Sex When Caregiving: Navigating Your Changing Relationship (Even if There’s Dementia)

by Nicole Didyk, MD

(This article is part 2 of a special guest series by geriatrician Dr. Nicole Didyk, founder of the blog and YouTube channel The Wrinkle. Like me, Dr. Didyk has a particular interest in informing and empowering older adults and families. So I’ve been very glad to have her contributing to the site these past few years — you may have noticed she’s been helping me answer comments — and I’m thrilled to say she’ll be covering some topics that I haven’t yet had the time to address. Enjoy! — L. Kernisan)

Let me begin by sharing a true story:

One of the most unforgettable couples I ever worked with was Grace and David. Grace developed Alzheimer’s at the age of 63, and within 2 years of diagnosis, her symptoms were such that she moved into a long-term care home and used a wheelchair to get around.

She and David had been married for 42 years, had 4 kids, a dairy farm, and a warm and affectionate marriage. David continued to visit Grace 3 times a week, until her death (after a bout of pneumonia) at the age of 69, and in the last two years, his girlfriend, Linda, accompanied him almost every time.

I remember being so touched by the way that David and his new partner lovingly advocated for Grace when she needed it, with both stepping in to provide hands-on care when staff at the home were overwhelmed. There were some who judged David for so boldly “having an affair”, but most saw his involvement in a new relationship as a much-needed respite for him, and a way to expand the circle of love for Grace.

Have you ever met a couple like Grace and David? Keep their story in mind, as I share more about Sex and Caregiving, and Sex and the Changing Brain.

How does sex and intimacy change when one partner becomes a caregiver?

[Read more…]

How Sex Changes With Aging (& What You Can Do About It)

by Nicole Didyk, MD

(This article is a special guest post by geriatrician Dr. Nicole Didyk, founder of the blog and YouTube channel The Wrinkle. Like me, Dr. Didyk has a particular interest in informing and empowering older adults and families. So I’ve been very glad to have her contributing to the site, and I appreciate her covering some topics that I haven’t had the time to address. Enjoy! — L. Kernisan)

Quick! Think about older adults and sex. What comes to mind? George Burns cracking wise about sex after 90 being like trying to shoot pool with a rope? A sweet old couple holding hands in their rocking chairs? Nothing?

The truth is that what pops into people’s minds, when it comes to older adults and sexuality, is often negative. For instance, it’s common for older adults to be thought of as:

“Cute” in a chaste and childlike way,
Predatory and/or “lecherous”, as in the “cougar” or the “dirty old man”, or
Problematic (think sexual behavior when someone has dementia, or sex between nursing home residents).

This, of course, is largely due to pervasive ageism in society. Sexuality, sexual expression, and the urge for physical intimacy is actually an important part of every adult person’s life.

So it’s sad that it’s so common for it to be treated as “inappropriate” or otherwise discouraged in later life. But fortunately, we’re starting to see significant progress in combatting this aspect of ageism, too.

In my job as a consultant Geriatrician, I see older adults about a wide range of issues, including memory changes, falls, pain, depression, and medication adjustment. But what is often affected by all of those medical issues – yet rarely talked about — is sex.

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Deprescribing: How to Be on Less Medication for Healthier Aging

by Leslie Kernisan, MD MPH

Have you ever wondered whether you — or your older relative — might be taking too many medications?

You’re certainly right to ask yourself this. I consider this for all my own patients, and wish every doctor would.

In part, this is because over the years, I’ve had countless older adults express their worries and frustrations, related to their prescription drugs. These include:

The hassle of having so many pills to take
Worries about side-effects
Frustration with medication costs
Wondering whether a given medication is the “right” one for you, or for your condition
The sneaky feeling that some of those medications don’t seem to help much
The hassle of coordinating a long medication list among multiple doctors

Needless to say, all of this is not so good for quality of life while aging.

And unlike some things that people worry about, these concerns are all actually justified, given what geriatricians know about older adults and medications.

So if you’ve ever experienced the above worries — or if you (or your older relative) are taking more than five medications — then I want to make sure you know about a process that can improve or resolve all those problems that older adults have with their medications.

It’s called deprescribing, and it’s really essential to optimizing the health of an older person.

In this article, I’ll cover what every older adult and family caregiver should know about it:

What is deprescribing?
Why is deprescribing especially important for older adults?
How does deprescribing work?
What medications are most important for older adults to consider deprescribing?
How can older adults and family caregivers get doctors to address deprescribing?

This way, you’ll have a better shot at what everyone wants when it comes to medication:

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Atrial Fibrillation in Aging:
What to Know & How to Treat

by Leslie Kernisan, MD MPH

The human heart is often described as a pump, but there’s much more to it: it also has a special electrical system that regulates and coordinates heartbeats.

Abnormal heartbeats are called arrhythmias, and probably the most common one is atrial fibrillation, a condition that affects millions of older adults and plays a major role in stroke, disability, and hospitalization.

Some people with atrial fibrillation come to medical attention because they feel unwell—short of breath, fatigued, or aware that their heart is racing. Others feel fine and are surprised when a clinician — or maybe even their smartwatch — tells them they have an irregular heartbeat. Families are often left trying to understand a diagnosis that sounds ominous and a set of treatment options that can feel confusing or even frightening.

To help clarify what matters most, I spoke with cardiologist and electrophysiologist Cara Pellegrini, MD, about atrial fibrillation in aging. Here’s what to know, including what atrial fibrillation is, why it matters, and how to think through treatment and stroke prevention—especially when frailty, falls, or cognitive impairment are part of the picture.

Dr. Kernisan: What exactly is atrial fibrillation?

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Urinary Incontinence in Aging:
What to know when you can’t wait to go

by Nicole Didyk, MD

“I know where every bathroom is at the mall, and my wife rolls her eyes every time I have to visit one when we just arrived – even after I went before leaving the house! What can I expect? Most old guys are in the same boat!”

If you opened this article, you probably relate to the quote above, and you’re not unlike millions of other older adults.

Incontinence doesn’t always mean wetting yourself. It can involve urgent needs to use the toilet, frequent bathroom trips, or losing tiny amounts of urine with certain activities.

Incontinence is more than inconvenient; it can be life-altering, leading to early retirement or social withdrawal, depression, and loss of independent function. Important incontinence stats include:

1 in 3 older women and 1 in 12 older men have lower urinary tract symptoms that can include incontinence
Urinary incontinence cost the US economy $66 billion in 2012
6-10% of nursing home admissions are due to urinary incontinence
Only 22% of men with urinary incontinence seek help for the problem, as compared to 45% of women

For this reason, in geriatrics, we often ask our patients about incontinence.

A while back I had the opportunity to talk to Dr. Adrian Wagg, a Geriatrician-Internist and international expert in urinary incontinence. You can listen to this interview, and find out how to download a transcript of it here. In this article, I’ll share some of his insights about the management of incontinence in older adults, and why it remains undertreated too often.

In particular, I’ll cover:

How urinary function changes with age
Types and causes of urinary incontinence in both men and women
What to do if you’re experiencing urinary incontinence and want help
How to help manage urinary incontinence in an older person you’re caring for

What happens to the Urinary System with Aging?

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Beyond Alzheimer’s:
Common Types of Dementia in Aging

by Leslie Kernisan, MD MPH

Are you dealing with a diagnosis of dementia?

If so, you might be wondering what type of dementia you are dealing with. Or, perhaps you’ve heard someone say it’s important to find out what type of dementia it is.

It’s true that there certainly are different types of dementia, and it’s often said that the most common one is Alzheimer’s disease.

But actually, especially as people get to be age 80 or older, by far the most common type of dementia is mixed dementia. Meaning, the dementia symptoms are caused by a mix of types.

If you are dealing with memory loss or other forms of cognitive decline, it’s a good idea to know the basics about the different types of dementia.

In this article, I’ll cover:

What is dementia and what’s the difference between Alzheimer’s and dementia
The most common types of dementia in older adults
When it might be important to find out what type of dementia it is
My usual approach to using dementia type to help patients

You can also watch my video covering Common Types of Dementia in Aging:

What is dementia?

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Top 10 Checklist for Better Health & Aging in 2026

by Leslie Kernisan, MD MPH

Do you find yourself taking stock and setting goals around the time of New Year’s?

It is indeed an excellent time to reflect on the past year.

And although one can set goals at any time of year, the start of the calendar year is a time that seems to inspire many people to think about their health and how to thrive over the coming year.

If better health while aging is important to you, here are my top ten suggestions for the coming year.

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How to Address Cardiovascular Risk Factors for Better Brain Health:
12 Risks to Know & 5 Things to Do

by Leslie Kernisan, MD MPH

A while back, I wrote an article on cerebral small vessel disease, a very common condition in which the small blood vessels of the brain develop signs of damage.

If you’re an older adult and you’ve had an MRI done of your brain, chances are pretty good that your scan showed signs of at least mild signs of this condition; one study of older adults aged 60-90 found that 95% of them showed signs of these white matter changes.

These are basically like teensy strokes in the brain. Most are un-noticeable to people, but if you have enough of them, you can certainly develop symptoms, such as cognitive impairment, balance problems, or even vascular dementia.

To date, the cerebral small vessel disease article has generated over 100 comments and questions from readers. A common theme was this: “My MRI shows signs of this condition. What can I do?”

As I explain in the article and the comments, the first thing to do is to work closely with your doctors to understand what is the likely cause of the damage to the brain’s small blood vessels.

Now, when you do this, you may well find that your doctor just shrugs, or waves off the question.

That’s because in most people, cerebral small vessel disease is thought to be in large part a result of atherosclerosis (more on this term below) affecting the smaller arteries of the brain. And atherosclerosis affects just about everyone as they age, because it’s related to many basic cardiovascular risk factors that become very common in late-life.

So in many cases, asking the doctor why you have signs of cerebral small vessel disease may be like asking why you might have high blood pressure, or arthritis. These are common conditions and they are usually due to medically mundane causes and risk factors, including sub-optimal “lifestyle” behaviors and the general “wear and tear” on the body that is associated with aging.

(However, in some people, damage to the small vessels in the brain may be related to one or more particular medical conditions. Younger people, in particular, seem more likely to have a particular condition or risk factor that may be causing most of the damage.)

Whether you are younger (i.e under age 60) or older, always start by asking your doctors what they think are the most likely causes for any cerebral small vessel disease, and what they recommend you do to slow the progression.

And for most people, the main advice will be this: evaluate and address your cardiovascular risk factors.

“Vascular,” as you probably already know, means “blood vessels.” And blood vessels are critical to the function of every part of the body, because blood vessels are what brings oxygen and nutrients to every cell in the body. They also carry away waste products and toxins. So, blood vessel health is key to brain health.

This article will help you better understand how to address blood vessel health. Specifically, I’ll cover:

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Cerebral Small Vessel Disease:
What to Know & What to Do

by Leslie Kernisan, MD MPH

Signs of cerebral small vessel disease. From Inzitari et al, BMJ. 2009 Jul 6;339:b2477. doi: 10.1136/bmj.b2477

This article is about the most common aging brain problem that you may have never heard of.

While leading a fall prevention workshop a few years ago, I mentioned that an older person’s walking and balance problems might well be related to the presence of “small vessel ischemic changes” in the brain, which are very common in aging adults. (This is also called “white matter disease.”)

This led to an immediate flurry of follow-up questions. What exactly are these changes, people wanted to know. Do they happen to every older adult? Is this the same as vascular dementia? And how they can best help their parents with cognitive decline?

Well, these types of brain lesions don’t happen to every older person, but they do happen to the vast majority of them. In fact, one study of older adults aged 60-90 found that 95% of them showed signs of these changes on brain MRI.

In other words, if your older parent ever gets an MRI of the head, he or she will probably show some signs of these changes.

So this is a condition that older adults and families should know about. Furthermore, these changes have been associated with problems of consequence to older adults, including:

Cognitive decline,
Problems with walking or balance,
Strokes,
Vascular dementia.

Now, perhaps the best technical term for what I’m referring to is “cerebral small vessel disease.” But many other synonyms are used by the medical community — especially in radiology reports. They include:

White matter disease
Small vessel ischemic disease
Brain lesions
Periventricular white matter changes
Perivascular chronic ischemic white matter disease of aging
Chronic microvascular changes, chronic microvascular ischemic changes
Chronic microvascular ischemia
White matter hyperintensities
Age-related white matter changes
Leukoaraiosis

In this post, I will explain what all older adults and their families should know about this extremely common condition related to the brain health of older adults.

In particular, I’ll address the following frequently asked questions:

What is cerebral small vessel disease (SVD)?
What are the symptoms of cerebral SVD?
How is cerebral small vessel disease related to vascular dementia and cerebrovascular accidents?
What causes cerebral SVD?
How can cerebral SVD be treated or prevented?
Should you request an MRI if you’re concerned about cerebral SVD?

I will also address what you can do, if you are concerned about cerebral SVD for yourself or an older loved one.

[Read more…]

How to Evaluate, Prevent & Manage Constipation in Aging

by Leslie Kernisan, MD MPH

Constipation is not a glamorous topic, but it’s certainly important, especially in older adults.

As anyone who has experienced occasional — or even chronic — constipation can tell you, it can really put a damper on quality of life and well-being.

Constipation can also cause more substantial problems, such as:

Severe abdominal pain, which can lead to emergency room visits
Hemorrhoids, which can bleed or be painful
Increased irritability, agitation, or even aggression, in people with Alzheimer’s disease or other forms of dementia
Stress and/or pain that can contribute to delirium (a state of new or worse confusion that often happens when older adults are hospitalized)
Fecal incontinence, which can be caused or worsened by having a hard lump of stool lodged in the lower bowel
Avoidance of needed pain medication, due to fear of constipation
Worsening of urinary leaks

Fortunately, it’s usually possible to help older adults effectively manage and prevent constipation. This helps maintain well-being and quality of life, and can also improve difficult behaviors related to dementia.

The trouble is that constipation is often either overlooked or sub-optimally managed by busy healthcare providers who aren’t trained in geriatrics. They are often focused on more “serious” health issues. Also, since many laxatives are available over-the-counter (OTC), some providers may assume that people will treat themselves if necessary.

Personally, I don’t like this hands-off approach to constipation. Although several useful laxatives, such as polyethylene glycol (brand name Miralax) are indeed available OTC, I’ve found that the average person doesn’t know enough to correctly choose among them.

Also, although in geriatrics we often do end up recommending or prescribing laxatives, it’s vital to start by figuring out what is likely to be causing — or worsening — an older person’s constipation.

For instance, many medications can make constipation worse, so we usually make an attempt to identify and perhaps deprescribe those.

In short, if you’re an older adult, or if you’re helping an older loved one with health issues, it’s worthwhile to learn the basics of how constipation should be evaluated and managed. This way, you’ll be better equipped to get help from your health providers, and if it seems advisable, choose among OTC laxative options.

Here’s what I’ll cover in this article:

[Read more…]

How does sex and intimacy change when one partner becomes a caregiver?

Dr. Kernisan: What exactly is atrial fibrillation?

What happens to the Urinary System with Aging?

What is dementia?

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