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.

Some older Americans have come to depend on virtual consultations with doctors, covered by Medicare. To keep that option in the future, Congress will have to act quickly. Since his cancer diagnosis last year, Kent Manuel has regularly seen an oncologist near his home in Indianapolis. It’s been a tough time: After spinal surgery for paralysis caused by his cancer, he is regaining the use of his legs with physical therapy but still uses a wheelchair.Now, Mr. Manuel said, “I’m dealing with pain.” His oncologist recommended palliative care, a medical specialty that helps people with serious illnesses cope with discomfort and distress and maintain quality of life.So in November, Mr. Manuel, 72, a semiretired accountant, started seeing Dr. Julia Frydman, a palliative care doctor. “We talk through what works and what doesn’t,” he said. “She listens to what I have to say. She’s very flexible.”The first two medications she prescribed to reduce pain had troublesome side effects. On the third try, though, “I think we’ve landed on something that’s working,” he said. His pain hasn’t fully abated, but it has diminished.Dr. Frydman, the senior medical director at a cancer care technology company called Thyme Care, works hundreds of miles away in a Manhattan office. She and Mr. Manuel used a video telemedicine link — an option that barely existed in traditional Medicare before the Covid pandemic, thanks to restrictive federal policies.Medicare expanded its telemedicine coverage substantially in 2020, and the expansion has regularly been renewed. That could all have ended on Dec. 31.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.

Shuttered drugstores pose a particular threat to older adults, who take more medications than younger people and often rely on pharmacies for advice.In July, a notice appeared on the front door of The Drug Store, the only pharmacy in rural Kernville, Calif. After 45 years, the proprietor wrote regretfully, it would be closing in four days and transferring customers’ prescriptions to a Rite Aid about 12 miles away.As the news spread, “there was a real sense of loss, a sense of mourning,” said Roberta Piazza Gordon, who owns Piazza’s Pine Cone Inn in Kernville. The pharmacy had served as a community crossroads where people chatted with neighbors and with the friendly staff.Its closing also created practical concerns. “We are an aging population,” Ms. Gordon, 69, said of the townspeople.She relied on The Drug Store for her blood pressure and cholesterol medications and for anti-inflammatories after injuring her shoulder. Her husband, who is 70, also regularly filled prescriptions there.At The Drug Store, “you got your flu shot, your Covid shot, your pneumonia shot,” she said.Now those services require a 20- to 30-minute drive to the Rite Aid, which is in Lake Isabella and which Ms. Gordon described as understaffed for its growing number of customers.“On any given day, there’s a line of 10 to 15 people waiting at the pickup window,” she said. Unlike The Drug Store, the Rite Aid doesn’t deliver.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.

“We’re putting another burden on the elderly that we don’t have to,” one researcher said.Some things you can no longer do with cash: Buy a well-loaded hot dog at any of the five Devil Dawgs eateries in and around Chicago. Order a Vermont Pale Lager from Hill Farmstead Brewery’s taproom in Greensboro Bend, Vt.Attend the annual BeachLife Festival in Redondo Beach, Calif., or buy food, drinks or merchandise there. Purchase admission to the Home of Franklin D. Roosevelt National Historic Site in Hyde Park, N.Y., or to many other sites maintained by the National Park Service.The park service’s expanding no-cash policy exasperated several would-be visitors enough for them to sue in federal court earlier this year.Anne Ronan, 70, a retired attorney, walks around Lake Merritt in Oakland, Calif., a few times a week. After the three-mile-plus trek, she sometimes stops at one of two local cafes. Neither accepts payment in cash.Nor do a restaurant and a cocktail lounge nearby on Grand Avenue. “I don’t find it unusual anymore,” Ms. Ronan said.To buy coffee and a croissant, she routinely carries a credit card in her pocket. She doesn’t find that bothersome, but “as a public policy, it’s not a good thing.”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.