Leslie Kernisan, MD MPH

Respiratory Syncytial Virus: What to Know About RSV & RSV Vaccines in Aging

It used to be that influenza was the main respiratory virus that got a lot of attention during the wintertime.

But now there’s another one that’s become known for its potential to cause serious illness in older adults: respiratory syncytial virus (RSV).

Unlike COVID-19, which only appeared in the U.S. in 2020, RSV has actually been around for decades. However, until recently, many doctors treated it mostly as a pediatric concern, because RSV is a top cause of hospitalization in young children.

This is now changing. RSV is actually similar to the flu, or even COVID, in that it’s older adults (along with young children) who are most likely to get dangerously ill.

Hence, this is a respiratory virus that all older adults should know about.

Furthermore, in 2023, the FDA approved the first RSV prevention shots for people aged 60 or older. As of 2024, there are three RSV vaccines licensed for use in the US, for adults ages 60 and older.

So in this article, I’ll explain what is RSV, and what older adults and families should know about it.

What is RSV (Respiratory Syncytial Virus)?

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Top 10 Checklist for Better Health & Aging in 2025

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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Is Your Aging Parent OK?
What to check & how to talk about it

by Leslie Kernisan, MD MPH

Have you been getting worried about your aging parent, or wondering if they are ok continuing to live as they are?

Maybe they’ve been mostly okay but now you’re spotting some problems with memory, such as forgetfulness or asking the same questions repeatedly. Or maybe you’ve noticed trouble with driving, keeping up the house, managing stairs, or paying bills.

Some aging parents simply begin to seem more withdrawn. Others start leveling accusations at others, claiming someone took or moved something, or acting paranoid.

When families notice these types of changes, it’s often really hard to know what to do next. How do you know if they really need help or not, and what kind of help to get? And what do you do if they refuse to discuss it, or get mad when you bring it up?

Since this is such a common dilemma for families, I’ve recorded a video, explaining exactly what you can do, if you’ve noticed some worrisome changes in your parent and are trying to figure out what to do next. Here’s how to know if your aging parent needs help, and how to talk to them about your concerns.

This video covers:

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How to Review Medications for Safety & Appropriateness in Aging

by Leslie Kernisan, MD MPH

By now you’ve probably heard that older adults are often taking “too many” medications.

You also hopefully know that older people are often prescribed medications that may be harmful, or no longer necessary. The CDC has estimated that adverse drug events send older adults to the emergency room 600,000 times per year.

Why does this happen? Research has shown that “inappropriate prescribing” is common in older adults. Meaning that, when patient charts are carefully reviewed, experts often find that older adults are receiving medications that are ineffective, duplicate the effect of another medication, or otherwise lack a basis for being prescribed.

So what can you do?

To reduce the chance of being harmed by inappropriate medications, the answer is not to look for a super doctor. The answer is to regularly conduct a methodical medication review, in which all medications are reviewed for appropriateness and safety. This is part of a process called “deprescribing.”

Scheduling such regular medication reviews is becoming more common in well-run primary care clinics. But if your doctor’s office doesn’t yet offer this service, you can ask for it.

Geriatricians are trained to do this, but if you can’t find a geriatrician, you should be able to get a decent review from the primary care doctor.

But before you go in, it pays to do a little homework on your own. That’s because the input of a patient and her caregivers is actually crucial to determining whether each medication is appropriate for her.

To help you complete this background preparation for a medication review, just follow the 5-Step process I describe below. This will free up some time when you’re actually seeing the doctor — which might mean more time for questions or discussion — and can help you spot safety issues that a non-geriatrician might otherwise not notice.

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4 Types of Brain-Slowing Medication to Avoid if You’re Worried About Memory

by Leslie Kernisan, MD MPH

A few years ago, while I was at a family celebration, several people mentioned memory concerns to me.

Some were older adults concerned about the memory of their spouses. Some were adult children concerned about the short-term memory of their parents. And a few were older adults who have noticed some slowing down of their own memory.

“But you know, nothing much that can be done at my age,” remarked one man in his eighties.

Wrong. In fact, there is a lot that can and should be done, if you notice memory loss or thinking changes in yourself or in another older adult. And you should do it because it ends up making a difference for brain health and quality of life.

First among them: identify medications that make brain function worse.

This is not just my personal opinion. Identifying and reducing such medications is a mainstay of geriatrics practice. Among other reasons, we do find that in some people, certain medications are causing memory loss symptoms — or other cognitive symptoms — to be worse.

And the expert authors of the National Academy of Medicine report on Cognitive Aging agree: in their Action Guide for Individuals and Families, they list “Manage your medications” among their “Top 3 actions you can take to help protect your cognitive health as you age.”

Unfortunately, many older adults are unaware of this recommendation. And I can’t tell you how often I find that seniors are taking over-the-counter or prescription medications that dampen their brain function. Sometimes it’s truly necessary but often it’s not.

What especially troubles me is that most of these older adults — and their families — have no idea that many have been linked to developing dementia, or to worsening of dementia symptoms. So it’s worth spotting them whether you are concerned about mild cognitive impairment or caring for someone with full-blown Alzheimer’s dementia.

Every older adult and family should know how to optimize brain function. Avoiding problem medications — or at least using them judiciously and in the lowest doses necessary — is key to this.

And don’t give anyone a pass when they say “Oh, I’ve always taken this drug.” Younger and healthier brains experience less dysfunction from these drugs. That’s because a younger brain has more processing power and is more resilient. So drugs that aren’t such problems earlier in life often have more impact later in life. Just because you took a drug in your youth or middle years doesn’t mean it’s harmless to continue once you are older.

You should also know that most of these drugs affect balance, and may increase fall risk. So there’s a double benefit in identifying them, and minimizing them.

Below, I share the most commonly used drugs that you should look out for if you are worried about memory loss.

Featured Download: Get my free list of medications that can affect memory and thinking in aging adults. This handy PDF includes all the medications I usually check for. Click here to download.

The Four Most Commonly Used Types of Medications That Dampen Brain Function

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4 Things to Try When Your Aging Parent Seems Irrational

by Leslie Kernisan, MD MPH

Dear Dr. K,

Any ideas on how I can relieve my mother’s anxiety about her thinking an animal got in the house? I can’t find anything and have moved the couches but she is convinced and scared.

She’s always been a worrier, plus her thinking has been deteriorating and her vision is impaired a bit. I take care of her and my Dad both 94. She gets upset if I tell her I think she just thought she was seeing something and says I think she is crazy. Last night she woke me up shaking and practically in tears because she thought she saw it again -I offered for her to come sleep with me but she wouldn’t. Any suggestions? — C.S.

Thanks so much for sending in this question. This is a very common complaint I hear from family caregivers, so I am happy to share some thoughts about what might be going on and what you can do.

Now, I can’t say for sure what is going on with your mother. That’s because she’s not my patient, and I’m not in a position to interview her and examine her.

What I can say, however, is that it’s very common for older adults to develop persisting fears, worries, and complaints that often strike their family members as irrational, paranoid, absurd, or ridiculous.

Why is this?

Among my own patients, I’ve found this is often related to underlying cognitive impairment. Meaning, a problem with memory or thinking that hasn’t yet been fully diagnosed by doctors. In some cases, this kind of complaint ends up being one of the very earliest signs of clinical dementia.

Lewy-Body dementia, in particular, is associated with visual hallucinations. But any process causing brain deterioration (Alzheimer’s, vascular dementia, etc.) can result in anxieties spiraling out of control, or persisting strange beliefs.

That said, it’s quite possible for an aging person to express such fears and not have it be dementia. Maybe there really is an animal in the house, or a person stealing your parent’s things. It’s also possible for people to develop confusion or false beliefs due a problem other than dementia, such as mental illness or delirium.

(For more in-depth information on the most common causes of paranoia and strange beliefs in older adults, see this article: 6 Causes of Paranoia in Aging & What to Do.)

Still, given your mom’s age and the fact you’ve noticed other signs of “thinking deterioration,” there’s a good chance that her persisting fear could be related to some chronic underlying cognitive impairment.

4 Things to try to help your mother

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Incompetence & Losing Capacity:
Answers to 8 FAQs

by Leslie Kernisan, MD MPH

Depositphotos_9669220_m-2015-brain-cogs-leaving-compressor

Have you ever been concerned about an older relative who seems to be making bad decisions?

Perhaps your elderly father insists he has no difficulties driving, even though he’s gotten into some fender benders and you find yourself a bit uncomfortable when you ride in the car with him.

Or you’ve worried about your aging aunt giving an alarming amount of money to people who call her on the phone.

Or maybe it’s your older spouse, who has started refusing to take his medication, claiming that it’s poisoned because the neighbor is out to get him.

These situations are certainly concerning, and they often prompt families to ask me if they should be worried about an older adult becoming “incompetent.”

In response, I usually answer that we need to do at least two things:

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How to Help Doctors Notice What’s Wrong: The story of the missed pelvic fracture

by Leslie Kernisan, MD MPH

Once upon a time, the ER missed a pelvic fracture in one of my older patients.

Actually, this kind of thing has happened more than once, and perhaps it’s happened to your family too.

As much as we’d like to believe that our older loved ones will get the right care when they are sick or injured, the truth is that our healthcare system is imperfect, and it’s fairly common for serious problems to be missed.

Unless, of course, a proactive family caregiver knows to help the doctor focus on what’s newly wrong.

Here is a true story about why geriatricians pay attention to “changes in function” and why it’s essential that you help doctors spot any changes in function or ability.

The case: unable to walk after a fall

My patient with Alzheimer’s dementia, 85-year-old Mr. C., sat down short of his easy chair at home and fell. Within minutes, his daughter found him on the floor. She helped him to the chair, and they watched some TV. But half an hour later, he was unable to get up again and walk. She took him to the emergency room for evaluation.

“I’m fine. Nothing hurts,” Mr. C. told the busy ER staff more than once. “I just want to go home.” X-rays of his hips and pelvis revealed nothing, and so — after an exam that probably lasted only a minute or two — he was discharged.

Back home, however, he still couldn’t walk. He still insisted nothing hurt. “I’m a tough old bird,” he told his daughter. Later that night, though, she noticed that he grimaced every time he rolled over in bed. She knew something was wrong. But what?

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How to Prevent Falls: 4 Proven Approaches To Ask Your Doctor About

by Leslie Kernisan, MD MPH

Worried about falls in an older parent or relative? If so, do you know if their doctor has considered the most useful fall prevention approaches?

Fall risk can be reduced, but it generally takes some thought and effort. That’s in part because most older adults have multiple factors making them vulnerable to falls.

In a related article on this site, I’ve explained that best fall prevention plans involve identifying an older person’s particular risks — especially risks related to health conditions — and trying to counter those.

Get Your Free Fall Prevention Resource Guide! A handy short PDF to help you quickly find the key online resources mentioned in this article. Click here to download.

So for instance, if an older person has diabetes and is having frequent moments of low blood sugar (also known as hypoglycemia), then to reduce falls, addressing the hypoglycemia is as important, if not more, as starting an exercise program.

In other words, I always recommend that aging adults and families learn to tailor their fall prevention plans. You want to focus on what are the most important modifiable risk factors for that individual person.

That said, over the years I’ve noticed that there are four approaches that I find myself using over and over again, in almost all my patients who have had repeated falls.

These four approaches are used often by geriatricians, but much less often by busy primary care doctors. Unless, that is, a proactive family asks about them.

My Four Most-Used Fall Prevention Approaches

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Age-Related Hearing Loss (Presbycusis):
What to Know & What to Do

by Leslie Kernisan, MD MPH

Have you noticed that an older relative seems to be having trouble hearing you at times?

Or perhaps you’ve realized that sometimes YOU are the one saying “What?”

These situations are extremely common. Sometimes the issue is that one is trying to communicate in a noisy place and there is no need for concern.

But in many cases, these kinds of issues can indicate that an older person (or even a middle-aged person) is being affected by age-related hearing loss. (The medical term is “presbycusis”)

You probably already know this: chronic hearing impairment becomes very common as one gets older. The National Institute on Aging reports that one in three adults aged 65-74 has hearing loss, and nearly half of those aged 75+ have difficulty with hearing.

Hearing loss also affects a significant number of people earlier in life. A 2011 study on the epidemiology of hearing loss documented hearing loss in 11% of participants aged 45-54, and 25% of those aged 55-64.

In short, research confirms that quite a lot of people experience hearing loss. But sadly, research also confirms that hearing loss is often under-recognized and inadequately addressed.

This is a major public health issue, for older adults and also for the many middle-aged adults experiencing hearing loss. At this point, we know quite a lot about: [Read more…]

What is RSV (Respiratory Syncytial Virus)?

The Four Most Commonly Used Types of Medications That Dampen Brain Function

4 Things to try to help your mother

The case: unable to walk after a fall

My Four Most-Used Fall Prevention Approaches

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