Leslie Kernisan, MD MPH

Vitamin D: What to Know
(& Why to Be Careful About High Doses)

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

That’s understandable. Once touted as the thing to take for health and well-being, vitamin D has actually not been meeting expectations in randomized trials. It’s even been demoted in some expert recommendations.

That said, there is still 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 it’s important to be careful about taking higher doses of vitamin D3.

I’ll also address the following vitamin D frequently asked questions:

How much vitamin D to take every day?
What does vitamin D do?
What to know about the symptoms of vitamin D deficiency
The benefits and side effects of vitamin D
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?

You can also learn more about the surprising risks of too much vitamin D in aging in this video:

Now, when I first wrote this article in 2015, vitamin D supplementation for older adults was recommended by experts — to help reduce the risk of falls and fractures, among other things — although most geriatrics experts did not think the high doses (e.g. 2000 IU daily or more) that many people take are indicated.

(For years now, many people have had unrealistic expectations of what vitamin D can do for them. Sometimes this is because they think it will improve their health. In other cases, it seems to be because their doctors never got around to reducing a higher dose which should’ve only been used for a limited time period. Either way, it’s concerning because taking high doses of vitamin D has been linked to problems, as I explain below.)

Today, experts in geriatrics are reassessing what to recommend for vitamin D supplementation.

This reassessment is in large part driven by the publication of a large randomized trial of vitamin D supplementation in older adults, the VITAL study, plus a few other research studies that have suggested that higher doses of vitamin D supplementation are associated with more falls and hospitalizations.

[Read more…]

Anemia in the Older Adult:
10 Common Causes & What to Ask

by Leslie Kernisan, MD MPH

Have you ever been told that you have anemia, or wondered about anemia symptoms?

Or perhaps you noticed the red blood cell count flagged as “low” in the bloodwork report? Or noticed “low hemoglobin” in a doctor’s report?

Anemia means having a red blood cell count that is lower than normal, and it’s very common in older adults. About 10% of independently living people over age 65 have anemia. And anemia becomes even more common as people get older.

But many older adults and families hardly understand anemia.

This isn’t surprising: anemia is associated with a dizzying array of underlying health conditions, and can represent anything from a life-threatening emergency to a mild chronic problem that barely makes the primary care doctor blink.

Still, it worries me that older adults and families don’t know more about anemia. If you or your relative has this condition, it’s important to understand what’s going on and what the follow-up plan is. (I’ve so often discovered that a patient didn’t know he or she had had anemia!) Misunderstanding anemia can also lead to unnecessary worrying, or perhaps even inappropriate treatment with iron supplements.

Featured Download: What to Ask Your Health Providers About Anemia. Use this free PDF to make sure you ask key questions about your anemia condition, including what’s been done to diagnose the cause, and what the plan is for treatment. Click here to download.

And since anemia is often caused by some other problem in the body, not understanding anemia often means that people don’t understand something else that is important regarding their health.

Fortunately, you don’t have to be a doctor to have a decent understanding of the basics of anemia.

This post will help you understand:

How anemia is detected and diagnosed in aging adults.
Symptoms of anemia.
The most common causes of anemia, and tests often used to check for them.
What to ask the doctor.
How to get better follow-up, if you or your relative is diagnosed with anemia.

You can also watch my video covering Anemia in Aging: Symptoms and Solutions:

[Read more…]

How We Diagnose Dementia: The Practical Basics to Know

by Leslie Kernisan, MD MPH

“Doctor, do you diagnose dementia? Because I need someone who can diagnose dementia.”

A man asked me this question recently. He explained that his 86 year-old father, who lived in the Bay Area, had recently been widowed. Since then the father had sold his long-time home rather quickly, and was hardly returning his son’s calls.

The son wanted to know if I could make a housecall. Specifically, he wanted to know if his father has dementia, such as Alzheimer’s disease.

This is a reasonable concern to have, given the circumstances.

However, it’s not very likely that I — or any clinician — will be able to definitely diagnose dementia based a single in-person visit.

But I get this kind of request fairly frequently. So in this post I want to share what I often find myself explaining to families: the basics of clinical dementia diagnosis, what kind of information I’ll need to obtain, and how long the process can take.

Now, note that this post is not about the comprehensive approach used in multi-disciplinary memory clinics. Those clinics have extra time and staff, and are designed to provide an extra-detailed evaluation. This is especially useful for unusual cases, such as cognitive problems in people who are relatively young.

Instead, in this post I’ll be describing the pragmatic approach that I use in my clinical practice. It is adapted to real-world constraints, meaning it can be used in a primary care setting. (Although like many aspects of geriatrics, it’s challenging to fit this into a 15 minute visit.)

Does this older person have dementia, such as Alzheimer’s disease? To understand how I go about answering the question, let’s start by reviewing the basics of what it means to have dementia.

5 Key Features of Dementia

A person having dementia means that all five of the following statements are true:

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Hospital Delirium: What to know & do

by Leslie Kernisan, MD MPH

“How should delirium be managed in the hospital?”

This question came up during a Q & A session, as we were discussing the Choosing Wisely recommendation to avoid tying down older adults who become confused during a hospitalization.

Delirium is a common and very important problem for all older adults in the hospital. It doesn’t just happen to people with Alzheimer’s or a dementia diagnosis. (And, it’s not the same thing.)

But many family caregivers have hardly heard of hospital delirium. This is too bad, since there’s a lot that family caregivers can do to prevent this serious complication, or at least prevent an older loved one from being physically restrained if delirium does occur.

In this post, I’ll review what older adults and families absolutely should know about hospital delirium. And, we’ll cover some of the things you can do if it happens to your loved one.

[Read more…]

Preventing Falls: 10 Types of Medications to Review if You’re Concerned About Falling

by Leslie Kernisan, MD MPH

Have you been concerned about falls for yourself, or for an aging parent?

If so, do you know if any of your medications might be increasing your risk for falls?

In its Stay Independent brochure, the Centers for Disease Control (CDC) recommends older adults do the following four things to prevent falls:

Ask your doctor or pharmacist to review your medicines.
Begin an exercise program to improve leg strength and balance.
Get annual eye check-ups and update your glasses.
Make your home safer.

In this article, we’ll focus on medications for three reasons:

Medications are among the most common causes of increased fall risk in older people.
Medications are usually among the easiest risk factors to change, when it comes to falls in older adults.
Medication-based risks are often missed by busy regular doctors. Older adults and family caregivers can make a big difference by being proactive in this area.

I want you to understand just what types of medications you and your doctors should be looking for, when you address medication review as part of fall prevention. This article will also explain exactly what to do, once you’ve identified any medications that are associated with falls.

[Read more…]

COVID & Aging Adults: 2025-2026 Updates

by Leslie Kernisan, MD MPH

COVID was really bad when it first came on the scene, especially for older adults, who made up the vast majority of people who were hospitalized or died from the virus.

Things are now much better. This is partly because most of us have now had exposure to COVID, either through having it, being vaccinated, or both. This provides most people with significant protection from the worst effects of COVID.

However, as people get older, their immune system ages and works less well.

This means that even if an older person has had COVID before, it can hit them harder than a few years ago (especially if their health has declined).

So COVID will continue to be an important health issue in geriatrics. Fortunately, the vaccine does significantly reduce the risk of hospitalization or death from COVID.

On this page, I’ll be posting updates related to COVID and older adults. I’ll be focusing on important developments and what I think is most important for older adults and their families to know.

I also have a section below on general COVID safety principles for older adults.

[Read more…]

4 Types of Exercise in Later Life: How to maintain strength, balance, & independence in aging

by Leslie Kernisan, MD MPH

It’s one of those cliches that is true: exercise really is very good for your health.

In fact, one expert in applied longevity wrote that:

“Exercise is by far the most potent longevity ‘drug’. No other intervention does nearly as much to prolong our life span and preserve our cognitive and physical function.” — Peter Attia, MD, in his book “Outlive.” (Note: the emphasis there is mine.)

If you’re an older adult: are you exercising regularly? And if so, are you doing enough of the “right” kinds of exercises?

People are often quite interested in “balance exercises for seniors,” especially if they’ve become concerned about preventing falls. Those are great, but there’s really much more to know and do, when it comes to exercise and aging.

Since exercise is such an essential activity that most older adults are under-using, in this article, I’ll explain what’s most important to know about exercising in later life, including what types of exercise to do.

Specifically, I’ll cover:

The benefits of exercising in aging
What to know about walking for exercise
Four types of exercise to make sure you do
Why balance exercises and strength are key to mobility and preventing falls
Protein intake and strength-building
The risks of exercise in aging and what to ask your doctors
How to avoid getting injured

You can also learn more about aging with strength, independence, and vitality in this video:

[Read more…]

Flu Shots for Older Adults: What to Know & Do for 2025

by Leslie Kernisan, MD MPH

It’s that time of the year: fall, which I think of as flu vaccination time.

I always think getting a flu vaccine is a good idea for most older adults. So I agree with the Centers for Disease Control (CDC), which is urging that people get vaccinated against influenza early in the fall (before the end of October 2025).

Now, vaccination against seasonal influenza can seem like a bit of a tricky topic. Many older adults are skeptical of the need to get a yearly vaccination against influenza. They aren’t sure it will help. Or they think that the vaccination will actually give them a mild case of the flu. Or they just don’t like needles.

Or maybe they aren’t sure which type of seasonal flu shot to get: the regular one or one of the newer “stronger” versions, designed for older adults?

And now that we have COVID-19 to contend with, vaccination for seasonal influenza might feel even more confusing for people.

Don’t let yourself be confused. In this article, I will share with you what I know about influenza vaccination and what I’ve learned about influenza in COVID times. I also have updates on the stronger flu vaccines that are now recommended for older adults.

This year, I agree with the CDC that it’s important for people to get their seasonal flu shot, and if you are an older adult, I recommend getting one of the three flu vaccines specifically recommended for older adults. (See below for more on these!)

Note: If you are age 65 or older and it’s been more than 2 months since your last COVID booster, you may be able to get your COVID fall booster shot at the same time.

In “normal” pre-COVID times, the Centers for Disease Control (CDC) estimates that every year, influenza affects 9-45 million Americans, causes 140,000-810,100 hospitalizations, and results in 12,000-61,000 deaths. In most years, influenza vaccination does help reduce hospitalizations and deaths (I go into details below).

So this year, it’s important to do what you can to reduce respiratory illness, to protect yourself, and to protect others. And getting vaccinated against influenza is one of the things we can do.

In fact, I’m about to go get mine. As a healthy woman in her 40s, I’m not that concerned about getting dangerously ill from influenza. Instead, I get my annual flu shot because I want to minimize my chance of getting sick and perhaps exposing my older patients to influenza.

Here’s what I’ll cover in this article:

The basics of influenza and vaccination against the flu
What we know about influenza and COVID-19
What to know about flu shots for older adults & the CDC’s new recommendations specifically for older adults
What’s new and resources for the 2025-2026 flu season
Which influenza vaccination is probably best for most older adults
What to do if your older parent or relative is unwilling or unable to get vaccinated
Whether it’s more important to get a flu shot or a COVID vaccination (or a booster)

[Read more…]

Why Older People Fall & How to Reduce Fall Risk

by Leslie Kernisan, MD MPH

Why do aging adults fall? 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? I fell recently and am worried it could happen again.”

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. (According to Google, “balance exercises for seniors” is a popular search query; I do like balance exercises in aging, especially when combined with strength training and other exercises.)

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.

And it’s easier to take action once we understand more about why an older person has fallen.

If you want to learn more, you’re in the right place. In this article, 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 person avoid falls, I recommend you learn to better understand why he or she, in particular, might fall.

Why? Because when you understand 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 an older person is likely to fall — and take steps to help them.

[Read more…]

6 Steps to Better High Blood Pressure Treatment for Older Adults

by Leslie Kernisan, MD MPH

Have you been concerned about high blood pressure (hypertension)? Or are you worried about an older relative having a stroke or heart attacks?

You’re not alone. After all, hypertension is the most common chronic condition among older adults, and medications for blood pressure (BP) are among the most commonly taken drugs in the US.

Even more important: poorly controlled hypertension is a major contributor to the most common causes of death and disability in older adults: strokes, heart attacks, and heart failure.

So it’s certainly sensible for older adults – and for those helping aging parents – to think about lowering blood pressure.

And once you start thinking about high blood pressure, you’ll probably start to wonder.

Are the blood pressure medications you’re taking enough? Is your blood pressure at the “right” level or should you and your doctors work on changing things?

And what about that major research – the SPRINT trial — that made the news in 2015? (In this study, older adults randomized to aim for a lower BP did better than those who got “standard” BP treatment.)

These are excellent questions to ask, so I’d like to help you answer them.

Now, I can’t provide exact answers on the Internet. But what I can do is provide a sensible process that will help you successfully address these questions about lowering blood pressure.

In this article, I’ll share with you the process that I use to:

Assess an older person’s blood pressure management plan, and
Determine whether we should attempt changes.

If you’re an older adult, you can use this approach to get started assessing your own BP management plan. This will help you to better work with your doctors on assessing and managing your blood pressure.

If you are helping an older relative manage health, you can follow these steps on behalf of your relative.

[Read more…]

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5 Key Features of Dementia

First, understand why older people fall

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