Leslie Kernisan, MD MPH

4 Steps to Get Better Advice from Doctors

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:

Grounded in the most recent medical knowledge.
Adapted to your preferences and values.
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?

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

by Leslie Kernisan, MD MPH

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.

4 Things to Do When an Older Person Resists Help

by Leslie Kernisan, MD MPH

“Doctor, my mom needs help but she won’t accept it and she won’t listen.”

Sound familiar? As several of you commented last fall, older relatives often seem reluctant to accept the help we think they need.

Now, I don’t have a magic formula for making this easy. But I do have a new article published on NextAvenue.org, that addresses this very issue:

“4 Things To Do When Your Parents Are Resisting Help“

In this article, I explain four approaches that I always recommend to families, when they are struggling to get older parents to make changes.

They aren’t silver bullets. But they should make it a little easier to get through difficult situations with older loved ones.

So take a look, and let me know what you think.

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

by Leslie Kernisan, MD MPH

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!

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.

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4 Practical Health & Aging Highlights from 2014

by Leslie Kernisan, MD MPH

Happy New Year!

In this post, I want to share four notable 2014 developments related to better health for older adults. They all struck me as practical information that should be useful to those of you helping an aging person with health and wellbeing.

In no particular order, here are my four geriatrics health highlights from 2014:

1. Two Separate One-Time Pneumococcal Vaccines Now Recommended for Older Adults

For several years now, the CDC and other experts have recommended that all seniors aged 65 or older get a one-time pneumonococcal vaccine. The particular vaccine recommended for older adults was the “23 valent” type (which means it protects against 23 subtypes of pneumococcal bacteria), branded as Pneumovax. Another vaccine, a “13 valent” branded as Prevnar, was recommended for children and some adults with weakened immune systems.

In September 2014, the US Advisory Committee on Immunization Practices (ACIP) published its recommendation that all adults aged 65+ get both types of pneumococcal vaccination (Prevnar and Pneumovax). This recommendation was based on their review of scientific studies.

For the ACIP’s technical statement explaining this recommendation, see “Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Recommendations of the Advisory Committee on Immunization Practices (ACIP).” This document was obviously not written for the lay public, but it provides a lot of important detail for those who want to dig into the nitty-gritty. (You can find a basic CDC page on this topic here.)

I’ll admit that I’ve read the ACIP’s statement and I don’t yet feel I clearly understand just how much extra protection an older person should expect, if she has already been vaccinated with Pneumovax and now should get Prevnar. (I do tend to err on the side of following guidelines unless I have good reason to believe that the likely harms outweigh the proposed likely benefit.)

Key things you should know: Yes, there are now two one-time “pneumonia” vaccines that are recommended for older adults. You should also know that these are not supposed to be given at the same time. For more information on how to space out these vaccines, talk to your doctor or take a look at the ACIP document mentioned above.

2. Benzodiazepines Linked (Again) to Higher Alzheimer’s Risk

Benzodiazepines are sedatives/tranquilizers that are often prescribed to treat anxiety or insomnia. Commonly used benzos include lorazepam, alprazolam, and diazepam (Ativan, Xanax, and Valium respectively).

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3 Links to Help You With Aging & Caregiving

by Leslie Kernisan, MD MPH

This month, I spotted a few useful online articles and resources that should come in handy for many of you. And if you’re joining your family for the holidays, these might spark some helpful conversations.

1. Caregiver Self -Assessment Questionnaire, from HealthInAging.org

What it is: A 1-page questionnaire about how you’ve been feeling, as you help a parent or other caree. It comes with a short list of resource websites for family caregivers.

Why I like it: It’s mostly yes/no questions, so it’s fast. This is a good way to check on yourself (or another family member who’s been doing a lot of helping). If you’re struggling, it’s important to get help sooner rather than later. To get help, try bringing a copy of this completed questionnaire to your doctor, or even to your older loved one’s doctor. You can also visit HealthinAging.org’s caregiver health webpage.

2. Video: 3 Easy Balance Exercises to Prevent Falls, from DailyCaring.com

What it is: 3 videos demonstrating easy balance exercises for seniors: the single-leg stand, the “arm-and-leg” raise, and the heel-to-toe walk.

Why I like this:

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How To Be An Engaged Patient or Caregiver

by Leslie Kernisan, MD MPH

Have you ever wondered what it means to be an “engaged patient,” or an engaged caregiver?

This is a hot topic right now within healthcare. The basic idea is simple: people get more from their healthcare when they are active participants, especially when they are proactive about their health. (Such people are sometimes called “e-patients,” with the “e” standing for engaged, enabled, equipped, and educated.)

This means doing things like asking questions, researching your health problems online, connecting with others facing similar health challenges, and most of all: making sure the healthcare providers know what’s important to YOU.

For instance, you should be actively involved in developing the medical plan, meaning that at a minimum, you should let the doctors know whether what they’re proposing sounds ok to you. And, you should be able to let them know if the treatment plan isn’t working out well for you.

Now, one big problem is that we’re often feeling sick when we’re involved with the healthcare system, especially when it comes to hospitals. Which is why family caregivers are very important, when it comes to being proactive and involved with healthcare. When a person has a family member or friend helping them be proactive, getting better healthcare is much more likely.

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Q&A: How to Feel Closer to A Spouse with Alzheimer’s

by Leslie Kernisan, MD MPH

Dear Dr. K,

I live with my wife, who has Alzheimer’s.

I don’t argue or try to correct my wife when she misremembers or confabulates but this makes for two different worlds – hers and mine – and so we have less in common and grow apart. Is this the only option or have you better advice? — D.T.

First and foremost, I want to thank you for everything you’ve done, and are doing, for your wife with Alzheimer’s. It’s not an easy journey, and she’s very fortunate to have you involved.

Your question really speaks to the relationship issues that arise in Alzheimer’s caregiving. As the disease changes your wife’s brain, this is going to change the way you and she relate to each other.

I’m glad you are looking for advice on this topic, because maintaining and improving your emotional connection can yield big benefits for both of you, in the short-run and in the long run. In fact, it’s quite possibly the most important thing that you can do for yourself and your wife.

Why maintaining an emotional connection is so important in Alzheimer’s

Feeling more connected will reduce stress for you both. This leads to three very important benefits:

It will help your wife have the best brain function possible;
It will help you manage caregiving challenges a little better;
It will improve your health and well-being.

In my opinion, reducing stress and improving emotional connection can probably do more for her brain health than most dementia medications, and most conventional medical interventions. (Avoiding delirium, however, might be equally valuable.)

The mind-body-heart connection is that important!

Plus, it’s a win-win, since what improves your relationship will help reduce the stress that caregiving can put on your own health.

So, my opinion as a doctor is that this is important enough to your health, and your wife’s health, that you should seriously consider investing time — and possibly money — in this nurturing of your relationship.

How to counter the way Alzheimer’s tends to drive couples apart

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Blog Update

by Leslie Kernisan, MD MPH

Dear readers,

Since I started the Geriatrics for Caregivers Blog a little over a year ago, I’ve done my best to post regularly to this blog. I hope the information has been helpful. Most of all, I’ve really appreciated the comments and feedback I’ve gotten from you.

I want to let you know that over the next few months, I’m going to be posting less often to this blog. That’s in part because I’m trying to finish an ebook. But it’s also because I’m working on better ways to bring you the information you need to help your loved ones.

For these reasons, the Geriatrics for Caregivers Q&A calls will be on hold until further notice.

But rest assured: I love making practical geriatrics health information available to caregivers like you, and I don’t plan to give it up!

Furthermore, I’d like to remain available to answer your questions via this site. So if you have a question about better health and wellbeing for an older person, please send it to me via the contact form below.

Although I can’t promise to address every question I receive, I will do my best to post answers to your questions, right here on this blog.

Thank you so much for your interest in learning about better health for aging adults!

Are You Regularly Informed of Non-Drug Treatment Options?

1. Two Separate One-Time Pneumococcal Vaccines Now Recommended for Older Adults

2. Benzodiazepines Linked (Again) to Higher Alzheimer’s Risk

Why maintaining an emotional connection is so important in Alzheimer’s

How to counter the way Alzheimer’s tends to drive couples apart

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