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Better Health While Aging

Practical information for aging health & family caregivers

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7 Steps to Managing Difficult Dementia Behaviors
(Safely & Without Medications)

by Paula Spencer Scott

(This article is by my colleague Paula Spencer Scott, author of the book Surviving Alzheimer’s: Practical Tips and Soul-Saving Wisdom for Caregivers. I invited her to share an article on this topic, since many in our community are coping with dementia behaviors. — L. Kernisan)

The odd behaviors of Alzheimer’s and other dementias can be so frustrating and stressful for families.

I’m talking about the kinds of behaviors that try patience, fray relationships, and drive us in desperate search of help:

“First she thinks the caregiver is stealing her sunglasses and now she accused me of having an affair.”

“When I tried to help Dad wash up, he hit me.”

“My husband follows me so closely I can’t stand it. But if I go in another room he’ll wander out of the house.” 

“Mom started unbuttoning her shirt in the middle of the restaurant!”

“Just when I’m completely exhausted at the end of the day, he seems to get revved up. He keeps peeking out the windows, convinced that someone is trying to break in. Now he won’t sleep.”

A common approach to difficult behaviors is to go right to medicating them with tranquilizers, sedatives, or antipsychotics. But that’s risky and often not what’s best.

In fact, experts recommend trying behavior management first, and for good reasons: It tends to be more effective in the long run than “chemical restraints,” has no dangerous side effects, and leads to a better care relationship. But people often don’t know how to do this.

I’ve learned how.

I’ve lived through five close family members’ experiences with Alzheimer’s and other forms of dementia. Lots of trial and error, and insights from dozens of top dementia experts (whose brains I’ve been lucky to pick as a journalist and dementia educator), got me through regular scenes with…

  • My father-in-law, who needed a walker to move yet spent hour after hour for several days straight hauling all his clothes and toiletries from his room to our driveway, insisting that his (imaginary) new wife was about to pick him up
  • My dad, a formerly sharp dresser who wore the same shirt and pants every day no matter how dirty
  • My grandmother, who insisted on going “home,” when she was home
  • And other relatives, in dozens of similar scenes.

In this article, I want to share what I wish someone had explained to me early on: the “Why-This, Try-This” approach to dealing with difficult behaviors.

This is a mental framework that can help you get unstuck from unproductive responses that get you nowhere or make things worse.

It can bring calm -– to both of you — whether the issue is verbal or physical aggression, agitation, confusion, wandering, disinhibition, delusions, hallucinations, or a restless or repetitive behavior (like pacing, shadowing, rummaging). It also works well with milder irritants like repetitive questions and indecision.

Then, I’ll boil down the Why-This, Try-This concept to a 7-step process you can use every time. These “7 R”s give you a basic platform for responding to any frustrating behavior:

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog, Helping Older Parents Articles Tagged With: alzheimer's, dementia

Why the Flu is Often Missed in Older Adults
(& What to Do About This)

by Leslie Kernisan, MD MPH

elderly flu symptomsYou’ve likely already heard the news: the flu is pretty bad this year, with the Centers for Disease Control (CDC) confirming a higher than usual level of illnesses, hospitalizations, and even deaths.

You also probably know that older adults (and certain other groups of people) have a higher risk of falling very ill from the flu, and have the highest death rates from flu.

But what many people don’t know is this: influenza is easily — and often — missed in older adults.

What do I mean by missed? I mean:

  • Older adults (or their family members) may not realize an older person has the flu, because many older people don’t develop “typical” influenza symptoms.
  • Health professionals often fail to test older people for influenza, even when they are sick enough to be hospitalized. This phenomenon was confirmed in a recently published study.

This is a very serious issue, especially when the flu virus is causing a lot of severe illness, as it is now.

The main problem is this: delayed — or entirely missed — recognition of influenza means that older adults often don’t get treated early — or at all — with anti-influenza drugs such as oseltamivir (brand name Tamiflu).

Particularly for those older adults who have chronic illnesses (especially those affecting the heart or lungs) or are frail, you don’t want to miss that chance to take anti-influenza drugs. They can’t guarantee an older person will avoid a hospitalization or death from influenza, but they do improve one’s chances.

And anti-influenza drugs are most likely to work when they are given within 48 hours of a person falling ill from influenza, with earlier being better.

So when flu activity is widespread, families need to be prepared to recognize potential flu.

And, you should be prepared for the possibility that the health providers might not think to test for influenza, unless you ask about it.

This article will help you learn to do these things. Here’s what I’ll cover:

  • What are the usual symptoms of “influenza-like illness”
  • Common symptoms of influenza in older adults
  • Why older adults may not show typical influenza symptoms
  • What we know about older adults & influenza testing
  • What the CDC currently recommends, regarding influenza diagnosis and treatment
  • What to do, if an older person falls ill during influenza season

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog, Helping Older Parents Articles Tagged With: flu, influenza

New High Blood Pressure Guidelines Again:
What the Cardiology Hypertension Guidelines Mean for Older Adults

by Leslie Kernisan, MD MPH

And once again, high blood pressure is making headlines in the news: the American Heart Association and the American College of Cardiology (AHA/ACC) have just released new guidelines about hypertension.

Since this development is likely to cause confusion and concern for many, I’m writing this post to help you understand the debate and what this might mean for you and your family.

By the way, if you’ve read any of my other blood pressure articles on this site, let me reassure you: I am not changing my clinical practice or what I recommend to others, based on the new AHA/ACC guidelines.

The core principles of better blood pressure management for older adults remain the same:

  • Take care in how you and your doctors measure blood pressure (more on that here),
  • Start by aiming to get blood pressure less than 150/90 mm Hg, as recommended by these expert guidelines issued in 2017 and in 2014,
  • And then learn more about what are the likely benefits versus risks of aiming for more intensive BP control.

Perhaps the most important thing to understand is this: treatment of high blood pressure in older adults offers “diminishing returns” as we treat BP to get lower and lower.

Scientific evidence indicates that the greatest health benefit, when it comes to reducing the risk of strokes and heart attacks, is in getting systolic blood pressure from high (i.e. 160-180) down to moderate (140-150).

From there, the famous SPRINT study, published in 2015, did show a further reduction in cardiovascular risk, when participants were treated to a lower systolic BP, such as a target of 120.

However, this was in a carefully selected group of participants, it required taking three blood pressure medications on average, and the reduction in risk was small. As I note in my article explaining SPRINT Senior, in participants aged 75 or older, pushing to that lower goal was associated with an estimated 1-in-27 chance of avoiding a cardiovascular event. (The benefit was even smaller in adults aged 50-75.)

SPRINT did not include people who have certain common conditions, including diabetes, heart failure, past stroke, or dementia. Hence it’s not clear that the (small) benefits of intensive blood pressure control would apply to those older adults who would not have qualified for the SPRINT trial.

I will come back to the SPRINT study later in the article, since it undoubtedly influenced the recent AHA/ACC guidelines. But first, a little on why the new guidelines are notable.

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog, Helping Older Parents Articles Tagged With: blood pressure

How Exercise Helps Aging Adults:
Key benefits (and disappointments) from a landmark study

by Leslie Kernisan, MD MPH

Exercising Grandma

Have you ever wondered whether it’s worth your while to encourage an older person to start exercising?

In 2014, the top-notch journal JAMA published the results of a fantastic research project: a study in which 1635 sedentary older adults (aged 70-89) were assigned to get either a structured exercise program, or a program of “successful aging” health education. The researchers called it the Lifestyle Interventions and Independence for Elders (LIFE) study. (You can read the full study here.)

During the LIFE study, the two groups were followed for a little over 2.5 years. And by the end of the study, guess which group of volunteers was more likely to still walk a quarter of a mile (without a walker)?

That’s right. When it came to avoiding “major mobility disability” — which the researchers defined as becoming unable to walk 400 meters or more — a structured exercise program was better than a program of healthy aging education.

Specifically, the researchers found that 30% of the exercisers experienced a period of major disability, compared to 35.5% of the seniors enrolled in the healthy aging education program.

This is a very encouraging finding! That said, it’s also a bit sobering to realize that even with exercise, almost 1 in 3 older adults experienced a period of limited mobility, of which half lasted 6 months or more.

In this post, I’ll share some more details on this study, because the results provide a wonderful wealth of information that can be helpful to older adults, family caregivers, and even geriatricians such as myself.

Want to know how often the exercisers experienced “adverse events”? (Hint: often!) Wondering just what the structured exercise program involved? (Hint: more than walking!)

Let’s dig into the details! At the end of this post, I’ll share my list of key take-home points for older adults and family caregivers.

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog, Helping Older Parents Articles Tagged With: exercise

How to Follow the Mediterranean Diet for Senior Health, & Related Research Findings

by Leslie Kernisan, MD MPH

Mediterranean diet

What kind of diet is best for maintaining the health of aging brains and bodies?

A common answer these days is the “Mediterranean diet,” due to a combination of recently published research studies and frequent media coverage.

In fact, a study published earlier this week found that older Spanish women who were randomly assigned to stick to a Mediterranean diet — supplemented by extra olive oil — developed fewer cases of invasive breast cancer, compared to women who were merely advised to reduce dietary fat.

This study was published by the same research team that reported earlier this year that Spaniards assigned to a Mediterranean diet — supplemented with either olive oil or nuts — experienced less cognitive decline. And a 2013 report from the same group found that the Mediterranean diet led to a 30% decrease in cardiovascular events (strokes and heart attacks).

Does this mean you should hustle to make sure your older relatives are eating a Mediterranean diet? Well, maybe. I will go into the study details later in the post, but for now, let’s say that the diet used in the study seems very sensible, provided one doesn’t suffer unduly from limited access to pork and cookies.

As is the case for many lifestyle changes that might affect cancer and dementia, a healthy diet reduces risk but is just one factor among many. Still, if we’ve learned of a good way to eat, why not consider it?

So in this post, here’s what I’ll review:

  • Just what people were eating, as part of the Spanish Mediterranean diet study (known as the PREDIMED study)
  • What kinds of older adults PREDIMED studied in Spain, and some of the major findings of interest
  • Where to find a comprehensive review of the scientific evidence for diet and brain health

How to follow the PREDIMED Mediterranean diet

PREDIMED (Prevención con Dieta Mediterránea) was a big randomized control trial conducted in Spain, from 2003 to 2009. It involved 7446 peopled aged 55-80. In the next section of the post I’ll describe the study in more detail, but let’s start with what you are probably most interested in:

Just what was the PREDIMED Mediterranean diet??

Fortunately, it is possible to find the research study’s materials online, and they describe the recommended diet in detail.

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog Tagged With: brain health, nutrition

What Is Geriatrics & Why It’s Not Just for the “Old-Old”

by Leslie Kernisan, MD MPH

Geriatrics is Better Senior Health

Pop quiz: Can you define geriatrics? And did you know that it’s not just for the “old-old”?

If you hesitated with these two questions, don’t feel bad. Most people know that geriatrics has something to do with the elderly, but beyond that there’s a lot of confusion about what it is, who it can help, and how it’s different from gerontology.

To clear up the confusion and help all seniors — whether younger or older — understand how to benefit from geriatrics, I’ve written an article for NextAvenue.org:

“How Geriatrics Can Help You – Even If You’re Not Yet ‘Old-Old‘”

In this article, I explain:

  • What is geriatrics
  • Why geriatrics, similar to pediatrics, involves a medical knowledge base along with an approach that’s better for certain age groups
  • What is a geriatrician
  • What is gerontology, and how it’s different from geriatrics
  • Why you do need geriatrics but probably don’t need a geriatrician

Why We Should All Understand What Geriatrics Is

I wrote this article because geriatrics has wonderful things to offer when it comes to the health of older adults, just as pediatrics offers wonderful benefits to children. (Kids need healthcare that’s adapted to their growing minds and bodies. Older adults need healthcare that’s adapted to their aging bodies and minds.)

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog, Helping Older Parents Articles

4 Steps to Get Better Advice from Doctors

by Leslie Kernisan, MD MPH

Doctor & Older Woman

Here’s an uncomfortable truth that every family should be aware of:

You shouldn’t assume your doctor is providing you with optimal medical advice.

By optimal, I mean advice that is:

  1. Grounded in the most recent medical knowledge.
  2. Adapted to your preferences and values.
  3. Made after helping you consider the various options, along with their risks and benefits.

Doctors are generally trying their best. But it’s hard for a single person to keep up with all the latest knowledge, plus doctors tend to get into practice habits that aren’t necessarily in your best interest.

Are You Regularly Informed of Non-Drug Treatment Options?

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog Tagged With: being a savvy patient, get better healthcare

How to Maintain Brain Health: The IOM Report on Cognitive Aging

by Leslie Kernisan, MD MPH

Aging brain

If you’ve been wondering just how to maintain a healthy brain for yourself, or for an older relative, then I have some very good news.

In April, the Institute of Medicine (IOM) published a comprehensive report on this very topic. It’s called “Cognitive Aging: Progress in Understanding and Opportunities for Action.”

This report manages to be innovative, comprehensive, and also incredibly useful to regular people and practicing doctors. That’s because the IOM created a number of practical guides and resource sheets, to accompany their detailed and exhaustively researched 385 page report.

To help get the word out about the highlights of this report, I’ve written an article about it for NextAvenue.org:

“4 Myths About Brain Health and How to Stay Sharp“

In this NextAvenue article, I review:

  • The definition of cognitive aging, and why everyone should expect it,
  • 4 commonly believed myths about cognitive aging,
  • 6 actions the IOM recommends people take to protect cognitive health as they age,
  • Why the  IOM is telling doctors to pay special attention to preventing delirium, and identifying risky medications,
  • The IOM’s conclusions regarding diet and brain health,
  • What you should know if you or your relative has been diagnosed with a dementia such as Alzheimer’s.

Since we’re all part of an aging society, it’s good for all of us to learn more about how the brain tends to change with age, and how we can optimize brain health as people get older.

As the health arm of the National Academy of Sciences, the IOM’s job is to provide “independent, objective, evidence-based advice to policy makers, health professionals, the private sector, and the public.”

When an IOM committee makes recommendations on a given health topic, you can rest assured that this represents the best available medical knowledge.

So before you read yet another article about “brain-boosting foods,” take a look at the NextAvenue article summarizing the highlights of the IOM report.

“4 Myths About Brain Health and How to Stay Sharp“

And then let me know which of the report highlights were most interesting to you.

Filed Under: Aging health, Geriatrics For Caregivers Blog Tagged With: brain health

How to Check an Older Adult for Common Health & Safety Problems

by Leslie Kernisan, MD MPH

Senior Health Checklist

Worried about an older relative, but not quite sure what to do?

Common concerns I hear include:

  • Are my parents safe living on their own?
  • Could my mom be getting Alzheimer’s disease?
  • How can I find help for my father who lives alone?
  • I’m worried my mom might fall at home and get hurt.
  • I’m worried that my dad isn’t taking good care of himself.
  • Is it time to move to assisted living?

To help people turn their worries into a practical action plan, I’ve created a special new resource. You can download it here:

Helping Older Parents Quick Start Guide: Check Your Parents in 5 Key Areas 

This guide is modeled on the mental checklists that I use when I first assess an older adult who lives at home.

Specifically, this is a quick version of how I initially check for the most common “don’t miss” health and safety red flags. It includes practical tips, such as who to ask for help, as well as a list of useful online resources.

If you’ve been concerned about an older adult who lives at home or in assisted-living, I hope you’ll take a look!

Filed Under: Aging health, Geriatrics For Caregivers Blog, Helping Older Parents Articles, Useful Links

8 Behaviors to Take Note of if You Think Someone Might Have Alzheimer’s

by Leslie Kernisan, MD MPH

Have you been worried about an older person’s memory or thinking skills? If so, you’ve probably found yourself wondering if this could be Alzheimer’s, or another dementia.

What to do next? If you look online or ask people, the advice is generally this: tell the doctor.

This advice isn’t wrong, but it’s incomplete. Yes, you should tell the doctor. But you’ll dramatically improve your chances of getting to the bottom of things if you come to the doctor with useful information on what you’ve observed.

In fact, research has found that interviewing family members about the presence or absence of eight particular behaviors can be just as effective, when it comes to detecting possible Alzheimer’s, as certain office-based cognitive tests.

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog, Helping Older Parents Articles Tagged With: alzheimer's, dementia, memory

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