Leslie Kernisan, MD MPH

Tools to Help with End-of-Life Planning

Yesterday I did a webinar with Family Caregiver Alliance, on end-of-life issues for dementia caregivers.

(4/10/14: I have just uploaded this powerpoint to Slideshare, so you can see my slides here.)

As you can imagine, this is a big topic that can’t be covered comprehensively in an hour.

So, I focused the talk mainly on something that I often find myself wishing families had spent more time on: advance care planning. Specifically, I talked about how individuals and families can approach planning for future medical care, in the context of a diagnosis of Alzheimer’s or another form of dementia.

Why? Because in my own experience, the last stage of life for a person with dementia is often strongly influenced by what kind of planning did — or didn’t — happen earlier on.

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Upcoming Webinar on Dementia & End-of-Life Planning

by Leslie Kernisan, MD MPH

Are you caring for an older person with Alzheimer’s or another dementia?

Would you like to learn more about planning and managing end-of-life issues?

If so, you might be interested in an online webinar this week that I’ll be doing in collaboration with Family Caregiver Alliance.

It’s scheduled for Thursday, November 7th, at 1pm PST (4pm EST). During the webinar, I’ll review how families can better address end-of-life planning in the context of a dementia diagnosis. I’ll also offer some suggestions as to how to handle common challenges at the end-of-life itself.

I will be taking live questions during the last part of the webinar. This is the part that I’m most looking forward to!

To sign up for the webinar, click here: https://www3.gotomeeting.com/register/764240806

Please note that Family Caregiver Alliance, who invited me to present, is charging $15 for the webinar.

How We Can Get to Better End-of-Life Care

by Leslie Kernisan, MD MPH

What is good care at the end-of-life, and how can we do better as a society?

This is the question that the Institute of Medicine (IOM) is now studying, and they have created a “Committee on Approaching Death: Addressing Key End-of-Life Issues.”

As part of their research into the current state of end-of-life care, the IOM is inviting the public to send them comments via this online comments page. (Comments must be submitted by November 1st, 2013.)

In particular, the IOM wants to hear about the following topics:

Barriers to and opportunities for improving care for individuals and their families,
Patient and family experiences with care, and
Health care provider experiences.

Now, as you can imagine, addressing end-of-life issues is a big part of what we do in geriatrics. Furthermore, I’m thrilled to see the IOM addressing this issue, since their reports are highly respected and often end up influencing policy and funding.

So I was very glad to provide some comments to the IOM, and encourage others — family caregivers, geriatric care managers, clinicians, or really anyone who has had personal experiences with end-of-life situations in the US — to submit comments as well.

The best reports, after all, result from the academics’ expert opinions being informed by the experiences of those of us in the trenches, trying to navigate real end-of-life situations.

My comments on Better End-of-Life Care for Older Adults

Below, I share the comments that I’m submitting in response to the IOM’s questions.

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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.

Tips for choosing a home blood pressure monitor

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3 Ways Home Blood Pressure Monitors Help Older Adults

by Leslie Kernisan, MD MPH

If I had to recommend one key piece of healthcare equipment that older adults & caregivers should have at home, it would be this: a good home blood pressure (BP) monitor.

Why? Because BP measurements (and pulse measurements, which machines check at the same time) are an incredibly useful tool when it comes to assessing and optimizing an older person’s health and wellbeing. This is true even for those older people who aren’t being treated for hypertension (chronic high BP).

As I’d love for more seniors and caregivers to understand how home BP monitors can help them, in this post I’ll explain how home BP monitors can be helpful specifically for older adults. Then in a follow-up post, I’ll offer a few thoughts as to how to go about choosing one and using it.

3 ways a home blood pressure monitor can help you

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Tools for Caregivers: How to Manage Tasks & To-dos

by Leslie Kernisan, MD MPH

This post is the fourth and final post in a series describing the four key types of tools that I recommended to caregivers at a retreat earlier this summer.

Just to recap, the key tools I recommended included a journal/notebook, a portable and up-to-date medication list, an organizer to keep copies of medical results (also known as a “personal health record”), and last but not least, a personal or family task organizer.

In this post, I’ll explain why I believe most caregivers can benefit from using some kind of task organizer in order to keep track of the to-dos related to an older person’s medical care. I’ve also tried some of the task management tools that are available, and will write about a few that caregivers may want to try.

Why I recommend task organizers to caregivers

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Tools for caregivers: Keeping & Organizing Medical Information

by Leslie Kernisan, MD MPH

This post is part 3 of a series describing the four key types of tools that I recommended to caregivers at a retreat earlier this summer:

Journal/notebook, for notes and symptom tracking (see this post for details)
Portable and up-to-date medication list (see this post for details)
Organizer to keep copies of medical results and medical records
Personal/family task organizer

In this post, I’ll explain why it’s important to keep copies of medical results and key medical records. I’ll then explain which kinds of medical information is most useful to keep, and I’ll describe a few ways that caregivers can do this.

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Tools for Caregivers: the Portable & Up-to-date Medication List

by Leslie Kernisan, MD MPH

At a recent retreat for family caregivers, I proposed four key tools that I recommend to caregivers who want to improve the healthcare of an older person:

Journal/notebook, for notes and symptom tracking (see last week‘s post for more details)
Portable and up-to-date medication list
Organizer to keep copies of medical results and medical records
Personal/family task organizer

In this post, I’ll explain why I always recommend caregivers make an effort to maintain a portable and up-to-date medication list. Then I’ll discuss some tech tools that caregivers can consider.

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Tools for Caregivers: How journals can help

by Leslie Kernisan, MD MPH

Last month, as I was preparing to present a talk at a Family Caregiver Alliance retreat, I spent some time looking into tech tools to recommend to caregivers.

As you might imagine, there are many apps and programs to consider, and I quickly realized that it wasn’t going to be possible to review everything that’s available.

So instead, I decided to start by thinking about my patients and families, and trying to identify a few key areas in which I’d seen tools and organizational strategies really help caregivers better manage an older person’s health needs.

I came up with four key categories of tools that I’ve recommended to families:

Journal/notebook, for notes and symptom tracking
Portable and up-to-date medication list
Organizer to keep copies of medical results and medical records
Personal/family task organizer

In this post, I explain how a journal can help caregivers with the medical parts of their caregiving. Then I’ll describe a few tech tools that caregivers might want to try.

[Read more…]

How to identify risky medications for older adults

by Leslie Kernisan, MD MPH

Many family caregivers know that medications can cause side-effects in older people, and may worry that perhaps their loved ones are being affected by medications.

It’s a very reasonable concern to have. Studies have shown that older adults, especially those taking multiple prescription medications, often experience potentially serious side-effects from their medications.

But having talked with many family caregivers over the years, I’ve found that even the savvy ones often haven’t heard of the “Beer’s List.”

What is the Beer’s List?

Technically known as the “American Geriatrics Society Updated Beers Criteria: Medications that Older Adults Should Avoid or Use with Caution,” this is a carefully reviewed list of medications that are “potentially inappropriate” for older adults, and includes many of the medications that we geriatricians tend to stop or reduce in our patients. (Seriously, identifying and reducing these medications is a big part of my clinical practice!)

Although mainly meant to be used as a reference by clinicians, the American Geriatrics Society(AGS) also provides the information in an easier-to-read format here.

What to do if you realize that you or a loved one is taking a potentially risky medication? Conveniently, AGS addresses this very issue and provides a handy online guide on “What to Do and What to Ask Your Healthcare Provider if a Medication You Take is Listed in the Beers Criteria for Potentially Inappropriate Medications to Use in Older Adults.”

If you’re a caregiver: Have you ever used the Beer’s list as a resource? Other ideas for how caregivers can be empowered to check on their loved one’s medications?

My comments on Better End-of-Life Care for Older Adults

Tips for choosing a home blood pressure monitor

3 ways a home blood pressure monitor can help you

Why I recommend task organizers to caregivers

What is the Beer’s List?

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