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.

Flu Shots for Older Adults During COVID Times: What to Know & Do for 2021

by Leslie Kernisan, MD MPH 142 Comments

It’s that time of the year: October, 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 2021).

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 newest high-dose vaccines available for older adults.

But let me share the bottom line with you right now. In general, I have always supported the CDC’s usual recommendation that everyone over the age of 6 months should get their seasonal flu shot.

This year, I agree with the CDC that it’s important for people to get their seasonal flu shot, as soon as you can, and if you are an older adult, I recommend getting one of the higher-dose vaccines.

Note: If you are age 65 or older and it’s been more than 6 months since you were vaccinated, you may be able to get your COVID booster shot at the same time. (For more on COVID vaccination, see COVID Vaccination for Aging Adults: What to Know & Do.)

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 is our second winter dealing with COVID-19 as well. As of October 2021, at least 700,000 Americans have died of this disease. We don’t know for sure what will happen this fall, now that we have COVID vaccines, but since COVID seems to spread more when people are indoors and in proximity to the exhalations of others, it’s certainly possible that COVID could get worse again this fall.

So this year, more than ever, 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
What’s new and resources for the 2021-2022 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)

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COVID Vaccination for Aging Adults:
What to Know & Do

by Leslie Kernisan, MD MPH 97 Comments

As everyone knows, the COVID-19 pandemic has caused a public health — and societal — crisis of epic proportions. The impact has been especially severe on older adults, who are more likely to be severely affected by COVID, and who represent a distressingly high proportion of the U.S.’s COVID deaths.

But, in an amazing feat of scientific achievement, COVID vaccines were developed in truly record time, and in 2021, a large-scale vaccination campaign has been rolled out in the U.S.

This doesn’t mean everything will be back to normal very soon. But vaccination is key to reducing the dangers of COVID, because to date, the Pfizer and Moderna vaccines have proven to be extremely effective in preventing hospitalizations and deaths due to COVID. They have also been shown to be safe.

Although it’s exciting that we benefit from the significant protection of COVID vaccines, these vaccines have also raised a lot of questions for people. This article summarizes what I think is most important for older adults and families to know about coronavirus vaccination.

In particular, I want to offer science-based information to help with common questions, such as “Which COVID vaccine is better for seniors?” or “Which COVID vaccine for a 90-year-old?”

I’ll also cover vaccine safety, and what we know so far about how effective these COVID vaccines are in older adults. And in Sept 2021, I am adding information related to the Delta variant and boosters.

Latest Updates:

Oct 8, 2021: Update on COVID boosters

On 9/22/21, the FDA authorized a single booster dose for Pfizer COVID vaccine recipients who are age 65 or older, plus for a few other select groups.
As of 10/8/21, boosters are not yet approved for people who were vaccinated against COVID with Moderna or J&J.
- The FDA will meet to consider boosters for these vaccines on October 14 and 15.
For information on who can currently get a COVID vaccine booster, see CDC: Who Is Eligible for a COVID-19 Vaccine Booster Shot?

Note: A COVID vaccine booster is not technically the same as getting a “third dose,” which was approved by the FDA on 8/21/21 for certain people who are immunocompromised and unlikely to mount sufficient response to the usual COVID vaccine schedule. For more on who qualifies for this type of extra dose, see CDC: COVID-19 Vaccines for Moderately to Severely Immunocompromised People.

Here is my most recent video update, from Sept 9, 2021:
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Financial Exploitation in Aging: What to Know & What to Do

by Leslie Kernisan, MD MPH 36 Comments

Here’s an upsetting situation that comes up a lot, and may have come up for you: is someone financially taking advantage of Mom or Dad?

It’s a pretty legitimate concern to have. To begin with, most people know that there are plenty of “scammers” out there, phoning or mailing older adults with deceptive information designed to hoodwink them out of some of their savings.

But there’s actually another form of exploitation that may be more common, and is often harder for families to address.

That would be exploitation perpetrated by a someone the older person knows and has a personal relationship with.

Sometimes the person suspected of exploitation is relatively new to the older person’s life, such as a new romantic interest, friend, or paid caregiver.

In other cases, family members become concerned that someone in the family – such as one of the older person’s children – is beginning to take financial advantage of things.

Exploitation in the context of personal relationships is often especially tricky for families to address. The older person may be quite attached to – or otherwise feel dependent on – the person that others perceive as suspicious or problematic. Or there may be concerns about stirring up family dramas and conflicts, by voicing concerns about a sibling or another relative.

People are often unsure of what exactly constitutes illegal activity, and what can be done if they are concerned about financial exploitation.

So in this article, I’ll cover the key things you should know, so that you can better evaluate and address a worrisome situation, should one arise.

Specifically, in this article I’ll explain: [Read more…]

6 Causes of Paranoia in Aging & What to Do

by Leslie Kernisan, MD MPH 88 Comments

Q: My mother is 80. She is very active (despite breaking her hip 2 years ago), she still attends water therapy 3 times a week at the YMCA, she drives to the base (which is 20 miles away) and pays her bills on time. She is a retired Psych nurse and has shown signs in the past of paranoia.

Lately, she has “heard” voices of her grandchildren in her home and called my sister. She also has difficulty with getting the right words to say out and has her sleep pattern out of whack and will call people at odd times of the night. With her independence comes the fact she won’t share any medical information because she thinks we are out to get her committed.

How can I test her/question her to find out the level of decline she may be in to make sure she is safe? — K

A: Great question. As you may know, it’s fairly common for aging parents to develop problems like the ones you are describing. Understandably, these problems are frustrating and worrying for adult children.

You are absolutely right to be concerned about your mom’s safety. I do have some ideas for how you can get started assessing her, which I share below.

But first I want to explain the most common causes of this type of behavior in older adults. That’s because one of the things you must do is help your mother and the doctors figure out why she’s developed these behavior changes and other symptoms.

A fair number of people don’t get around to the medical evaluation because they assume that these crazy behaviors are either normal aging (definitely false) or dementia such as Alzheimer’s (true about 40% of the time).

Furthermore, it’s often hard to get a resistant older parent medically evaluated.

Still, it’s worth persisting in this, because many causes of paranoia or other odd behavior in older people can be treated.

6 common causes of paranoid symptoms in aging adults

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Q&A: What to do if your aging parent becomes rude & resistant

by Leslie Kernisan, MD MPH 101 Comments

Q: My loving, Jewish mother is 92 and has turned into a rude, abusive foul-mouthed woman who I no longer recognize.

She’s in relatively good health and amazingly lives in the same house I grew up in. She has an aide during the day. She won’t leave the house,treats the aide poorly and last weekend cursed out my very patient spouse. We’ve been getting 5 calls as day such as ” I”m having a heart attack; no one will tell me whether recycling comes today”!

I know she has early signs of dementia. Her cardiologist tells me not to take it to heart and this is not the same women who raised me. She won’t go to the JCC adult programs, complains about being lonely at night, yet hangs up on me when I tell her we can get an aide at night or sell the home and let her live in a facility with women her age, etc. She threatens to call the Police if someone comes to her home at night. I have a POA but don’t want to rob her of her independence at 92. I try to tell her to speak nicely to the aides, myself, my spouse, but she says ” I don’t remember or I must have reacted to something someone did or said.”

I feel guilty as I’m not spending as much time with her as I would like, but it’s a matter of survival. Jewish guilt is thrown about with impunity and I can’t tell whether she’s being manipulative and obsessing over bullshit ( “oh my God the outside light may burn out tonight” ) or she really can’t control herself. Her aide is a lovely human being but my mom orders her around like a slave. Who is this woman? I’m torn, anguishing over what to do and am doing nothing but try to correct her inappropriate behavior and language. I wanted to take her to a geriatric psychiatrist but she refused to go. Medication to calm her down is dangerous per the MD as she could fall, etc.

What should I do? I’m at my wits end.

Dr. K’s answer:

Wow, difficult situation but unfortunately not uncommon.

You say your mother has early signs of dementia, and it is true that “personality changes” can be due to an underlying dementia, such as fronto-temporal dementia or Alzheimer’s, especially if a family notices other changes in memory or thinking abilities.

But it doesn’t sound like your mother’s been clinically evaluated for dementia, and you don’t say whether this has been brought up with her primary care doctor.

How to Get Memory & Thinking (or Personality Changes) Evaluated

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The Geriatrics For Caregivers Blog

Latest Updates:

6 common causes of paranoid symptoms in aging adults

Dr. K’s answer:

How to Get Memory & Thinking (or Personality Changes) Evaluated

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