Kidney Disease in Aging: Causes, Symptoms, and Treatment

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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Heart Failure in Aging: Symptoms, Types, Causes & Treatments

by Leslie Kernisan, MD MPH

Have you been told that you — or someone important to you — has heart failure?

This wouldn’t surprise me, as this is one of the most common heart conditions affecting older adults. People are sometimes alarmed by the term “heart failure”; does it mean the heart is about to stop working? Luckily, that’s not usually the case.

Heart failure actually means that the heart is not pumping or filling as well as it should. This can affect how well blood moves through the body, and it can lead to symptoms such as shortness of breath, fatigue, swelling, and reduced ability to exercise.

Heart failure can be serious, and it is important to take it seriously. But it is also a condition that many older adults live with for years, especially when it is properly diagnosed and treated.

In this article, I’ll explain:

What heart failure means
The main types of heart failure
Common causes in older adults
Symptoms to watch for
How heart failure is diagnosed
How it is treated and managed
What to know if an older person is frail
Questions to ask the doctor

This information is based on a Better Health While Aging video podcast conversation with cardiologist Cara Pellegrini, MD, who is a professor at UCSF.

What Is Heart Failure?

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How to Help Doctors Notice What’s Wrong: The story of the missed pelvic fracture

by Leslie Kernisan, MD MPH

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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What is “Successful Aging”?

by Leslie Kernisan, MD MPH

Every May, the Administration for Community Living leads the national observance of “Older Americans Month.” The theme this year is “Champion Your Health.”

But to be honest, I prefer the theme from 2018, which was “Engage at Every Age.”

And I found myself thinking that this would be a nice opportunity to consider: just what does it mean to “succeed” or do well as an older adult?

This is important, because our understanding of what is “success,” and what to strive for, is fundamental to how we judge ourselves and others.

And for us as a society, articulating what’s involved in experiencing “good” or “successful” aging is important because it can help us understand what kinds of things we should focus on, to help more older adults age well, or otherwise “succeed” in late-life.

So, just as philosophers and others have long debated what it means to “live a good life,” we should ask ourselves what it means to “succeed” as an older adult.

This way, we can know whether we are “succeeding” as a society that supports and values its older population.

I also did a video elaborating on what it means to be “aging successfully”, which can be found on my Youtube channel.

What IS “successful aging?”

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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

What Is Heart Failure?

The case: unable to walk after a fall

What IS “successful aging?”

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