As days grow shorter, and daylight becomes scarce in late fall and winter, 4 to 6 percent of Americans experience a form of depression called winter-onset Seasonal Affective Disorder *(SAD). Another 10 to 20 percent have milder cases. Many mistakenly write off SAD as the winter blues or cabin fever, but as a recognized type of clinical depression, SAD requires professional diagnosis and attention, the American Academy of Family Physicians (AAFP) advises.

Although SAD is more common among younger adults (75 percent of SAD patients are women, most in their 20s, 30s and 40s), it also affects seniors.

And seniors diagnosed with other forms of depression may have symptoms aggravated by the isolating effect of forbidding winter weather. Treatment for SAD and other forms of depression is especially critical for older adults, who are at greater risk of suicide than the rest of the U.S. population, according to the Centers for Disease Control. While American seniors make up 12 percent of the population they account for 16 percent of all suicides—and white men over 85 are at six times greater risk of suicide than other population segments.

Other means to help seniors elevate mood and fend off the effects of winter and depression include:

• Open curtains and blinds to allow in as much daylight as possible. Sitting near a window can increase daylight’s positive effects.

• As safety permits, spend time outdoors every day. Even on cloudy days the effect of daylight can be beneficial. For the added benefit of companionship, as well as safety, a family or professional caregiver may need to accompany a senior.

• Eat a well-balanced diet that provides recommended amounts of vitamins and minerals to maintain energy. Limit consumption of starchy and sweet foods.

• Get physical activity 30 minutes a day, three times a week. Again, a family or professional caregiver can help seniors achieve this safely with the added, healthful benefit of companionship.

• Stay involved with hobbies, church and social activities and friends to prevent feelings of isolation that winter can bring.

As delivery of healthcare continues to change, your relationship with your doctor may no longer be like talking to Marcus Welby. No matter what you heard, Dr. Welby was an actor not a doctor.

Managed care, restrictions and reimbursement reductions imposed by Medicare and private insurance have forced doctors to see more patients just to keep their practices afloat. This means less time for each patient.

Even the most confident big wigs may feel intimidated as they wait barefoot in an exam room in a open-backed hospital gown. To complicate matters, all the restrictions, paperwork and limits on reimbursements contribute to a shortage of front line doctors like internists and general practitioners. In addition, a movement to empower the patient to become more involved in their own care has shifted relationship focus from primary care doctor to specialist, who typically have even less time to foster a long-term patient-doctor relationship.

So how do you handle a doctor appointment, get answers to your questions and understand what the doctor tells you? Here are a few tips to help you make your doctor visit a success:

• Start with a pencil and paper. If you are experiencing a symptom that has prompted you to consider an appointment, keep a diary of what is happening, what activities bring on your symptoms and when you experience them so you can give your doctor the most accurate information. If you are experiencing pain rank it in the diary from 1 to 10. If the symptoms or pain are aggravated or relieved by medication you are taking, note that too.

• Learn how to communicate effectively with the office staff.  Making an appointment with a doctor can be a challenge in itself. If a health issue is potentially embarrassing, asking the doctor to call you may not be the best course to take without giving them an inkling to the why you are calling. If a script is helpful when you call and talk to the receptionist or scheduler, write one. Regardless of the issue, give the receptionist at least some idea of why you are calling. Don’t worry – he or she has heard worse. One trick that works well for me is to fax the doctor. I give a brief, written explanation, and I always get a quick call from the nurse or physicians assistance. If the office will give you an e-mail address, that’s even better. You can e-mail your notes or symptom diary.

• Bring someone that will keep you occupied and not aggravated in the waiting room. If you feel you may benefit by someone being there with you, then bring a friend, family member or caregiver. Another set of ears and someone who is slightly detached from your symptoms may make the visit even more beneficial. Of course, this is your appointment and you should be communicating directly with the doctor.  Your support person should be there just to support you and should not be having the primary conversation with the doctor.

• Remember your doctor is here to help you. You should clearly communicate all information, issues and concerns with your doctor.  Your doctor can then more thoroughly evaluate you and then offer a clear explanation or solution that you can understand.

• Take notes. If necessary, ask the doctor to repeat what he or she told you so you can make notes. If your doctor is giving you too much information too quickly, speak up and let him or her know to slow down. A small tape recorder could come in very handy for playback later.

• If you feel that good bedside manner is lacking in your relationship with your doctor, a change may be in order. Not all doctors have good bedside or exam table manners. While they may be great technicians or mechanics, they may lack in the personality arena. More and more, medical schools are focusing on this intra-personal area of medicine. Many are adopting role playing scenarios to allow doctors to understand how their mannerisms can affect their patients. You should expect your doctor to treat you with respect.

• Being open and honest with your doctor is in your best interest. If you have a concern about what you are being told, tell him or her. If there is some underlying issue that may affect when, where or how you may be able to comply with recommendations, tell your doctor. The more your doctor knows about you, the better he or she can help you.

Where did I put my keys? Or, where did I park my car? For most people, these questions probably sound more than vaguely familiar. That is because aging normally involves a certain degree of memory loss. Over the course of our lives—starting in our 20s—we lose brain cells, a few at a time, causing a normal decline in the brain’s ability to remember.

We can take an active role in keeping our minds sharp and slowing memory loss. Eating right provides valuable nutrients and exercising improves circulation to the brain. Reading, playing cards, learning new skills, doing puzzles and brain teasers, maintaining an active social life and getting adequate rest also help maintain a fit brain.

The American Academy of Family Physicians offers tips to help your memory stay sharp:

• Repeat names when you first meet people
• Put important things, such as keys, in the same place every time
• Keep lists and a detailed calendar
• Make associations, such as using landmarks to help you find places
• Follow a routine
• Run through the ABC’s in your head to help think of words you are having trouble remembering. “Hearing” the first letter of a word may jog your memory.
• Exercise your mind and body

When starting an exercise program, seniors should seek an array of workouts. Just like a balanced diet from the basic food groups, exercise best promotes good health and independent living when it consists of a variety of activities. Here are some general exercise guidelines for seniors:

• Consult a physician before beginning an exercise program.

• Aerobic activities such as walking, bicycling, swimming, dancing and other low-impact aerobic activities are good options for seniors and can improve heart and lung health and help manage weight.

• Seniors should try to work out up to 30 minutes a day most days of the week. For those with arthritis, low- to no-impact exercise such as water aerobics, swimming, elliptical trainer and stationary bicycle may be best.

• Flexibility and agility exercises such as stretching, yoga and tai chi can increase range of motion and improve balance, which helps prevent falls.

• Yoga classes also offer relaxation techniques such as deep breathing, improving overall cardiac fitness, blood pressure and the immune system.

For suggestions on adopting an exercise program, read the National Institute on Aging’s exercise guide.

Seasonal flu will be upon us soon, and more communities will be affected this fall and winter by the H1N1 virus than in the spring and summer of this year’s outbreak. Severity of the H1N1 outbreak will be hard to determine, so you need to plan your strategies to protect against illness.

The most important way to help prevent exposure to the flu is by washing your hands regularly. It is important to remember that hand washing is more than using soap and water or using alcohol based products. You need to know how and when to wash your hands.

How to wash your hands:

• Wet your hands with warm water
• Apply soap and rub your hands together for at least 10-15 seconds. Wash the front and back of hands and wrists, between fingers and under nails
• Rinse well. Let water run down your fingers – not down your arms
• Dry hands with a paper towel, but leave the water running
• Use elbows or a new paper towel to turn off faucets

When to wash your hands:

• Whenever hands become obviously soiled
• After contact with blood, body fluids, mucous membranes or non-intact skin
• Before putting on or after removing protective medical gear
• Before and after a work shift
• After handling contaminated equipment or articles
• After using the toilet, blowing your nose, covering a sneeze, etc.
• Before eating, drinking or handling food
• Before and after smoking

As people age, it becomes even more important to keep the brain active. Here are some tips that can help your mind stay in shape:

• Play. Word games or puzzles are an excellent way to exercise your mind. Routinely working through complex thought processes will keep your brain functioning quickly. You don’t have to stick with simple crosswords. Sudoku, word scrambles, and spelling games are also good ways to play and exercise your brain at the same time.

• Learn. Just because you’re beyond your school years, doesn’t mean you should stop learning. Learning new things helps work your brain. As the cerebral synapses figure out new paths, you can figure out a new topic or skill.

• Eat (healthy). Lots of foods have brain benefits. Strive for a balanced diet, but load up on the fruits, vegetables, and nuts.

• Relax. Stress and worry can bog down the brain. So, stop worrying and try some relaxing activities to keep your mind working well.

• Exercise. This one comes as no surprise. We have all heard about the benefits of exercise, but most people don’t connect physical health to brain health. An exercise regimen with regular aerobic activity helps cognitive function.