Blog - Better Health While Aging

How to Avoid Problems Due to Aging Incapacity: The (Better) Durable General Power of Attorney

One of the most common concerns I hear from people is “My older parent’s behavior is concerning me and I’m worried about her mental abilities.”

As I explained in a related article: it’s not always dementia but often it is. And unless an older person has done a good job planning ahead, it can be very hard and messy for others to intervene as needed.

But hopefully, that’s not yet your situation.

In which case, you might be wondering: Given that it’s so common for aging adults to eventually start slipping mentally — or to be suddenly disabled due to an accident or serious health crisis — what kind of planning should older adults and families do to avoid this kind of situation?

I’ve done some research on this question, and here’s what I found out.

One of the simplest — and often less expensive — smart planning approaches is for an older adult to complete a general durable power of attorney (POA) document.

Especially if the powers granted are broad — which they often are — a POA can enable the designated person (known as the “agent”) to step in and assist with finances, housing, safety, and anything else covered by the POA .

A durable POA allows an agent to take action once the older person is “incapacitated.” In California, such POAs can be used to move a person with dementia to a different living arrangement.

Now, the durable power of attorney approach isn’t perfect. Over the years, I’ve noticed that two broad categories of problems come up:

Concerns as to whether the agent might be using the POA to financially exploit the situation
Issues related to determining incapacity and whether the older person should be overridden.

In truth, I have occasionally encountered situations in which different doctors had different opinions on whether an older person was incapacitated. This troubles me, because agents should really only be stepping in and overriding older adults if we’re all sure they’ve lost capacity and are making decisions that don’t serve their overall goals, or are hazardous to others.

Still, a general durable POA is an excellent approach to consider. But I would recommend you pay special attention to how the document is drafted, in order to reduce the risk of financial exploitation and to avoid pitfalls related to determining incapacity.

In this post, I will share:

What I’ve learned about general durable power of attorney documents
Why determining incapacitation is often problematic in the real world
Tips on avoiding a common POA weakness
What to know about including third-party accounting and other strategies recommended by the American Bar Association, to reduce the risk of financial exploitation by an agent
Useful resources I’ve found online for more information

[Read more…]

5 Questions to Ask Yourself on National Healthcare Decisions Day

by Leslie Kernisan, MD MPH 9 Comments

Since 2008, April 16th has been designated as “National Healthcare Decisions Day” (NHDD).

It’s an initiative meant to “inspire, educate and empower the public and providers about the importance of advance care planning.”

In other words, National Healthcare Decisions Day is meant to get you to plan for your future…a future time during which you might be ill and others — most likely your family — will have to make decisions about your healthcare.

This is not a particularly unlikely scenario. Between the present-at-all-ages possibility of being in a bad accident and the increased likelihood of illness as one ages, you’d actually have to be quite lucky — or unlucky, depending on how you see it — to reach the end of your life without anyone else ever having to make a medical decision on your behalf.

Still, studies and surveys generally find that many of us have not taken the needed steps to “make our wishes known.”

And even among those who have “made their wishes known,” there’s usually more to it than they realize, and they often have skipped an important piece of the process. [Read more…]

Medications Older Adults Should Avoid or Use with Caution:
The American Geriatrics Society Beers Criteria (2019 Update)

by Leslie Kernisan, MD MPH 18 Comments

Today we’re covering a touchstone resource for geriatricians: the “Beers List” of medications that older adults should avoid or use with caution.

(Technically, it’s called “The AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults.” I personally think of it as the list of “risky medications” for older adults.)

If you want to know which medications older adults, in particular, should be careful with, this is the list!

Now, I have good news and bad news about the Beers criteria.

The good news is that they were just updated and revised, so the Beers Criteria published in January 2019 is about as up-to-date as you can get for this type of guideline document. (Yay!)

The bad news is that this year, the American Geriatrics Society (AGS), which has historically made the list freely available to the public on HealthinAging.org, has not released the updated information for free on its page about the Beers Criteria. (Bummer!)

Instead, they’ve posted a notice that “To access the complete AGS Beers Criteria^® and its related resources, please visit GeriatricsCareOnline.org.” From there, the article is available for purchase.

(My suggestion for those who really want the list: consider getting the handy 2019 AGS Beers Criteria® Pocketcard, which is $9.99. Or, ask your health provider to print it for you.)

I think it’s really too bad that it’s become harder for regular people to access this wonderful resource, but oh well.

Whether or not you obtain access to the full 2019 Beers Criteria, I still think it’s important for older adults and families to at least be aware that this resource exists, and to understand how it can help make the medical care of older adults safer.

You absolutely should know that experts in geriatrics and in medication safety go through a very careful process of reviewing the research on medications, and of updating this list of medications that older adults should avoid or use with caution.

So in this article, here’s what I’ll be sharing with you: [Read more…]

How to Make Hospitalization Better & Safer in Aging

by Leslie Kernisan, MD MPH 10 Comments

As you may know, hospitalization is actually somewhat risky for older adults.

This is sometimes surprising to older adults and families. After all, hospitals are supposed to be places where people who are ill or injured can get the medical supervision and services that they need, to recover and be restored to health.

Well, it’s certainly true that hospitalization is often the only way for a person to obtain more substantial care from nurses and doctors. (There actually is an alternative called Hospital at Home, but it’s not widely available.)

If you’ve broken a hip, or have developed really significant shortness of breath from pneumonia, or otherwise are too unwell to be safely treated in the outpatient setting, hospitalization is often necessary. And since aging increases one’s vulnerability to a variety of health problems, older adults get hospitalized at higher rates than younger people do.

The problem, however, is that although hospitalization is intended to help patients, we’ve also realized that it tends to stress the body and mind in many ways. This is hard on every patient, but especially affects older adults. For instance: [Read more…]

9 Types of Issues to Address When Helping Older Parents

by Leslie Kernisan, MD MPH 25 Comments

Aging Parents To Do List Most older adults don’t need much help from others.

In fact, many of them are quite busy assisting others and otherwise contributing to their families, communities, and/or workplaces.

But of course, many older people eventually do need some help from others, especially if they live into their 80s, 90s, or beyond. After all, only a minority of people transition from being fully independent to deceased, with no intervening period of needing assistance.

When an older person does start to need help, it tends to be close family members — assuming the person has family — that step in: spouses, adult children, siblings, nephews or nieces, grandchildren, and so forth. In fact, family members are by far the number one source of “long-term care supports and services” for older adults.

Sometimes providing this support can be fairly straightforward: a little help with transportation, or arranging for some assistance with shopping or household chores.

But in other cases, family members find themselves having to take on quite a lot. This is often due to health issues affecting the older person’s ability to remain independent and manage various aspects of life.

Some situations that commonly bring this on include: [Read more…]

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