Leslie Kernisan, MD MPH

Vitamin D: the Healthy Aging Dose
(Plus Answers to 7 FAQs)

Confused by all the back and forth in the media about vitamin D?

Don’t be. There’s actually a pretty easy and straightforward approach that most older adults can take.

In this post, I’ll explain what I recommend to most of my older patients, and why.

I’ll also address the following frequently asked questions:

Which type of Vitamin D should I take?
Do I need to have my vitamin D blood level checked?
What should one’s vitamin D level be?
Will vitamin D really prevent falls or fractures?
Will vitamin D prevent dementia, cancer, and/or premature death?
I am outside a lot. Do I need a vitamin D supplement?
I heard that a higher level of vitamin D is better for you. How much is too much?

By the way, I maintain this post in part because a few years back, I was disappointed by the recent NY Times article “Why Are So Many People Popping Vitamin D?”

Among other things, that article should have had a different headline. The key problem the article described is that there are too many people being tested for vitamin D. The article did not make the case that too many people are taking vitamin D supplements.

In fact, vitamin D supplementation remains recommended by experts. And as I’ll explain below, there are good reasons to believe that vitamin D supplementation is especially useful for older adults. [Read more…]

Incompetence & Losing Capacity:
Answers to 8 FAQs

by Leslie Kernisan, MD MPH 120 Comments

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: [Read more…]

3 Ways to Prevent Injury From a Fall
(Plus 2 Ways That Don’t Work as Well as You’d Think)

by Leslie Kernisan, MD MPH 15 Comments

$elderly person falling hip fracture$ Worried about falls in an older person?

You’re right to be concerned, especially if the older person has already experienced a fall. Research suggests that falling once doubles your chance of falling again.

And falls, as everyone knows, can cause life-changing injuries. The Centers for Disease Control (CDC) reports that:

One out of five falls causes a serious injury such as broken bones or a head injury
Each year at least 300,000 older people are hospitalized for hip fractures
More than 95% of hip fractures are caused by falling, usually by falling sideways
Falls are the most common cause of traumatic brain injuries

For these reasons and more, preventing falls is a major focus of preventive care for older adults, and is a big part of what we do in geriatrics. (Learn more about how we do this in this article: Why Older People Fall & How to Reduce Fall Risk.)

But if we want to protect older people from the potentially devastating consequences of falls, it’s not enough to help them reduce falls.

We also need to think about how we can reduce the likelihood of injury from a fall.

In this article, I’ll share with you three approaches that can help reduce fall-related injuries.

Then I’ll address two other approaches that are sometimes tried, but are less likely to help.

3 ways to prevent fractures and other injuries related to falls

[Read more…]

5 Types of Medication Used to Treat Difficult Dementia Behaviors

by Leslie Kernisan, MD MPH 179 Comments

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

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

Delusions, 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.

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…]

Why Older People Fall & How to Reduce Fall Risk

by Leslie Kernisan, MD MPH 98 Comments

To be honest, people don’t usually ask me this.

Instead, they want to know things like “How do I keep my mother from falling?” or “What should I do? My grandfather’s been falling.”

After all, falls are a scary thing. Most people know that falls are dangerous for older adults.

The Center for Disease Control (CDC) reports that one in five falls causes a serious injury such as a broken bone or head injury. Fear of falling can also seriously affect an aging adult’s quality of life and sadly, can keep a person from being active and thriving.

So, many older adults and family caregivers are interested in fall prevention because the risks are so great. And the good news is that although it’s not possible to prevent all falls, it almost always IS possible to take actions that will reduce the chance of a bad fall.

If you want to learn more, you’re in the right place.

In this post, I’ll cover:

How understanding why aging adults fall can help you keep an older parent — or yourself — safer,
Why personalized fall prevention plans work better than relying on general fall prevention tips,
The four-step process I use to help older adults prevent falls,
A practical example showing you how to use these steps to avoid falls yourself.

First, understand why older people fall

There are many reasons that aging adults fall. Most older people will be falling due to their own unique combination of reasons.

So how, exactly, should YOU go about reducing fall risk?

Now, you can — and should — try to implement the general tips that are often listed in most fall prevention resources: exercise, medication review with the doctor, vision checks, and home safety reviews.

But if you really want to help an older loved one avoid falls, I recommend you learn to better understand why he or she, in particular, might fall.

Why? Because when you understanding the specific reasons an older person may be falling, you’ll then be able to:

Identify which fall prevention strategies are most likely to help the person you worry about,
Recognize risky situations, and take steps to avoid them,
Know which medical conditions — and which medications — to ask your doctors to look into,
Understand what may have caused a specific fall, which can help you avoid future falls.

In other words, learning why older people fall means that you’ll be able to figure out why YOUR older relative is likely to fall — and take steps to help them. [Read more…]

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3 ways to prevent fractures and other injuries related to falls

First, understand why older people fall

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