Featured Archives - Better Health While Aging

Beyond Alzheimer’s:
Common Types of Dementia in Aging

Are you dealing with a diagnosis of dementia?

If so, you might be wondering what type of dementia you are dealing with. Or, perhaps you’ve heard someone say it’s important to find out what type of dementia it is.

It’s true that there certainly are different types of dementia, and it’s often said that the most common one is Alzheimer’s disease.

But actually, especially as people get to be age 80 or older, by far the most common type of dementia is mixed dementia. Meaning, the dementia symptoms are caused by a mix of types.

If you are dealing with memory loss or other forms of cognitive decline, it’s a good idea to know the basics about the different types of dementia.

In this article, I’ll cover:

What is dementia and what’s the difference between Alzheimer’s and dementia
The most common types of dementia in older adults
When it might be important to find out what type of dementia it is
My usual approach to using dementia type to help patients

You can also watch my video covering Common Types of Dementia in Aging:

What is dementia?

[Read more…]

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…]

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…]

Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check

by Leslie Kernisan, MD MPH

Have you been worried about an older person’s memory or thinking abilities?

Maybe your parent has seemed more confused recently. Or you may have noticed that your aging spouse is repeating herself, or struggling to do things that didn’t use to pose much of a problem.

Or you may have noticed false accusations, or irrational worries getting out of control.

These are very common concerns, and they often lead to questions such as:

Is this normal aging or something more significant?
What is wrong?
Could this be Alzheimer’s? Or some other form of dementia?
Can these memory problems be treated or reversed?
What should we do about this??

The answer to the last question is this: if you are worried about memory or thinking, then you should seek out some kind of medical evaluation.

That’s because when families worry about an older person’s cognitive abilities, there often are some underlying health issues affecting the mind’s function.

Those need to be detected, and treated if at all possible. So, you’ll need to request help from a health professional, and in this article, I’ll explain what that initial help should consist of. This way you’ll know what to expect, and what the doctor might ask you about.

Technically, these kinds of problems are called “cognitive impairment.” This is a broad term that means some kind of problem or difficulty with one’s memory, thinking, concentration, and other functions of the conscious brain, beyond what might be expected due to normal “cognitive aging.”

(For more on “cognitive aging” and what types of changes are considered normal aging, see this article: 6 Ways that Memory & Thinking Change with Normal Aging, & What to Do About This.)

Cognitive impairment — which is also called “cognitive decline” — can come on suddenly or gradually, and can be temporary or more permanent. It may or may not keep getting slowly worse; it all depends on the underlying cause or causes.

In this article, I’ll share with you the more common causes of cognitive impairment in older adults.

I’ll then share a list of 10 things that should generally be done, during a preliminary medical evaluation for cognitive decline in an older adult.

You can also watch a subtitled video version of this information below.

[Read more…]

COVID & Aging Adults: 2023-2024 Updates

by Leslie Kernisan, MD MPH

Since the COVID-19 pandemic emerged in early 2020, COVID has become one of the top causes of illness and death in the US, and has especially impacted aging adults, for both health and social reasons.

Older age is one of the top risk factors for severe COVID; it’s even a stronger risk factor than vaccination status. So this is an important issue for us to follow in geriatrics.

On this page, I’ll be posting updates related to COVID and older adults, for 2023. I’ll be focusing on important developments and what I think is most important for older adults and their families to know, to be safer and manage these COVID times we are living through.

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

Covid & Aging Adults: COVID News 2023-2024

COVID winter update December 20, 2023

As anticipated, we are seeing a substantial rise in COVID activity this month. This can be seen in wastewater and we’re also seeing a rise in hospitalizations.

What is a little more worrisome is that a new variant, JN.1, now seems to be taking off in the US. This variant has been active in Europe, where it is causing a marked exponential spike in COVID wastewater levels.

We are also seeing a fair amount of RSV circulating, plus some influenza.

For more on the state of these respiratory viruses, I highly recommend reading this update by epidemiologist Katelyn Jetelina, MPH PhD: State of Affairs: Dec 19, 2023.

All three of these viruses (COVID, RSV, influenza) can hospitalize vulnerable older adults 🙁

So as you consider holiday travel and gatherings, here are my recommendations:

Avoid gathering with others inside if you have cold symptoms (or anything worse). If you need to gather, consider wearing a mask and be sure to ventilate the space with a HEPA air filter (or open windows).
Consider rapid tests for COVID before having a gathering with vulnerable older adults.
Wear a N95 or KN95 when traveling on planes or other forms of crowded public transit.
- Consider a mask when in malls or other crowded indoor spaces.
People over age 65 should get the 2024 COVID vaccine (if they haven’t yet had it), for renewed protection against hospitalization.
- The exception is if you’ve actually had COVID within the past few months; that’s like getting a booster but much more effective.
Paxlovid still works. Older adults should request it if they test positive for COVID.

COVID fall vaccine update September 21, 2023

The CDC announced recently that new COVID vaccines are available for the 2023-2024 season.

They are recommended for everyone over the age of 6 months, and are especially recommended for adults over the age of 65.

This fall, the COVID vaccine is a monovalent vaccine based on the XBB.1.5 subvariant of Omicron (which was the most prevalent variant at the beginning of the summer). Although there are different Omicron subvariants currently circulating, the XBB.1.5 is expected to provide good protection against hospitalization and deaths.

If you are a details and data person, you can find the slides presented at the 9/12/23 CDC meeting here.

Learn more about the new fall COVID vaccines here: CDC: Stay Up to Date with COVID-19 Vaccines.

I highly recommend that adults aged 65+ get this updated COVID vaccine, especially if they have not had COVID in the past 4 months.

I also recommend that aging adults get their annual flu shot (get one of the stronger ones recommended for older adults) and consider the new RSV vaccine for older adults.

Otherwise, my recommendations for how to stay safe in regards to COVID have not changed since my most recent video update from August, which you can view below.

Here is my most recent video update, from August 14, 2023: [Read more…]

Is Your Aging Parent OK?
What to check & how to talk about it

by Leslie Kernisan, MD MPH

Have you been getting worried about your aging parent, or wondering if they are ok continuing to live as they are?

Maybe they’ve been mostly okay but now you’re spotting some 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.

When families notice these types of changes, it’s often really hard to know what to do next. How do you know if they really need help or not, and what kind of help to get? And what do you do if they refuse to discuss it, or get mad when you bring it up?

Since this is such a common dilemma for families, I’ve recorded a video, explaining exactly what you can do, if you’ve noticed some worrisome changes in your parent and are trying to figure out what to do next. Here’s how to know if your aging parent needs help, and how to talk to them about your concerns.

This video covers:

[Read more…]

4 Types of Brain-Slowing Medication to Avoid if You’re Worried About Memory

by Leslie Kernisan, MD MPH

A few years ago, while I was at a family celebration, several people mentioned memory concerns to me.

Some were older adults concerned about the memory of their spouses. Some were adult children concerned about the memory of their parents. And a few were older adults who have noticed some slowing down of their own memory.

“But you know, nothing much that can be done at my age,” remarked one man in his eighties.

Wrong. In fact, there is a lot that can and should be done, if you notice memory or thinking changes in yourself or in another older adult. And you should do it because it ends up making a difference for brain health and quality of life.

First among them: identify medications that make brain function worse.

This is not just my personal opinion. Identifying and reducing such medications is a mainstay of geriatrics practice. Among other reasons, we do find that in some people, certain medications are causing memory loss symptoms — or other cognitive symptoms — to be worse.

And the expert authors of the National Academy of Medicine report on Cognitive Aging agree: in their Action Guide for Individuals and Families, they list “Manage your medications” among their “Top 3 actions you can take to help protect your cognitive health as you age.”

Unfortunately, many older adults are unaware of this recommendation. And I can’t tell you how often I find that seniors are taking over-the-counter or prescription medications that dampen their brain function. Sometimes it’s truly necessary but often it’s not.

What especially troubles me is that most of these older adults — and their families — have no idea that many have been linked to developing dementia, or to worsening of dementia symptoms. So it’s worth spotting them whether you are concerned about mild cognitive impairment or caring for someone with full-blown Alzheimers.

Every older adult and family should know how to optimize brain function. Avoiding problem medications — or at least using them judiciously and in the lowest doses necessary — is key to this.

And don’t give anyone a pass when they say “Oh, I’ve always taken this drug.” Younger and healthier brains experience less dysfunction from these drugs. That’s because a younger brain has more processing power and is more resilient. So drugs that aren’t such problems earlier in life often have more impact later in life. Just because you took a drug in your youth or middle years doesn’t mean it’s harmless to continue once you are older.

You should also know that most of these drugs affect balance, and may increase fall risk. So there’s a double benefit in identifying them, and minimizing them.

Below, I share the most commonly used drugs that you should look out for if you are worried about memory problems.

Featured Download: Get my free list of medications that can affect memory and thinking in aging adults. This handy PDF includes all the medications I usually check for. Click here to download.

The Four Most Commonly Used Types of Medications That Dampen Brain Function

[Read more…]

8 Things to Have the Doctor Check After an Aging Person Falls

by Leslie Kernisan, MD MPH

If you want to prevent dangerous falls in an aging adult, here’s one of the very best things you can do: be proactive about getting the right kind of medical assessment after a fall.

Why? There are three major reasons for this:

A fall can be a sign of a new and serious medical problem that needs treatment. For instance, an older person can be weakened and fall because of illnesses such as dehydration, or a serious urinary tract infection.
Older adults who have fallen are at higher risk for a future fall. Although it’s a good idea for any older person to be proactive about identifying and reducing fall risk factors, it’s vital to do this well after a fall.
Busy doctors may not be thorough unless caregivers are proactive about asking questions. Most doctors have the best intentions, but studies have shown that older patients often don’t get recommended care. By being politely proactive, you can make sure that certain things aren’t overlooked (such as medications that worsen balance).

All too often, a medical visit after a fall is mainly about addressing any injuries that the older person may have suffered.

Obviously, this is very important; one doesn’t want to miss a fracture or other serious injury in an older person.

However, if you want to help prevent future falls, it’s also important to make sure the doctors have checked on all the things that could have contributed to the fall.

This is really key to preventing falls in an aging adult. Even if you’re pretty sure your loved one just tripped and stumbled, a good evaluation can uncover issues that made those trips and stumbles more likely.

In this article, I’ll list eight key items that you can make sure the doctors check on, after an older person falls. This will help you make sure your loved one has had a thorough work-up, and can reduce the chance of future serious falls.

This list is partly based on the American Geriatrics Society’s Clinical Practice Guidelines on Preventing Falls.

8 Things the Doctors Should Check After a Fall

[Read more…]

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.

[Read more…]

Tools for caregivers: Keeping & Organizing Medical Information

by Leslie Kernisan, MD MPH

This post is part 3 of a series describing the four key types of tools that I recommended to caregivers at a retreat earlier this summer:

Journal/notebook, for notes and symptom tracking (see this post for details)
Portable and up-to-date medication list (see this post for details)
Organizer to keep copies of medical results and medical records
Personal/family task organizer

In this post, I’ll explain why it’s important to keep copies of medical results and key medical records. I’ll then explain which kinds of medical information is most useful to keep, and I’ll describe a few ways that caregivers can do this.

[Read more…]

What is dementia?

Covid & Aging Adults: COVID News 2023-2024

COVID winter update December 20, 2023

COVID fall vaccine update September 21, 2023

The Four Most Commonly Used Types of Medications That Dampen Brain Function

8 Things the Doctors Should Check After a Fall

Disclaimer