​Check out this list of what you need and when you need them

You already know it’s important to get your flu vaccine every year, ideally by the end of October. And when you go in for the shot, it’s a great time to make sure you’re up to date on all the other immunizations you should be receiving as an adult.

After all, it’s not just babies and youngsters who need a poke to protect against serious, and potentially lethal, diseases. Adults need them too, especially as our immune systems weaken with age.

So what shots should you get at 50 and beyond? “There are new vaccines that have come out in the past several years, specifically aimed at older adults,” says Morgan Katz, M.D., an assistant professor of medicine at Johns Hopkins University School of Medicine.

Checking In On Polio Vaccination Status

With newfound evidence that the poliovirus is circulating in the U.S., experts are recommending that anyone who is unvaccinated get immunized against the potentially debilitating disease. The CDC says most adults in the U.S. were vaccinated against polio as children (the vaccine first became available in 1955), and that continues to be the case. However, if you’re unsure of your status and are concerned, the CDC says it’s safe to repeat the vaccine.

One of them is Shingrix, the amazingly effective shingles vaccine. And there are a few new pneumococcal vaccines on the market that go hand-in-hand with updated recommendations for older adults.

Below you’ll find the vaccinations every adult needs, followed by two — for hepatitis A and B — that you need only if you have certain risk factors. What you won’t see on the list? Measles and chicken pox vaccines. Anyone born before 1957 wouldn’t need a measles vaccine because the disease was so prevalent when they grew up that immunity as an adult is assumed.

Chicken pox is similar in that most adults already have immunity from childhood exposure to the disease, Katz says. “Almost all adults over 40 have been exposed to chicken pox,” she adds, noting that it would be “an extremely rare case” for an adult not to have been. That said, if you think you could be in that tiny minority, ask your doctor about getting the chicken pox vaccine as an adult.

For the rest of the list, you can get your necessary shots at doctors’ offices, pharmacies, workplaces, community health clinics and other locations. And most health insurance plans will pick up the tab. So stop in and let ’em stick it to you. 

Influenza vaccine 

Who needs it: All adults, no matter the age.

How often: Once a year. “The virus itself changes every year,” Katz says. “Researchers try to predict what will be the most common strain that season, then reformulate the vaccine accordingly.” 

Flu season typically begins in October and ends in March, though experts predict it could hit earlier this year. And so the Centers for Disease Control and Prevention (CDC) recommends rolling up your sleeve by the end of October, since it takes about two weeks after a vaccination for flu-fighting antibodies to develop in the body. 

What you need: While experts say a standard flu shot is certainly better than no flu shot, the CDC is now recommending that adults 65 and older — a group at higher risk of complications from an influenza infection — opt for a high-dose version. Here’s a rundown of the options:

• Fluzone High-Dose Quadrivalent is an injectable vaccine that contains four times the antigen (the flu proteins that our immune system recognizes and attacks) of a standard-dose inactivated flu vaccine, to help create a stronger immune response. A study published in The Lancet Respiratory Medicine reported that people 65 years and older who got Fluzone High-Dose (a previously available trivalent high-dose vaccine) had a lower risk of hospitalization compared with people in that age group who got the standard dose, especially those living in long-term care facilities. What’s more, research published in The New England Journal of Medicine found it to be more effective in preventing flu in adults 65 years and older relative to a standard-dose vaccine.
  
• Fluad Quadrivalent is an adjuvanted flu vaccine, made with an MF59 adjuvant, an additive that creates a more robust immune response
  
• Flublok Quadrivalent. This is a recombinant vaccine, which means it does not require an egg-grown virus and does not use chicken eggs in the manufacturing process. This may be a good option if you are allergic to eggs (the Fluzone and Fluad offerings are grown in eggs). Flublok Quadrivalent contains three times the antigen of other standard-dose inactivated flu vaccines.

Why you need it: The flu can lead to hospitalization and sometimes death — and seniors are the most vulnerable. In any year, 50 to 70 percent of flu-related hospitalizations occur among people 65 and older, according to the CDC. Still, research compiled by AARP found that only half of U.S. adults ages 50 to 64 had the influenza vaccine in 2020; 70 percent of adults 65 and older went in for the jab.

Talk to your doctor if: You’ve had a severe reaction to the flu shot in the past, are allergic to eggs, have (or have had) Guillain-Barré syndrome, or have a fever. (In that case, you’ll likely be asked to wait until your temp is back to normal before you get the vaccine.)

Parting shot: Even if you’re vaccinated, there’s a possibility you could get the flu. How well the inoculation protects depends on different factors, including your age and health status. That said, a flu vaccination may lessen the severity of illness if you do get sick. A 2017 study found that flu vaccination reduced ICU admissions and the length of hospital stays among flu patients, especially among older adults. It also reduced death.

COVID-19 vaccine  

Who needs it: All adults, no matter the age, and especially people ages 50 and older, who are considered to be at increased risk for complications from a coronavirus infection.

How often: It’s recommended that all adults receive their primary series (this is two shots, given a few weeks apart), followed by an updated (omicron) booster to protect against the coronavirus variants that are currently circulating. In the past, booster schedules varied — some older adults may have received two or more. However, the new recommendation is that all fully vaccinated adults — no matter how many boosters are under their belt — should get the newly authorized omicron booster at least two months after their last shot. Health officials are hopeful boosters from here on out will be on an annual schedule; stay tuned.

What you need: There are four different vaccines available, one from Novavax, one from Moderna, one from Pfizer-BioNTech and one from Johnson & Johnson, though the CDC recommends the J&J vaccine be considered only in some situations. The vast majority of Americans have been vaccinated with either Pfizer or Moderna.

The primary series for the Novavax, Moderna and Pfizer COVID-19 vaccines requires two shots, spaced a few weeks apart. Both Moderna and Pfizer have updated boosters; Novavax is expected to have a booster soon.

Why you need it: COVID-19 has killed more than 1 million Americans since it started circulating in the U.S. two years ago and has hospitalized countless others. It’s especially risky for adults 50 and older who are more likely to suffer complications from an infection.

CDC data from June 2022 shows that unvaccinated people are five times more likely to die from COVID-19 than their vaccinated peers. And among adults 50 and older, unvaccinated people are 14 times more likely to die from the illness than adults who are up to date on their COVID-19 vaccines and boosters.  

Talk to your doctor if: You’ve had a severe allergic reaction to a medication or vaccine in the past.

Parting shot: As the newly authorized omicron boosters ship out and supplies ramp up, health experts are encouraging people to schedule their COVID-19 booster at the same time as their flu shot for added convenience and enhanced protection against two illnesses that tend to spread more in the cold-weather months.

Pneumococcal vaccine

Who needs it: Healthy adults 65 years and older, or adults 19-64 with certain risk factors (smoking, or health problems, such as chronic lung or heart disease, leukemia, lymphoma or alcoholism).

How often: Adults who haven’t received a pneumococcal vaccine should opt for either the PCV15 or PCV20. If PCV15 is used, it should be followed by a dose of PPSV23 a year later. (If you’re immunocompromised, you may get it sooner.) 

Why you need it: Before COVID-19 came along, pneumococcal disease, which can cause pneumonia, killed more people in the U.S. each year than all other vaccine-preventable diseases combined. Young children and those over 65 have the highest incidence of serious illness, and older adults are more likely to die from it. Experts estimate PCV13 (one of the pneumococcal vaccines available) prevented more than 30,000 cases of invasive pneumococcal disease and 3,000 deaths in its first three years of use. About 65 percent of adults 65 and older received the pneumococcal vaccine in 2020, an AARP report shows.

Parting shot: If you work around chronically ill people — say, in a hospital or nursing home — you should get the vaccine, even if you’re healthy.

Tdap vaccine (tetanus, diphtheria, pertussis) and/or the Td booster (tetanus, diphtheria)

Who needs it: The Tdap vaccine came out in 2005, and along with protecting against tetanus and diphtheria, like the vaccine it replaced, it also includes new, additional protection against whooping cough, also known as pertussis. If you can’t remember ever getting this shot, you probably need it. And doing so, says Katz, can also count for one of the Td boosters you’re supposed to get every 10 years. (You know the one … it’s the shot you wonder if you’re current on after you step on a rusty nail during your vacation.)

How often: Adults should receive a booster dose of either Tdap or Td (a different vaccine that protects against tetanus and diphtheria, but not pertussis) every 10 years, the CDC says, or after five years if you get a severe wound or burn.

Why you need it: Due to a rise in whooping cough cases in the U.S., you really do need to be vaccinated against it, even if you’re over 65. In the first year after getting vaccinated, Tdap prevents the illness in about 7 out of 10 people who received the vaccine. 

Talk to your doctor if: You have epilepsy or other nervous system problems, had severe swelling or pain after a previous dose of either vaccine, or have (or have had) Guillain-Barré syndrome.

Parting shot: This vaccine is especially crucial for people who have close contact with children younger than 12 months of age — including parents, grandparents and child care provider

Shingles (herpes zoster) vaccine

Who needs it: The CDC recommends that everyone 50 and older get the Shingrix shingles vaccine, even if they had the earlier recommended vaccine, Zostavax — which was much less effective — and even if they’ve already had shingles. 

How often: For now, the CDC is recommending only that you get this new vaccine, which is given in two doses spaced two to six months apart, to prevent both shingles and its complications. It remains to be seen if the agency will recommend getting it again after, say, five years, as its effectiveness starts to wane. 

Why you need it: One in 3 people will get shingles, usually after age 50. The risk rises with age. By 85, half of adults will have had at least one outbreak. Chicken pox and shingles are caused by the same virus, varicella zoster. After a person recovers from chicken pox, this virus stays dormant for decades in the body, ready to appear when the immune system is weakened by stress, medication or disease. This infection causes a red rash and painful blisters. About 15 percent of sufferers are left with extreme nerve pain — a condition called postherpetic neuralgia, which can last for months or years. Shingrix can protect 97 percent of people in their 50s and 60s, and 91 percent of those in their 70s and 80s. Data compiled by AARP shows that 16 percent of adults 50 to 64 received the shingles vaccine in 2020; that percentage jumps to 43 percent when looking at adults 65 and older.

Talk to your doctor if: You are not feeling well, or currently have shingles. There are few other reasons not to get the vaccine. 

Parting shot: Older adults should also get this vaccine whether or not they remember having had chicken pox as a child. Why? More than 99 percent of Americans over the age of 40 have been exposed to the varicella zoster virus, even if they don’t recall getting chicken pox. 

Hepatitis A vaccine 

Who needs it: People 50 and older who are at high risk for hepatitis A, a disease of the liver. Infections result primarily from travel to another country where hepatitis A virus transmission is common, through close contact with a hepatitis A–infected individual, or recreational drug use.

How often: Once, but given in two doses over six months.

Why you need it: Hepatitis A rates in the U.S. have declined by more than 95 percent since the hepatitis A vaccine first became available in 1995. In 2016, there were an estimated 4,000 hepatitis A cases in the U.S.

Parting shot: This is a sneaky disease. You may not have any telltale signs — and the likelihood of symptoms decreases as you age.

Hepatitis B vaccine

Who needs it: Adults 50 and older who are at risk for contracting hepatitis B, a liver infection. Hepatitis B is transmitted when a body fluid (blood, semen, saliva) from a person infected with the hepatitis B virus enters the body of someone who is not infected. This can happen through sexual contact, or things like contact with blood or open sores (say, from a job that exposes you to human blood or other bodily fluids), or sharing anything from a needle to a razor to a toothbrush with an infected person. Other risk factors for infection include being on kidney dialysis, traveling to countries where hepatitis B is common, or having HIV.

How often: Adults getting the vaccine need three doses — the second dose given four weeks after the first; the third dose five months after the second. There is also a combination vaccine for both hepatitis A and B called Twinrix, which is given in three doses over six months.

Why you need it: The CDC estimates that the number of new hepatitis B infections in 2016 was 20,900.

Talk to your doctor if: You have a life-threatening allergy to yeast, or to any other component of the vaccine, or are moderately or severely ill when a dose of vaccine is scheduled.

Reprinted from AARP

The festive season means fun with friends and family, goodwill and giving. Sadly, it’s also a prime time for cybercrooks to cook up nefarious schemes.

Three-quarters of U.S. consumers have experienced or been targeted by at least one form of fraud that can be tied to the holidays, including requests from (often fake) charities, online shopping scams and fraudulent communications about shipping problems, according to a new AARP Fraud Watch Network™ report, “Preparing for the Holidays? So Are Criminals: Already Rampant Fraud Expected to Spike.”

Most scams are variations on everyday fraud, ramped up to match seasonal spikes in spending and web traffic. Not surprisingly, they often center on shopping, especially online. As real retailers roll out their seasonal deals, scammers seek to snare bargain-hunting shoppers with bogus websites and social media campaigns that impersonate major brands. These “spoofing” sites and fake posts entice you to spend money for products you’ll never receive.

No matter where you live, fraud is never far away. Report a scam or search for existing scams near you.

Many are vehicles for harvesting credit card numbers and other personal data that criminals use to commit identity theft or sell on the dark web. Scammers may distribute malware-loaded links or attachments via supposed coupon offers or “order confirmation” emails. Fraud involving drained gift cards — hugely popular for both giving and receiving — also shift into high gear.

Other hallmarks of the season provide grist for grifters:

• Charity scams: One-third of all charitable giving is done in December, reports fundraising software company Network for Good. That means more sham charities exploiting Americans’ goodwill via fake websites and pushy telemarketers. 
• Delivery scams: As holiday packages crisscross the country, scammers send out phishing emails and texts disguised as UPS, FedEx or U.S. Postal Service notifications about incoming or missed deliveries. Links lead to phony sign-in pages asking for personal information, or to sites infested with malware.
• Travel scams: Some criminals send scam emails and texts offering promotions such as free flights to get you to share credit card information or click on links that download malware. Also be wary of the many spoofed websites pretending to be legitimate hotels, airlines and other travel-related businesses.

How to Avoid Holiday Scams

Warning Signs

• Huge discounts on hot gift items, especially when touted on social media posts or unfamiliar websites. 
• Spelling errors or shoddy grammar on a shopping website or in an email or text. 
• An unsolicited email that asks you to click on a link or download an app to access a deal or arrange a delivery.
• Pressure from a charity fundraiser to donate right away.

How to protect yourself from this scam

• Rather than clicking on a link from an email or text to a hot deal, go to your web browser and type in the web address of the company purportedly offering said great deal.
• Pay by credit card. This way you can dispute charges and limit the damage if the transaction was fraudulent. 
• Buy gifts cards online directly from the issuing business instead of from a retail rack, where the cards can be tampered with. When receiving a gift card as a present, register it if that’s an option, and use it sooner rather than later.  
• Avoid conducting any business online (making a purchase, donating, accessing password-protected sites) while using a public Wi-Fi network unless you employ a virtual private network (VPN).
• Pushy charities could be an indicator that the cause is bogus; legitimate charities will accept your donations on your own timeline.
• Anytime you are prompted to make a purchase or a donation by wire transfer or gift card, it is a scam. 

More Resources

Charity Navigator, CharityWatch and GuideStar provide a bevy of resources on charitable organizations, including ratings, reviews and financial information.

If you encounter a holiday scam, file a complaint with the Federal Trade Commission (online or at 877-382-4357) and report it to your state’s attorney general and consumer protection office.

Reprinted from aarp.com

It’s Medicare open enrollment season, which means it’s also Medicare scam season. Eligible beneficiaries have until‍ Dece‍mber ‍7 to shop for the best deals for their health care dollar. Unfortunately, some of the offers won’t be deals at all. Here’s how to avoid the scams this open enrollment season. How It Works • The Medicare Open Enrollment Period runs from Octo‍ber 1‍5 to Dece‍mber ‍7‍. During this time, Medicare recipients can explore other health plans. • Because plans change from year to year, beneficiaries can save money by exploring different coverage options. • However, Medicare scams spike during open enrollment season, with bogus offers from real or impersonated insurance providers pitching free gifts or limited time offers. • Scammers also call Medicare beneficiaries claiming to be from Medicare, asking them to verify their information to issue a “new” card. What You Should Know • These scams are designed to capture personal information that can be used to bill Medicare fraudulently. • Criminals use free offers to entice people. From cheap giveaways to promises of free medical supplies, these tactics seek to harvest Medicare information or even a credit card number for alleged shipping charges, for instance. Unscrupulous salespeople may also try to pressure you to buy often worthless supplemental insurance products that will supposedly save thousands. Know that Medicare will never call you out of the blue. Criminals use “spoofing” technology to make it look like their incoming calls are coming from Medicare, so your caller ID is not trustworthy. Medicare is not sending out new cards; anyone suggesting otherwise is lying to you. What You Should Do Beneficiaries can compare plans safely and change their enrollment by going to www.medicare.gov or by calling 80‍0-‍63‍3-‍42‍27. Also, every state has a State Health Insurance Assistance Program (SHIP) with counselors who can help answer your questions. • Be suspicious of unsolicited offers, offers that are exceedingly generous and offers for free products in exchange for your personal information.

What to eat or drink to build a stronger defense this winter

The saying “you are what you eat” applies to your entire body, but it’s especially important when it comes to your immune system during flu season. “As we get older, our immunity starts to decline, but if we get the right nutrients, we can help our immune systems do their jobs to protect us against viruses like the flu,” says Samantha Heller, a New York City nutritionist.

You can keep it in tip-top shape during this flu season — which may be a doozy — if you focus on a plant-based diet rich in whole unprocessed foods, Heller says. One of the best eating patterns to illustrate this is the Mediterranean diet, which is rich in fruits, veggies, whole grains, nuts, beans and healthy fats such as fatty fish and olive oil. A study published in March in the journal Frontiers in Nutrition found that people who followed this diet were less likely to become infected by or die from COVID-19, suggesting it may provide an immune system boost that could protect you from other viral infections, too.

Here, more immunity boosting foods that research, and nutritionists, recommend for right now.

1. Green tea

Whether these particular tea leaves can really fend off the flu has been a source of debate among health researchers for years. But a new meta-analysis published in July in the journal Molecules looked at more than eight studies involving more than 5,000 participants to conclude there really is ample evidence to believe the beverage — and specifically, the catechins that provide its antioxidant power — can help your immune system fend off influenza.

2. Sweet potatoes

They’re a great source of beta carotene, a phytonutrient that helps your body make vitamin A. “It supports respiratory health by increasing the number of immune cells in the body,” explains Anna Taylor, lead outpatient clinical dietitian at the Cleveland Clinic’s Center for Human Nutrition. This is especially important for older adults, as our bodies make fewer immune cells as we age, she adds. Instead of cooking them with butter or brown sugar, Taylor recommends that you roast them with olive oil, oregano and black pepper. “You’ll get additional benefits from the spices, but you’re not loading up on sugar and saturated fat, both of which suppress your immune system,” she says.

3. Berries

They’re a rich source of vitamin C, which stimulates production of infection fighting white blood cells, Taylor says. A 2018 review of studies found that berries increased levels of disease fighting cells in older adults, such as natural killer cells and T-cells. They also contain flavonoids, substances that have antioxidant properties and protect all your cells — including your immune system cells — from damage, she adds. It’s so easy to incorporate them into your diet: ”Add them to your morning yogurt or oatmeal, or even cook them and throw them on your French toast instead of maple syrup,” Taylor recommends.

4. Beans

Chickpeas, black beans, kidney beans, they’re all rich in vitamin B12, a nutrient many older adults are low in, Heller says. “People over the age of 50 don’t absorb vitamin B12 as well in their body, but your immune system needs it to fight disease and repair damaged cells to keep you healthy,” she explains. They’re also high in zinc, which helps boost your body’s production of white blood cells, Taylor says. “Zinc deficiency has been linked to immune system dysfunction,” she says. Taylor recommends at least a half a cup of cooked beans three times a week. You can throw them into soups, chili, salads or even rice dishes. For a healthy crunchy snack, roast chickpeas in some olive oil.  

5. Nuts and seeds

These foods are rich in vitamin E, which plays a key role in your immune system by supporting the growth of T-cells, says Lauri Wright, chair of the Department of Nutrition and Dietetics at the University of North Florida. They’re also a good source of omega-6 fatty acids. Walnuts are an especially good choice, as research shows they have a very positive effect on your gut microbiome, says Kate Cohen, a registered dietitian nutritionist with the Ellison Institute for Transformative Medicine at Providence Saint John’s Health Center in Santa Monica, California. They also have more alpha-linolenic acid — an essential fatty acid important for immune function — than any other type of nut.

6. Salmon

It’s not plant-based, but it is one of the few foods that provides vitamin D, which plays a huge role in regulating your immune system, says Jennifer McDaniel, owner of McDaniel Nutrition Therapy in Clayton, Missouri. A 2020 study published in the journal JAMA Network Open found that people who had untreated vitamin D deficiency were almost twice as likely to test positive for COVID-19 as patients who had sufficient levels of the vitamin. A 6-ounce salmon filet has about 600 IU of vitamin D, which is close to the 800 IU that is recommended for people 70 and older. Another bonus: It’s rich in omega-3 fatty acids, which have also been shown to strengthen your immune system.

If you’re not a fan of fish, McDaniel suggests marinating it in brown sugar and Dijon mustard for 45 minutes, then throwing it on the grill. “It mellows out that fishy taste, and it gives it a smoky flavor,” she explains. Canned salmon counts, too: Throw it over a salad for a quick meal, she says. 

7. Garlic

It’s rich in a compound called alliin, which may be the source of its immune boosting properties, notes Libby Mills, a Philadelphia nutritionist and spokesperson for the Academy of Nutrition and Dietetics. A 2020 review published in the journal Medical Hypotheses found that garlic itself seems to stimulate cells related to immune system function. Another study published in the Journal of Nutrition found that people given about 2½ grams of aged garlic extract for 90 days not only had higher levels of immune system cells, but they also had fewer symptoms of cold and flu, and missed fewer workdays due to these respiratory illnesses, than a control group. At the very least, if you eat enough of it, you’ll probably keep people away from you, Mills jokes.

Although there’s probably not enough research to support taking a garlic supplement, Mills recommends that you cook with it in the colder winter months. You can make your own pasta sauce with tomatoes and garlic, since vitamin C (found in tomatoes) is itself an antioxidant that helps the immune system she says.

8. Kefir

Recent research, including a 2021 study published in Biomedicine & Pharmacotherapy, suggests that certain compounds found in fermented dairy such as kefir (which is like a thin yogurt) have anti-inflammatory properties that can help the immune system fight viral infections. The probiotics found in kefir and other fermented foods also help to calm chronic inflammation, according to Harvard Health.

“Fermented dairy is rich in probiotics, which seem to have a positive effect on the immune system,” Mills explains.

Why Fluids Matter if You Get the Flu

Whether water, electrolyte-rich beverages, broths, or green tea (see above), you really do need liquids if you’re sick with the flu. Not only is it important to fend off dehydration, staying hydrated helps you maintain enough circulating blood volume to treat infection. (Just go easy on the caffeinated sodas and coffee.) And yes, doctors say chicken soup can’t hurt, since fever can cause you to lose water as well as salt.​

Reprinted from AARP.org

Scams aren’t always high tech, and they aren’t always new. Stealing checks from the mail and “washing” them used to be a common crime but faded away over time. Now it’s back with a vengeance. In 2021, the US Postal Inspection Service (USPIS) received 33,000 reports of incidents involving mail carrier robberies and mail theft, up from 24,000 in 2019.More from the AARP Fraud Watch Network•Learn More About Fake Check Scams•How to Prevent ID Theft•Do you think you have been targeted or have fallen victim to a scam? Contact the AARP Fraud Watch Network Helpline. Call 877‍-‍908‍-‍3360.

How It Works• Residential mailboxes with the raised flag that indicates outgoing mail are a big draw for criminals since they often contain bill payments with personal checks included.•Thieves also go “fishing” inside the blue mailboxes by inserting long flexible items with adhesive on the end in hopes of pulling out checks.•Another way into mailboxes is to steal a master key from a postal worker. These “arrow keys” open multiple mailboxes and sell for between $5,000 and $10,000 on the black market.•Once they have a personal check, thieves “wash” the ink off with household chemicals and fill it out to a new recipient for whatever amount they wish. Often, they will apply super glue on the signature to keep it intact. What You Should Know• Mail theft cases used to be more prevalent on the West Coast; however, USPIS has recently seen more incidents in the eastern US, particularly around Philadelphia, New York City and Washington, DC.•Rather than cashing forged checks themselves, criminals often sell the “washed” checks through online black-market channels, with personal checks fetching around $175 a pop.•Financial institutions typically make your account whole in the case of forged checks, but the investigation could take weeks, leaving you without access to funds during that time. What You Should Do• Bring checks inside the post office for mailing, or, if you choose to deposit mail containing checks, cash or sensitive personal information in collection boxes, do so as close to the indicated pickup time as possible.•When you put outgoing mail in your mailbox, don’t put up the flag and try not to leave outgoing mail in your mailbox for long periods of time.•Keep an eye on your account balances and report any suspicious activity right away.•Sign up for Informed Delivery from the US Postal Service. It’s a free daily service that emails you a scan of what is coming in your mail. Also, place a hold on your mail when out of town.

More than 600 drugs have been linked to hearing loss and tinnitus, including over-the-counter pain relievers

It’s normal to experience hearing loss and balance issues as you get older. But before you chalk up those problems to age, experts say you should consider whether a medication could be damaging your ears.

More than 600 medicines have been linked to hearing loss, ringing in the ear (tinnitus) or balance problems. The list of so-called “ototoxic” drugs includes both over-the-counter and prescription options. Among them: medications that treat heart problems, pain, infections and more.

In some cases, the hearing problems caused by a medication is reversible and will go away when you stop taking it, says Lawrence Lustig, an otolaryngologist at New York-Presbyterian/Columbia University Irving Medical Center.

But some drugs can cause permanent damage.

Older patients are especially vulnerable because their kidneys often aren’t as efficient at flushing out medications, putting them at higher risk of toxicity if a drug builds up in their system, Lustig says. Adults age 65-plus are also more likely to be taking more than one drug at a time and sometimes the combined effect of two medications can be worse than a drug on its own.

3 Ways to Protect Yourself

1. Ask about side effects. Ask your health care provider if hearing loss or tinnitus is a side effect of any of your prescriptions or over-the-counter medications.
2. Recognize early signs of trouble. Ringing or buzzing in your ears — or worsening tinnitus if you already have it — is often the first sign that a medication could be harming your hearing.
3. Opt for nondrug alternatives. Instead of reaching for a pain reliever for your bad back or bum knee, consider trying physical therapy, yoga or acupuncture.

Before starting a medicine classified as ototoxic, Lustig recommends getting a baseline hearing test and balance assessment, and then going for regular testing during treatment. That can help you and your doctor identify any hearing-related side effects early, since medicines often impact high frequency hearing first, so you might not notice the change without a hearing test.

Here are some common medications linked to hearing loss and what you need to know about this potentially life-altering side effect.

1. Over-the-counter pain relievers

Because painkillers such as aspirin, acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil and Motrin are widely available without a prescription, many patients take them regularly and assume that they are harmless. In fact, about 1 in 3 Americans takes a store-bought pain medication every day, according to a 2022 survey.

However, research indicates that over-the-counter pain relievers can contribute to both hearing loss and tinnitus, especially if they’re used for two or more days per week, says Sharon Curhan, an epidemiologist at Brigham and Women’s Hospital and Harvard Medical School and author of several studies on the connection.

In a 2012 study that followed more than 62,000 women, Curhan discovered that frequent use of acetaminophen or NSAIDs, even in typical doses, was linked to an up to 24 percent higher risk of developing hearing loss.  In men, a similar study demonstrated that regular use — two or more times per week — of acetaminophen, NSAIDs and aspirin are all associated with a higher risk of hearing loss.

Another large study, the Epidemiology of Hearing Loss Study, found that among adults who already had hearing loss, NSAID use was associated with a 45 percent higher risk of progression of their hearing loss.

Researchers speculate that the medications may reduce blood flow to the cochlea, an organ in the inner ear that helps with hearing.

“The overarching message from these findings is that even though these analgesics are widely available without a prescription, these are still medications and there are potential side effects,” Curhan says. “For anyone who is considering taking these types of medications regularly, it is advisable to consult with a health-care professional to discuss the risks and benefits and to explore whether there are alternatives to using medication.”

Fortunately, frequent use of low-dose aspirin (100 mg or less) has not been linked to hearing-related side effects. Many older adults take a low dose of the drug daily to prevent cardiovascular disease.

2. Aminoglycoside antibiotics

Some of the most damaging medications to hearing are a class of antibiotics called aminoglycosides, Lustig says. Available in pill form, as well as intravenously, they are believed to damage the sensory cells inside your ear needed for balance and hearing.

One aminoglycoside, called gentamicin, is often administered intravenously in the hospital to fight severe bacterial infections, such as a bone or an organ infection. Other drugs in the class also include “micin” or “mycin” at the end, such as streptomycin, neomycin, kanamycin and tobramycin.

Studies show more than 50 percent of patients who require multiple rounds of intravenous aminoglycosides may experience hearing loss. Even at recommended dosages, taking them “can result in rapid, profound, and irreversible hearing loss,” according to one review study. That study’s authors found that a single dose can result in permanent hearing loss in patients with a certain genetic mutation.

Despite the risks, these antibiotics are sometimes needed to treat what can be a life-threatening infection, says Wendi D. Jones, a pharmacist with AspenRX Health in Washington, North Carolina.

If your doctor prescribes an aminoglycoside, your health care provider should do concurrent blood testing to ensure the drug levels in your blood don’t get too high, Jones says. They should also monitor you for hearing-related side effects.

3. Loop diuretics

Loop diuretics are powerful medications that are used to treat high blood pressure and fluid retention due to heart failure, liver disease or kidney disease. The most commonly used loop diuretics are Lasix (furosemide), Bumex (bumetanide) and Demadex (torsemide).  

Experts believe these medications interfere with the ionic composition of the fluids in the ear, contributing to hearing loss. Although loop diuretics can cause permanent damage if you get a large dose by injection in the hospital, in most cases, they cause only temporary hearing loss that clears up once you stop using the drug.

“Using the lowest dose that will effectively treat the condition helps prevent ototoxicity,” Curhan notes.

If you already have hearing or balance problems, you might want to ask your doctor if a different type of diuretic would be a better choice for you.

4. Some chemotherapy drugs

Platinum-based chemotherapy drugs such as cisplatin and carboplatin are used to treat many types of cancer, including lung, reproductive, head and neck cancers.

However, they can cause permanent hearing loss, tinnitus and balance problems.

Because the drugs can be lifesaving, health care providers have to balance the pros and cons when deciding about treatment. “If a patient has to have it for a life-threatening condition, you give it to them,” Lustig says.

Scientists are working to develop medications and treatment protocols to help protect hearing while a patient is being treated with the drugs.  

5. Long-term hormone therapy

Hormone therapy can be helpful for treating menopausal symptoms such as hot flashes, but a large study led by Curhan and published in the Menopause in 2017 found a strong correlation between oral hormone therapy and hearing loss. The study, which followed almost 81,000 postmenopausal women for more than 20 years, found that the longer a woman took hormone therapy (estrogen therapy or estrogen plus progestogen therapy), the greater her risk of hearing loss.

Compared to those who never took hormones, the risk of hearing loss was 15 percent higher among women who used oral hormone therapy for five to nearly 10 years and 21 percent higher among women who used the therapy for 10 years or longer, the study showed.

Based on those results, Curhan recommends that women concerned about hearing limit their use of hormone therapy to five years or less.

6. Quinine, chloroquine and hydroxychloroquine

Quinine, a therapy to prevent and treat malaria, has long been known to cause temporary hearing loss, especially if given in large doses. Quinine is also sometimes prescribed off label to treat nocturnal leg cramps.

Two similar drugs, chloroquine and hydroxychloroquine, are also used to treat malaria and are sometimes prescribed for autoimmune diseases such as Lupus. Both chloroquine and hydroxychloroquine were investigated as possible treatments for COVID-19 infection.

Although all three drugs have been linked to temporary hearing loss and tinnitus, fortunately most patients find the hearing problems go away once they stop the medication.

Signs a Drug May be Harming Your Hearing

Just because a medication has been tied to hearing problems doesn’t necessarily mean you need to worry.

The severity and extent of the damage, if any, depends on many factors, including the dosage, how long you have been taking it, how often you take it, your kidney function, what other drugs you take, your age, if you’re dehydrated and even your genetic susceptibility, Lustig and Curhan say.

Contact a health care provider if you experience any of these signs that a medication could be harming your hearing:

• A ringing, roaring or buzzing sound in one or both ears or in your head (tinnitus)
• Worsening of existing tinnitus or you notice a new sound
• A feeling of fullness or pressure in your ears (that isn’t due to an infection)
• New onset of hearing loss or worsening of existing hearing loss
• Vertigo or a spinning sensation, which sometimes can be accompanied by nausea

If you’re concerned, it’s important to consult to your health care provider before you make any changes to your medications, Curhan says. “Together, you can evaluate the risks and benefits and explore possible alternatives,” she says. 

Reprinted from AARP.

Important: Updated COVID-19 vaccines are now available to provide increased protection against the currently circulating Omicron BA.4 and BA.5 subvariants.

If it has been at least 2 months since you completed your COVID-19 primary series or had your last booster, then you are eligible for an updated vaccine. 

As with other diseases, you’re protected best from COVID-19 when you stay up to date with the recommended vaccines. COVID-19 vaccines are effective at protecting people from getting seriously ill.

Symptoms can be subtle, but that doesn’t mean they’re any less dangerous

Despite its depiction in the movies, a heart attack doesn’t always produce pain or pressure so intense it causes a person to clutch their chest and collapse to the floor. Most people who have a heart attack experience a much less dramatic version. And some have no symptoms at all — or symptoms that are so subtle they’re mistaken for something else entirely.

These so-called silent heart attacks account for about 20 percent of all heart attacks, according to 2022 statistics from the American Heart Association. Some experts estimate that percentage is even higher — closer to 50 percent.

What is a silent heart attack?

A heart attack happens when the arteries that carry blood to the heart become blocked, thereby depriving the heart muscle of oxygen and nutrients. If a person having a heart attack feels pain or pressure, it’s because of this blockage, says Eduardo Marban, M.D., executive director of the Smidt Heart Institute at Cedars-Sinai Medical Center in Los Angeles.

The same thing happens during a silent heart attack — blocked arteries make it so that oxygen-rich blood can’t reach the heart. The only difference is the problem goes unnoticed. “It’s not necessarily that there were no symptoms; it may just be that the patient didn’t recognize them as heart symptoms and wasn’t concerned,” Marban says.

Symptoms of a silent heart attack

Few people actually exhibit no symptoms. But signs of a heart attack can be muted or confused with other conditions. Here’s what to look out for:

1. Shortness of breath
2. Weakness or fatigue
3. A general feeling of unease or discomfort
4. Sweating
5. Nausea or vomiting
6. Lightheadedness or dizziness
7. Mild pain in the throat or chest
8. Pain in the back or arms, like a sprained or pulled muscle

For example, it’s not uncommon for silent heart attacks to be written off as indigestion, a sprained or strained muscle, fatigue or “just feeling run-down,” Marban says.

People who later realize they’ve had a silent heart attack may also recall experiencing shortness of breath at the time, or a general state of discomfort that led to a night of lost sleep, says Robert Lager, M.D., an interventional cardiologist at MedStar Washington Hospital Center in Washington, D.C. Nausea, sweating, dizziness and an overall feeling of unease are also signs of a silent heart attack.

If you experience any of these symptoms, “don’t sit around and wonder” what could be wrong. “Time is muscle,” Lager says, referring to the damage that decreased blood flow can inflict on the heart. “The longer one waits to get evaluated, the more likely that there will be irreversible damage.”

That said, some people truly experience no symptoms — understated or otherwise — when they have a heart attack. Diabetics who have nerve issues that interfere with pain signals (called neuropathy), for example, are at higher risk for having a literal silent heart attack, Lager says. Women and older adults are also more likely to have an event without warning signs.

Is it a heart attack … or something else?

Silent heart attacks don’t just fool patients; they can be misdiagnosed in health care settings too. Shortness of breath may be mistaken for a pulmonary problem, for instance. And pain in the shoulder or arm can be misdiagnosed as an orthopedic issue. “So there are lots of different forms of symptoms that are referred pain from the heart that can be very confusing and sometimes can be misleading,” Lager says.

One way to tell if the symptoms you’re experiencing are due to a heart attack or another condition is to know that the warning signs of heart trouble are “not positional,” Lager says. This means that the sprain-like pain in your neck and arm won’t get better if you stretch it or shake it out. And shortness of breath or sweating won’t subside if you take it easy and lie down.

“That’s a really good rule of thumb,” Lager says. “If you’re not sure if you’re having a symptom, see if you can manipulate it in some way. Can you press on the chest? Can you change your position? Can you stand up or sit down? Does it make a difference, positionally? Because the heart has no gyroscope; it doesn’t know where it is in space. And it doesn’t matter if you put the heart upside down or right side up, it’s going to give you the same signals if it’s in trouble.”

Another thing to keep in mind: Any symptom that results from the loss of oxygen to the heart will generally get worse if you increase demand on the heart. “So if someone has chest discomfort at rest and gets up and walks around, you’re increasing the heart’s demand for oxygen, so the symptoms usually will get worse if it’s a heart issue,” Lager says.

The risks factors for silent heart attacks are the same as those for a heart attack with symptoms. The most common include:

• Age (for men, 45 and older; for women, 55 and older)
• Diabetes
• Excess weight
• High blood pressure
• High cholesterol
• Lack of exercise
• Prior heart attack
• Tobacco use
• A family history of heart disease

The dangers of having a heart attack and not knowing

Many people who have had a silent heart attack find out about it after the fact — sometimes months or years later — usually during a routine electrocardiogram, or EKG. Symptoms that arise afterward can also bring patients in to see a health care provider. Lager says people who have suffered a silent heart attack may notice a faster heart rate or increased exercise intolerance, for example.

Usually when someone finds out they’ve had a silent heart attack, the damage has already been done. But identifying a past heart attack can help you and your doctor mitigate risks for future cardiac events. After all, a silent heart attack is associated with an increased risk of heart failure, a 2018 study in the Journal of the American College of Cardiology found. It just needs to be on the name of the journal.. It also increases the likelihood of sudden death, stroke and having another heart attack.

Dangerous heart arrhythmias are another concern your doctor may monitor for if you had an undetected heart attack in the past. These can develop when parts of the heart muscle are scarred from the loss of blood. And another worry: Because “our blood gets thicker under stress,” Lager says, blood clots are also more likely to crop up after you’ve had a heart attack.

“Once the diagnosis is made, either of a recognized heart attack or a silent heart attack, everything is put into a higher risk category in terms of the complications that can ensue,” Marban says. “So it’s not something that we should just consider a curiosity and do nothing about. … Detecting a heart attack and acknowledging it is the first step towards putting the patient back on the kind of effective therapy that we know is helpful.”

Don’t ignore out-of-the-blue issues

The take-home message, Lager says, is to pay attention to a change in patterns in your body.

“If you’re someone who occasionally has some chest discomfort that’s mild, transient and occurs in certain predictable patterns, then it’s not nearly the same as someone who has new symptoms never felt before,” he says.

And if you’re prone to indigestion and just ate a spicy meal, the burning feeling in your chest is likely heartburn. But if it comes on out of the blue and the symptoms get worse, especially as you walk around or exercise, “that’s a real warning sign that it’s not gastrointestinal,” Lager says.

Reprinted from AARP.

With 228 million licensed drivers in the United States, nearly all of us will interact with our state’s Department of Motor Vehicles, or DMV (although your state may call it something different). Unfortunately, government impostor scammers know this and are shifting DMV scams into high gear for their own financial benefit.

How It Works •A text message from your state’s DMV requests payment for an overdue fee and threatens license suspension if you do not pay immediately.•Alternatively, the message may say you are due for a refund from an overpayment or — this is especially timely — it may say you are entitled to a fuel rebate to offset high gas prices.•A web search for your state DMV lands you on what you think is your state’s official DMV site. What You Should Know •In some states, DMVs do send text messages, but only to consumers who have signed up to receive them.•At any rate, government agencies, including the DMV, will not ask for personal or private data by text message.•Criminals buy online ads to lead web searchers to fake DMV pages with the goal of capturing a payment method or sensitive data that can be used for identity fraud. What You Should Do •Carefully scrutinize DMV text messages for misspellings or unusual grammar.•Avoid clicking any links in an unsolicited text message or email, even if it claims to be a government agency.•Know your state motor vehicle office’s correct name. Crooks often use the generic “DMV” in scam messages, even in states with different agency names, such as Massachusetts Registry of Motor Vehicles or Illinois’ Department of Driver Services.•Confirm that a DMV website is genuine by looking for a .gov suffix in the address, which every state motor vehicle agency uses (except for Wyoming).•Report DMV scams to the Federal Trade Commission, online or by calling 877‍-‍382‍-‍4357, and to your state’s consumer protection office.

What could be causing your fatigue — and how to fight it

David Levine feels tired — a lot — and laments how he rarely makes it to the end of a movie. The 68-year-old Manhattan journalist has a pretty good idea why: A night in the sleep lab showed he had borderline sleep apnea. “But certain medications I take, especially Lipitor, make me even more tired,” he says. “I went off it for two months, and I felt a lot better.”

Levine is in good company. Research suggests that fatigue (or anergia, in medical lingo) runs as high as 50 percent in people 65 and older, compared with rates in the general population, which range from 10 to 25 percent.

Yet “fatigue is not a natural consequence of aging,” says Barbara Resnick, codirector of the Biology and Behavior Across the Lifespan Organized Research Center at the University of Maryland School of Nursing.  “It’s more related to the changes that occur due to age and commonly associated diseases.”

Fatigue is common when you’re fighting any kind of illness, from infections to autoimmune disorders. Some treatments, such as chemotherapy, are notoriously exhausting. And, of course, fatigue is also a symptom of COVID-19, although it’s usually accompanied by more telling signs like fever and chills, even in minor cases of the disease caused by the coronavirus.

Beyond that, “all of us feel tired some of the time,” says Suzanne Salamon, M.D., assistant professor of geriatric medicine and primary care at Beth Israel Deaconess Medical Center in Boston. “Usually, it goes away, either with sleep or time.”

But if unexplained fatigue continues for more than a few weeks, it’s time to figure out what’s causing it. Here are some of the likely suspects (keep in mind, though, that more than one culprit may be responsible).

1. Your medications are sapping your energy

“Older adults take a lot of medications, and a lot of those medications tend to make people feel tired,” explains Brenda Windemuth, director of the Adult Gerontology Primary Care Nurse Practitioner Program at the University of Maryland School of Nursing. Chief among these: certain antidepressants, antianxiety drugs, sedatives, antihistamines, steroids, and blood pressure and cholesterol medications.

Antipsychotics, pain meds, seizure drugs and chemotherapy also stir up trouble. Others, like diuretics, contribute to exhaustion by disturbing your sleep. 

“Not all drugs cause the same effects in all people,” Salamon says. “If a person has started a new medicine and they notice fatigue, they should report this to the doctor. Sometimes just moving the drug to the evening or lowering the dose can help, but sometimes you need to change to a different medicine.” She recommends always bringing all your medicines — prescription and over the counter — to your office visits so your doctor can check doses and duplicates.

Levine was able to take a lower dose of his cholesterol drug and still get its benefits. Although he still feels somewhat tired, he’s decided to stay on it. “The trade-off is worth it,” he says. “I’m a tennis player and I don’t want to drop dead on the court.”

2. Your sleep hygiene may need improvement 

Many of us simply aren’t getting enough slumber and are paying the price the next day.

Poor sleep habits are often to blame. If you’re lying in bed and can’t fall asleep, Resnick advises, get up and do something until you feel tired, and then go back and try again. “The other really big mistake people make is that they expect to lie around all day and then be able to sleep at night,” she observes. “You only want to spend time in bed when it’s sleep time. Some people like to control the world from their bed.”

Other advice: Maintain a regular sleep pattern, and avoid alcohol at night. Consider keeping a sleep diary to help you identify factors — foods, drinks, medicines — that may be keeping you from solid slumber. Keep in mind that as you get older you may not require the seven to nine hours you used to, Windemuth says.

Obstructive sleep apnea is another culprit. Patients experience as many as 30 awakenings an hour when the soft tissues of the throat relax and obstruct the airway during sleep; as a result, they feel exhausted the next day.

Loud snoring is a clue. Spending the night in a sleep lab can confirm the diagnosis. The standard treatment, a continuous positive air pressure (CPAP) machine, involves wearing a mask over the nose to force air into the throat and keep the airways open.

3. You’re missing key nutrients 

People over 50 are more likely to experience nutrient deficiencies — especially vitamins B12 and D, iron and folic acid — that cause fatigue. If your doctor suspects a deficiency, she’ll send you for a blood test, and you may need a supplement. 

4. You’re anemic

This means that your blood has too few red cells or those cells have too little hemoglobin, which transports oxygen through the bloodstream. The result: fatigue.

A simple blood test provides a diagnosis, after which your physician will investigate possible reasons for the anemia and may put you on iron pills. 

There are three main reasons older adults become anemic. Kidney disease is one. If your kidneys are not working properly, they may not be able to help your body make the red blood cells it needs. “It can also be due to blood loss from somewhere, usually along the gastrointestinal tract,” Resnick says, “or it’s in the bone marrow, which could be due to a malignancy.”

5. You have a heart or pulmonary problem

Cardiac issues — including heart failure, coronary artery disease, valvular heart disease, asthma and chronic obstructive pulmonary disease (COPD) — are among the most common causes of fatigue in older people.

Heart disease can cause the heart to pump blood less efficiently and fluid to build up in the lungs. This, in turn, results in shortness of breath and less oxygen supply to the heart and lungs. So be sure to follow doctor’s orders when it comes to treatment.

6. You’re anxious or depressed

“Depression, being alone and other psychosocial issues are a huge factor in older people,” Windemuth says. “People are losing friends and spouses. They’re being uprooted from their homes or going into assisted living. That can lead to fatigue.”

Antidepressant medications are sometimes the answer. “We also encourage people to go out, become more involved and find things that they really enjoy doing,” Windemuth adds.

Paradoxically, exercise can make a huge difference. “The best thing for fatigue is physical activity — no matter what the underlying problem,” Resnick says. “The goal should be 30 minutes daily of moderate-level activity.”

Playing tennis has been a lifesaver for Levine, helping him to keep up his energy level. “If I exercise in the afternoon, I feel better,” he says.

7. COVID could be the Culprit

When COVID-19 symptoms linger long after a person’s initial illness, fatigue is a very common complaint. “Estimates of the prevalence are variable but some sources suggest that more than 50 percent of all COVID survivors are affected by persistent fatigue,” says John Baratta, M.D., founder and codirector of the UNC COVID Recovery Clinic at UNC Health in Chapel Hill, North Carolina. “In our Long COVID clinic, over 90 percent are troubled by this symptom.”

Before treating the fatigue, doctors first investigate other potential factors that may be contributing to extreme tiredness, such as sleep apnea, depression and chronic pain, says Benjamin Abramoff, M.D., head of the Post-COVID Assessment and Recovery Clinic at Penn Medicine in Philadelphia. Then you may be prescribed physical therapy or a graded exercise program, where the duration and intensity of activity is gradually increased. Both can improve stamina, but it’s important to pace yourself to avoid exacerbating symptoms or risking relapse, Baratta says.

“We have also found benefits from certain medications, such as antidepressants and stimulants, in certain situations,” Baratta adds. These include certain antidepressants in the SSRI (selective serotonin reuptake inhibitor) class and stimulants like those used to treat attention deficit disorder.

If you’re suffering from fatigue related to long COVID, ask your doctor about such strategies or consider making an appointment at a post-COVID clinic. These programs typically take a multidisciplinary approach to treating the disease’s lasting symptoms, fatigue included.

Reprinted from AARP