Choosing & Using a Home Blood Pressure Monitor, & What to Ask the Doctor

In another article, I’ve explained the key reasons that I recommend older adults and their caregivers have a blood pressure (BP) monitor at home.

To very briefly recap:

Many of the problems of older adults (including falls) can be related to blood pressure.
Home blood pressure measurements can help:
- evaluate for drops in blood pressure with standing (a common cause of dizziness in elders)
- check for serious illness, since these often (but not always) cause the blood pressure and pulse to be very different from usual
- follow-up on blood pressure after a change in medication, which can help doctors and families figure out the best medication dosing for an older person much faster. This is safer for seniors.

In this post, I’ll share some tips on choosing and using a home BP monitor.

And don’t worry: I won’t tell you that you have to plan on checking every day for the rest of your lives. Although there are times when it’s great to check daily — like the week after a change in medication — the most important thing is to have a good BP monitor at home and know how to use it at least occasionally.

I also share some more guidance and advice in my Youtube video on high blood pressure here:

Tips for choosing a home blood pressure monitor

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How Much to Lower Blood Pressure in Aging?

by Leslie Kernisan, MD MPH

What should an older adult’s blood pressure be? And what if that older person is over age 75?

It’s an important question to consider, because in many cases, the medical care that is ideal at age 50 is no longer ideal as people get into their 70s, 80s, or 90s.

And high blood pressure — also known as hypertension — is a very common condition, and becomes even more common as people get older.

Fortunately, several years ago, a very well-done randomized trial provided us with answers to these important questions. It was published in the prestigious JAMA journal: “Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years.

When a major study like this is published, people often wonder: does this mean they should change the way their hypertension — or their parent’s hypertension — is being managed? Is their blood pressure (BP) at a good level? Should they be on more medication?

In this post, I review the most essential things to know about these landmark blood pressure research findings. This will enable you to take full advantage of a related post, in which I share with you a step-by-step process you can use, to start to figure out whether an older person’s BP management plan might need to be revised. I also share some more guidance and advice in my Youtube video on high blood pressure here:

Warning: this is one of those medically nerdy posts. But I have to write it, as it’s a foundation for later answering your questions on what your parents’ BP (or your own BP) should be, and whether you should consider a change in medication or treatment. If you just want to know the essentials, skip down to the key takeaways at the end.

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Q&A: How to Prevent, Detect, & Treat Dehydration in Aging Adults

by Leslie Kernisan, MD MPH

Q: How can we get my older mother to drink more water? She is susceptible to urinary tract infections and seems to be often dehydrated no matter what we do. We were also wondering if coffee and tea are okay, or should they be avoided to reduce dehydration? And what are symptoms of dehydration in older women that we can look out for?

A: Dehydration is indeed an important problem for older adults. It can be common even when it’s not hot outside.

Helping an older person increase her fluid intake, as you’re trying to do, is one of the best ways to reduce the risk of dehydration.

Now how to actually do this? Studies — and practical experience — suggest that the best approaches include:

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Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check

by Leslie Kernisan, MD MPH

Have you been worried about an older person’s memory or thinking abilities?

Maybe your parent has seemed more confused recently. Or you may have noticed that your aging spouse is repeating herself, or struggling to do things that didn’t use to pose much of a problem.

Or you may have noticed false accusations, or irrational worries getting out of control.

These are very common concerns, and they often lead to questions such as:

Is this normal aging or something more significant?
What is wrong?
Could this be Alzheimer’s? Or some other form of dementia?
Can these memory problems be treated or reversed?
What should we do about this??

The answer to the last question is this: if you are worried about memory or thinking, then you should seek out some kind of medical evaluation.

That’s because when families worry about an older person’s cognitive abilities, there often are some underlying health issues affecting the mind’s function.

Those need to be detected, and treated if at all possible. So, you’ll need to request help from a health professional, and in this article, I’ll explain what that initial help should consist of. This way you’ll know what to expect, and what the doctor might ask you about.

Technically, these kinds of problems are called “cognitive impairment.” This is a broad term that means some kind of problem or difficulty with one’s memory, thinking, concentration, and other functions of the conscious brain, beyond what might be expected due to normal “cognitive aging.”

(For more on “cognitive aging” and what types of changes are considered normal aging, see this article: 6 Ways that Memory & Thinking Change with Normal Aging, & What to Do About This.)

Cognitive impairment — which is also called “cognitive decline” — can come on suddenly or gradually, and can be temporary or more permanent. It may or may not keep getting slowly worse; it all depends on the underlying cause or causes.

In this article, I’ll share with you the more common causes of cognitive impairment in older adults.

I’ll then share a list of 10 things that should generally be done, during a preliminary medical evaluation for cognitive decline in an older adult.

You can also watch a subtitled video version of this information below.

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5 Top Causes of Sleep Problems in Aging, & Proven Ways to Treat Insomnia

by Leslie Kernisan, MD MPH

What should you do if an older person complains of insomnia, or is not sleeping well at night?

Experts do believe that “normal aging” brings on some changes to sleep. (See this post for more on how sleep changes with aging.) Basically, older adults tend to get sleepy earlier in the evening, and tend to sleep less deeply than when they were younger.

So it’s probably not realistic to expect that as you get older, you’ll sleep as long or as soundly as when you were younger.

That said, although aging by itself does change sleep, it’s also quite common for older adults to develop health problems that can cause sleep disturbances. So if you’re older and aren’t sleeping well, you’ll want to make sure you’ve been checked for these. Figuring out what’s going on is always the first step in being able to improve things.

And remember, getting enough good quality sleep helps maintain brain health, physical health, and mood.

In this article, I’ll cover the top causes of sleep problems in older adults. I’ll also tell you about what approaches have been proven to work, to help treat insomnia and sleep problems in older adults.

Last but not least, if you (or your older relative) have experienced the very common combination of waking up to pee at night and difficulty sleeping, I highly recommend listening to this podcast episode, which features a geriatrician who is an expert on this: 092- Interview: Addressing Nighttime Urination & Insomnia in Aging.

5 Common Causes of Sleep Disturbances in Older Adults

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3 Ways Home Blood Pressure Monitors Help Older Adults

by Leslie Kernisan, MD MPH

If I had to recommend one key piece of healthcare equipment that older adults & caregivers should have at home, it would be this: a good home blood pressure (BP) monitor.

Why? Because BP measurements (and pulse measurements, which machines check at the same time) are an incredibly useful tool when it comes to assessing and optimizing an older person’s health and well-being. This is true even for those older people who aren’t being treated for hypertension (chronic high BP).

As I’d love for more older adults and families to understand how home BP monitors can help them, in this article I’ll explain how home BP monitors can be helpful specifically for older adults. (And then see my related article here: Choosing & Using a Home Blood Pressure Monitor, & What to Ask the Doctor .)

3 ways a home blood pressure monitor can help you

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Medications Older Adults Should Avoid or Use with Caution:
The American Geriatrics Society Beers Criteria

by Leslie Kernisan, MD MPH

Today we’re covering a touchstone resource for geriatricians: the “Beers List” of medications that older adults should avoid or use with caution.

(Technically, it’s called “The AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults.” I personally think of it as the list of “risky medications” for older adults.)

If you want to know which medications older adults should be careful about, this is the list!

This list gets updated every few years, so the Beers Criteria published in May 2023 is about as up-to-date as you can get for this type of guideline document.

You should know that experts in geriatrics and in medication safety go through a very careful process of reviewing the research on medications, and of updating this list of medications that older adults should avoid or use with caution.

So in this article, here’s what I’ll be sharing with you:

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Addressing Medical, Legal, & Financial Advance Care Planning:
The Healthy Aging Checklist Part 6

by Leslie Kernisan, MD MPH

This is the sixth and final post covering the Healthy Aging Checklist, a set of six core activities that will help any older adult maintain the best possible health while aging.

They are:

Promote brain health and emotional well-being.
Promote physical health.
Check for and address common aging health problems (such as falls, memory concerns, depression, incontinence, pain, isolation, polypharmacy).
Learn to optimize the management of any chronic conditions.
Get recommended preventive health services for older adults.
Address medical, legal, and financial advance care planning.

In this post, I’ll address the last item on the list: advance planning for medical, legal, and financial issues. This includes power of attorney documents, plus much more.

This is a big topic, and it’s not possible to cover everything you could or should do in a single article. You would need a book for that — I suggest three down below — plus it’s best to work with qualified professionals (healthcare providers, eldercare attorneys, and financial planners) before completing any legally binding paperwork.

But every day as I work, I see older adults and families whose health and well-being is being affected by the consequences of their planning — or lack of planning, as the case often is.

So in this post, I will share some practical information that should make it easier for you to address planning that covers some common age-related challenges:

The three key steps involved in all advance planning for aging
5 common problems every older adult and family should consider planning for
5 key steps for advanced planning in healthcare, and where to get a good free medical power of attorney (POA)
4 key steps for advance planning for legal and financial issues, and what to know about general POAs
Tips for adult children, including what to do if you’re concerned about mental capacity or undue influence

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27 Recommended Preventive Health Services for Older Adults: the Healthy Aging Checklist Part 5

by Leslie Kernisan, MD MPH

This is the fifth in a series of posts covering the Healthy Aging Checklist, which is my list of six fundamental activities that will help any older adult maintain the best possible health while aging.

They are:

Promote brain health and emotional well-being.
Promote physical health.
Check for and address common aging health problems (such as falls, memory concerns, depression, incontinence, pain, isolation, polypharmacy).
Learn to optimize the management of any chronic conditions.
Get recommended preventive health services for older adults.
Address medical, legal, and financial advance care planning.

In this post, I’ll cover recommended preventive health screening guidelines and other prevention services for older adults. These are based on the recommendations of the U.S. Preventive Services Task Force (USPSTF) and also on Medicare’s coverage of preventive health services.

By my count, based on the USPSTF and Medicare guidelines, there are currently 27 preventive health services that older adults should consider. I have a summary list here, and then detailed information on each service starting here.

Get Your Free Preventive Health Cheatsheet! The 27 proven preventive health services for older adults, in a handy PDF checklist that you can print or save. Includes details on who should get each service, and helpful links. Click here now.

But before you read about them, let’s go over the basics of how health screening and other preventive health services work, including why they can sometimes be harmful, or sometimes fall out of favor.

This way, when you review the list of preventive services to consider, you’ll better understand which services are likely to help, and why certain services may not be a good fit for you or your parent.

Understanding Preventive Health Services

Preventive health services essentially fall into three categories:

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How to Age Better by Optimizing Chronic Conditions:
The Healthy Aging Checklist Part 4

by Leslie Kernisan, MD MPH

This is the fourth in a series of posts covering the Healthy Aging Checklist.

Again, the Healthy Aging Checklist summarizes the six fundamental activities I recommend when asked what to do to maintain the best possible health while aging. They are:

Promote brain health and emotional well-being.
Promote physical health.
Check for and address common aging health problems (such as falls, memory concerns, depression, incontinence, pain, isolation, polypharmacy).
Learn to optimize the management of any chronic conditions.
Get recommended preventive health services for older adults.
Address medical, legal, and financial advance care planning.

In this post, I’ll cover the fourth item: learning to optimize the management of any chronic conditions.

Now, people are often very interested in “prevention” and in “staying healthy.” But far fewer people seem to be interested in making sure that they and their doctors are doing the right things for any chronic conditions they already have, and — equally importantly — avoiding the wrong things.

This is a serious oversight, because most of the “aging” problems that older adults eventually develop are due to chronic health conditions that have progressed or caused complications.

So optimizing the care of chronic conditions is very important for the prevention of future health deterioration. And it’s also vital to helping older adults feel and function their best in the here and now.

According to Medicare, over two-thirds of beneficiaries have two or more chronic conditions. Here’s a figure from the Medicare Chronic Conditions Chartbook, showing what percentage of older adults are affected by the 15 most common chronic conditions:

Prevalence of Chronic Conditions Medicare 2012 Chartbookjpg_Page1

I can’t emphasize this enough: these chronic conditions often are the key drivers, when it comes to an older person’s symptoms, health crises, health declines, and the eventual development of disabilities.

Furthermore, I’m sorry to say this but here goes: you should not assume that doctors will provide you with optimal care for chronic conditions. Experts have estimated that patients get only about half of recommended healthcare. A large body of healthcare quality research has repeatedly documented that it is very common for older adults to receive healthcare that varies from “wrong” (e.g. totally counter to guidelines with no documented justification for this) to “sub-optimal” (which means it’s not very deficient but could and should be better).

Later in this article, I will go into more detail on why doctors often provide sub-optimal care, and what you can do about it.

But first, let’s review what’s at stake and why it’s worthwhile to make sure you optimize the healthcare of an older adult’s chronic conditions. I’ll then finish by providing some practical tips to help you be proactive so you can optimize the care of chronic conditions, for healthier aging.

8 Ways Chronic Conditions Harm the Health & Well-being of Older Adults

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Tips for choosing a home blood pressure monitor

5 Common Causes of Sleep Disturbances in Older Adults

3 ways a home blood pressure monitor can help you

Understanding Preventive Health Services

8 Ways Chronic Conditions Harm the Health & Well-being of Older Adults

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