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.

5 Things to Know about Aging Parents & Financial Decline

by Leslie Kernisan, MD MPH

You probably already know that many older adults develop problems managing finances as they age.

Now how would you answer the questions below:

Has your aging parent planned for a decline in financial abilities?
Are you prepared to detect signs of a financial decline?
Do you know what to do if you do notice problems with finances?

Many people, even the ones who are caring and well-informed, will often answer “no” to these questions.

But this post will equip you to start answering yes. And I want you to be able to answer yes, because declines in the ability to manage finances are very common among older adults, and often causes serious health and life problems.

The trouble, of course, is that financial decline is uncomfortable for older adults and their families to think about. Managing money, after all, is one of the ways we maintain autonomy and control over our lives.

So nobody likes to confront the fact that our ability to manage money will — in all likelihood — someday decline. (Research suggests that even aging adults who don’t develop dementia often experience declines in financial ability.) And families are understandably squeamish about monitoring an older relative’s financial abilities.

Fortunately, a little education and guidance can make it much easier to be more proactive about this tough topic.

In this post, I’ll cover

Five warning signs of financial decline
Five important things to know about aging & finances
How to protect aging parents from financial problems
What to do if your aging parent is having trouble managing their finances

I’ll also cover some ways that geriatricians and other healthcare providers can help, both to reduce declines in financial ability and to properly evaluate them when they occur.

5 Warning Signs of Financial Decline

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COVID Vaccination for Aging Adults:
What to Know & Do

by Leslie Kernisan, MD MPH

COVID is an important issue for older adults: they are more likely to be severely affected by COVID, and they represent most COVID deaths.

Luckily, COVID vaccines are effective and significantly reduce the risk of hospitalization and death in older adults. 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?”

This page covers my older science-based updates on COVID vaccines.

For my latest update, see here: Covid & Aging Adults: Current Vaccines & Updates

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Coronavirus Update & Suggestions (7.16.20 Edition)

by Leslie Kernisan, MD MPH

Like many of you, I continue to follow the coronavirus situation closely, for personal and professional reasons.

Given the dismaying surge in COVID cases over the past several weeks, this week I devoted part of my twice-monthly Helping Older Parents members call to this topic, and I have decided to share this part of the call below.

This video covers:

The coronavirus situation today
Are we better at preventing COVID?
Are we better at treating COVID?
Current COVID treatments available in the hospital
My take on hospitalization for frail older adults with COVID
Useful resources and my recommendations for this summer

The video is below, or get the audio-only through the podcast here.
(For those who have asked about transcripts: I wish I could but right now we are too short on funding; transcripts cost $1.25/minute to produce plus more time to format and finalize.)

Please stay as safe as you can, and take care!

Related resources:

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Coronavirus Info: What to Expect Regarding Hospitalization (3.27.20)

by Leslie Kernisan, MD MPH

Like many of you, I’ve been following the recent coronavirus developments closely.

In March, I devoted my twice-monthly Helping Older Parents members calls to this topic.

Here is a video commentary I recorded on 3.27.20. Although the statistics about COVID numbers in the US quickly fell out of date, I am leaving this video available as the information on what to expect regarding hospitalization should be relevant for quite a while. This video covers:

What I’d recently learned about the clinical course of COVID
If you think you (or your older relative) might be sick with coronavirus
What to know about hospitalization for this, and how a “surge” situation might affect that
Options for care at home, including palliative care
My recommendations on planning ahead and then hoping for the best.

Also, in the video, I forgot to mention that one of my favorite clinical sources is currently making its coronavirus topic free to the public: Uptodate.com: Coronavirus disease 2019 (COVID-19).

Please stay as safe as you can, and take care!

Related resources:

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5 Easy Ways to Connect with a Different Generation (& Why it Matters)

by Leslie Kernisan, MD MPH

When is the last time you had a really meaningful conversation with someone from a different generation? And who was it with?

Was it with a grandchild? A niece? Your own parent? A neighbor? Or maybe even the person standing next to you in line at the store?

While these types of connections happen every day across the United States, they probably aren’t happening enough.

And that’s a shame, given that research suggests these intergenerational connections are actually really valuable to people of all ages.

For instance, in 2018, the AARP conducted a national survey of grandparents to learn more about this intergenerational relationship and what it means to older adults. Almost 90% of grandparents reported their relationship with their grandchildren is good for their mental well-being.

However, the survey also found that distance was the number one barrier to seeing grandchildren more often, with over half of grandparents reporting they have at least one grandchild who lives more than 200 miles away. Sixty-one percent of grandparents reported wanting more information about connecting with their grandchildren and staying relevant in their lives.

I first heard about these findings at a conference last summer, when I met Kerry Byrne, PhD, a fellow aging and family caregiving expert who has developed a special interest in intergenerational connections, and in the grandparent-grandchild relationship in particular.

Partly due to her own experience living abroad and trying to keep her children close to their grandparents, in 2019 she founded The Long Distance Grandparent, a website dedicated to helping grandparents and grandchildren connected, even if they live far from each other.

I find this topic of intergenerational connections fascinating. Among other things, it has a role in countering ageism!

So I invited Kerry to join me on the podcast, to talk about how older adults can stay more connected to people of different generations, whether that’s with grandchildren or with people outside their family.

If you are a grandparent yourself, or just want to learn more about why intergeneration connections matter and how you can foster them in your own life, I hope you’ll take a listen to the podcast, or read through the transcript.

Both are available on the show notes page, which you can find here: 102 – Interview: The Importance of Grandparents & Intergenerational Connections

5 Practical Ways to Have More Intergenerational Connections

Here are five specific things Kerry suggests that older adults can do, to foster more intergenerational connections:

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How to Make Hospitalization Better & Safer in Aging

by Leslie Kernisan, MD MPH

Dr. Stephanie Rogers UCSF Inpatient Geriatrics

As you may know, hospitalization is actually somewhat risky for older adults.

This is sometimes surprising to older adults and families. After all, hospitals are supposed to be places where people who are ill or injured can get the medical supervision and services that they need, to recover and be restored to health.

Well, it’s certainly true that hospitalization is often the only way for a person to obtain more substantial care from nurses and doctors. (There actually is an alternative called Hospital at Home, but it’s not widely available.)

If you’ve broken a hip, or have developed really significant shortness of breath from pneumonia, or otherwise are too unwell to be safely treated in the outpatient setting, hospitalization is often necessary. And since aging increases one’s vulnerability to a variety of health problems, older adults get hospitalized at higher rates than younger people do.

The problem, however, is that although hospitalization is intended to help patients, we’ve also realized that it tends to stress the body and mind in many ways. This is hard on every patient, but especially affects older adults. For instance:

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13 Recommended Resources for National Family Caregivers Month

by Leslie Kernisan, MD MPH

This month — November — is National Family Caregivers Month.

If you’ve been in any way assisting another adult with managing health concerns or life tasks, you qualify as one of the estimated 40 million family caregivers in the US.

Such help often starts out with small things, such as helping an older relative get to appointments or assisting with grocery shopping.

But it’s also fairly common for families to end up providing quite a lot of care. A 2015 report found that on average, family caregivers provided 24.4 hours of assistance per week, and 23% of caregivers were clocking 41 hours or more.

Many people find themselves eventually struggling with the caregiving. Most of us haven’t prepared or been trained to do this, and many people are unsure of where to get information, help, or support.

So in this article, I’ll share some of my favorite resources to make family caregiving a little easier.

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End of Life Planning Made Easy Through PREPARE

by Team BHWA

Living wills. Advance directives. Powers of attorney for healthcare. Making your wishes known.

Many older adults have never gotten around to addressing these issues, and of those who have, many are overdue for a review.

After all, this is not something where you should “set-it-and-forget-it.” Especially not if you completed the paperwork with a lawyer years ago, and have experienced changes in your health since then.

But if you wanted to get started addressing this, you may have run into a few common hitches. The forms are often in legalese and hard to understand. And people often are sure just how to go about “making their wishes known.”

Fortunately, geriatrician Rebecca Sudore, MD, noticed this problem early in her career, and decided to do something about it.

Over the past 15 years, she developed and tested California’s first easy-to-read advance directive, then designed PREPARE, an easy online video program created to help older adults address advance care planning.

In a recent podcast episode, she and Dr. Kernisan discussed PREPARE, advance care planning, and how to make it easier for older adults to address what matters most to them when it comes to end-of-life planning.

This article will share some highlights and key points from their conversation, including:

The easy-to-read advance directives (and where you can get one)
Why advance care planning needs to include more than completing forms
How the PREPARE program helps older adults talk about what matters most
How to use PREPARE resources to help yourself or your loved ones talk about what matters and complete your planning

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

by Leslie Kernisan, MD MPH

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

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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.

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5 Warning Signs of Financial Decline

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5 Practical Ways to Have More Intergenerational Connections

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