Leslie Kernisan, MD MPH

What’s Hardest About Helping Aging Loved Ones

“What’s your biggest frustration with helping aging parents, or aging loved ones?”

This is a question that I periodically ask the readers of my eldercare newsletter.

I ask because in order to provide truly useful information on this website, I feel I should periodically check in and learn more about what you’re finding especially challenging.

Whenever I ask, I receive many replies, I learn quite a lot, and as usual, I find myself inspired by the remarkable efforts you are undertaking.

Now, I hadn’t initially been planning to share people’s answers on the blog. But when a reader wrote to me asking about the results of the “survey,” I realized that many of you may be wondering: “What do other people find most frustrating about helping an aging loved one?”

Below, you’ll find a series of quotes from the responses. I hope you find them as enlightening and inspiring as I did.

What Readers Say is Hard About Helping an Older Loved One

“My biggest problem with dealing with my aging parents (both in their 80s) is the delicate “dance” of trying to help them while still respecting their own right to make choices for themselves…My mom had some sudden health issues this summer which, now that they’re pretty much handled, have left her suddenly aged and also with some minor short-term memory problems…It’s tough to know how far to push or how much to do for her…I’m also having to tread lightly about suggesting things [my father] hasn’t thought of…In short, it’s a little tough dealing with the reversal of roles when they aren’t totally reversed.”

[Read more…]

7 Commonly Neglected Problems to Address for Healthier Aging:
The Healthy Aging Checklist Part 3

by Leslie Kernisan, MD MPH

This is the third 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 third item: addressing commonly neglected aging health problems that routinely sabotage healthy aging.

These issues are sometimes referred to as geriatric syndromes. They affect health and quality of life, and although they happen more in people who are older or frailer, they affect countless people in their 60s and 70s as well.

Virtually all of these issues affect a older adults’s ability to socialize, be physically active, and take good care of himself or herself. So addressing these is key to enabling healthier aging.

Unfortunately, these issues routinely fall through the cracks of usual medical care. People often suffer from these problems for years without anyone taking effective action.

This may be because many people — doctors, older adults themselves, or family members — assume nothing can be done about these, and that they are just “part of getting old.”

Don’t believe that. We have studied these problems in geriatrics and most of the time, correctly evaluating and then managing these problems helps older adults and their families feel better, live better, and sometimes even live longer.

Remember, healthy aging is not just about preventing problems. It’s also about spotting them and addressing them before they get worse, or drag down the rest of your health and independence.

So for healthier aging, be proactive in checking for these oft-neglected problems.

And then remember: sub-optimal treatment of these problems is all too common. So you’ll need to be proactive about getting them correctly managed — which might mean either seeing a geriatrician (here’s how to find a geriatrician) or making sure your usual doctor is thinking like one.

Here’s what to look for, and how to learn more:

7 Common Problems to Check for and Address for Healthier Aging

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How to Promote Physical Health While Aging:
The Healthy Aging Checklist Part 2

by Leslie Kernisan, MD MPH

Old man shooting a basketball ball and looking to sky in the park

This is the second in a series of posts explaining my Healthy Aging Checklist.

Remember, for the healthiest aging, we need to do the things that optimize health — and health care — so that the brain and body work at their best for now, and for the future.

I’ve identified six broad actions to take:

The Healthy Aging Checklist:

Promote brain health and emotional well-being.
Promote physical health.
Check for and address common aging health problems (e.g. falls, pain, memory problems, depression, isolation, incontinence, polypharmacy, etc).
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, we’ll cover proven ways to promote and maintain physical health as one ages.

6 Proven Ways to Promote Physical Health

Here are the six “healthy living” actions that I recommend, for promoting physical health in all older adults. They all have a solid track record (which cannot be said for everything I see recommended online). They are also good “bang-for-the-buck,” in part because they provide real benefits to just about everyone who adopts them. And they help whether or not an older person has already developed chronic illnesses.

[Read more…]

5 Types of Medication Used to Treat Sundowning & Difficult Dementia Behaviors

by Leslie Kernisan, MD MPH

One of the greatest challenges, when it comes to Alzheimer’s disease and other dementias, is coping with sundowning and with difficult behaviors.

These are symptoms beyond the chronic memory/thinking problems that are the hallmark of dementia. They include problems like:

Delusions, false accusations, paranoid behaviors, or irrational beliefs
Agitation (getting “amped up” or “revved up”) and/or aggressive behavior
Restless pacing or wandering
Disinhibited behaviors, which means saying or doing socially inappropriate things
Sleep disturbances

These are technically called “neuropsychiatric” symptoms, but regular people might refer to them as “acting crazy” symptoms. Or even “crazy-making” symptoms, as they do tend to drive family caregivers a bit nuts.

And when these behaviors happen in the late afternoon or early evening, it’s usually called “sundowning“. (In most cases, sundowning is triggered by fatigue; anticholinergic medications may cause sundowning symptoms as well.)

Because these behaviors are difficult and stressful for caregivers — and often for the person with dementia — people often ask if any medications can help.

The short answer is “Maybe.”

[Read more…]

How to Promote Brain Health:
The Healthy Aging Checklist, Part 1

by Leslie Kernisan, MD MPH

“Doctor, what do you recommend for healthy aging?”

“My mom is getting older and I want to help her stay healthy. What should we be doing?”

On this site, I usually write about how to manage or avoid specific aging health challenges. But in real life, I often get asked the questions above. After all, many people want advice on how to be healthier, or stay healthy.

That’s because we all intuitively know that maintaining good health (including cognitive function) is key to maintaining what is most important to us as we age: our ability to be physically and mentally capable, so that we can remain active, engaged in our lives, and as independent as possible.

We also know that poor health can bring on pain and other symptoms, as well as disabilities that can jeopardize how we live our usual lives. In fact, most “aging” problems that older adults and families struggle with — like difficulties with mobility, memory, or independence — track back to underlying health problems.

So it’s good to know how to maintain one’s health as one ages, in order to keep our minds and bodies working well for as long as possible.

Furthermore, healthy aging isn’t just about forestalling aging or disability. It’s also about knowing how to make the best of things even once you do have chronic diseases or chronic disabilities of the mind or body. I call this optimizing health, for better health while aging.

It means optimizing one’s health — and health care — so that the brain and body work at their best for now and for the future. And the beauty of this is that the same key things work, whether you are a “healthy” older person with no particular health problems versus someone who has chronic conditions or even an “uncurable” disabling disease such as Alzheimer’s.

In this series of posts, I’m going to tell you how to do this.

The Healthy Aging Checklist

For the healthiest aging, do this:

[Read more…]

How to find geriatric care — or a medication review — near you

by Leslie Kernisan, MD MPH

A caregiving daughter once wrote in and asked me this common question:

“How can I find a gerontologist* near me to review medications, and help care for my mother with dementia?”

As you may have noticed if you’re a regular reader, I often emphasize the importance of spotting and reducing risky medications, especially those associated with falls or memory problems.

Understandably, this caregiver wants to find a geriatrician who can review her mother’s medications, and otherwise oversee her mother’s care.

(*Note: Technically, a geriatrician and a gerontologist are not the same. Gerontology is the social science discipline of all things aging, and one can get either a master’s or a doctorate in this field. Whereas geriatrics is a medical specialty, so geriatricians must first get a medical degree, then do a residency in internal medicine or family medicine, and then do specialty training. So when people say they want a gerontologist for medical care, what they really want is a geriatrician.)

Now, medication review is usually included in geriatrics primary care. Geriatric care, after all, means healthcare modified to be a better fit with what happens as people get older. And being careful with medications is pretty integral to this approach.

But, although geriatric primary care is certainly worth looking for, it can be hard to find. (Read on for suggestions below.)

So it’s good to have a plan B, which can be getting a medication review — and fall risk assessment — outside of geriatric primary care. This can also be a good option if an older person is reluctant to change primary care doctors.

In this article, I’ll describe 3 places to look for geriatric primary care, and then 3 options for medication review.

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6 Causes of Paranoia in Aging & What to Do

by Leslie Kernisan, MD MPH

Q: My mother is 80. She is very active (despite breaking her hip 2 years ago), she still attends water therapy 3 times a week at the YMCA, she drives to the base (which is 20 miles away) and pays her bills on time. She is a retired Psych nurse and has shown signs in the past of paranoia.

Lately, she has “heard” voices of her grandchildren in her home and called my sister. She also has difficulty with getting the right words to say out and has her sleep pattern out of whack and will call people at odd times of the night. With her independence comes the fact she won’t share any medical information because she thinks we are out to get her committed.

How can I test her/question her to find out the level of decline she may be in to make sure she is safe? — K

A: Great question. As you may know, it’s fairly common for aging adults to develop problems like the ones you are describing. Some older adults will also start leveling a lot of false accusations. Understandably, these problems are frustrating and worrying for adult children.

You are absolutely right to be concerned about your mom’s safety. I do have some ideas for how you can get started assessing her, which I share below.

But first I want to explain the most common causes of this type of behavior in older adults. That’s because one of the things you must do is help your mother and the doctors figure out why she’s developed these behavior changes and other symptoms.

A fair number of people don’t get around to the medical evaluation because they assume that these crazy behaviors are either normal aging (definitely false) or dementia such as Alzheimer’s (true about 40% of the time).

Furthermore, it’s often hard to get a resistant older parent medically evaluated.

Still, it’s worth persisting in this, because many causes of paranoia or other odd behavior in older people can be treated.

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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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5 Geriatrics Medication Safety Tips for Older Adults

by Leslie Kernisan, MD MPH

Just as we all benefit when we all are better informed about health, everyone involved in the health care of older adults can benefit from learning to think more like a geriatrician.

This means keeping certain guiding principles in mind. It also means watching for certain common pitfalls, when it comes to the medical care of aging adults.

In 2016, the most important principles of geriatric care were distilled down to a “4 Ms” model for age-friendly care:

Mentation: preventing, identifying, treating and managing mental health and cognitive conditions
Mobility: helping older adults avoid falls and remain mobile, for maximum independence
Medication: optimizing medication use to avoid harm and improve health
What Matters: ensuring that medical care addresses what matters most to an older person and is aligned with their specific health goals and care preferences

Problems in aging health are especially common when it comes to medications. So geriatricians always pay attention to what drugs have been prescribed, and why. Then we often improve an older person’s health by suggesting changes to their medications.

In this article, I’ll share five geriatrics medication safety truths that I often find myself explaining to families. They are what I always keep in mind as I do my work, as they are the foundation for better prescribing in aging adults, as well as for checking an older adult’s medications for safety and appropriateness.

I tell people these medication safety truths because I know that most older adults will not have their medications regularly reviewed by a geriatrician or geriatric pharmacist.

But with the right knowledge, you’ll be better prepared to ask your doctors the right questions. This can help them address common oversights, and can improve the safety of your medications.

Here’s what you should know, along with tips on what you can do:

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The Power of Offering Alternatives: a true end-of-life story

by Leslie Kernisan, MD MPH

How might we help a sick older person have a better end-of-life experience? Planning for future health crises and end-of-life situations — a process known as advance care planning — is certainly important.

But, not every health crisis can be completely planned for. And it’s often hard, in the moment, for family members and doctors to figure out how to honor a person’s wishes. Below, I’d like to share a true story about a dangerously ill older woman, who wasn’t on hospice but said she didn’t want to go to the hospital.

The case: To ER or not to ER?

As I puttered around my house one Saturday morning, my pager went off. “Dr. Kernisan? This is Tina from the nursing home. We’re calling you about Mrs. F. She’s 78 and has a diagnosis of advanced lymphoma. She’s been anemic and just got a blood transfusion again a few days ago. She’s now very weak, pale, and her blood pressure is low. Her poop looks red.”

Although by then I had fired up my computer and was remotely logging in to Mrs. F’s chart, this sounded like a no-brainer. I didn’t know Mrs. F personally, but that weekend I was on call by phone for our medical group’s nursing home. From the brief description, Mrs. F sounded critically ill, and was probably bleeding internally. She needed hospitalization ASAP.

“But she says she doesn’t want to go to the ER,” the nurse continued. “She says she hates the hospital and wants to stay in the nursing home.”

This stopped me short. “Is there an advance directive in her chart? Is she usually able to make medical decisions?” I asked.

“It says she is DNR, but it looks like that was just decided a few weeks ago. It says transfer to the hospital is ok. It looks like she’s been offered hospice, but she hasn’t signed up for it. She does usually make medical decisions.”

I frowned at my computer screen, scrolling through Mrs. F’s chart. She definitely sounded dangerously ill. She had to be hospitalized, probably in the Intensive Care Unit.

Or did she?

[Read more…]

What Readers Say is Hard About Helping an Older Loved One

7 Common Problems to Check for and Address for Healthier Aging

6 Proven Ways to Promote Physical Health

The Healthy Aging Checklist

The case: To ER or not to ER?

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