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Better Health While Aging

Practical information for aging health & family caregivers

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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.

7 Steps to Managing Difficult Dementia Behaviors
(Safely & Without Medications)

by Paula Spencer Scott

(This article is by my colleague Paula Spencer Scott, author of the book Surviving Alzheimer’s: Practical Tips and Soul-Saving Wisdom for Caregivers. I invited her to share an article on this topic, since many in our community are coping with dementia behaviors. — L. Kernisan)

The odd behaviors of Alzheimer’s and other dementias can be so frustrating and stressful for families.

I’m talking about the kinds of behaviors that try patience, fray relationships, and drive us in desperate search of help:

“First she thinks the caregiver is stealing her sunglasses and now she accused me of having an affair.”

“When I tried to help Dad wash up, he hit me.”

“My husband follows me so closely I can’t stand it. But if I go in another room he’ll wander out of the house.” 

“Mom started unbuttoning her shirt in the middle of the restaurant!”

“Just when I’m completely exhausted at the end of the day, he seems to get revved up. He keeps peeking out the windows, convinced that someone is trying to break in. Now he won’t sleep.”

A common approach to difficult behaviors is to go right to medicating them with tranquilizers, sedatives, or antipsychotics. But that’s risky and often not what’s best.

In fact, experts recommend trying behavior management first, and for good reasons: It tends to be more effective in the long run than “chemical restraints,” has no dangerous side effects, and leads to a better care relationship. But people often don’t know how to do this.

I’ve learned how.

I’ve lived through five close family members’ experiences with Alzheimer’s and other forms of dementia. Lots of trial and error, and insights from dozens of top dementia experts (whose brains I’ve been lucky to pick as a journalist and dementia educator), got me through regular scenes with…

  • My father-in-law, who needed a walker to move yet spent hour after hour for several days straight hauling all his clothes and toiletries from his room to our driveway, insisting that his (imaginary) new wife was about to pick him up
  • My dad, a formerly sharp dresser who wore the same shirt and pants every day no matter how dirty
  • My grandmother, who insisted on going “home,” when she was home
  • And other relatives, in dozens of similar scenes.

In this article, I want to share what I wish someone had explained to me early on: the “Why-This, Try-This” approach to dealing with difficult behaviors.

This is a mental framework that can help you get unstuck from unproductive responses that get you nowhere or make things worse.

It can bring calm -– to both of you — whether the issue is verbal or physical aggression, agitation, confusion, wandering, disinhibition, delusions, hallucinations, or a restless or repetitive behavior (like pacing, shadowing, rummaging). It also works well with milder irritants like repetitive questions and indecision.

Then, I’ll boil down the Why-This, Try-This concept to a 7-step process you can use every time. These “7 R”s give you a basic platform for responding to any frustrating behavior:

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog, Helping Older Parents Articles Tagged With: alzheimer's, dementia

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

by Leslie Kernisan, MD MPH

elderly flu symptomsYou’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…]

Filed Under: Aging health, Geriatrics For Caregivers Blog, Helping Older Parents Articles Tagged With: flu, influenza

New High Blood Pressure Guidelines Again:
What the Cardiology Hypertension Guidelines Mean for Older Adults

by Leslie Kernisan, MD MPH

And once again, high blood pressure is making headlines in the news: the American Heart Association and the American College of Cardiology (AHA/ACC) have just released new guidelines about hypertension.

Since this development is likely to cause confusion and concern for many, I’m writing this post to help you understand the debate and what this might mean for you and your family.

By the way, if you’ve read any of my other blood pressure articles on this site, let me reassure you: I am not changing my clinical practice or what I recommend to others, based on the new AHA/ACC guidelines.

The core principles of better blood pressure management for older adults remain the same:

  • Take care in how you and your doctors measure blood pressure (more on that here),
  • Start by aiming to get blood pressure less than 150/90 mm Hg, as recommended by these expert guidelines issued in 2017 and in 2014,
  • And then learn more about what are the likely benefits versus risks of aiming for more intensive BP control.

Perhaps the most important thing to understand is this: treatment of high blood pressure in older adults offers “diminishing returns” as we treat BP to get lower and lower.

Scientific evidence indicates that the greatest health benefit, when it comes to reducing the risk of strokes and heart attacks, is in getting systolic blood pressure from high (i.e. 160-180) down to moderate (140-150).

From there, the famous SPRINT study, published in 2015, did show a further reduction in cardiovascular risk, when participants were treated to a lower systolic BP, such as a target of 120.

However, this was in a carefully selected group of participants, it required taking three blood pressure medications on average, and the reduction in risk was small. As I note in my article explaining SPRINT Senior, in participants aged 75 or older, pushing to that lower goal was associated with an estimated 1-in-27 chance of avoiding a cardiovascular event. (The benefit was even smaller in adults aged 50-75.)

SPRINT did not include people who have certain common conditions, including diabetes, heart failure, past stroke, or dementia. Hence it’s not clear that the (small) benefits of intensive blood pressure control would apply to those older adults who would not have qualified for the SPRINT trial.

I will come back to the SPRINT study later in the article, since it undoubtedly influenced the recent AHA/ACC guidelines. But first, a little on why the new guidelines are notable.

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog, Helping Older Parents Articles Tagged With: blood pressure

How Exercise Helps Aging Adults:
Key benefits (and disappointments) from a landmark study

by Leslie Kernisan, MD MPH

Exercising Grandma

Have you ever wondered whether it’s worth your while to encourage an older person to start exercising?

In 2014, the top-notch journal JAMA published the results of a fantastic research project: a study in which 1635 sedentary older adults (aged 70-89) were assigned to get either a structured exercise program, or a program of “successful aging” health education. The researchers called it the Lifestyle Interventions and Independence for Elders (LIFE) study. (You can read the full study here.)

During the LIFE study, the two groups were followed for a little over 2.5 years. And by the end of the study, guess which group of volunteers was more likely to still walk a quarter of a mile (without a walker)?

That’s right. When it came to avoiding “major mobility disability” — which the researchers defined as becoming unable to walk 400 meters or more — a structured exercise program was better than a program of healthy aging education.

Specifically, the researchers found that 30% of the exercisers experienced a period of major disability, compared to 35.5% of the seniors enrolled in the healthy aging education program.

This is a very encouraging finding! That said, it’s also a bit sobering to realize that even with exercise, almost 1 in 3 older adults experienced a period of limited mobility, of which half lasted 6 months or more.

In this post, I’ll share some more details on this study, because the results provide a wonderful wealth of information that can be helpful to older adults, family caregivers, and even geriatricians such as myself.

Want to know how often the exercisers experienced “adverse events”? (Hint: often!) Wondering just what the structured exercise program involved? (Hint: more than walking!)

Let’s dig into the details! At the end of this post, I’ll share my list of key take-home points for older adults and family caregivers.

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog, Helping Older Parents Articles Tagged With: exercise

Q&A: Hospice in Dementia, Medications, & What to Do If You’re Concerned

by Leslie Kernisan, MD MPH

hospice in Alzheimer's dementia

Q: Dear Dr. K,

With all the news about opioids and benzodiazepines, and their risk of death, I would love to hear your take on the use of these drugs in hospice.

We’ve had two family experiences now (my Mom and my Aunt) who were given these drugs right away when they went on hospice…without hospice trying anything else first that would be less dangerous. My Mom was up and about walking one day at her memory care facility, even laughing. The next day, when hospice put her on morphine and Ativan, she was in a coma. She died 13 days later without ever regaining consciousness. When I protested and asked why she wasn’t waking up, the hospice nurse said, “It’s not the drugs, it’s the disease.” (Mom had dementia.) The nurses wouldn’t let us give her fluids (“you don’t want your mother to aspirate, do you?”) or feed her (“you don’t want your mother to choke, do you?”).

With my Aunt, she had also been in the memory care facility and got to the point of needing a two-person assist. Her power of attorney (POA) was given the choice of moving my Aunt into a nursing home or bringing in hospice. Hospice immediately gave her morphine and Ativan, then backed off the Ativan and gave her morphine every two hours until she died 3 days later. 

Now the third sister, also with dementia, has been in hospice for two months and counting. She is lucid most days, eating/drinking, comfortable—all without the opioid/benzo drug combo, because of our experience.

How can family members identify a hospice that doesn’t use this troubling combination of drugs from the start, without first trying something less dangerous, to make a patient “comfortable”? 

A: Thanks for sending in this question. I’m very sorry to hear that your experiences with hospice have left you concerned.

It is indeed extremely common for hospice to use morphine and lorazepam (brand name Ativan) to treat end-of-life symptoms. That’s because many people on hospice are suffering from troubling symptoms that these medications can relieve, such as pain, shortness of breath, anxiety, and agitation.

Still, these medications are not always necessary. They are supposed to be prescribed and used as required to relieve the dying person’s symptoms, not by default. So the situation you describe with your mother and your aunt does sound potentially concerning. At a bare minimum, the hospice personnel should have done a better job of discussing their proposed care plan with your family.

Now let me be clear: I cannot say if the way they prescribed morphine and lorazepam was inappropriate or not, because it’s impossible for me to know the specifics of your mother and aunt’s medical situation.

Still, we can certainly review some basics about hospice care for people with Alzheimer’s and related dementias, as well as recommended best practices, when it comes to using opioids and benzodiazepine sedatives.

Here’s what I’ll cover:

[Read more…]

Filed Under: Geriatrics For Caregivers Blog, Helping Older Parents Articles, Q&A Tagged With: alzheimer's, dementia, end-of-life care, hospice, medication s

Our Podcasts & How to Listen

by Leslie Kernisan, MD MPH

I’m very happy to announce that the new Helping Older Parents Podcast is now live and available for you to listen, alongside the existing Better Health While Aging Podcast!

You can find all the new Helping Older Parents Podcast episodes here, and over 100 existing Better Health While Aging Podcast episodes here.

Leslie Kernisan Podcast Cover With Subtitle 320px

       

And now, let me answer some of the questions people have already asked me about the shows and about listening to podcasts.

[Read more…]

Filed Under: Geriatrics For Caregivers Blog, Helping Older Parents Articles Tagged With: podcast

New Year, New Name:
Introducing Better Health While Aging

by Leslie Kernisan, MD MPH

Hello 2016

Dear Readers,

Welcome to our new and improved website! I’m very pleased to announce that the Geriatrics For Caregivers website has been renamed Better Health While Aging.

But don’t worry, all of our practical geriatrics health information for family caregivers is still here.

[Read more…]

Filed Under: Geriatrics For Caregivers Blog

3 Guides to Help With “The Talk” With Aging Parents, & More Useful Resources

by Leslie Kernisan, MD MPH

Aging Parents To Do List

It’s that time of the year again: first Thanksgiving, and then winter holidays. Which means this is the time of the year when families are most likely to get together with older parents.

Ideally, this means a time for families to bond and spend joyful times together. And no matter what is going on in your older relative’s life, bonding and joy are always possible. So I hope this holiday season brings you many opportunities to enjoy your aging relatives.

But there are two more challenging things that tend to happen during the holidays:

  • Families — especially adult children who don’t see their parents often — may find themselves concerned about an older relative’s health or safety or well-being.
  • Families often use the holidays as a time to get together and have “the talk.” Or otherwise try to plan and “get things in order.”

Nobody likes addressing these two situations. But they do come up a lot at this time of year.

In case any concerns or planning needs come up for you during the holidays, here’s what I’ll be sharing in this post:

  • 3 useful guides, to help you address common aging and caregiving concerns
  • Tips on what to do if you’re worried about an older relative
  • 6 common problems that worry families, with resources on addressing them

3 Guides to Help You Have “The Talk” With Aging Relatives

Here are three online guides that can help you. They all include a printable PDF version.

[Read more…]

Filed Under: Geriatrics For Caregivers Blog, Helping Older Parents Articles, Useful Links

How Sleep Affects Health, & Changes With Aging

by Leslie Kernisan, MD MPH

Older man sleeping

Sleep. Everybody needs it. Many of us don’t get enough of it.

These are common truths that almost everyone knows. But recently, I had the opportunity to learn quite a bit more about sleep, and how it affects health.

I came away convinced that sleep is a core pillar of health. It deserves more attention from us as doctors, and as individuals concerned about our own health or that of an aging relative.

I also know that sleep problems are very common among family caregivers, and among aging adults. So I was glad to learn more about sleep health, as this has the potential to really help people get through caregiving and aging challenges.

In this article, I’ll share some of the interesting facts I learned about sleep, including how it affects the health of the body and mind, and how it changes with aging.

You may also want to read the following related articles:

  • 5 Top Causes of Sleep Problems in Aging, & Proven Ways to Treat Insomnia
  • How to Manage Sleep Problems in Dementia

4 Things To Know About Sleep & Health

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog Tagged With: brain health, sleep

How to Follow the Mediterranean Diet for Senior Health, & Related Research Findings

by Leslie Kernisan, MD MPH

Mediterranean diet

What kind of diet is best for maintaining the health of aging brains and bodies?

A common answer these days is the “Mediterranean diet,” due to a combination of recently published research studies and frequent media coverage.

In fact, a study published earlier this week found that older Spanish women who were randomly assigned to stick to a Mediterranean diet — supplemented by extra olive oil — developed fewer cases of invasive breast cancer, compared to women who were merely advised to reduce dietary fat.

This study was published by the same research team that reported earlier this year that Spaniards assigned to a Mediterranean diet — supplemented with either olive oil or nuts — experienced less cognitive decline. And a 2013 report from the same group found that the Mediterranean diet led to a 30% decrease in cardiovascular events (strokes and heart attacks).

Does this mean you should hustle to make sure your older relatives are eating a Mediterranean diet? Well, maybe. I will go into the study details later in the post, but for now, let’s say that the diet used in the study seems very sensible, provided one doesn’t suffer unduly from limited access to pork and cookies.

As is the case for many lifestyle changes that might affect cancer and dementia, a healthy diet reduces risk but is just one factor among many. Still, if we’ve learned of a good way to eat, why not consider it?

So in this post, here’s what I’ll review:

  • Just what people were eating, as part of the Spanish Mediterranean diet study (known as the PREDIMED study)
  • What kinds of older adults PREDIMED studied in Spain, and some of the major findings of interest
  • Where to find a comprehensive review of the scientific evidence for diet and brain health

How to follow the PREDIMED Mediterranean diet

PREDIMED (Prevención con Dieta Mediterránea) was a big randomized control trial conducted in Spain, from 2003 to 2009. It involved 7446 peopled aged 55-80. In the next section of the post I’ll describe the study in more detail, but let’s start with what you are probably most interested in:

Just what was the PREDIMED Mediterranean diet??

Fortunately, it is possible to find the research study’s materials online, and they describe the recommended diet in detail.

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog Tagged With: brain health, nutrition

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