Better Health While Aging

Practical information for aging health & family caregivers

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

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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 

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

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blood pressure monitor and medications

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 have changed, especially due to the results 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 should talk to the doctor about changing your BP medications?

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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10 Things to Know About Delirium

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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.

What is Delirium

Delirium is a state of worse-than-usual mental confusion, brought on by some type of unusual stress on the body or mind. It’s sometimes referred to as an “acute confusional state,” because it develops fairly quickly (e.g., over hours to days), whereas mental confusion due to Alzheimer’s or another dementia usually develops over a long time.

The key symptom of delirium is that the person develops difficulty focusing or paying attention. Delirium also often causes a variety of other cognitive symptoms, such as memory problems, language problems, disorientation, or even vivid hallucinations. In most cases, the symptoms “fluctuate,” with the person appearing better at certain times and worse at other times, especially later in the day.

Delirium is usually triggered by a medical illness, or by the stress of hospitalization, especially if the hospitalization includes surgery and anesthesia. However, in people who have especially vulnerable brains (such as those with Alzheimer’s or another dementia), delirium can be provoked by medication side-effects or less severe illnesses.

It’s much more common than many people realize: about 30% of older adults experience delirium at some point during a hospitalization.

That confusion after surgery that older adults often experience? That’s delirium.

The way your elderly mother with dementia gets twice as confused when she has a urinary tract infection? That’s delirium too.

Or the common phenomenon of “ICU psychosis”? That too is delirium.

What Causes Delirium?

In older adults, delirium often has multiple causes and contributors. These can include:

  • Infection (including UTI, pneumonia, the flu, COVID)
  • Other serious medical illness (e.g. heart attack, kidney failure, stroke, and more)
  • Metabolic imbalances (e.g. abnormal blood levels of sodium, calcium, or other electrolytes)
  • Dehydration
  • Medication side-effects
  • Sleep deprivation
  • Uncontrolled pain
  • Sensory impairment (e.g. poor vision and hearing, which can worsen if the person is lacking their usual glasses or hearing aids)
  • Alcohol withdrawal

Delirium vs. Dementia

People often confuse delirium and dementia (such as Alzheimer’s disease), because both conditions cause confusion and appear superficially similar. Furthermore, people with dementia are actually quite prone to develop delirium. That’s because delirium is basically a reflection of the brain going haywire when it gets overloaded by the stress of illness or toxins, and brains with dementia get overloaded more easily.

In fact, the more vulnerable a person’s brain is, the less it takes to tip them into delirium. So a younger person generally has to be very very sick to become delirious. But a frail older person with Alzheimer’s might become delirious just from being stressed and sleep-deprived while in the hospital.

Why Delirium is Such an Important Problem

There are three major reasons why delirium is an important problem for us all to prevent, detect, and manage.

First, delirium is a sign of illness or stress on the body and mind. So if a person becomes delirious, it’s important to identify the underlying problems – such as an infection or untreated pain – and correct them, so that the person can heal and improve.

The second reason delirium is important is that a confused person is at higher risk for falls and injuries during the period of delirium.

The third reason is that delirium often causes serious consequences related to health and well-being.

In the short term, delirium increases the length of hospital stays, and has been linked to a higher chance of dying during hospitalization. In the longer term, delirium has been linked to worse health outcomes, such as declines in independence, and even acceleration of cognitive decline.

Now let’s cover 10 more important facts you should know about delirium, especially if you’re concerned about an aging parent or other older relative.

10 Things to Know About Delirium, and What You Can Do

1.Delirium is extremely common in aging adults.

Almost a third of adults aged 65 and older experience delirium at some point during a hospitalization, with delirium being even more common in the intensive care unit, where it’s been found to affect 70% of patients. Delirium is also common in rehabilitation units, with one study finding that 16% of patients were experiencing delirium.

Delirium is less common in the outpatient setting (e.g. home, assisted-living, or primary care office). But it still can occur when an older adults gets sick or is affected by medications, especially if the person has a dementia such as Alzheimer’s.

What to do: Learn about delirium, so that you can help your older loved ones reduce the risk, get help quickly if needed, and better understand what to expect if someone does develop delirium. You should be especially be prepared to spot delirium if your parent or loved one is hospitalized, or has a dementia diagnosis. Don’t assume this is a rare problem that probably won’t affect your family. For more on hospital delirium, see Hospital Delirium: What to know & do.

2. Delirium can make a person quieter.

Although people often think of delirium meaning as a state of agitation and or restlessness, many older delirious people get quieter instead. This is called hypoactive delirium. It’s still linked with difficulty focusing attention, fluctuating symptoms, and worse than usual thinking. It’s also linked with poor outcomes. But it’s of course harder for people to notice, since there’s little “raving” or restlessness to catch people’s attention.

What to do: Be alert to those signs of difficulty focusing and worse-than-usual confusion, even if your older person seems quiet and isn’t agitated. Tell the hospital staff if you think your relative may be having hypoactive delirium. In the hospital, it’s normal for older patients to be tired. It’s not normal for them to have a lot more difficulty than usual making sense of what you say to them.

3. Delirium is often missed by hospital staff.

Despite the fact that delirium is extremely common, it is often missed in hospitalized older adults, with some reports estimating it’s being missed 70% of the time. That’s because busy hospital staff will have trouble realizing that an older person’s confusion is new or worse-than-usual. This is especially true for people who either look quite old – in which case hospital staff may assume the person has Alzheimer’s – or have a diagnosis of dementia in their chart.

What to do: You must be prepared to speak up if you notice that your family member isn’t in his or her usual state of mind. Hypoactive delirium is especially easy for hospital staff to miss. Hospitals are trying to improve delirium prevention and detection, but we all benefit when families help out. Remember, no hospital person knows your older person the way that you do.

4. Delirium can be the only outward sign of a potentially life-threatening problem.

Although delirium can be brought on or worsened by “little things” such as sleep deprivation or untreated constipation, it can also be a sign of a very serious medical problem. For instance, older adults have been known to become delirious in response to urinary tract infections, pneumonia, and heart attacks.

In general, it tends to be older persons with dementia who are most likely to show delirium as the only outward symptom of a very serious medical illness. But whether or not your older relative has dementia, if you notice delirium, you’ll want to get a medical evaluation as soon as possible.

What to do: Again, if you notice new or worse-than-usual mental functioning, you must bring it up and get your older loved one medically evaluated without delay. For older adults who are at home or in assisted -living, you should call the primary care doctor’s office, so that a nurse or doctor can help you determine whether you need an urgent care visit versus an emergency room evaluation.

5. Delirium often has multiple underlying causes.

In older adults with delirium, we often end up identifying several problems that collectively might be overwhelming an older person’s mental resilience. Along with serious medical illnesses, common contributors/causes for delirium include medication side effects (especially medications that are sedating or affect brain function), anesthesia, blood electrolyte imbalances, sleep deprivation, lack of hearing aids and glasses, and uncontrolled pain or constipation. Substance abuse or withdrawal can also provoke delirium.

What to do: To prevent delirium, learn about common contributors and try to avoid them or manage them proactively. For instance, if you have a choice regarding where to hospitalize an older person, some hospitals have “acute care for elders” units that try to minimize sleep deprivation and other hospital-related stressors. If your older relative does develop delirium, realize that there is often not a single “smoking gun” when it comes to delirium. A good delirium evaluation will attempt to identify and correct as many factors as possible.

6. Delirium is diagnosed by clinical evaluation.

To diagnose delirium, a doctor first has to notice – or be alerted to – the fact that a person may not be in his or her usual state of mind. Experts recommend that doctors then use the Confusion Assessment Method (CAM), which describes four features that doctors must assess. Delirium can be diagnosed if a patient’s symptoms include “acute onset and fluctuating course,” “difficulty paying attention,” and then either “disorganized thinking” or “altered level of consciousness.”

Delirium cannot be diagnosed by lab tests or scans. However, if an older adult is diagnosed with delirium, doctors generally should order tests and review medications, in order to identify factors that have caused or worsened the delirium.

What to do: Again, the most important thing for you to do is to get help for your loved one if you notice worse-than-usual confusion or difficulty focusing. Although families have historically not had a major role in delirium diagnosis, delirium experts have developed a family version of the CAM (FAM-CAM), which is designed for non-clinicians and has been shown to help detect delirium.

7. Delirium is treated by identifying and reversing triggers, and providing supportive care.

Delirium treatment requires a care team to take a three-pronged approach.

  1. Health providers must identify and reverse the illness or problems provoking the delirium.
  2. They have to manage any agitation or restless behavior, which can be tricky since a fair number of sedating medications can worsen delirium.
    1. The safest approach is a reassuring presence (family is best, but hospitals sometimes also provide a “sitter”) to be with the person, plus improve the environment if possible (e.g. a room with a window and natural light).
    2. The once-popular practice of physically restraining agitated older adults has been shown to sometimes worsen delirium, and should be avoided if possible.
  3. The care team needs to provide general supportive care to help the brain and body recover.

What to do: The reassuring presence of family is often key to providing a supportive environment that promotes delirium recovery. You can also help by making sure your loved one has glasses and hearing aids, and by alerting the doctors if you notice pain or constipation. Ask the clinical team how you can assist, if restlessness or agitation are an issue. Bear in mind that physical restraints should be avoided, as there are generally safer ways to manage agitation in delirium.

8. It can take older adults a long time to fully recover from delirium.

Most people are noticeably better within a few days, once the delirium triggers have been addressed. But it can take weeks, or even months, for some aging adults to fully recover.

For instance, a study of older heart surgery patients found that delirium occurred in 46% of the patients. After 6 months, 40% of those who had developed delirium still hadn’t recovered to their pre-hospital cognitive abilities.

What to do: If your parent or someone you love is diagnosed with delirium, don’t be surprised if it takes quite a while for him or her to fully recover. It’s good to be prepared to offer extra help during this period of time. You can facilitate recovery by creating a restful recuperation environment that minimizes mental stress and promotes physical well-being.

9. Delirium has been associated with accelerated cognitive decline and with developing dementia.

This is unfortunate, but true, especially in people who already have Alzheimer’s or another type of dementia. A 2009 study found that in such persons, delirium during hospitalization is linked to a much faster cognitive decline in the following year. A 2012 study reached similar conclusions, estimating that cognition declined about twice as quickly after delirium in the hospital.

In older adults who don’t have dementia, studies have found that delirium increases the risk of later developing dementia.

What to do: Experts aren’t sure what can be done to counter this unfortunate consequence of delirium, other than to try to optimize brain well-being in general. (For this, I suggest avoiding risky medications, getting enough exercise and sleep, being socially and intellectually active, and avoiding future delirium if possible; learn more here.)

The main thing to know is that delirium has serious consequences, so it’s often worth it for a family to be careful about surgery in an older person, and it’s good to learn about delirium prevention (see below).

10. Delirium is preventable, although not all cases can be prevented.

Experts estimate that delirium is preventable in about 40% of cases. Preventive strategies are meant to reduce stress and strain on an older person, and also try to minimize delirium triggers, such as uncontrolled pain or risky medications.

In the hospital setting, programs such as the Hospital Elder Life Program (HELP) for Prevention of Delirium have been shown to work. For ideas on how families can help, see this family tip sheet from the Hospital Elder Life Program. For instance, families can help reorient a relative in the hospital, ensure that glasses and hearing aids are available, and provide a reassuring presence to counter the stress of the hospital setting.

Less is known about preventing delirium in the home setting. However, since taking anticholinergic medications (such as sedating antihistamines) has been linked with hospitalizations for confusion, you can probably prevent delirium by learning to spot risky medications your parent might be taking.

What to do: To prevent hospital delirium, carefully weigh the risks and benefits before proceeding with elective surgery. If your older loved one must be hospitalized, choose a facility using the HELP program or with an Acute Care for Elders unit if possible. Be sure to read HELP’s tips for families on preventing hospital delirium.

Remember, delirium is common and can be the only outward sign of a serious medical problem.

By educating yourself and helping your older loved ones be proactive about prevention, you can reduce the chance of harm from this condition.

And if you do notice symptoms of delirium, make sure to tell the doctors! This will help your parent get the evaluation and treatment that he or she needs.

Useful Online Resources Related to Delirium

Here are links to some of the resources I reference in the article:

Last but not least, for my previous posts on delirium:

This article was reviewed and updated in January 2025. 

Respiratory Syncytial Virus: What to Know About RSV & RSV Vaccines in Aging

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It used to be that influenza was the main respiratory virus that got a lot of attention during the wintertime.

But now there’s another one that’s become known for its potential to cause serious illness in older adults: respiratory syncytial virus (RSV).

Unlike COVID-19, which only appeared in the U.S. in 2020, RSV has actually been around for decades. However, until recently, many doctors treated it mostly as a pediatric concern, because RSV is a top cause of hospitalization in young children.

This is now changing. RSV is actually similar to the flu, or even COVID, in that it’s older adults (along with young children) who are most likely to get dangerously ill.

Hence, this is a respiratory virus that all older adults should know about.

Furthermore, in 2023, the FDA approved the first RSV prevention shots for people aged 60 or older. As of 2024, there are three RSV vaccines licensed for use in the US, for adults ages 60 and older.

So in this article, I’ll explain what is RSV, and what older adults and families should know about it.

What is RSV (Respiratory Syncytial Virus)?

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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

[Read more…]

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.

[Read more…]

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