The Geriatrics For Caregivers Blog

Learn practical ways to improve the health and wellbeing of older adults!

Written especially for family caregivers of older adults, but useful for all who want to learn how geriatricians help aging adults.

What is “Successful Aging”?

by Leslie Kernisan, MD MPH 25 Comments

Every May, the Administration on Aging leads the national observance of “Older Americans Month.” The theme this year is “Engage at Any Age.”

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

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

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

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

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

What IS “successful aging?”

[Read more…]

5 Questions to Ask Yourself on National Healthcare Decisions Day

by Leslie Kernisan, MD MPH 6 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…]

Q&A: What to Do About Unintentional Weight Loss

by Leslie Kernisan, MD MPH 25 Comments

Q: My 88-year-old father lives in his own home about 100 miles from us. He’s been living alone since my mother died five years ago. I thought he looked rather thin last time we saw him. I’m starting to feel worried about his nutrition. Should I be concerned? Would you recommend he start drinking a supplement such as Boost or Ensure?

A: This question comes up a lot for families. It is indeed very common for older adults to experience unintentional weight loss at some point in late-life.

The brief answer is that yes, you should be concerned. But I wouldn’t recommend you jump to purchasing Boost or Ensure.

Now, in most cases, some nutritional supplementation is in order. But before focusing on this, you should first get help figuring out why your father is losing weight.

For doctors, unintended weight loss is a major red flag when it comes to the health of an older person.

So in geriatrics, we usually recommend that an older person — or their caregivers — monitor weight regularly. This enables us to spot weight loss sooner rather than later.

Once we’ve spotted unintentional weight loss, the next step is to figure out what might be causing it. And then we’re in a better position to recommend a treatment plan, which might well include a nutritional supplement.

In this post, I’ll go over each of these steps in more detail.

Why you should monitor for unintentional weight loss

[Read more…]

How to Evaluate, Prevent & Manage Constipation in Aging

by Leslie Kernisan, MD MPH 30 Comments

Constipation is not a glamorous topic, but it’s certainly important, especially in older adults.

As anyone who has experienced occasional — or even chronic — constipation can tell you, it can really put a damper on quality of life and well-being.

Constipation can also cause more substantial problems, such as:

Severe abdominal pain, which can lead to emergency room visits
Hemorrhoids, which can bleed or be painful
Increased irritability, agitation, or even aggression, in people with Alzheimer’s disease or other forms of dementia
Stress and/or pain that can contribute to delirium (a state of new or worse confusion that often happens when older adults are hospitalized)
Fecal incontinence, which can be caused or worsened by having a hard lump of stool lodged in the lower bowel
Avoidance of needed pain medication, due to fear of constipation

Fortunately, it’s usually possible to help older adults effectively manage and prevent constipation. This helps maintain well-being and quality of life, and can also improve difficult behaviors related to dementia.

The trouble is that constipation is often either overlooked or sub-optimally managed by busy healthcare providers who aren’t trained in geriatrics. They are often focused on more “serious” health issues. Also, since many laxatives are available over-the-counter, some providers may assume that people will treat themselves if necessary.

Personally, I don’t like this hands-off approach to constipation. Although several useful laxatives are indeed available over-the-counter (OTC), I’ve found that the average person doesn’t know enough to correctly choose among them.

Also, although in geriatrics we often do end up recommending or prescribing laxatives, it’s vital to start by figuring out what is likely to be causing — or worsening — an older person’s constipation.

For instance, many medications can make constipation worse, so we usually make an attempt to identify and perhaps deprescribe those.

In short, if you’re an older adult, or if you’re helping an older loved one with health issues, it’s worthwhile to learn the basics of how constipation should be evaluated and managed. This way, you’ll be better equipped to get help from your health providers, and if it seems advisable, choose among OTC laxative options.

Here’s what I’ll cover in this article: [Read more…]

Why the Flu is Often Missed in Older Adults
(& What to Do About This)

by Leslie Kernisan, MD MPH 14 Comments

elderly flu symptoms You’ve likely already heard the news: the flu is pretty bad this year, with the Centers for Disease Control (CDC) confirming a higher than usual level of illnesses, hospitalizations, and even deaths.

You also probably know that older adults (and certain other groups of people) have a higher risk of falling very ill from the flu, and have the highest death rates from flu.

But what many people don’t know is this: influenza is easily — and often — missed in older adults.

What do I mean by missed? I mean:

Older adults (or their family members) may not realize an older person has the flu, because many older people don’t develop “typical” influenza symptoms.
Health professionals often fail to test older people for influenza, even when they are sick enough to be hospitalized. This phenomenon was confirmed in a recently published study.

This is a very serious issue, especially when the flu virus is causing a lot of severe illness, as it is now.

The main problem is this: delayed — or entirely missed — recognition of influenza means that older adults often don’t get treated early — or at all — with anti-influenza drugs such as oseltamivir (brand name Tamiflu).

Particularly for those older adults who have chronic illnesses (especially those affecting the heart or lungs) or are frail, you don’t want to miss that chance to take anti-influenza drugs. They can’t guarantee an older person will avoid a hospitalization or death from influenza, but they do improve one’s chances.

And anti-influenza drugs are most likely to work when they are given within 48 hours of a person falling ill from influenza, with earlier being better.

So when flu activity is widespread, families need to be prepared to recognize potential flu.

And, you should be prepared for the possibility that the health providers might not think to test for influenza, unless you ask about it.

This article will help you learn to do these things. Here’s what I’ll cover:

What are the usual symptoms of “influenza-like illness”
Common symptoms of influenza in older adults
Why older adults may not show typical influenza symptoms
What we know about older adults & influenza testing
What the CDC currently recommends, regarding influenza diagnosis and treatment
What to do, if an older person falls ill during influenza season

[Read more…]

The Geriatrics For Caregivers Blog

What IS “successful aging?”

Why you should monitor for unintentional weight loss

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