UTIs and Urine Bacteria in Aging:
How to get the right diagnosis & when to take antibiotics

by Leslie Kernisan, MD MPH

Q: An older friend, who is in her 90s, has been having bacteria in her urine, but no symptoms. Despite treatment with antibiotics, she was still having bacteria in the urine, so the doctor recommended chronic antibiotics and a referral to urology.

What can be done when an elderly woman has bacteria in her urine but no symptoms? Can a urology consultation help?

A: This is a great question. People often think that your friend is having a “recurring urinary tract infection (UTI)” or even a chronic UTI. But actually, you are describing something called asymptomatic bacteriuria, which means having urine bacteria without symptoms.

Every older person and family caregiver should know about asymptomatic bacteriuria. Here’s why:

It’s very common in older adults. This condition is found in an estimated 20% of women aged 80 or older, and also affects older men. The older the person, the more common it is. Asymptomatic bacteriuria is even more common in nursing homes, where it’s estimated to affect 30-50% of residents.

It’s often confused with a urinary tract infection (UTI). This can lead to unnecessary — and potentially harmful — treatment with antibiotics.

It usually does NOT need to be treated with antibiotics. As I’ll explain below, research shows that people don’t live better or longer when asymptomatic bacteriuria is treated. In fact, such treatment can be harmful: one study found that treatment increased the risk of future (real) UTIs, and increased the risk of infection with antibiotic-resistant bacteria.

[Read more…]

How to Avoid Problems Due to Aging Incapacity: The (Better) Durable General Power of Attorney

by Leslie Kernisan, MD MPH

One of the most common concerns I hear from people is “My older parent’s behavior is concerning me and I’m worried about her mental abilities.”

As I explained in a related article: it’s not always dementia but often it is. And unless an older person has done a good job planning ahead, it can be very hard and messy for others to intervene as needed.

But hopefully, that’s not yet your situation.

In which case, you might be wondering: Given that it’s so common for aging adults to eventually start slipping mentally — or to be suddenly disabled due to an accident or serious health crisis — what kind of planning should older adults and families do to avoid this kind of situation?

I’ve done some research on this question, and here’s what I found out.

One of the simplest — and often less expensive — smart planning approaches is for an older adult to complete a general durable power of attorney (POA) document.

Especially if the powers granted are broad — which they often are — a POA can enable the designated person (known as the “agent”) to step in and assist with finances, housing, safety, and anything else covered by the POA .

A durable POA allows an agent to take action once the older person is “incapacitated.” In California, such POAs can be used to move a person with dementia to a different living arrangement.

Now, the durable power of attorney approach isn’t perfect. Over the years, I’ve noticed that two broad categories of problems come up:

Concerns as to whether the agent might be using the POA to financially exploit the situation
Issues related to determining incapacity and whether the older person should be overridden.

In truth, I have occasionally encountered situations in which different doctors had different opinions on whether an older person was incapacitated. This troubles me, because agents should really only be stepping in and overriding older adults if we’re all sure they’ve lost capacity and are making decisions that don’t serve their overall goals, or are hazardous to others.

Still, a general durable POA is an excellent approach to consider. But I would recommend you pay special attention to how the document is drafted, in order to reduce the risk of financial exploitation and to avoid pitfalls related to determining incapacity.

In this post, I will share:

What I’ve learned about general durable power of attorney documents
Why determining incapacitation is often problematic in the real world
Tips on avoiding a common POA weakness
What to know about including third-party accounting and other strategies recommended by the American Bar Association, to reduce the risk of financial exploitation by an agent
Useful resources I’ve found online for more information

[Read more…]

Q&A: How to Diagnose & Treat Mild Cognitive Impairment?

by Leslie Kernisan, MD MPH

Q: I realize that I sometimes have difficulty connecting a name and a face. I presume that this is mild cognitive impairment.

On researching the topic online, I find a variety of suggestions for alleviating it. These include supplements (lipoic acid, vitamin E, omega 3s, curcumin), food choices (fish, vegetables, black and green teas), aerobic exercise, yoga, and meditation.

Do these actually help with mild cognitive impairment? What’s been proven to work?

A: It’s common for older adults to feel they’re having trouble with certain memory or thinking tasks as they get older.

I can’t say whether it’s mild cognitive impairment (MCI) in your particular case. But we can review what is known about stopping or slowing cognitive changes in people diagnosed with MCI.

First, let’s start by reviewing what MCI is, and how it’s diagnosed. Then I’ll share some information on the approaches you are asking about, as well as other approaches for treating MCI.

What is Mild Cognitive Impairment?

[Read more…]

Leg Swelling in Aging: What to Know & What to Do

by Nicole Didyk, MD

Swelling in the lower legs – known as “lower extremity edema” in medical terms – is a problem that often affects older adults.

The good news is that most of the time, it’s annoying, but not terribly dangerous. However, in other cases, swelling in the feet, ankles, or lower legs can be the sign of a new health problem, or a worsening chronic condition.

And, even if it’s “benign” and not related to a dangerous health condition, edema can be a major risk factor for skin breakdown and reduced mobility in aging adults.

Since leg swelling becomes so common as people get older, in this article we’ll demystify leg edema and cover the most important things that older adults and families should know about this condition. In particular, we’ll cover:

How does edema happen?
Common causes of swollen ankles or legs in aging adults
Medications that can cause leg swelling as a side-effect
How leg swelling should be medically evaluated
How to prevent and treat leg swelling
What to know BEFORE going on a “water pill”

[Read more…]

7 Common Brain-Slowing Anticholinergic Drugs Older Adults Should Use With Caution

by Leslie Kernisan, MD MPH

Want to keep your brain — or the brain of someone you love — as healthy as possible?

Then it’s essential to know which commonly used medications affect brain function.

In this article, I’ll go into details regarding a type of medication that I wish all older adults knew about: anticholinergic drugs.

[Read more…]

How to Use a Personal Health Record to Improve Healthcare in Aging

by Leslie Kernisan, MD MPH

Everyone wants to get the right medical care. But doctors are often lacking key medical information at the time they see you (or, your aging relative).

The solution: setting up and using a personal health record (PHR).

This is a big step up from what many people do, which is to create an “in-case-of-emergency” packet. Such medical information packets usually include a list of medications, chronic conditions, and allergies, along with the names of next-of-kin and perhaps a POLST form.

I’ve reviewed such medical information packets, and they are certainly better than nothing. But in general, they don’t help older adults avoid these very common — and potentially serious — problems with their medical care:

Delays in treatment/action because test results aren’t available. Often doctors need test results in order to know how to proceed medically. If tests have been done but the results aren’t available, the doctor’s options are to fly blind, re-order the tests, or plan to request the test results and then see you again once the results are available.
Getting worse care in the emergency room, or in urgent care. An urgent medical problem often means seeing new doctors. Those doctors have to offer help quickly, but if they are lacking detailed medical information, it’s generally harder for them to offer the right medical management.
Suboptimal medication prescribing. Whenever medications are prescribed without first considering all other medications being taken, an older adult’s health is being put at risk. Although bringing an up-to-date medication list (or better yet, all the medication bottles) is very helpful, it’s also valuable for doctors to understand why another doctor prescribed a medication.
Suboptimal care from a new primary care provider (PCP). Adults in late life often move and have to establish care with a new PCP. Especially when an older person has multiple chronic conditions or a complicated health history, delays in getting medical information means it often takes the new PCP months to get up to speed so that he or she can properly help the older person with his or health concerns.
Inadequate help from a specialist or consultant. Aging adults are often referred to specialists, but studies have found that specialists often don’t receive enough information to do their work. Again, at best this means delays and inconvenience for you; at worst this can lead to serious health problems if you get the wrong care, or get the needed care too late.

Fortunately, even a very basic and low-tech PHR can help you avoid the problems listed above, and will improve your personal health information management.

At a minimum, you’ll save yourself hassle and the extra appointments that get scheduled because the doctor didn’t have the needed medical information the first time around. You’ll also spare yourself the discomfort and expense of enduring duplicate testing.

More importantly, properly maintaining and using a personal health record (PHR) will go a long way to ensuring that you get better, safer medical care. It can also help you avoid potentially life-threatening medical mishaps.

The key is to learn what medical information to put into this PHR, and how to use it effectively for care coordination. This post will tell you what you need to know, to set up and use a PHR.

[Read more…]

10 Useful Types of Medical Information to Bring to a New Doctor

by Leslie Kernisan, MD MPH

Personal health information to bring to a new doctor

Here’s a situation that comes up for many people: you move in later life.

Or maybe it’s your older mother — or father, or other older relative — who’s moving to a new town, perhaps to be closer to you, or otherwise be somewhere more conducive to aging in place.

Such a move means that you’ll need to establish care with a new primary care provider.

For most older adults, establishing a good working relationship with a new health provider is a challenge. If nothing else, it can take some time to feel that each party knows and understands the other.

But it’s also in many cases a terrific opportunity to review a person’s health and healthcare. Provided, of course, that everyone involved makes an effort, and has good information to work with.

In this post, I’ll share my list of the most useful medical records and health information that you should bring to that first visit with the new primary care provider.

Do you have to bring this information? Of course not. In my own experience, most people bring nothing more than a medication list, if that. And they leave it to the new doctors to request health information from the previous doctors, which often arrives well after that first new patient visit.

But this is a problem, because it makes it quite difficult for that first visit to be truly useful.

Sure, the doctor can interview you, and do a physical exam. Yet for many older adults, that interview and exam is often much more productive if a doctor can combine it with a review of the most useful health information.

I myself used to see a fair number of new older patients, when I was a primary care geriatrician at the Over 60 Health Center. Those first visits often felt like fumbling around in a dark room, feeling the walls and furniture and trying to get a sense of the overall layout.

But occasionally, a new patient would come with useful health information in hand. This generally made a big difference in how quickly we could ensure that our new patient was getting the right medical care from us, and from other involved doctors.

So if you want to have the best start possible with a new doctor — or help your aging parent do so — you’ll need to do a little advance preparation. This often requires some time and energy. But it will pay off, by ensuring that the new doctor has the information he or she needs, to provide you with good healthcare.

Also, if you are in that season of life where you’re starting to be more involved with your aging parent’s health (or think perhaps you should be), this is a great opportunity to learn more about your parent’s health.

10 Useful Types of Medical Information to Bring to a New Primary Care Provider

Here’s my list of what I ask patients and families to bring to me, in order to make that new patient visit most useful.

[Read more…]

Understanding Laboratory Tests:
10 Commonly Used Blood Tests for Older Adults

by Leslie Kernisan, MD MPH

In this article, I’ll address a real mainstay of modern medicine: laboratory tests that require drawing blood.

This is sometimes referred to as “checking labs,” “doing bloodwork,” or even “checking blood.”

Most older adults have been through this. For instance, it’s pretty much impossible to be hospitalized without having bloodwork done, and it’s part of most emergency room care. Such testing is also often done as part of an annual exam, or “complete physical.”

Last but not least, blood testing is usually — although not always — very helpful when it comes to evaluating many common complaints that affect aging adults.

Fatigued and experiencing low energy? We should perhaps check for anemia and thyroid problems, among other things.

Confused and delirious? Bloodwork can help us check on an older person’s electrolytes (they can be thrown off by a medication side-effect, as well as by other causes). Blood tests can also provide us with information related to infection, kidney function, and much more. I also go into these details in my Youtube video:

[Read more…]

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

by Leslie Kernisan, MD MPH

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

[Read more…]

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.

[Read more…]

« Previous Page
1
…
3
4
5
6
7
…
12
Next Page »

What is Mild Cognitive Impairment?

10 Useful Types of Medical Information to Bring to a New Primary Care Provider

Tips for choosing a home blood pressure monitor

Disclaimer