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What does a birth doula do?

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.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

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 … See Full Bio View all posts by Maureen Salamon

About the Reviewer

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

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

Want to reduce your risk of dementia? Get your hearing checked today

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.

About the Author

Andrew E. Budson, MD, Contributor; Editorial Advisory Board Member, Harvard Health Publishing

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 … See Full Bio View all posts by Andrew E. Budson, MD

Does running cause arthritis?

When I took up running in college, a friend of mine scoffed at the idea. He hated running and was convinced runners were “wearing out” their joints. He liked to say he was saving his knees for his old age.

So, was he onto something? Does running really ruin your joints, as many people believe?

Runners can get arthritis, but is running the cause?

You may think the answer is obvious. Surely, years of running (pounding pavements, or even softer surfaces) could wear out your joints, much like tires wear out after you put enough miles on them. And osteoarthritis, the most common type of arthritis, usually affects older adults. In fact, it’s often described as age-related and degenerative. That sounds like a wear-and-tear sort of situation, right?

Maybe not. Sure, it’s easy to blame running when a person who runs regularly develops arthritis. But that blame may be misguided. The questions to ask are:

Does running damage the joints and lead to arthritis?
Does arthritis develop first and become more noticeable while running?
Is the connection more complicated? Perhaps there’s no connection between running and arthritis for most people. But maybe those destined to develop arthritis (due to their genes, for example) get it sooner if they take up running.

Extensive research over the last several decades has investigated these questions. While the answers are still not entirely clear, we’re moving closer.

What is the relationship between running and arthritis?

Mounting evidence suggests that that running does not cause osteoarthritis, or any other joint disease.

A study published in 2017 found that recreational runners had lower rates of hip and knee osteoarthritis (3.5%) compared with competitive runners (13.3%) and nonrunners (10.2%).
According to a 2018 study, the rate of hip or knee arthritis among 675 marathon runners was half the rate expected within the US population.
A 2022 analysis of 24 studies found no evidence of significant harm to the cartilage lining the knee joints on MRIs taken just after running.

These are just a few of the published medical studies on the subject. Overall, research suggests that running is an unlikely cause of arthritis — and might even be protective.

Why is it hard to study running and arthritis?

Osteoarthritis takes many years to develop. Convincing research would require a long time, perhaps a decade or more.
It’s impossible to perform an ideal study. The most powerful type of research study is a double-blind, randomized, controlled trial. Participants in these studies are assigned to a treatment group (perhaps taking a new drug) or a control group (often taking a placebo). Double-blind means neither researchers nor participants know which people are in the treatment group and which people are getting a placebo. When the treatment being studied is running, there’s no way to conduct this kind of trial.
Beware the confounders. A confounder is a factor or variable you can’t account for in a study. There may be important differences between people who run and those who don’t that have nothing to do with running. For example, runners may follow a healthier diet, maintain a healthier weight, or smoke less than nonrunners. They may differ with respect to how their joints are aligned, the strength of their ligaments, or genes that direct development of the musculoskeletal system. These factors could affect the risk of arthritis and make study results hard to interpret clearly. In fact, they may explain why some studies find that running is protective.
The effect of running may vary between people. For example, it’s possible, though not proven, that people with obesity who run regularly are at increased risk of arthritis due to the stress of excess weight on the joints.

The bottom line

Trends in recent research suggest that running does not wear out your joints. That should be reassuring for those of us who enjoy running. And if you don’t like to run, that’s fine: try to find forms of exercise that you enjoy more. Just don’t base your decision — or excuse — for not running on the idea that it will ruin your joints.

About the Author

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

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

Do children get migraine headaches? What parents need to know

Headaches are very common in children and teens. In fact, more than half will suffer from headaches at some point, and by 18 years the majority of adolescents have had them. And while most headaches are part of a viral illness, some are migraines. In fact, recurring migraines affect as many as one in 10 children and teens overall.

What should you know — and do — if you think your child or teen may be having migraines?

How early do migraines start to occur?

We don’t tend to think about migraines in children, but by age 10, one in 20 children has had a migraine. And migraines sometimes occur even earlier.

Before puberty, boys and girls are equally likely to have them. After puberty, migraines are more common in girls.

Which migraine symptoms are most common in children?

Migraines are often one-sided in adults. In children they are more likely to be felt on both sides of the head, either in both temples or both sides of the forehead.

While it’s not always easy to tell a migraine from another kind of headache, children

often report throbbing pain
may experience nausea and sensitivity to light and noise.

The flashing lights and other vision changes people often see as a migraine begins are less common in children. However, parents may notice that their child is more tired, irritable, or pale before a migraine begins — and takes a while to get back to normal after it ends.

What causes migraines in children?

We don’t know exactly what causes migraines. We used to think it had to do with blood flow to the brain, but that does not seem to be the case. It appears that migraines are caused by the nerves being more sensitive, and more reactive to stimulation. That stimulation could be stress, fatigue, hunger, almost anything.

Migraines run in families. In fact, most migraine sufferers have someone in the family who gets migraines too.

Can migraines be prevented?

The best way to prevent migraines is to identify and avoid triggers. The triggers are different in each person, which is why it’s a good idea to keep a headache diary.

When your child gets a headache, write down what was happening before the headache, how badly it hurt and where, what helped, and anything else about it you can think of. This helps you and your doctor see patterns that can help you understand your child’s particular triggers.

It’s a good idea to make sure your child gets enough sleep, eats regularly and healthfully, drinks water regularly, gets exercise, and manages stress. Doing this not only helps prevent migraines, but is also good for overall health!

How can you help your child ease a migraine?

When a migraine strikes, sometimes just lying down in a dark, quiet room with a cool cloth on the forehead is enough. If it’s not, ibuprofen or acetaminophen can be helpful; your doctor can tell you the best dose for your child.

It’s important not to give your child these medications more than about 14 days a month, as giving them more often can lead to rebound headaches and make everything worse!

Are there prescription medicines that can help children with migraines?

If those approaches aren’t enough, a class of medications called triptans can be helpful in stopping migraines in children ages 6 and up.

If a child experiences frequent or severe migraines, leading to missed days of school or otherwise interfering with life, doctors often use medications to prevent migraines. There are a number of different kinds, and your doctor can advise you on what would be best for your child.

Some girls get migraines around the time of their period. If that happens frequently, sometimes taking a prevention medicine around the time of menses each month can be helpful.

When to contact your doctor

If you think your child might be having migraines, you should call and make an appointment. Bring the headache diary with you. Your doctor will ask a bunch of questions, do a physical examination, and make a diagnosis. Together you can come up with the best plan for your child.

You should always call your doctor, or go to an emergency room, if your child has a severe headache, a stiff neck, trouble with coordination or movement, is abnormally sleepy, or isn’t talking or behaving normally.

The American Academy of Pediatrics has additional useful information about migraines, and how to treat and prevent them, on their website.

About the Author

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

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

When should you hire in-home help or health aides?

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

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

Is it time to hire in-home help?

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

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

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

Start here: Ask yourself hard questions

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

For example:

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

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

What do health aides do?

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

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

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

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

How much does hiring health aides cost?

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

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

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

What might hold you back from getting help you need?

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

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

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

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

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

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

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

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

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

About the Reviewer

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

A tough question: When should an older driver stop driving?

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

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

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

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

How safe are older drivers on the road?

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

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

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

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

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

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

1. Seeing any red flags?

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

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

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

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

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

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

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

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

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

4. Accept that conversations about not driving are challenging

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

Challenges facing the driver:

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

Challenges facing the family:

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

Finding a path forward

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

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

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

About the Author

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

3 ways to create community and counter loneliness

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
meditation
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.

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

About the Reviewer

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

Veins are a key player in the body: Here’s why

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.

About the Author

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

21 spices for healthy holiday foods

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.

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

About the Reviewer

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

What to do when driving skills decline

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

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:

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

About the Author

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

What’s the difference between doulas and midwives?

Are doulas trained or licensed?

Is doula care covered by insurance?

Can working with a doula improve birth outcomes?

How do people collaborate with doulas?

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

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

About the Author

About the Reviewer

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?

What to do if you have hearing loss

About the Author

Runners can get arthritis, but is running the cause?

What is the relationship between running and arthritis?

Why is it hard to study running and arthritis?

The bottom line

About the Author

How early do migraines start to occur?

Which migraine symptoms are most common in children?

What causes migraines in children?

Can migraines be prevented?

How can you help your child ease a migraine?

Are there prescription medicines that can help children with migraines?

When to contact your doctor

About the Author

Is it time to hire in-home help?

Start here: Ask yourself hard questions

What do health aides do?

How much does hiring health aides cost?

What might hold you back from getting help you need?

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

About the Author

About the Reviewer

How safe are older drivers on the road?

1. Seeing any red flags?

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

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

4. Accept that conversations about not driving are challenging

Finding a path forward

About the Author

Taking the first steps

1. Seek like-minded souls

2. Create opportunities

3. Brush up your social skills

About the Author

About the Reviewer

What are veins and what do they do?

How do veins help keep blood flowing?

Why are veins blue?

What sort of problems can occur in veins?

Top 5 ways to improve vein health

The bottom line

About the Author

Amp up holiday foods with herbs and spices

About the Author

About the Reviewer

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

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

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

The bottom line

About the Author

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