More older people are using cannabis products regularly, but research suggests their cannabis-related health problems are also on the rise.Dr. Benjamin Han, a geriatrician and addiction medicine specialist at the University of California, San Diego, tells his students a cautionary tale about a 76-year-old patient who, like many older people, struggled with insomnia.“She had problems falling asleep, and she’d wake up in the middle of the night,” he said. “So her daughter brought her some sleep gummies” — edible cannabis candies.“She tried a gummy after dinner and waited half an hour,” Dr. Han said.Feeling no effects, she took another gummy, then one more — a total of four over several hours.Dr. Han advises patients who are trying cannabis to “start low; go slow,” beginning with products that contain just 1 or 2.5 milligrams of tetrahydrocannabinol, or THC, the psychoactive ingredient that many cannabis products contain. Each of the four gummies this patient took, however, contained 10 milligrams.The woman started feeling intense anxiety and experiencing heart palpitations. A young person might have shrugged off such symptoms, but this patient had hypertension and the heart arrhythmia called atrial fibrillation. Frightened, she went to an emergency roomLab tests and a cardiac work-up determined that the woman wasn’t having a heart attack, and the staff sent her home. Her only lingering symptom was embarrassment, Dr. Han said. But what if she’d grown dizzy or lightheaded and was hurt in a fall? He said he has had patients injured in falls or while driving after using cannabis. What if the cannabis had interacted with the prescription drugs she took?We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

So-called transient ischemic attacks can eventually lead to cognitive declines as steep as those following a full-on stroke, new research finds.Kristin Kramer woke up early on a Tuesday morning 10 years ago because one of her dogs needed to go out. Then, a couple of odd things happened.When she tried to call her other dog, “I couldn’t speak,” she said. As she walked downstairs to let them into the yard, “I noticed that my right hand wasn’t working.”But she went back to bed, “which was totally stupid,” said Ms. Kramer, now 54, an office manager in Muncie, Ind. “It didn’t register that something major was happening,” especially because, reawakening an hour later, “I was perfectly fine.”So she “just kind of blew it off” and went to work.It’s a common response to the neurological symptoms that signal a T.I.A., a transient ischemic attack or ministroke. At least 240,000 Americans experience one each year, with the incidence increasing sharply with age.Because the symptoms disappear quickly, usually within minutes, people don’t seek immediate treatment, putting them at high risk for a bigger stroke.Ms. Kramer felt some arm tingling over the next couple of days and saw her doctor, who found nothing alarming on a CT scan. But then she started “jumbling” her words and finally had a relative drive her to an emergency room.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

A new training program teaches aides to stop baby talk and address older people as adults.A prime example of elderspeak: Cindy Smith was visiting with her father in his assisted living apartment in Roseville, Calif. An aide who was trying to induce him to do something — Ms. Smith no longer remembers exactly what — said, “Let me help you, sweetheart.”“He just gave her The Look — under his bushy eyebrows — and said, ‘What, are we getting married?’” recalled Ms. Smith, who had a good laugh, she said. Her father was then 92, a retired county planner and a World War II veteran; macular degeneration had reduced the quality of his vision and he used a walker to get around, but he remained cognitively sharp.“He wouldn’t normally get too frosty with people,” Ms. Smith said. “But he did have the sense that he was a grown up, and he wasn’t always treated like one.”People understand almost intuitively what “elderspeak” means. “It’s communication to older adults that sounds like baby talk,” said Clarissa Shaw, a dementia care researcher at the University of Iowa College of Nursing and a coauthor of a recent article that helps researchers document its use.“It arises from an ageist assumption of frailty, incompetence and dependence.”Its elements include inappropriate endearments. “Elderspeak can be controlling, kind of bossy, so to soften that message there’s ‘honey,’ ‘dearie,’ ‘sweetie,’” said Kristine Williams, a nurse gerontologist at the University of Kansas School of Nursing and another coauthor.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

People with dementia often forget even close family members as the disease advances. “It can throw people into an existential crisis,” one expert said.It happened more than a decade ago, but the moment remains with her.Sara Stewart was talking at the dining room table with her mother, Barbara Cole, 86, in Bar Harbor, Maine. Ms. Stewart, then 59, a lawyer, was making one of her extended visits from out of state.Two or three years earlier, Ms. Cole had begun showing troubling signs of dementia, probably from a series of small strokes. “I didn’t want to yank her out of her home,” Ms. Stewart said.So with a squadron of helpers — a housekeeper, regular family visitors, a watchful neighbor and a meal-delivery service — Ms. Cole remained in the house she and her late husband had built 30-odd years earlier.She was managing, and she usually seemed cheerful and chatty. But this conversation in 2014 took a different turn.“She said to me: ‘Now, where is it we know each other from? Was it from school?’” her daughter and firstborn recalled. “I felt like I’d been kicked.”Ms. Stewart remembers thinking that “in the natural course of things, you were supposed to die before me. But you were never supposed to forget who I am.” Later, alone, she wept.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Roughly 20 states now have laws permitting families to place cameras in the rooms of loved ones. Facility operators are often opposed.The assisted-living facility in Edina, Minn., where Jean H. Peters and her siblings moved their mother in 2011, looked lovely. “But then you start uncovering things,” Ms. Peters said.Her mother, Jackie Hourigan, widowed and developing memory problems at 82, too often was still in bed when her children came to see her in mid-morning.“She wasn’t being toileted, so her pants would be soaked,” said Ms. Peters, 69, a retired nurse-practitioner in Bloomington, Minn. “They didn’t give her water. They didn’t get her up for meals.” She dwindled to 94 pounds.Most ominously, Ms. Peters said, “we noticed bruises on her arm that we couldn’t account for.” Complaints to administrators — in person, by phone and by email — brought “tons of excuses.”So Ms. Peters bought an inexpensive camera at Best Buy. She and her sisters installed it atop the refrigerator in her mother’s apartment, worrying that the facility might evict her if the staff noticed it.Monitoring from an app on their phones, the family saw Ms. Hourigan going hours without being changed. They saw and heard an aide loudly berating her and handling her roughly as she helped her dress.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

The number of cases will increase, but the rates seem to be declining with every birth cohort that reaches advanced ages, researchers said.Joan Presky worries about dementia. Her mother lived with Alzheimer’s disease for 14 years, the last seven in a memory-care residence, and her maternal grandfather developed dementia, too.“I’m 100 percent convinced that this is in my future,” said Ms. Presky, 70, a retired attorney in Thornton, Colo.Last year, she spent almost a full day with a neuropsychologist, undergoing an extensive evaluation. The results indicated that her short-term memory was fine — which she found “shocking and comforting” — and that she tested average or above in every cognitive category but one.She’s not reassured. “I saw what Alzheimer’s was like,” she said of her mother’s long decline. “The memory of what she went through is profound for me.”The prospect of dementia, which encompasses Alzheimer’s disease and a number of other cognitive disorders, so frightens Americans that a recent study projecting steep increases in cases over the next three decades drew enormous public attention. The researchers’ findings, published in January in Nature Medicine, even showed up as a joke on the Weekend Update segment of “Saturday Night Live.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Intensive management of diabetes pays fewer dividends as patients age and raises the chances of hypoglycemia. But many people have not gotten the message.By now, Ora Larson recognizes what’s happening. “It feels like you’re shaking inside,” she said. “I’m speeded up. I’m anxious.” If someone asks whether she would like a salad for lunch, she doesn’t know how to respond.She has had several such episodes this year, and they seem to be coming more frequently.“She stares and gets a gray color and then she gets confused,” her daughter, Susan Larson, 61, said. “It’s really scary.”Hypoglycemia occurs when levels of blood sugar, or glucose, fall too low; a reading below 70 milligrams per deciliter is an accepted definition. It can afflict anyone using glucose-lowering medications to control the condition.But it occurs more frequently at advanced ages. “If you’ve been a diabetic for years, it’s likely you’ve experienced an episode,” said Dr. Sei Lee, a geriatrician at the University of California, San Francisco, who researches diabetes in older adults.The elder Ms. Larson, 85, has had Type 2 diabetes for decades. Now her endocrinologist and her primary care doctor worry that hypoglycemia may cause falls, broken bones, heart arrhythmias and cognitive damage.Both have advised her to let her hemoglobin A1c, a measure of average blood glucose over several months, rise past 7 percent. “They say, ‘Don’t worry too much about the highs — we want to prevent the lows,’” the younger Ms. Larson said.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Heart disease is more common in people over 65, but treatments are better than ever. That can complicate decision-making for older heart patients.It turns out that the Isley Brothers, who sang that 1966 Motown hit “This Old Heart of Mine (Is Weak for You),” were onto something when they linked age to an aching and flagging heart.Heart disease, the nation’s leading cause of death and disability, has been diagnosed in about 6 percent of Americans ages 45 to 64, but in more than 18 percent of those over 65, according to the Centers for Disease Control and Prevention.Old hearts are physiologically different. “The heart gets stiffer as we age,” said Dr. John Dodson, director of the geriatric cardiology program at NYU Langone Health. “It doesn’t fill with blood as easily. The muscles don’t relax as well.”Age also changes the blood vessels, which can grow rigid and cause hypertension, and the nerve fibers that send electrical impulses to the heart. It affects other organs and systems that play a role in cardiovascular health, too. “After age 75 is when things accelerate,” Dr. Dodson said.But in recent years, dramatic improvements in treatments for many kinds of cardiovascular conditions have helped reduce both heart attacks and cardiac deaths.“Cardiology has been blessed with a lot of progress and research and drug development,” said Dr. Karen Alexander, who teaches geriatric cardiology at Duke University. “The medications are better than ever, and we know how to use them better.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

Fake nurseries and town squares seem to comfort patients. But some experts wonder whether they are patronizing, even infantilizing.The nursery at RiverSpring Residences in the Bronx is a sunny, inviting space outfitted with a bassinet, a crib with a musical mobile, a few toys, bottles, picture books for bedtime reading and a rack of clothing in tiny sizes.The other morning, Wilma Rosa was there trying to soothe one of its cranky, small charges. “What’s the matter, baby?” she crooned, patting the complainer’s back. “You OK? I want you to go to sleep for a little while.”Ms. Rosa, 76, a memory care resident in assisted living, visits the nursery daily. She has had plenty of experience with babies.She was the oldest girl of eight children, so she handled lots of family responsibilities, she told Catherine Dolan, the facility’s director of life enrichment, who was asking questions to help the memories flow. Later in life, Ms. Rosa worked in a bank and a store; the stories emerged as she cuddled the doll.No actual babies live in this immersive environment, where the fragrance blend includes a talcum scent. Just as no actual sales were taking place at the store down the corridor, another new RiverSpring undertaking.Amid its wooden shelves of clothing, accessories and tchotchkes, the sales clerks were, like Ms. Dolan, staff members trained to interact effectively with residents with dementia.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

It doesn’t happen often. But when it does, some residents risk losing everything.Three years ago, when Bob and Sandy Curtis moved into an upscale continuing care retirement community in Port Washington, N.Y., he thought they had found the best possible elder care solution.In exchange for a steep entrance fee — about $840,000, funded by the sale of the Long Island house they had owned for nearly 50 years — they would have care for the rest of their lives at the Harborside. They selected a contract from several options that set stable monthly fees at about $6,000 for both of them and would refund half the entrance fee to their estate after their deaths.“This was the final chapter,” Mr. Curtis, 88, said. “That was the deal I made.”C.C.R.C.s, or life plan communities, provide levels of increasing care on a single campus, from independent and assisted living to nursing homes and memory care. Unlike most senior living facilities, they’re predominantly nonprofit.More than 1,900 C.C.R.C.s house about 900,000 Americans, according to LeadingAge, which represents nonprofit senior housing providers. Some communities offer lower and higher refunds, many avoid buy-in fees altogether and operate as rentals, and others are hybrids.For the Curtises, the Harborside offered reassurance. Mr. Curtis, an industrial engineer who works as a consultant, took a comfortable one-bedroom apartment in the independent living wing. “It was a vibrant community,” he said. “Meals. Amenities. A gym.”Every day he spends time with Sandy, 84, who lives in the facility’s memory care unit, an elevator ride away. The staff members there “treat Sandy with love and care,” Mr. Curtis said. “It would have been wonderful if it could have continued.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.