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.

4 Key Things to Know About Age-Related Hearing Loss

by Leslie Kernisan, MD MPH 18 Comments

Have you noticed that an older relative seems to be having trouble hearing you at times?

Or perhaps you’ve realized that sometimes YOU are the one saying “What?”

These situations are extremely common. Sometimes the issue is that one is trying to communicate in a noisy place and there is no need for concern.

But in many cases, these kinds of issues can indicate that an older person (or even a middle-aged person) is being affected by progressively worsening hearing loss.

You probably already know this: chronic hearing impairment becomes very common as one gets older. The National Institute on Aging reports that one in three adults aged 65-74 has hearing loss, and nearly half of those aged 75+ have difficulty with hearing.

Hearing loss also affects a significant number of people earlier in life. A 2011 study on the epidemiology of hearing loss documented hearing loss in 11% of participants aged 45-54, and 25% of those aged 55-64.

In short, research confirms that quite a lot of people experience hearing loss. But sadly, research also confirms that hearing loss is often under-recognized and inadequately addressed.

This is a major public health issue, for older adults and also for the many middle-aged adults experiencing hearing loss. At this point, we know quite a lot about: [Read more…]

Q&A: How to Prevent, Detect, & Treat Dehydration in Aging Adults

by Leslie Kernisan, MD MPH 37 Comments

Q: How can we get my older mother to drink more water? She is susceptible to urinary tract infections and seems to be often dehydrated no matter what we do. We were also wondering if coffee and tea are okay, or should they be avoided to reduce dehydration?

A: Dehydration is indeed an important problem for older adults. It can be common even when it’s not hot outside.

Helping an older person increase her fluid intake, as you’re trying to do, is one of the best ways to reduce the risk of dehydration.

Now how to actually do this? Studies — and practical experience — suggest that the best approaches include: [Read more…]

5 Top Causes of Sleep Problems in Aging, & Proven Ways to Treat Insomnia

by Leslie Kernisan, MD MPH 92 Comments

What should you do if an older person complains of not sleeping well at night?

Experts do believe that “normal aging” brings on some changes to sleep. (See my previous post for more on this.) Basically, older adults tend to get sleepy earlier in the evening, and tend to sleep less deeply than when they were younger.

So it’s probably not realistic to expect that as you get older, you’ll sleep as long or as soundly as when you were younger.

That said, although aging by itself does change sleep, it’s also quite common for older adults to develop health problems that can cause sleep disturbances. So when your older relatives say they aren’t sleeping well, you’ll want to help them check for these. Figuring out what’s going on is always the first step in being able to improve things.

And remember, getting enough good quality sleep helps maintain brain health, physical health, and mood.

Recently, I did a little research to identify the top causes of sleep problems in older adults. In this article, I’ll share what I found out. I’ll also tell you about what approaches have been proven to work, to help treat insomnia and sleep problems in older adults.

Last but not least, if you (or your older relative) have experienced the very common combination of waking up to pee at night and difficulty sleeping, I highly recommend listening to this podcast episode, which features a geriatrician who is an expert on this: 092- Interview: Addressing Nighttime Urination & Insomnia in Aging.

5 Common Causes of Sleep Problems in Older Adults

[Read more…]

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

by Leslie Kernisan, MD MPH 22 Comments

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 10 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…]

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5 Common Causes of Sleep Problems in Older Adults

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