Q&A: How to Prevent, Detect, & Treat Dehydration in Aging Adults

Q: How can we get my older mother to drink more water? She is susceptible to urinary tract infections and seems to be often dehydrated no matter what we do. We were also wondering if coffee and tea are okay, or should they be avoided to reduce dehydration? And what are symptoms of dehydration in older women that we can look out for?

A: Dehydration is indeed an important problem for older adults. It can be common even when it’s not hot outside.

Helping an older person increase her fluid intake, as you’re trying to do, is one of the best ways to reduce the risk of dehydration.

Now how to actually do this? Studies — and practical experience — suggest that the best approaches include:

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5 Geriatrics Medication Safety Tips for Older Adults

by Leslie Kernisan, MD MPH

Just as we all benefit when we all are better informed about health, everyone involved in the health care of older adults can benefit from learning to think more like a geriatrician.

This means keeping certain guiding principles in mind. It also means watching for certain common pitfalls, when it comes to the medical care of aging adults.

In 2016, the most important principles of geriatric care were distilled down to a “4 Ms” model for age-friendly care:

Mentation: preventing, identifying, treating and managing mental health and cognitive conditions
Mobility: helping older adults avoid falls and remain mobile, for maximum independence
Medication: optimizing medication use to avoid harm and improve health
What Matters: ensuring that medical care addresses what matters most to an older person and is aligned with their specific health goals and care preferences

Problems in aging health are especially common when it comes to medications. So geriatricians always pay attention to what drugs have been prescribed, and why. Then we often improve an older person’s health by suggesting changes to their medications.

In this article, I’ll share five geriatrics medication safety truths that I often find myself explaining to families. They are what I always keep in mind as I do my work, as they are the foundation for better prescribing in aging adults, as well as for checking an older adult’s medications for safety and appropriateness.

I tell people these medication safety truths because I know that most older adults will not have their medications regularly reviewed by a geriatrician or geriatric pharmacist.

But with the right knowledge, you’ll be better prepared to ask your doctors the right questions. This can help them address common oversights, and can improve the safety of your medications.

Here’s what you should know, along with tips on what you can do:

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The Power of Offering Alternatives: a true end-of-life story

by Leslie Kernisan, MD MPH

How might we help a sick older person have a better end-of-life experience? Planning for future health crises and end-of-life situations — a process known as advance care planning — is certainly important.

But, not every health crisis can be completely planned for. And it’s often hard, in the moment, for family members and doctors to figure out how to honor a person’s wishes. Below, I’d like to share a true story about a dangerously ill older woman, who wasn’t on hospice but said she didn’t want to go to the hospital.

The case: To ER or not to ER?

As I puttered around my house one Saturday morning, my pager went off. “Dr. Kernisan? This is Tina from the nursing home. We’re calling you about Mrs. F. She’s 78 and has a diagnosis of advanced lymphoma. She’s been anemic and just got a blood transfusion again a few days ago. She’s now very weak, pale, and her blood pressure is low. Her poop looks red.”

Although by then I had fired up my computer and was remotely logging in to Mrs. F’s chart, this sounded like a no-brainer. I didn’t know Mrs. F personally, but that weekend I was on call by phone for our medical group’s nursing home. From the brief description, Mrs. F sounded critically ill, and was probably bleeding internally. She needed hospitalization ASAP.

“But she says she doesn’t want to go to the ER,” the nurse continued. “She says she hates the hospital and wants to stay in the nursing home.”

This stopped me short. “Is there an advance directive in her chart? Is she usually able to make medical decisions?” I asked.

“It says she is DNR, but it looks like that was just decided a few weeks ago. It says transfer to the hospital is ok. It looks like she’s been offered hospice, but she hasn’t signed up for it. She does usually make medical decisions.”

I frowned at my computer screen, scrolling through Mrs. F’s chart. She definitely sounded dangerously ill. She had to be hospitalized, probably in the Intensive Care Unit.

Or did she?

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Kidney Disease in Aging: Causes, Symptoms, and Treatment

by Leslie Kernisan, MD MPH

Have you been told that you — or an older person you care about — has kidney disease?

If so, you’re not alone: kidney disease is very common in older adults. Almost everyone’s kidney function declines at least a little with aging, with actual chronic kidney disease affecting an estimated 35% of people over age 65.

It’s also fairly common for older adults to develop an “acute kidney injury,” which means the kidneys suddenly start working less well. This often happens during an illness, dehydration, infection, or hospitalization.

Fortunately, in most cases, acute kidney injuries improve, and chronic kidney disease remains fairly manageable, with only a minority of older adults progressing to needing dialysis.

But kidney disease is still important to recognize and monitor, because it can affect medication safety, blood pressure, fluid balance, and overall health.

In this article, I’ll cover what older adults and families should know about kidney disease in aging.

What Do the Kidneys Do?

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What the New Blood Pressure Guidelines — & Research — Mean For Older Adults

by Leslie Kernisan, MD MPH

Are you on medication to lower blood pressure? Or are you caring for an older person with hypertension, also known as high blood pressure?

If so, you are probably wondering just what is the right blood pressure (BP) for older adults.

This is a good question, given that guidelines on blood pressure for older adults changed as a result of the landmark Systolic Blood Pressure Intervention Trial (abbreviated as “SPRINT”).

The SPRINT study first made headlines in part because the findings seemed to contradict expert hypertension guidelines released in December 2013, which for the first time had proposed a higher goal BP (a systolic BP of less than 150mm mercury) for most adults aged 60 or older.

In particular, SPRINT randomly assigned participants — all of whom were aged 50 or older, and were at high risk for cardiovascular events — to have their systolic blood pressure (that’s the top number) treated to a goal of either 140, or 120. Because the study found that people randomized to a goal of 120 were experiencing better health outcomes, the study was ended early.

For those of us who specialize in optimizing the health of older adults, this was obviously an important research development that could change our medical recommendations for certain older adults.

But what about for you, or for your older relative? Do the SPRINT results mean you aim for a BP goal of 120?

Maybe yes, but quite possibly no. In this article, I’ll help you better understand the SPRINT study and results, as well as the side-effects and special considerations for older adults at risk for falls. This way, you’ll better understand how SPRINT’s findings might inform the BP goals that you and your doctors choose to pursue.

Here’s what this post will cover:

What is currently considered “normal” blood pressure for older adults in their 60s, 70s, 80s
What the latest blood pressure guidelines recommend
What to know about the landmark SPRINT blood pressure in older adults trial, including who was included and excluded, and what type of BP medications were used most often
What the actual likelihood of benefits and harms was within SPRINT, and what you might expect if you are similar to the SPRINT participants
Why you probably need to make a change in how your blood pressure is measured before considering a SPRINT-style systolic BP goal of 120
My own approach and how to avoid over-treatment of high blood pressure

I also cover the details of this article in video form on my Youtube channel:

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

by Leslie Kernisan, MD MPH

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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How Sleep Affects Health, & Changes With Aging

by Leslie Kernisan, MD MPH

Sleep. Everybody needs it. Many of us don’t get enough of it.

These are common truths that almost everyone knows. But a few years ago, I had the opportunity to learn quite a bit more about sleep, and how it affects health.

I came away convinced that sleep is a core pillar of health. It deserves more attention from us as doctors, and as individuals concerned about our own health or that of an aging relative.

I also know that sleep problems are very common among family caregivers, and among aging adults. So I was glad to learn more about sleep health, as this has the potential to really help people get through caregiving and aging challenges.

In this article, I’ll share some of the interesting facts I learned about sleep, including how it affects the health of the body and mind, and how it changes with aging.

You may also want to read my related articles:

4 Things To Know About Sleep & Health

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

by Leslie Kernisan, MD MPH

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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10 Things to Know About Delirium

by Leslie Kernisan, MD MPH

Pop quiz: What aging health problem is extremely common, has serious implications for an older person’s health and wellbeing, and can often – but not always – be prevented?

It’s delirium. In my opinion, this is one of the most important aging health problems for older adults to be aware of. It’s also vital for family caregivers to know about this condition, since families can be integral to preventing and detecting delirium.

In this article, I’ll explain just what delirium is, and how it compares to dementia. Then I’ll share 10 things you should know, and what you can do.

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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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The case: To ER or not to ER?

What Do the Kidneys Do?

4 Things To Know About Sleep & Health

5 Key Basics About HIPAA

4 Things to try to help your mother

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