical care that can help, such as cataract surgery, treatment for sleep apnea, or adjustments to medications that might affect driving.

Take a self-evaluation test or an on-road test.AAA has tools to help with this, or you can check with your local department of motor vehicles for options. Even if you feel it’s unnecessary, a driving test can be reassuring to your loved ones that you’re still safe behind the wheel.

Take driving classes. In many places, there are general refresher courses, courses for defensive driving, and even simulators that don’t require actual road tests. AAA and AARP offer online courses that can help you improve your driving. (And by the way, these courses may also reduce the cost of your auto insurance!)

Consider alternatives to how you drive. Stick to roads that are close to home or to routes that have traffic lights (rather than having to decide when traffic is clear enough to turn). Consider giving up night driving if that is particularly difficult.

Make adjustments to your car that can help. Examples include using a steering wheel cover to improve your grip or changing the position of your seat to improve your view of the road. Check out the CarFit program that aims to optimize the “fit” of a driver in their car.

In addition, explore options that don’t require you to drive as often or at all:

grocery delivery

public or senior transportation (if offered or available where you live)

carpooling with friends or family

ride-hailing services or taxis

hiring a driver.

Cost and availability may be barriers, but it’s worth looking into these options.

If you’re a concerned family member or friend: Start a conversation

With so much at stake, the language you use matters. So, it’s a good idea to think ahead about how to talk about these challenges.

Put safety and solutions first. It’s best not to lead by criticizing driving skills. Instead, talk about driving with safety and solutions in mind, such as the options described above.

Choose your words carefully. It helps to avoid threats or confrontational language: rather than saying “Your driving is terrible so I’ve taken away your keys,” focus on safety and support:

n Let’s talk about how I can help so you don’t have to drive. I can drive you to get your groceries on Sundays and we can make a day of it!n

n How do you think those dents got on your car? Are you having trouble with your vision?n

We’d all feel terrible if you had an accident and got hurt or hurt someone else.

Offer to go for a ride together and then to talk about specific concerns, such as staying in the proper lane, changing lanes, making left-hand turns, speed, or sudden braking. Encourage consideration of a self-evaluation or on-road test, and driving classes to help polish skills.

Use examples from familiar experiences. It can be helpful to remind your loved one how his or her parents or grandparents had to cut back on their driving, or how an older neighbor was an unsafe driver.

Focus on the risks posed by other drivers. Aggressive or unpredictable drivers can pose more danger to older drivers with slower reaction times.

How else can families or friends of older drivers be helpful?

Consider whether to contact their doctor. Ask their doctor if it’s possible to talk with your loved one or friend about their driving. State regulations vary on mandatory reporting of conditions that affect a patient’s ability to drive. Be aware that some doctors may be reluctant to report their patients to their registry of motor vehicles, due to concerns about patient privacy or jeopardizing the patient-doctor relationship.

Look into rules and regulations around older drivers where your loved one lives. Illinois is currently the only state that requires a road test for older drivers. But many states require vision tests and in-person renewal with increasing frequency for older drivers.

Consider reporting an unsafe driver to traffic safety authorities. This may feel like a betrayal, but if other efforts have failed this option might be better than waiting until there’s a serious accident.

The bottom line

In the future, safe, driverless cars may be a solution to the challenge of waning driving skills among older drivers. But we’re not there yet.

Right now, we should all acknowledge that it’s not easy to address concerns about impaired older drivers. My best advice is that older drivers and their loved ones try to talk about ways to remain a safe driver and put a plan in place. Ideally, we all would start the conversation well before any driving problems are evident.

And it may take more than one conversation. Many more. But let’s face it: sooner or later, most drivers will have to stop driving. For some older drivers, that time may be now. For the rest of us, recognizing this eventuality could help when our time comes.

“,”excerpt”:”n

n “,”short_excerpt”:”n

n “,”description”:null,”author”:null,”slug”:”what-to-do-when-driving-skills-decline-202311152991″,”sort_date”:”2023-11-15T05:00:00.000000Z”,”contentable_type”:”AppModelsMarketingBlogPost”,”contentable_id”:2991,”replacement_content_id”:null,”landing_page_landing_page_group_id”:null,”ucr_content_id”:”BL111523″,”publication_date”:”2023-11-15T15:30:00.000000Z”,”last_review_date”:null,”imported_at”:”2023-11-22T10:00:04.000000Z”,”last_import_type”:”update”,”last_modified_date”:”2023-11-21T05:00:00.000000Z”,”active”:1,”created_at”:”2023-11-15T10:00:03.000000Z”,”updated_at”:”2023-11-22T10:00:04.000000Z”,”deleted_at”:null,”images_remapped”:0,”old_product_id”:null,”old_content_id”:null,”hide_ads”:0,”primary_content_topic_id”:44,”ecommerce_type”:”CATALOG”,”authors”:[{“id”:23,”cr_id”:2,”featured”:1,”hhp_staff”:1,”hidden”:0,”name”:”Robert H. Shmerling, MD”,”title”:null,”first_name”:”Robert”,”middle_name”:”H.”,”last_name”:”Shmerling”,”suffix”:”MD”,”slug”:”robert-h-shmerling-md”,”byline”:”Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing”,”description”:”

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Navigating whether or when an older person should limit or stop driving is tricky. Whether these concerns are about a family member or yourself, it's helpful to be aware of red flags and to understand how driving abilities –– and risk for motor vehicle accidents –– change with age.

“,”content”:”

rnrn

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

rnrn

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

rnrn

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

rnrn

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

rnrn

How safe are older drivers on the road?

rnrn

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

rnrn

Fatalities occurring in crashes involving a driver ages 15 to 20 rose nearly 10% between 2020 and 2021, accounting for 5,565 deaths.

rnt

Among drivers 65 or older, fatalities rose 15% between 2020 and 2021, accounting for more than 8,200 deaths.

rnrn

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

rnrn

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

rnrn

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

rnrn

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

rnrn

1. Seeing any red flags?

rnrn

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

rnrn

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

rnrn

concerned comments from family or friends

rnt

reluctance of others to ride with them

rnt

input from other drivers (why is everyone honking at me?) or traffic authorities (why am I getting all these traffic tickets?)

rnt

getting lost on familiar roads

rnt

consistently driving too slowly or too fast

rnt

unexplained dents or scratches appearing on the car

rnt

frequent accidents or near-misses.

rnrn

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

rnrn

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

rnrn

medical conditions, such as arthritis, neuropathy, or dementia

rnt

medications, such as sedatives or certain antidepressants

rnt

age-related changes in reaction time

rnt

trouble with vision or hearing

rnt

other physical changes related to aging, such as less flexibility or strength

rnt

difficulty processing rapidly changing information. For example, an older driver may be more likely than a younger driver to accidentally press the gas pedal instead of the brake when needing to stop suddenly.

rnrn

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

rnrn

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

rnrn

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

rnrn

4. Accept that conversations about not driving are challenging

rnrn

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

rnrn

Challenges facing the driver:

rnrn

It's not easy to acknowledge declining function. Driving impairment is an unsettling milestone, an indication that the future may include further loss of abilities.

rnt

It can feel unnecessary and unreasonable. Most older folks facing a decision about whether it's safe to continue driving were good drivers not so long ago. They may still see themselves as competent drivers, and see efforts to restrict their driving as overly cautious or demeaning.

rnt

Denial and defensiveness are common. Even when all the signs are there, it may be tempting for a poor driver to deflect blame (for example, blaming other drivers).

rnt

Not driving is a loss of independence. Sure, there are other ways to get around and nondrivers can certainly be independent. But few alternatives rival the independence that comes with being able to drive yourself. And, depending on where you live, public transportation or other alternatives to driving may be limited.

rnrn

Challenges facing the family:

rnrn

Often, the older driver doesn't share their family's concerns about driving safety. This can lead to arguments, confrontation, and resentment.

rnt

The safety of others is at stake. The older driver with waning skills may endanger many people besides themselves: passengers in their care, other drivers and their passengers, cyclists, and pedestrians.

rnt

It's hard to know when the time is right. Speaking up too soon may lead to unnecessary restrictions on a loved one's favored means of transportation, not to mention family strife. Waiting too long can lead to avoidable tragedy.

rnrn

Finding a path forward

rnrn

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

rnrn

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

rnrn

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

“,”excerpt”:”

“,”short_excerpt”:”n

n “,”description”:null,”author”:null,”slug”:”a-tough-question-when-should-an-older-driver-stop-driving-202311132992″,”sort_date”:”2023-11-13T05:00:00.000000Z”,”contentable_type”:”AppModelsMarketingBlogPost”,”contentable_id”:2992,”replacement_content_id”:null,”landing_page_landing_page_group_id”:null,”ucr_content_id”:”BL111323″,”publication_date”:”2023-11-13T05:00:00.000000Z”,”last_review_date”:null,”imported_at”:”2023-11-21T05:00:00.000000Z”,”last_import_type”:”update”,”last_modified_date”:”2023-11-20T05:00:00.000000Z”,”active”:1,”created_at”:”2023-11-15T21:34:38.000000Z”,”updated_at”:”2023-11-21T20:20:05.000000Z”,”deleted_at”:null,”images_remapped”:0,”old_product_id”:null,”old_content_id”:null,”hide_ads”:0,”primary_content_topic_id”:44,”ecommerce_type”:”CATALOG”,”authors”:[{“id”:23,”cr_id”:2,”featured”:1,”hhp_staff”:1,”hidden”:0,”name”:”Robert H. Shmerling, MD”,”title”:null,”first_name”:”Robert”,”middle_name”:”H.”,”last_name”:”Shmerling”,”suffix”:”MD”,”slug”:”robert-h-shmerling-md”,”byline”:”Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing”,”description”:”

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Loneliness boosts risk for many health problems, and can even contribute to an early death. Many people find it hard to reach out to make new friends, but there are strategies that can help.

n “,”content”:”n

n n

Loneliness is complicated. You can feel lonely when you lack friends and miss companionship, or when you’re surrounded by people — even friends and family.

Either way, loneliness can have devastating health effects. It boosts risk for coronary artery disease, stroke, depression, high blood pressure, declining thinking skills, inability to perform daily living tasks, and even an early death. The remedy? Below we offer three ways to ease loneliness and add happiness by helping you expand your social network.

Taking the first steps

Not all loneliness can be solved by seeking out people. Loneliness that occurs despite relationships may require talk therapy and a journey that looks inward.

Reducing loneliness caused by a lack of relationships is more of an outward journey to make new friends. “That’s a challenge as we get older, because people are often established in their social groups and aren’t as available as they might have been in a different phase of life. So you have to be more entrepreneurial and work harder to make friends than you once did,” says Dr. Jacqueline Olds, a psychiatrist at Harvard-affiliated McLean Hospital and the coauthor of two books on loneliness.

Trying these strategies can help.

1. Seek like-minded souls

Being around people who share your interests gives you a head start on making friends: you already have something in common.

Start by considering your interests. Are you a voracious reader, a history lover, a movie aficionado, a gardener, a foodie, a puppy parent, or an athlete? Are you passionate about a cause, your community, or your heritage? Do you collect things? Do you love classic cars? Do you enjoy sprucing up old furniture? Maybe you want to learn something new, like how to cook Chinese food or speak another language. Search for online groups, in-person clubs, volunteer opportunities, or classes that match any of your interests or things you’d like to try.

Once you join a group, you’ll need to take part in it regularly to build bonds. If you can gather in person, it’s even better. “The part of our brain involved in social connection is stimulated by all five senses. When you’re with someone in the same room, you get a much stronger set of stimuli than you do by watching them on an electronic screen,” Dr. Olds says.

2. Create opportunities

If joining someone else’s group is unappealing, start your own. Host gatherings at your place or elsewhere. “All it takes is three people. You can say, ‘Let’s read books or talk about a TV show or have a dinner group on a regular basis,'” Dr. Olds says.

Other ideas for gatherings — either weekly or monthly — include:

game nights

trivia nights

hikes in interesting parks

beach walks

bird-watching expeditions

running or cycling

n meditationn

museum visits

cooking

knitting, sewing, or crafting

shopping

day trips to nearby towns

jewelry making

collector show-and-tell (comic books, antique dolls, baseball cards).

The people you invite don’t have to be dear friends; they can just be people you’d like to get to know better — perhaps neighbors or work acquaintances.

If they’re interested in a regular gathering, pin down dates and times. Otherwise, the idea might stay stuck in the talking stages. “Don’t be timid. Say, ‘Let’s get our calendars out and get this scheduled,'” Dr. Olds says.

3. Brush up your social skills

Sometimes we’re rusty in surface social graces that help build deeper connections. “It makes a huge difference when you can be enthusiastic rather than just sitting there and hoping someone will realize how interesting you are,” Dr. Olds says.

Tips to practice:

Smile more. Smiling is welcoming, inviting, and hospitable to others.

Be engaging. Prepare a few topics to talk about or questions to ask — perhaps about the news or the reason you’ve gathered (if it’s a seminar, for example, ask how long someone has been interested in the subject). Or look for a conversation starter. “Maybe the person is wearing a pretty brooch. Ask if there’s a story behind it,” Dr. Olds suggests.

Be a good listener. “Listen in a way that someone realizes you’re paying attention. Hold their gaze, nod your head or say ‘Mm hmm’ as they’re talking so you give feedback. Assume everyone in the world is just yearning for your feedback,” Dr. Olds says.

Ask follow-up questions. Don’t ignore signals that someone has interesting stories to tell. “If they allude to something, your job is to look fascinated and ask if they can tell you more. They’re dropping crumbs on a path to a deeper exchange,” Dr. Olds notes.

Even chats that don’t lead to friendships can be enriching. A 2022 study found that people who had the most diverse portfolios of social interactions — exchanges with strangers, acquaintances, friends, or family members — were much happier than those with the least diverse social portfolios.

Ultimately, a wide variety of interactions contributes to well-being, whether you’re talking to the cashier at the supermarket, a neighbor, an old friend, or a new one. And all of these connections combined may go a long way toward helping you feel less lonely.

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Loneliness boosts risk for many health problems, and can even contribute to an early death. Many people find it hard to reach out to make new friends, but there are strategies that can help.

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Loneliness boosts risk for many health problems, and can even contribute to an early death. Many people find it hard to reach out to make new friends, but there are strategies that can help.

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Recent Blog Articles

December 1, 2023

By
Jenette Restivo,

Health Writer, Harvard Health Publishing

Including protein-rich foods in your diet is vital for maintaining overall health and well-being. But how much protein do you need and what are the best sources of this essential macronutrient?

Why we need protein

Proteins are building blocks in the body. They make up bones, cartilage, muscle, blood, skin, enzymes, hormones, and vitamins. They’re essential for growth and development, repair and build cells and tissue such as muscle, and play an important role in body processes such as blood clotting, fluid balance, and the immune response.

Proteins are made from amino acids. There are some amino acids that our bodies can make on their own. These are called nonessential amino acids. But there are nine amino acids that our bodies must get by consuming foods that contain them. These are called essential amino acids, and they are necessary for normal body functioning.

What foods are high in protein?

We can get protein from plant or animal sources. Protein in our diet can come from meat, dairy products, nuts, some vegetables, and certain grains and beans.

Examples of high-protein foods
Food type	Examples
beans, peas, and lentils	chickpeas, lentils
nuts and seeds	walnuts, pumpkin seeds
lean meats	chicken, turkey
fish	salmon, tuna
dairy products	milk, yogurt
soy products	tofu

Try to eat a variety of protein-rich foods to ensure you are meeting your daily protein needs as well as getting the vitamins, minerals, and other nutrients needed for optimal health. Proteins that come from animal sources, such as meat, eggs, and milk, as well as soy and quinoa, are called complete proteins. This means they contain all the essential amino acids the body needs and are the highest-quality protein sources.

You can also get essential amino acids from plant-based foods. However, most plant-based proteins do not contain all of the needed essential amino acids, and so are called incomplete proteins. If you avoid animal proteins, the best way to ensure you are consuming a healthy mix of amino acids is to enjoy a variety of plant-based proteins through the day.

Foods that are particularly high in protein include:

Lean meats such as chicken, turkey, beef, and pork are excellent sources of high-quality protein as well as important nutrients like iron and zinc. To avoid unhealthy saturated fat, opt for lean or low-fat meat options such as lean ground beef, pork loin, or skinless chicken breasts.

Fish like salmon, tuna, and mackerel are not only rich in protein but also contain omega-3 fatty acids, which are beneficial for heart health. Look for seafood options that are lower in methylmercury, such as salmon, anchovies, and trout.

Dairy products like milk, cheese, and yogurt are rich in protein, calcium, and other essential nutrients. Greek yogurt is a great option, as it is high in protein as well as nutrients such as calcium, vitamins, and minerals. Dairy products can be high in saturated fat, so choose low-fat dairy options and limit the amount of cheese you eat.

Beans, peas, and lentils include kidney beans, pinto beans, white beans, black beans, lima beans, fava beans, soybeans, chickpeas, black-eyed peas, pigeon peas, split peas, lentils, and edamame. These plant-based foods are excellent sources of protein as well as fiber, folate, potassium, iron, and zinc.

Nuts and seeds include almonds, hazelnuts, walnuts, peanuts, chia seeds, pumpkin seeds, sunflower seeds, and peanut butter. They are not only rich in protein but also provide healthy fats, vitamins, and minerals. Nuts are high in fat and calories, so be mindful of portion sizes.

Eggs contain all of the essential amino acids, making them a complete protein source. Eggs are also a source of vitamins, minerals, healthy fats, and antioxidants.

Quinoa is a plant-based protein source that is also a complete protein. A cup of cooked quinoa provides about 8 grams of protein and 5 grams of fiber. Quinoa is also a good source of minerals such as manganese, phosphorus, and copper.

Soy products such as tofu and tempeh are good sources of protein, especially for vegetarians and vegans. One-quarter cup of tofu provides seven grams of protein.

How much protein should you eat daily?

For the average adult, the Recommended Dietary Allowance (RDA) for protein, or the amount you need to meet your basic nutritional requirements and not get sick, is 0.8 grams of protein per kilogram of body weight, or 0.36 grams per pound. For a person who weighs 75 kg (165 pounds), that comes to 60 grams of protein per day.

To determine your target daily protein intake, you can multiply your weight in pounds by 0.36, or use this online calculator.

It’s important to keep in mind that your daily protein need is not a fixed number. For example, your protein needs will fluctuate depending on your level of physical activity, and whether you are pregnant or breastfeeding.

Should I get my protein from animal or plant sources?

In order to get enough dietary protein in the most healthful way, nutritional guidelines have shifted away from specific amounts of daily protein, and toward the importance of eating healthier, protein-rich foods.

It’s important to think about the protein “package” when making protein choices because food containing protein also includes fats, carbohydrates, vitamins, minerals, sugar, sodium, additives, and other components.

While meat provides high-quality protein, some meats also provide unhealthy amounts of saturated fats and sodium. If you eat meat, it’s important to choose leaner meats and poultry. According to the United States Department of Agriculture (USDA), meats that are high in saturated fat include:

fatty cuts of beef, pork, and lamb
ground beef (75% to 85% lean)
processed meats such as bologna, salami, sausages, hot dogs, bacon
some poultry, such as duck.

A high-protein diet that is predominantly made up of red meat or processed meat is a cause for concern. Research has consistently found that both unprocessed and processed red meat are linked to higher risks of cardiovascular disease and diabetes. One meta-analysis found that replacing red meat with healthy plant proteins decreased the risk of cardiovascular disease.

For optimal health and nutrition, you should emphasize plant-based protein and protein from a variety of sources. The Mediterranean style of eating is one approach that emphasizes healthy protein sources.

Benefits of a higher protein diet

While most Americans consume more than enough protein, some people may benefit from a higher intake of protein.

To maintain or gain muscle mass

If you are over age 50, you should increase protein intake to one gram per kilogram of your body weight just to maintain muscle mass, which declines with age.

If you’re trying to gain muscle mass, a higher-protein diet can help support muscle repair and growth. When you exercise, muscle cells break down. Protein from food helps to repair the damage, ultimately strengthening muscles.

To lose weight

The value of high-protein diets for weight loss remains controversial. However, one meta-analysis found that a high-protein diet could lead to weight loss and prevent weight regain after weight loss. The authors note the need for future studies that follow patients for longer than one year for more insight into this issue.

Other benefits

One study found that eating plant-based protein was associated with lower odds of developing cognitive decline later in life. For every 5% of calories that came from plant protein instead of carbohydrates, researchers observed a 26% lower risk for developing dementia in study participants.

How much protein is too much?

The idea of an upper limit of protein intake is controversial. Some experts believe the recommended amounts are too low. Others believe we are overconsuming protein.

In general, the average person (not a body builder or an elite athlete) does not need high levels of protein and should not exceed 2 grams per kilogram; or about 125 grams per day for a 140-pound person.

A main concern with taking in too much protein is an overall dietary imbalance. Consuming excessive protein may lead to inadequate intake of carbohydrates and fats. It’s important to maintain a well-rounded diet that includes a balance of all three macronutrients for overall health.

In addition, if you increase your protein intake without increasing physical activity, you may be taking in too many calories without expending enough, which could result in weight gain.

There is also some evidence that eating a relatively high-protein diet can be problematic for individuals with pre-existing kidney conditions. A diet high in animal protein may pose a higher risk of kidney stones.

About the Author

Jenette Restivo,
Health Writer, Harvard Health Publishing

Jenette Restivo is a Health Content Writer at Harvard Health Publishing. Jenette is a media professional with a 20-year-career creating strategic content for broadcast, nonprofits, and websites. Jenette started her career in health editing at About.com. She …
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View all posts by Jenette Restivo

About the Reviewer

Teresa Fung, MS, RD, ScD,
Contributor

Teresa Fung is an adjunct professor at the Harvard T.H. Chan School of Public Health. She received her BS and MS in nutrition from Cornell University, and her ScD in both nutrition and epidemiology from HSPH. She …
See Full Bio

View all posts by Teresa Fung, MS, RD, ScD

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Disclaimer:

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles.

No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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But not only is moderate to severe hearing loss disruptive to one’s life, it also makes you more likely to develop dementia. A new study helps explain why — and what you can do about it.

What did the new study look at and find?

What else to know about this study

How do hearing aids reduce the risk of dementia?

This research helps us understand why hearing loss causes dementia. Here’s the connection:

What to do if you have hearing loss

Don’t let hearing loss raise your risk of dementia.

Keep your ears clean. (But remember, never put anything in your ears smaller than your elbow. Ask your doctor if you’re not sure how to clean your ears.)

If you can’t hear and you don’t have hearing aids, get them. Hearing aids now available over the counter can help many people with mild to moderate hearing loss.

If you have hearing aids, wear them.

If your hearing aids aren’t working, get them fixed.

Don’t be passive — ramp up your social life and other activities.

All these things will help to reduce your risk of dementia. And you might just find that, despite some hearing loss, you’re enjoying life more.

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What are veins and what do they do?

How do veins help keep blood flowing?

But wait. As you head back to the lungs to load up on more oxygen and release carbon dioxide, there’s a steep climb straight up. How can you make it back to the lungs without help?

Why are veins blue?

Actually, they aren’t. People think they’re blue because that’s often how they appear in diagrams and illustrations. But that’s just to set them apart from the bright red arteries.

If you could look at veins directly, without any skin in the way, they’d appear pale because they are naturally colorless, or dark red due to the blood inside them.

What sort of problems can occur in veins?

Blood clots, varicose veins, and venous insufficiency are some of the most common health conditions affecting the veins:

Deep vein thrombosis (DVT) occurs when a blood clot forms in a deep vein, blocking blood flow. This condition is potentially serious because clots in deep veins can travel to the lungs, causing a life-threatening pulmonary embolism by blocking an artery that delivers blood to part of the lungs.

Superficial thrombophlebitis is a blood clot in a small vein just under the skin. This causes inflammation and pain.

Varicose veins are small veins under the skin that swell and twist. While these may be harmless, they can cause pain and are occasionally complicated by blood clots.

Venous insufficiency occurs when the valves in veins are damaged — due to aging or prior blood clots, for example. The blood flow through the veins may be impaired, leading to leg swelling, increased pressure, inflamed skin, and poor healing.

All of these conditions can affect circulation temporarily or in a lasting way. Treatments are aimed at restoring circulation, if possible.

Top 5 ways to improve vein health

Healthy veins help the heart, brain, and every other part of your body. Here are five ways to improve vein health, even if you already have vein disease:

Be active. Exercise regularly and avoid prolonged standing or sitting.

Choose healthy foods, such as those in a plant-based, heart-healthy diet.

Maintain a healthy weight.

Don’t smoke.

Wear compression stockings if you already have vein disease such as venous insufficiency.

And of course, seek medical care for unexplained swelling, inflammation, or ulcers on your legs, ankles, or feet.

The bottom line

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Is toddler formula more nutritious than milk?

Do some toddlers need specialized formulas?

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

Are toddler formulas regulated in any way?

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

What might make a toddler formula unhealthy?

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

Is your toddler’s diet healthy?

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

fruits and vegetables

whole grains

protein (such as meat, fish, beans, and nut butters)

dairy or dairy substitutes fortified with calcium and vitamin D.

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Why do we fight at the holidays?

As a result, we are often emotionally vulnerable during the holidays, Gillis says. It’s hard to manage intense feelings, express ourselves accurately, or be open and nonjudgmental.

“When we increase emotional arousal, it impacts our reasoning and subsequent behaviors. So we may be more defensive, or express ourselves in ways that result in conflict,” Gillis says.

Plan ahead to help defuse emotions and arguments

It’s challenging to control emotions in a heated moment. A bit of planning can help you avoid potential arguments or take appropriate action if angry words start flying. Here are some helpful tips.

“I appreciate your thoughts, but let’s talk about something we agree on or share.”

“I care about you, but I’m starting to feel sad and I don’t want to continue a negative conversation.”

“I appreciate and respect your passion about this, but I don’t think I can talk about this anymore.”

How to de-escalate arguments

Other tips to keep in mind:

Respond with kindness. “If someone is angry with you, that suggests they really care what you think. Remember that and try to maintain a compassionate stance and response,” Gillis advises.

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EmpowerHER: Tackling Black maternal health disparities in Indy

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Here’s what to know if you’re considering doula care.

What’s the difference between doulas and midwives?

Midwives and doulas tend to have a few overlapping duties. But there’s a key difference: midwives provide medical care and doulas don’t.

Midwives: Their primary responsibility is to maintain the physical health of a woman and her baby throughout childbirth. Certified nurse-midwives like Richey are also trained nurses, but most midwives have undergone some type of medical training. This may vary depending on state laws.

Doulas: Unlike midwives, doulas don’t perform any medical tasks. Their main role is to help laboring women remain comfortable and calm using various methods, including suggesting comfort measures and optimal positions for labor and pushing.

Are doulas trained or licensed?

Is doula care covered by insurance?

Private insurers often do not cover doula care, which can cost several thousand dollars when arranged for privately.

Can working with a doula improve birth outcomes?

How do people collaborate with doulas?

Like obstetricians, doulas are on call 24/7 to support clients who have gone into labor or who have their labor induced. Doulas stay throughout the birth process.

“Having someone there who’s seen quite a few births, who can support and advocate for them, can be a huge comfort,” says Richey.

How might a doula work with the OB/GYN team?

“If the baby’s heart rate is down, for instance, the expertise needs to be left to the midwife or doctor,” Richey explains.

What questions should you ask if you’re interested in working with a doula?

Richey suggests starting by asking yourself:

What are my hopes and goals for the childbirth process? Might a doula enhance my ability to achieve them?

How do I envision my support team during delivery? Do I have a partner, a mom, or a friend I want there? Would a doula add to any support I already have?

Do I have friends or family members who have used doulas in the past? What were their impressions of the experience? Can they recommend a doula?

If you contact a doula to explore your options, ask about:

their training and certification

how many births they’ve attended

how they believe they can help you during your pregnancy and during labor

how they will collaborate with your partner or spouse and the medical team

whether they provide support after a birth — if so, what type of support and for how long?

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What are the symptoms of cellulitis?

How is cellulitis treated?

The typical treatment is five to 10 days of antibiotic pills. More serious cases may require intravenous antibiotics.

How quickly can antibiotics help cellulitis resolve?

After starting antibiotic treatment, people usually notice improvement within a few days. However, the area may remain swollen, warm, and painful even after 10 days.

“The healing process has two parts, which is why a full recovery takes longer than you might think,” says Dr. Mostaghimi.

What did the study find?

The study included 247 people with mild to moderate cellulitis of the lower leg who received antibiotics for seven to 10 days. By day 10:

Their swelling had lessened by 50%, and the size of the affected area had shrunk by about 55%.

A blood marker of inflammation, C-reactive protein, dropped during treatment and reached near-normal levels in all the participants.

Still, more than half continued to report discomfort in the affected leg, with 14% ranking their pain as 5 or greater on a scale of 1 to 10.