Better Health While Aging

Practical information for aging health & family caregivers

4 Things to Try When Your Aging Parent Seems Irrational

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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

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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

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Pelvic X-Ray

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

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elderly woman falling

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.

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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How You Can Help Someone Stop Ativan

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Ativan

Have you heard of Ativan (generic name lorazepam), and of the risks of benzodiazepines drugs in older adults? Is an older person you care for taking prescription medication for sleep, anxiety, or “nerves”?

Would you like an easy, practical tool to help someone stop a drug whose risks often outweigh the benefits?

If so, I have good news: a wonderful patient education tool has been created by a well-respected expert in geriatrics, Dr. Cara Tannenbaum. Best of all, a randomized trial has proved that this tool works.

As in, 62% older adults who received this tool — a brochure with a quiz followed by key information — discussed stopping the medication with a doctor or pharmacist, and 27% were successful in discontinuing their benzodiazepine. The brochure includes a handy illustrated guide on slowly and safely weaning a person off these habit-forming drugs.

This is big news because although experts widely agree that long-term benzodiazepine use should be avoided in older adults, getting doctors and patients to work together to stop has been tough. It is, after all, generally easier to start a tranquilizer than to stop it!

But through a patient education brochure, Dr. Tannenbaum’s team was able to make this tricky process much more doable for older adults, their families, and their doctors.

Why it’s important to try to stop lorazepam & other benzodiazepines

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10 Things to Know About HIPAA & Access to a Relative’s Health Information

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Depositphotos_71539567_m-2015-HIPAA-compressor

Have you ever had questions about what might be going on with an older loved one’s health? But then you find that your older relative is unable — or unwilling — to let you in on the health details?

Or maybe you’ve wanted to talk to your parent’s doctor, but worried that doing so might be a HIPAA violation?

Such issues come up often for the family caregivers of aging adults. Common situations include:

  • An older parent who starts to act in ways that are strange or worrisome, such as becoming paranoid or delusional.
  • An older adult who seems to be physically or mentally declining, but seems reluctant to discuss the situation
  • A hospitalization or emergency room visit
  • A hospitalized older person becoming confused (this would be delirium) and becoming no longer able to explain to family what the doctors have said

In these situations, family caregivers often find themselves grappling with issues related to the HIPAA (Health Insurance Portability and Accountability Act) Privacy Rule.

Why all the grappling?

Well, although most people — and all clinicians — have heard of HIPAA, its rules and requirements are often misunderstood. So for instance, families may assume that it’s a HIPAA violation to report a relative’s worrisome behavior to the doctor, because their relative hasn’t given them permission to do so.

Even worse:  doctors and other clinicians sometimes refuse to disclose any information to families, and will incorrectly claim that it’s a HIPAA violation to do so. This can create extra confusion and stress for families, or can even sometimes put an older person at risk for harm.

If you’ve been concerned about an aging parent’s health, or are otherwise helping someone with their health concerns, then it can be very helpful to understand HIPAA better. HIPAA regulations will also govern your access to medical records and other important health information.

In fact, the American Bar Association includes “Know your rights of access to health information” among its Ten Legal Tips for Caregivers.

The detailed ins and outs of HIPAA can indeed be hard to fully understand. But, it’s not too hard to learn some practical basics, especially since the US Department of Health and Human Services (HHS) provides a Summary of the Privacy Rule here, and maintains a truly useful set of online FAQs about HIPAA here.

In this article, I’ll explain five useful key basics to help you understand HIPAA better, especially when it comes to getting information and medical records as a family caregiver.

I’ll also address five questions I’ve often heard family caregivers ask about HIPAA.

At the end, I’ll share some of my favorite online HIPAA resources, as well as some final tips to keep in mind.

5 Key Basics About HIPAA

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Age-Related Hearing Loss:
What to Know & What to Do

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Image Credit: DepositPhotos.

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:

  • The many ways hearing loss negatively impacts the person affected by it (and their family),
  • The many ways we can help correct hearing loss, through hearing aids, other amplification options, and better communication techniques.

Since this is such an important issue, in this article, I’ll share the following:

  • 4 key things to know about hearing loss in aging
  • What to do if you’re concerned about hearing loss
  • A brochure you can use to persuade a reluctant older adult to address hearing loss
  • The simple device many geriatricians use for hearing loss

4 Key Things to Know about Hearing Loss in Aging

A while back, I interviewed my UCSF colleague, Professor Meg Wallhagen, PhD, to join me on my podcast to talk about hearing loss and what can and should be done about it. She is a nationally recognized expert on hearing loss and spent years on the board of the Hearing Loss Association of America.

You can listen to these podcast episodes here:

094 – Interview: Hearing Loss in Aging: Why It Matters & Getting Evaluated

095 – Interview: Hearing Aids & Other Hearing Loss Treatment Options

Here are my four top takeaways from the interviews with Professor Meg Wallhagen:

1. It’s not good to put off addressing hearing loss.

Why this is important:

  • Your brain’s auditory cortex needs the hearing input to remain in good shape!
    • Hearing involves getting the input through your ears and the related nerves, AND then your brain must process this sensory input in what’s known as the “auditory cortex.”
    • “Use it or lose it” applies here. Your brain’s auditory cortex will get worse at processing sound, if you don’t give it enough good quality input to work with.
  • Hearing loss is associated with negative impacts on cognitive function.
  • It is easier and better for the brain if you try to correct hearing loss sooner rather than later.
    • The sooner you improve the hearing input coming into the brain, the better it is for the brain. This is also much better for social relationships, work relationships, safety, and more.
    • Hearing aids also require a period of adaptation and learning. This becomes harder as brains get older. It also becomes harder as hearing loss becomes more severe with time.
  • Hearing loss has a significant impact on social relationships.
    • Friends and families become tired of all the extra effort required to communicate when there is hearing loss, and may engage less with a person. Spouses, in particular, can become very frustrated.
    • Workplace performance and relationships can be affected, and this can negatively impact an older person’s job and ability to maintain their job.
    • People with unaddressed hearing loss are more likely to become socially isolated.

2. Don’t assume that your primary care doctor will notice hearing loss or initiate a suitable evaluation.

Why this is important:

  • Research shows that hearing loss is commonly overlooked in primary care.
    • Patients and families should be proactive in bringing up hearing loss and in asking their health providers to address it.
    • If your older parents or another relative is experiencing hearing loss, encourage them to talk to their health provider about it.
  • Traditional Medicare, unfortunately, does not cover routine audiology testing.
    • It may cover this type of testing when it is ordered by a medical professional “for the purpose of informing the physician’s diagnostic medical evaluation or determining appropriate medical or surgical treatment of a hearing deficit or related medical problem.”
    • Some Medicare Advantage plans may cover audiology.
    • The best is to ask your health provider and see if you can get this testing covered.

Provided there are no medical red flags noted, evaluation of most age-related hearing loss requires removing earwax and then a referral to audiology, for in-depth testing of hearing. For more on what is covered in the audiology evaluation, see here and here.

3. Consider options other than hearing aids, especially for people who aren’t good candidates for hearing aids.

Why this is important:

  • Hearing aids can be very effective, but they aren’t right for everyone. That’s because:
    • For them to help with hearing, a person must put in some time and effort in getting them properly adjusted, and in letting the brain learn to work with them. They require much more work than glasses!
    • People who are cognitively impaired, or have very severe hearing loss, may not be able to handle the work of adapting to hearing aids.
    • Hearing aids also require maintenance. Some older adults will not able to manage changing batteries, keep track of these devices, or making necessary adjustments.
  • Not everyone is a good candidate for hearing aids.
    • People with dementia often have difficulty cooperating with the fitting and adjustment period. Plus, the dementia process affecting their brain may also make it harder for their auditory cortex to learn to adapt to the hearing aid.
    • People with very severe or long-standing hearing loss may be less likely to benefit from hearing aids. This is in part because more amplification and correction is needed, and also because the brain needs to do more work to compensate for all that time during which it wasn’t getting the right input.
  • Other approaches to amplification and communication can be effective to help with hearing loss. These include:
    • Assistive devices for phones
    • Assistive devices for TVs and other devices
    • Better communication strategies, such as seeking quieter places to talk when possible and directly facing the person with hearing loss, so they can see the face and lips of a speaker.
    • “Pocketalkers“*, which are a simple and inexpensive hearing amplification device used by geriatricians and others. They can also usually be used with people who have dementia.

Note: as of October 2022, over-the-counter (OTC) hearing aids have finally become available. The National Council on Aging has a list of best OTC hearing aids here. As far as I can tell, the main advantage of OTC devices is that they are less expensive than conventional hearing aids. If a person is not a good candidate for a hearing aid, an OTC hearing aid is not going to fix that problem.

4. Age-related hearing loss affects higher frequency sounds in particular, and causes distortion (not muffling) of sounds. 

Why this is important:

  • This is why older people with hearing loss will say they can hear.
    • They are right, they CAN hear! But their hearing loss makes it harder for them to hear certain speech frequencies, which leads to distortion of sound.
    • It’s important to realize that age-related hearing loss causes distortion, not muffling.
  • This is why it’s usually not helpful to shout at someone with age-related hearing loss.
  • This is why deciphering speech becomes difficult for someone with age-related hearing loss.
    • Many consonants are spoken at a relatively high frequency.
    • When age-related hearing loss affects the ability to hear different consonants, human speech becomes harder to decipher.
  • This is why older adults with hearing loss may have difficulty understanding children, and other high-pitched voices.
    • Young children often have higher-pitched voices. These can be hard for older adults with hearing loss to decipher, unless the hearing loss is addressed.

What to do if you’ve been concerned about hearing loss

Talking to Professor Wallhagen really brought this home for me: hearing loss is important and it’s much better to address it sooner rather than later!

In particular, addressing hearing loss earlier is better for the brain, better for relationships, and may even help a person perform better at work.

If you’ve had any concerns about hearing loss for yourself or for another older adult, here are the basic next steps:

1.Bring it to the attention of your primary care provider (PCP). 

Start by letting your PCP know of any potential hearing loss. The PCP should do a related “history and physical examination”, meaning they will ask questions about related symptoms and medical conditions that can affect hearing. They will also do a physical examination related to auditory issues.

Most hearing loss in older adults is garden-variety age-related hearing loss (which is technically called “presbycusis“). It usually happens due to a combination of age-related changes and noise-related damage to the inner ear, and it slowly gets worse over time.

It’s also extremely common for hearing loss to be caused by — or usually worsened by — ear wax (technically called “cerumen”) plugging up the ear canal.

For this reason, it’s essential that the PCP look in both ear canals, to make sure there aren’t any blockages.

If there is any ear wax accumulation, the ear wax should be removed. This is sometimes done in the doctor’s office, but it’s also common (and probably safer) to do this at home, using some ear wax softening drops and a bulb syringe to gently rinse the ear canal.  AARP has a good article on this topic here: The Ins and Outs of Safe Earwax Removal.

There are also many other medical conditions that can cause hearing loss. Among other reasons, hearing loss can be related to a viral infection, to brain changes, or even to certain medications.

A medical exam related to hearing can help check for these less common causes of hearing loss, before you proceed with further audiology evaluation. In some cases, the PCP might refer you to an ears-nose-throat specialist (an otolaryngologist). But in many cases, the initial medical examination can be done in primary care.

2. Get an audiology evaluation.

An audiology evaluation is a special detailed test of a person’s hearing.

During the evaluation, the audiologist will vary the pitch and loudness of sounds, to determine what is the quietest sound each ear can hear at different frequencies. Audiology evaluations also usually include speech recognition tests.

You can learn more about audiology evaluations here: Hearing Tests for Adults.

The audiology evaluation helps pinpoint the specific types of sounds that a person is having difficulty hearing, and also helps classify the hearing loss as mild, moderate, or severe.

These results can then be used to determine what type of hearing aids might be suitable, or whether other types of hearing assistive technology should be considered.

3. Seek out suitable hearing assistive technology.

If the older person is a good candidate for hearing aids (remember, not everyone is!), then you should look into getting suitable hearing aids.

Until recently, this required being fitted for hearing aids by an audiologist. However, as of October 2022, over-the-counter (OTC) hearing aids have become available. A small randomized trial published in April 2023 found that “self-reported and speech-in-noise benefit was equivalent between the self-fitting OTC and audiologist-fitted hearing aid conditions at the end of 6 weeks.”

In other words, preliminary research suggests that OTC hearing aids, which are generally more affordable than audiologist-fitted hearing aids, are a good option for people with mild to moderate hearing loss. (Note: the average age of participants in this trial was 64.)

There are also other hearing assistive technologies to consider. The Hearing Loss Association of America provides a nice overview here: Hearing Assistive Technology.

4. Learn and use hearing loss communication strategies.

Whether or not an older person is using hearing aids or other hearing assistive technology, it’s worth learning and using certain strategies that make communication easier when someone has hearing loss.

These include:

  • Face the hearing-impaired person directly, with the speaker’s face in good lighting. Avoid being backlit when you are speaking.
  • Avoid shouting, which distorts speech. Instead, speak clearly, distinctly, and not too fast.
  • Try to minimize background noise.
  • Say the person’s name when you start speaking, or otherwise get their attention before you continue speaking.
  • Don’t cover your mouth or chew food while speaking to someone with hearing loss.

There is a good list of communication tips available here: Communicating with People with Hearing Loss.

What to do if an older person won’t address their hearing loss

There are, of course, common obstacles that come up to addressing hearing loss.

A major one is that affected person often either doesn’t notice their hearing loss or avoids addressing it. They don’t want to feel old. They may have heard “hearing aids don’t work,” or that they’re expensive. Or they may just be waiting for their doctor to bring it up.

If this has come up for you, I highly recommend you try using Professor Wallhagen’s specially designed brochure. It’s been clinically tested in research, which has confirmed that it helps older adults address hearing loss.

Click here for the brochure: Hearing Helps Us Stay Connected to Others.

Use the brochure to help an older adult address their hearing loss. You can print it out, discuss it with family, and then use it to spark a conversation with your health providers. Here it is again: Hearing Helps Us Stay Connected to Others.

The simple device many geriatricians use for hearing loss

The best approach to hearing loss is the one I described above: get evaluated by the PCP, get an audiology evaluation, and then get suitable hearing assistive technology.

But what if you’re trying to communicate with an older adult who hasn’t yet gotten evaluated for hearing loss? Or maybe isn’t a good candidate for hearing aids?

In this case, a short-term solution to consider is a Pocketalker * type of device. These are especially helpful when it comes to people with dementia, who often are not good candidates for hearing aids.

Many geriatricians carry pocket talkers with them, since they are so handy for communicating with those “hard-of-hearing” patients. In fact, I’ve had a Pocketalker in my doctor’s bag since geriatrics fellowship, and always take it with me on housecalls.

To help you address hearing loss 

Again, I highly recommend UCSF Professor Meg Wallhagen’s wonderful informative brochure, which has been clinically proven to help older adults address hearing loss:

Click here for the brochure: Hearing Helps Us Stay Connected to Others.

Good luck addressing hearing loss! It’s really worthwhile, even if it can be an effort to get the process started.

5 Things to Know about Aging Parents & Financial Decline

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Aging woman counting money

You probably already know that many older adults develop problems managing finances as they age.

Now how would you answer the questions below:

  • Has your aging parent planned for a decline in financial abilities?
  • Are you prepared to detect signs of a financial decline?
  • Do you know what to do if you do notice problems with finances?

Many people, even the ones who are caring and well-informed, will often answer “no” to these questions.

But this post will equip you to start answering yes. And I want you to be able to answer yes, because declines in the ability to manage finances are very common among older adults, and often causes serious health and life problems.

The trouble, of course, is that financial decline is uncomfortable for older adults and their families to think about. Managing money, after all, is one of the ways we maintain autonomy and control over our lives.

So nobody likes to confront the fact that our ability to manage money will — in all likelihood — someday decline. (Research suggests that even aging adults who don’t develop dementia often experience declines in financial ability.) And families are understandably squeamish about monitoring an older relative’s financial abilities.

Fortunately, a little education and guidance can make it much easier to be more proactive about this tough topic.

In this post, I’ll cover

  • Five warning signs of financial decline
  • Five important things to know about aging & finances
  • How to protect aging parents from financial problems
  • What to do if your aging parent is having trouble managing their finances

I’ll also cover some ways that geriatricians and other healthcare providers can help, both to reduce declines in financial ability and to properly evaluate them when they occur.

5 Warning Signs of Financial Decline

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6 Steps to Take When Aging Parents Need Help – Even if They’re Resisting

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getting aging mother to accept help

Have you noticed worrisome changes in your aging parent?

Maybe they’ve been mostly okay but now you’re seeing 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.

For many adult children, these changes lead to mounting questions. What’s wrong? What’s happening? Is it safe for Mom to keep driving? Should Dad live alone much longer?

I think of this as the “uh-oh” stage. It’s a transition no one looks forward to, and most haven’t prepared for: the time when you might have to start helping your aging parent.

And for many, it comes with an added challenge:  Most aging parents don’t welcome much help from their adult children. They may see it as interference, or an invasion of privacy.

Some parents might even refuse to accept that they’re having difficulties, despite issues that feel glaringly obvious—and concerning—to you.

By the time you’re noticing changes and have safety concerns, it’s quite possible that you’re right: that your parent does need help of some kind. So how should you best get involved, especially if your attempts to do so have gone poorly in the past?

Well, it’s certainly not easy. These situations are complicated from a medical and eldercare perspective, plus they tend to bring up difficult emotions for older parents and adult children alike.

But I do believe that it’s crucial for families to get involved. It’s not likely to be easy. But it can be easier, if you’re able to learn the better ways to do so—and also what to stop doing.

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COVID Vaccination for Aging Adults:
What to Know & Do

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COVID is an important issue for older adults: they are more likely to be severely affected by COVID, and they represent most COVID deaths.

Luckily, COVID vaccines are effective and significantly reduce the risk of hospitalization and death in older adults. In particular, I want to offer science-based information to help with common questions, such as “Which COVID vaccine is better for seniors?” or “Which COVID vaccine for a 90-year-old?”

This page covers my older science-based updates on COVID vaccines.

For my latest update, see here: Covid & Aging Adults: Current Vaccines & Updates

 

[Read more…]

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