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.

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

by Leslie Kernisan, MD MPH 15 Comments

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

[Read more…]

8 Great Gift Ideas for Older Adults & Family Caregivers

by Leslie Kernisan, MD MPH

It’s getting to be that time of the year: the season when many of us start looking for a thoughtful gift to give to an older loved one.

I’ll be honest: I’m not much of a shopper and it’s not my style to give physical gifts just for the sake of doing so.

But I do think it can be wonderful to give something that brightens a person’s day.

And it’s even better when a gift is practical, useful, or otherwise helps an older person make the best out of life.

One of my favorite resources, when it comes to identifying useful items to help with age-related challenges or caregiving, are the lists put together by DailyCaring.com.

They have a great list of 50 top gift ideas for seniors, and another terrific list of gifts related to Alzheimer’s and dementia.

In this article, I’ll share my list of eight gifts that can help older adults cope with common late-life challenges.

Four are for older adults in general, and then four are especially useful for those living with Alzheimer’s or a related dementia.

Four great gift ideas for older adults:

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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:

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3 Ways Home Blood Pressure Monitors Help Older Adults

by Leslie Kernisan, MD MPH

If I had to recommend one key piece of healthcare equipment that older adults & caregivers should have at home, it would be this: a good home blood pressure (BP) monitor.

Why? Because BP measurements (and pulse measurements, which machines check at the same time) are an incredibly useful tool when it comes to assessing and optimizing an older person’s health and well-being. This is true even for those older people who aren’t being treated for hypertension (chronic high BP).

As I’d love for more older adults and families to understand how home BP monitors can help them, in this article I’ll explain how home BP monitors can be helpful specifically for older adults. (And then see my related article here: Choosing & Using a Home Blood Pressure Monitor, & What to Ask the Doctor .)

3 ways a home blood pressure monitor can help you

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

by Leslie Kernisan, MD MPH

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
What this means for new blood pressure guidelines

[Read more…]

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

by Leslie Kernisan, MD MPH

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

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Medications Older Adults Should Avoid or Use with Caution:
The American Geriatrics Society Beers Criteria (2023 Update)

by Leslie Kernisan, MD MPH

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 should be careful about, this is the list!

This list gets updated every few years, so the Beers Criteria published in May 2023 is about as up-to-date as you can get for this type of guideline document.

You 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:

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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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COVID & Aging Adults: 2023 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

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…]

Flu Shots for Older Adults During COVID Times: What to Know & Do for 2023

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. In these COVID pandemic times, I think it’s even more important. 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 2023).

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. (For more on the fall 2023 COVID booster, see COVID & Aging Adults: 2023 Updates)

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).

And now this fall, this will be our fourth winter dealing with COVID-19 as well. (Plus there is now RSV!) As of September 2023, we still have 500-900 people dying of COVID every week, most of whom are people over age 65. We don’t know for sure what will happen this fall, but since COVID seems to spread more when people are indoors and in proximity to the exhalations of others, it’s likely that COVID will get worse again this winter.

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 2023-2024 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…]

The Geriatrics For Caregivers Blog

3 ways to prevent fractures and other injuries related to falls

Four great gift ideas for older adults:

3 ways a home blood pressure monitor can help you

5 Key Features of Dementia

Covid & Aging Adults: COVID News 2023

COVID fall vaccine update September 21, 2023

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