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Common Chronic Health Diseases in Older Adults As we grow older, our bodies face new challenges that can affect our overall well-being. For many adults aged 65 years and older, managing chronic diseases becomes an important part of maintaining a good quality of life. In the United States, chronic illnesses like heart disease and chronic obstructive pulmonary disease (COPD) are common among older adults. Understanding these conditions, their risk factors, and how to manage them can make a significant difference in reducing health complications and improving day-to-day life. Understanding Chronic Diseases in Older AdultsA chronic condition is a health issue that lasts a year or more and requires ongoing medical attention or limits daily activities. These conditions become more prevalent as we age, and for adults age 65 or older, the likelihood of developing a chronic illness increases significantly. Some of the most common chronic diseases in older adults include heart disease, COPD, diabetes, and arthritis. Each condition comes with its own set of challenges, but with proper management, individuals can lead fulfilling and active lives. Risk Factors for Chronic IllnessesA variety of factors can increase the risk of developing chronic conditions in older adults. Some of the most common risk factors include: Age: As we age, the body naturally undergoes changes that can contribute to the development of chronic diseases. Genetics: Family history plays a significant role in conditions like heart disease and diabetes. Lifestyle Choices: Smoking, poor diet, lack of exercise, and excessive alcohol consumption can significantly increase the risk of chronic illnesses. Environmental Factors: Exposure to air pollution, secondhand smoke, and other environmental hazards can contribute to conditions like COPD and respiratory issues. While some risk factors, like age and genetics, are beyond our control, many lifestyle choices can be adjusted to reduce the risk of developing chronic conditions. Common Chronic Health Diseases in Older Adults  Heart Disease Heart disease is the leading cause of death for adults aged 65 and older in the United States. This chronic illness includes a range of conditions, such as coronary artery disease, heart failure, and arrhythmias. Symptoms can vary but often include chest pain, shortness of breath, and fatigue. Managing heart disease involves medication, lifestyle changes, and regular monitoring by healthcare professionals. For older adults, taking steps like maintaining a healthy diet, exercising regularly, and quitting smoking can significantly improve heart health and quality of life.  Chronic Obstructive Pulmonary Disease (COPD) COPD is a chronic lung disease that makes it difficult to breathe due to obstructed airflow. It is often caused by smoking or long-term exposure to irritants such as pollution. Older adults with COPD may experience frequent respiratory infections, shortness of breath, and chronic cough. Proper management includes medications, oxygen therapy, and pulmonary rehabilitation. Older adults living with COPD can improve their lung function and overall well-being by quitting smoking, practicing breathing techniques, and joining a COPD management program.  Flu and Pneumonia While the flu and pneumonia may not be considered chronic conditions on their own, they can pose serious risks for older adults, especially those with existing chronic illnesses. Older adults are more likely to experience severe complications from these respiratory infections, leading to hospitalization or even death. Annual flu vaccines and pneumonia vaccinations are vital for protecting older adults from these illnesses. For those with chronic conditions like heart disease or COPD, preventing the flu and pneumonia can help reduce the strain on their already compromised systems.  Diabetes Diabetes is another common chronic illness among older adults. This condition affects how the body processes blood sugar and can lead to complications such as kidney disease, nerve damage, and vision problems. Managing diabetes requires a combination of medication, dietary changes, and regular blood sugar monitoring. Older adults with diabetes should work closely with their healthcare providers to create a management plan that keeps their blood sugar levels stable and reduces the risk of complications. Improving Quality of Life with Chronic IllnessLiving with a chronic condition can feel overwhelming, but older adults can take several steps to maintain their quality of life. Joining a chronic disease management program can provide education, support, and resources to help individuals better manage their conditions. Additionally, staying active, eating a balanced diet, and following medical advice are key to improving overall health and reducing the impact of chronic illnesses. For older adults, managing chronic conditions is not just about addressing symptomsits about making lifestyle changes that enhance daily life. Simple steps like staying up to date on vaccinations, attending regular check-ups, and seeking emotional support can have a significant positive effect. Be Proactive and Take Charge of Your HealthChronic diseases are a common part of aging, but with the right knowledge, support, and management, older adults can live full and active lives. Understanding risk factors, staying on top of preventative care, and managing chronic conditions such as heart disease, COPD, and diabetes can make a world of difference. By being proactive, you can take control of your health and continue to enjoy the things that matter most. At VIPcare, we understand the unique challenges that come with managing chronic diseases. Were here to help every step of the way. Our compassionate care team takes a personalized approach, focusing on the whole patient to ensure that each individuals health needs are met. Through comprehensive management programs, we provide ongoing support, from regular checkups to medication management and lifestyle guidance. Whether its heart disease, COPD, diabetes, or another chronic condition, VIPcare works closely with patients to reduce health risks and improve their overall quality of life. By fostering strong patient-doctor relationships, we empower individuals to take control of their health and achieve better outcomes. If youre suffering from a chronic condition, schedule an appointment with a VIPcare provider near you. Get the support and care you deserve and need so you can start living your best life. VIPcare doctors in Alabama cater to the unique needs of seniors who are 65+. Our primary care approach is to help you get and stay healthy is focused on preventive care and managing chronic conditions. Contact VIPcare at 251-257-2886 to find your location and make an appointment. 

Managing Arthritis Pain in Cold Weather: Tips for SeniorsAs the winter months approach, many seniors find that their arthritis pain intensifies. The drop in temperature and changes in barometric pressure can lead to increased joint pain, stiffness, and discomfort, making daily activities more challenging. However, with a few lifestyle adjustments, you can help manage arthritis in cold weather and stay comfortable during winter. Why Does Cold Weather Affect Arthritis?If you suffer from arthritis, you may notice that your symptoms worsen when winter weather arrives. Although the exact reason is not fully understood, several factors contribute to this phenomenon. One key factor is the change in barometric pressurethe weight of the air pressing down on the body. When barometric pressure drops, it can cause joints, especially those affected by arthritis, to expand slightly, leading to achy joints and increased joint pain.Cold weather can also cause muscles to stiffen, restricting blood flow to joints and making it harder to stay limber. This reduced circulation can lead to joint pain and stiffness, particularly in the hands, knees, and hips. Tips to Manage Arthritis Pain in Cold WeatherWhen cold weather sets in, managing arthritis can become more challenging, especially for seniors. By incorporating specific strategies into your daily routine, you can ease the discomfort of arthritis and stay mobile. Here are some practical ways to help you manage arthritis pain and stay active during the winter months: Stay WarmOne of the most effective ways to reduce arthritis pain in the cold is to stay warm. Dress in layers, especially when going outdoors, and pay attention to your hands, feet, and joints. Wearing thermal clothing, gloves, and warm socks can help keep these vulnerable areas insulated. At home, use heating pads or warm blankets to soothe sore joints and muscles. Heating pads are especially helpful in improving blood flow to painful areas, which can reduce joint pain and stiffness. A warm bath or shower can also work wonders to loosen stiff joints. Stay ActiveWhile it might be tempting to stay indoors and rest during the winter months, staying physically active is essential for managing arthritis pain. Regular physical activity helps to maintain joint mobility, reduce stiffness, and increase flexibility. The Centers for Disease Control and Prevention (CDC) recommends that older adults aim for at least 150 minutes of moderately intense physical activity each week. This can be broken down into manageable chunks, such as 30 minutes of exercise five days a week. For people with arthritis, low-impact activities like walking, swimming, or cycling are excellent options. Even gentle stretching and yoga can help alleviate pain and keep joints moving. In addition to aerobic exercise, strength training sessions are important for improving joint support and muscle strength. These sessions, which can be done two to three times per week, should target the muscles around your achy joints to provide better stability and reduce the strain on your joints. Get Your Daily Dose of SunshineDuring the winter, we tend to spend more time indoors, leading to reduced exposure to sunlight and lower levels of vitamin D, often called the sunshine vitamin. Low vitamin D levels can worsen arthritis symptoms and lead to weakened bones. If you live in an area with limited sunshine during the winter months, consider taking a vitamin D supplement or eating foods rich in vitamin D, such as fatty fish, fortified dairy products, and eggs. Always check with your doctor before starting any new supplements. Use Heat TherapyAs mentioned earlier, applying heat can provide relief for achy joints during the cold weather. In addition to using heating pads, consider trying paraffin wax baths for hand pain or taking a warm bath to help relax tight muscles. For people with rheumatoid arthritis, these methods can be particularly beneficial in easing joint discomfort. However, be mindful not to apply heat for too long or use it on inflamed areas, as this may exacerbate swelling. If your joints are swollen, cold therapy, like using an ice pack, may be a better option. Stay Hydrated and Eat WellProper hydration is often overlooked during the winter months, but staying hydrated helps keep your joints lubricated and can reduce stiffness. Drink plenty of water throughout the day, and limit your intake of caffeine and alcohol, as these can dehydrate you. Eating a balanced diet that includes anti-inflammatory foods, such as leafy greens, nuts, and fatty fish, can also help reduce arthritis pain. Foods rich in omega-3 fatty acids, for example, can help fight inflammation and improve joint function. Embrace the Cold with ConfidenceManaging arthritis pain in the cold weather can be challenging, but by taking proactive steps, you can reduce discomfort and maintain your quality of life. Remember to stay warm, stay active, and incorporate strategies like heat therapy and proper nutrition into your routine. With these adjustments, the winter season can be more manageable for people with arthritis.If youre struggling with your arthritis symptoms, be sure to consult with a healthcare provider. They can offer personalized advice to help you stay comfortable during the winter months and beyond.  VIPcare doctors in Alabama cater to the unique needs of seniors who are 65+. Our primary care approach is to help you get and stay healthy is focused on preventive care and managing chronic conditions. Contact VIPcare at 251-257-2886 to find your location and make an appointment.

Alzheimer's- should it be called type 3 diabetes? More and more scientists are saying that, but why?A recent study shows that people with diabetes have a higher risk for Alzheimer's. Some think it may be because of high blood sugar levels alone. Others think it is because insulin resistance affects all organs, including the brain. There is a concept that most doctors don't know: it is called central nervous system insulin resistance. There is a type of antidiabetic medication such as sitagliptin that is used for diabetics, but is not usually prescribed for Alzheimer's disease.They reviewed the clinical records of patients that met certain criteria for probable Alzheimer's dementia. They performed special scans that identified the presence of a substance in the brain that is associated with dementia. They also used standardized tests to evaluate cognitive impairment.Three groups of patients were evaluated, diabetic patients under treatment with the medication, diabetic patients without the treatment, and non-diabetic patients.The results were fascinating; they found that diabetic patients under treatment with medication showed lower amounts of the dementia substance in the brain, better results in cognitive tests, and overall slower cognitive decline when compared with patients that weren't using the medication.In Alzheimer's disease, the amount of dementia related substance in the brain, as well as insulin resistance, play a vital role in the development of cognitive decline.All of these findings suggest that managing insulin resistant diabetes with this certain type of medication improves not only diabetes, but Alzheimer's disease as well.Editors Note:  The author is Ford Brewer, MD, MPH with Jubilee Primary Care. 

Embracing Friendship: A Guide to Making Connections Later in LifeWhen we were young, it was easy to make friends. No matter where we went, it was an opportunity to connect with others. But as we journey through life, the landscape of our social circles begins to undergo significant changes. Whether it's due to career moves, life transitions, or the natural ebb and flow of relationships, finding new friends can become a bit more challenging as we get older. But fear not! Making friends in your later years is not only possible but can be incredibly rewarding. Here are some tips to help you navigate the waters of adult friendship and build meaningful connections.Embrace Your HobbiesOne of the best ways to meet like-minded individuals is by engaging in activities you love. Whether it's joining a local book club, taking up a new hobby like painting or photography, or participating in community events, pursuing your passions can lead you to people who share your interests. Conversations flow more naturally when you're discussing something you love, providing a solid foundation for friendship.Attend Social EventsMany communities host social events that cater to a wide range of interests and ages. Attend local gatherings, festivals, or workshops to meet new people. This creates an organic environment for striking up conversations and finding common ground. Don't be shy to initiate discussions or join group activities. Remember, everyone is there to connect and make friends!Leverage TechnologyIn our digitally connected world, technology can be a powerful tool for forging new friendships. Join online communities and social media groups, or use apps designed to connect people with similar interests. Attend virtual events or participate in online forums related to your hobbies or passions. You might be surprised by the genuine connections that can blossom through these platforms.Volunteer Your TimeGiving back to the community is not only a fulfilling experience but also an excellent way to meet new people. Plus, its been proven that its good for your health! Another little perk. Volunteer at local charities, community centers, or events, and you'll likely encounter individuals who share your commitment to making a positive impact. Shared values can be a strong foundation for lasting friendships and relationships.Be Open and ApproachableFriendships often begin with a simple smile or a friendly greeting. Practice being open and approachable, even in everyday situations like at the grocery store or in your neighborhood. Small talk can lead to deeper conversations, and you never know when a chance encounter might turn into a meaningful connection.Reconnect with Old AcquaintancesLife gets busy, and people often lose touch with friends from their past. Take the initiative to reach out to old acquaintances or classmates. Rekindling old connections can be a delightful way to expand your social circle, and you may find that you have more in common now than you did before. Not to mention, its always fun to reminiscence on the past. Join Classes or WorkshopsLearning something new can be a fantastic way to meet people. Enroll in classes or workshops that interest you, whether it's a language course, dance class, or cooking workshop. The shared learning experience can foster a sense of camaraderie, making it easier to strike up conversations and build friendships.Attend Meetup GroupsPlatforms like Meetup.com offer a plethora of groups centered around various interests and activities. Whether you're into hiking, board games, or meditation, there's likely a meetup group in your area that caters to your preferences. Attend events hosted by these groups to meet individuals who share your hobbies.Remember, making friends at any age is about being genuine, open-minded, and patient. Building meaningful connections takes time, but the journey is well worth the effort. So, embrace the opportunities around you, be true to yourself, and watch as your circle of friends blossoms with kindred spirits. After all, friendship knows no age limits, and the joy of companionship is a treasure that can be discovered at any stage of life.This article was submitted by VIPCare Senior Primary Care.  

For older adults, life can become quieter and lonely as the years go by. One way to combat this life change is by owning a pet. The health benefits of owning a pet for seniors far outweigh the work that goes into owning one.Our furry, feathery, or even scaly family members can provide a variety of physical, mental, and emotional benefits. The bond between seniors and their pets goes far beyond mere companionship. Here are some of the top health benefits of owning a pet for seniorsReduces Loneliness And IsolationAs they get older, many seniors experience feelings of social isolation and loneliness. This can lead to depression and other significant health problems. Having a pet, whether its a dog, cat, or even a bird, provides companionship and helps to reduce these feelings of isolation. Pets are loyal and loving, offering unconditional affection that can significantly improve your mental and emotional well-being.Increases Physical ActivityOne of the biggest benefits of owning a pet, particularly an active dog, is that it forces you to be physical. Dogs need to be walked, which in turn encourages regular physical activity on your part. Seniors with dogs are more likely to go for daily walks or play with them in the yard. Even this little bit of physical activity helps maintain mobility, joint flexibility, and cardiovascular health. In addition, physical activity of any kind leads to a stronger immune system and a reduced risk of chronic diseases like heart disease and diabetes.Lowers Stress And AnxietySimply looking at a picture of a little puppy or kitten is almost guaranteed to put a smile on your face. Studies show that petting a dog or cat can trigger the release of the mood-regulating hormone serotonin. It also increases the feel good hormone dopamine while decreasing the level of the stress hormone cortisol. This fluctuation helps to reduce stress and anxiety levels. Additionally, a pets rhythmic, soothing presence can help lower blood pressure, contributing to overall cardiovascular health.Boosts Mental AlertnessInteracting with pets can stimulate mental alertness and cognitive function. While training your pet and teaching them tricks helps to boost their mental capacity, it also helps to maintain your mental acuity. This mental stimulation can delay the onset of cognitive decline and reduce your risk of dementia and Alzheimers disease.Fosters A Sense Of PurposeMost of us work hard and look forward to the day we can finally hang up our work boots and retire. However, when that day finally comes, many seniors often experience a diminished sense of purpose. Owning a pet can give you back a sense of responsibility and purpose. Caring for a pet requires routine tasks like feeding, grooming, and exercise, providing structure to your days and a reason to get out of bed in the morning.Enhances Social ConnectionsA study has shown pet owners are more apt to meet their neighbors than non-pet owners. Pets make great icebreakers for seniors when they are out on walks or at pet-friendly facilities. This can give you an opportunity to connect with others and strike up a conversation.Reduces The Risk Of Allergies And AsthmaAlthough it sounds like it would be the opposite, having a pet has been found to reduce the risk of developing allergies and asthma the older we get. This can be an added health benefit for seniors who have had pets throughout their lives.Get Your Purrfect CompanionOwning a pet can do wonders for your health and well-being. These little bundles of joy enrich seniors lives in ways that extend far beyond companionship. The emotional, physical, and mental health benefits of having a pet cannot be argued or overlooked. Seniors who share their lives with a furry friend often experience reduced stress, increased physical activity, enhanced emotional well-being, and a greater sense of purpose. This article was submitted by VIPCare.  For more information visit the website: getvipcare.com

Safe Weight Loss Strategies for Older AdultsMaintaining a healthy weight is an important goal at any age. However, as we age, it can get trickier and more challenging to drop any excess weight we may be carrying. Especially those pesky holiday pounds. When it comes to losing weight, weight loss strategies for older adults should prioritize safety and long-term health rather than quick fixes.Although they are becoming increasingly popular, weight loss drugs arent always the most effective or safest method for weight loss. The same goes for the trendy fad diets you read about online. When it comes to losing weight, you need to look at it as a marathon, not a sprint.Adopting sustainable lifestyle changes is crucial for shedding excess pounds while safeguarding against potential health risks. Whether youre looking to slim down or just maintain a healthy weight, here are some healthy and safe weight loss strategies for older adults that will help you along your journey to Better HealthPlace Focus on Balanced NutritionA well-balanced diet is the foundation for healthy weight loss. Focus on nutrient-dense foods, including fruits, vegetables, whole grains, lean proteins, and healthy fats. Limiting processed foods, sugary snacks, and excessive salt intake is crucial for maintaining optimal health. Set a goal to eat a piece of fruit or a vegetable at every meal and for every snack. Incorporate avocados into your diet to increase your healthy fats. Instead of white pasta or rice, swap it out for brown or whole wheat. Making little adjustments to your diet can produce big rewards for weight loss.Practice Portion ControlControlling portion sizes is vital for managing caloric intake. Losing weight is all about burning more calories than you eat or drink. And if you focus on consuming fewer calories through portion control, that will make it easier to do so. Older adults may find it helpful to use smaller plates, which can create the illusion of a fuller plate and contribute to reduced portion sizes. Additionally, paying attention to hunger and fullness cues can prevent overeating. Youve heard the saying, Eating with your eyes. Well, you want to do the exact opposite and eat with your stomach. Dont rely on visual cues like a clean plate to stop eating. Listen to your stomach and stop when you feel full.Drink Up to Stay HydratedDrinking an adequate amount of water is crucial for overall health and can support weight loss. Sometimes, the body can confuse thirst with hunger, leading to unnecessary calorie consumption. Drinking water before meals can also contribute to a feeling of fullness, reducing the likelihood of overeating. Make it a goal to increase your water intake throughout the day. If you get bored with water, try swapping still water for sparkling. If you still crave something different, drink liquids that have some sort of nutritional value, such as broth and 100% fruit juice with no added sugar. You can also hydrate through your food. Oranges and cucumbers are great foods that offer a hydration boost. Participate In Regular ExerciseEngaging in regular physical activity is essential for weight loss and maintaining muscle mass. Again you want to burn more calories than you consume. Older adults should incorporate a mix of aerobic exercises, strength training, and flexibility exercises into their routine. Its advisable to start slowly and gradually increase intensity, focusing on activities that are enjoyable and sustainable. Make realistic and attainable goals. Instead of saying youre going to work out every single day, set a goal to walk for 15 minutes three days a week. Then, gradually work up to every single day. Get Adequate SleepAdequate sleep is a crucial yet often underestimated factor in successful weight loss. Research consistently shows that insufficient sleep can disrupt hormonal balance, affecting key regulators of hunger and satiety. Furthermore, inadequate sleep can impair glucose metabolism and insulin sensitivity, promoting the storage of excess calories as fat. Prioritize quality sleep by aiming for seven to nine hours of quality sleep per night. Monitor Your Progress GraduallyWeight loss strategies require monitoring your progress. However, rather than focusing solely on the scale, you should monitor progress through various measures, including changes in energy levels, improved mobility, and better overall well-being. Celebrating small victories can help maintain motivation and reinforce positive lifestyle changes. Again, losing and maintaining a healthy weight is a marathon. Consult with a Healthcare ProfessionalReady to take charge of your health and achieve your weight loss goals? Look no further! Contact a VIPcare primary care provider today at 251-257-2886 and embark on a personalized journey towards a healthier, happier you. With our expert guidance and support, together, we can make your wellness aspirations a reality. Don't wait any longeryour best self awaits!   

The Sweet Tooth Mystery: Why Seniors Crave Sweets After Eating Do you find yourself or older loved ones reaching for dessert shortly after finishing a meal? If so, you're not alone. It's a common observation that many seniors have a seemingly insatiable craving for sweets after they've finished their main course. And its not just a coincidence, either. There are actually several physiological and psychological factors that are responsible for the guilty pleasure and can explain why seniors crave sweets after eating.  Lets shine some light on both the biological and emotional underpinnings of this common occurrence. Changing Taste BudsAs we age, our taste buds undergo significant changes. Think about some of the food items you like now that you wouldnt dare touch when you were a child. Broccoli, Brussels sprouts, the list goes on. But as you get older, the sense of taste becomes less acute, and certain flavors, particularly sweet ones, become more appealing. This is often because the perception of sweetness lessens with age, making sugary foods more enjoyable. You may find that you need more intense flavors to satisfy your palate, and sweet foods provide this intensity. Thus leading to seniors craving sweets after eating. Nutrient DeficienciesIts not uncommon for seniors to have some sort of nutrient deficiency due to various factors, such as poor dietary choices or medical conditions. Cravings for sweets can be a result of the body seeking essential nutrients. For example, a deficiency in certain minerals like magnesium or zinc can lead to sugar cravings. Chocolate is a common sugar craving resulting from vitamin deficiency. Eating sweets can provide a temporary boost in energy and mood, but it's important for seniors to address any underlying nutrient deficiencies through a balanced diet or supplements. Emotional ComfortWhat do most of us reach for when were depressed? SWEETS! It doesnt get any easier the older we get. Seniors often face unique emotional challenges, such as loneliness, grief, or the physical limitations that can come with aging. Sweets are associated with comfort and can trigger the release of endorphins, which provide a temporary emotional boost. This psychological connection between sugary treats and comfort can lead to cravings. The taste of sweets provides solace, helping to comfort us during our difficult times.  Medications and Side EffectsMany seniors are on various medications to manage chronic health diseases and conditions. Some of these medications can cause changes in taste perception or trigger a metallic aftertaste, which may make sweets more palatable. Additionally, certain medications can affect blood sugar levels or metabolism, leading to sugar cravings as the body seeks to maintain equilibrium. Social and Cultural FactorsThe social aspect of sharing dessert with family and friends after a meal can also be a powerful motivator. Seniors may have fond memories of family gatherings and celebrations where sweets were a central part of the experience. This cultural and social conditioning can create a desire for sweets, especially after a satisfying meal. Habitual BehaviorSeniors who have developed a lifelong habit of indulging in desserts after meals may continue this pattern. Habits are difficult to break, and the association between eating sweets and feeling satisfied after a meal can be deeply ingrained. How to Manage Sweet CravingsWhile some level of craving for sweets after a meal is common, especially in seniors, it's important to strike a balance to maintain a healthy diet. Here are some tips for managing sweet cravings. Maintain a Balanced Diet: Ensure youre following a well-balanced diet that meets your nutritional needs. Incorporate fruits and other healthier sweet alternatives to satisfy your cravings. Monitor Medications: Discuss any medication-related changes in taste or appetite with a healthcare provider and explore potential solutions or alternatives. Emotional Support: Address emotional factors by providing companionship, engaging in activities that bring joy, and connecting with others and support networks to combat loneliness. Hydration: Sometimes thirst can be misinterpreted as hunger or sugar cravings. Make sure you stay adequately hydrated to avoid unnecessary cravings. Small Portions: Instead of eliminating sweets entirely, enjoy smaller portions to satisfy the craving without overindulging.  The tendency for seniors to crave sweets after eating isnt as simple as one might think.  Understanding the physiological and psychological factors that contribute to these cravings can help you find the necessary support and guidance to ensure you dont overindulge. While a sweet treat can be enjoyable and comforting, moderation and balanced nutrition remain key to promoting overall health and well-being.This article was contributed by VIPcare of Alabama.  VIPcare provides primary care for the 65+ community.  Call VIPcare at 866-333-7897 for more information or to make an appointment.