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.

What Is Geriatrics & Why It’s Not Just for the “Old-Old”

by Leslie Kernisan, MD MPH

Pop quiz: Can you define geriatrics? And did you know that it’s not just for the “old-old”?

If you hesitated with these two questions, don’t feel bad. Most people know that geriatrics has something to do with the elderly, but beyond that there’s a lot of confusion about what it is, who it can help, and how it’s different from gerontology.

To clear up the confusion and help all seniors — whether younger or older — understand how to benefit from geriatrics, I’ve written an article for NextAvenue.org:

“How Geriatrics Can Help You – Even If You’re Not Yet ‘Old-Old‘”

In this article, I explain:

What is geriatrics
Why geriatrics, similar to pediatrics, involves a medical knowledge base along with an approach that’s better for certain age groups
What is a geriatrician
What is gerontology, and how it’s different from geriatrics
Why you do need geriatrics but probably don’t need a geriatrician

Why We Should All Understand What Geriatrics Is

I wrote this article because geriatrics has wonderful things to offer when it comes to the health of older adults, just as pediatrics offers wonderful benefits to children. (Kids need healthcare that’s adapted to their growing minds and bodies. Older adults need healthcare that’s adapted to their aging bodies and minds.)

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4 Steps to Get Better Advice from Doctors

by Leslie Kernisan, MD MPH

Here’s an uncomfortable truth that every family should be aware of:

You shouldn’t assume your doctor is providing you with optimal medical advice.

By optimal, I mean advice that is:

Grounded in the most recent medical knowledge.
Adapted to your preferences and values.
Made after helping you consider the various options, along with their risks and benefits.

Doctors are generally trying their best. But it’s hard for a single person to keep up with all the latest knowledge, plus doctors tend to get into practice habits that aren’t necessarily in your best interest.

Are You Regularly Informed of Non-Drug Treatment Options?

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5 Medication Safety Principles for Older Adults

by Leslie Kernisan, MD MPH

Have you found yourself eyeing an older person’s medication list, wondering if you should worry?

It’s smart to be concerned, especially if your older relative takes five or more medications. Medications can provide many benefits, but they also can easily cause problems.

The CDC estimates that every year 177,000 older adults visit the emergency room due to medication-related problems. But even medications that don’t prompt ER visits may be causing more harm than good, and researchers have documented that “inappropriate prescribing” is common among seniors.

For all these reasons, a big part of what we do as geriatricians is to regularly review an older person’s medications, for safety and appropriateness.

Now, to properly review medications, you do need to work with clinically trained professionals such as doctors, pharmacists, and nurses.

But I am a big believer in the idea that well-informed patients and families are key to getting the healthcare work done better.

So I’ve written a two-part article for A Place for Mom, about how you can help an older person get the most out of his or her medication review. Here’s part one:

“How to Think Like a Geriatrician About Medications for Older Adults“

In this article, I share five medication safety truths that I always keep in mind, and that you should too! They are:

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How to Maintain Brain Health: The IOM Report on Cognitive Aging

by Leslie Kernisan, MD MPH

If you’ve been wondering just how to maintain a healthy brain for yourself, or for an older relative, then I have some very good news.

In April, the Institute of Medicine (IOM) published a comprehensive report on this very topic. It’s called “Cognitive Aging: Progress in Understanding and Opportunities for Action.”

This report manages to be innovative, comprehensive, and also incredibly useful to regular people and practicing doctors. That’s because the IOM created a number of practical guides and resource sheets, to accompany their detailed and exhaustively researched 385 page report.

To help get the word out about the highlights of this report, I’ve written an article about it for NextAvenue.org:

“4 Myths About Brain Health and How to Stay Sharp“

In this NextAvenue article, I review:

The definition of cognitive aging, and why everyone should expect it,
4 commonly believed myths about cognitive aging,
6 actions the IOM recommends people take to protect cognitive health as they age,
Why the IOM is telling doctors to pay special attention to preventing delirium, and identifying risky medications,
The IOM’s conclusions regarding diet and brain health,
What you should know if you or your relative has been diagnosed with a dementia such as Alzheimer’s.

Since we’re all part of an aging society, it’s good for all of us to learn more about how the brain tends to change with age, and how we can optimize brain health as people get older.

As the health arm of the National Academy of Sciences, the IOM’s job is to provide “independent, objective, evidence-based advice to policy makers, health professionals, the private sector, and the public.”

When an IOM committee makes recommendations on a given health topic, you can rest assured that this represents the best available medical knowledge.

So before you read yet another article about “brain-boosting foods,” take a look at the NextAvenue article summarizing the highlights of the IOM report.

“4 Myths About Brain Health and How to Stay Sharp“

And then let me know which of the report highlights were most interesting to you.

4 Things to Do When an Older Person Resists Help

by Leslie Kernisan, MD MPH

“Doctor, my mom needs help but she won’t accept it and she won’t listen.”

Sound familiar? As several of you commented last fall, older relatives often seem reluctant to accept the help we think they need.

Now, I don’t have a magic formula for making this easy. But I do have a new article published on NextAvenue.org, that addresses this very issue:

“4 Things To Do When Your Parents Are Resisting Help“

In this article, I explain four approaches that I always recommend to families, when they are struggling to get older parents to make changes.

They aren’t silver bullets. But they should make it a little easier to get through difficult situations with older loved ones.

So take a look, and let me know what you think.

How to Check an Older Adult for Common Health & Safety Problems

by Leslie Kernisan, MD MPH

Worried about an older relative, but not quite sure what to do?

Common concerns I hear include:

Are my parents safe living on their own?
Could my mom be getting Alzheimer’s disease?
How can I find help for my father who lives alone?
I’m worried my mom might fall at home and get hurt.
I’m worried that my dad isn’t taking good care of himself.
Is it time to move to assisted living?

To help people turn their worries into a practical action plan, I’ve created a special new resource. You can download it here:

Helping Older Parents Quick Start Guide: Check Your Parents in 5 Key Areas

This guide is modeled on the mental checklists that I use when I first assess an older adult who lives at home.

Specifically, this is a quick version of how I initially check for the most common “don’t miss” health and safety red flags. It includes practical tips, such as who to ask for help, as well as a list of useful online resources.

If you’ve been concerned about an older adult who lives at home or in assisted-living, I hope you’ll take a look!

8 Behaviors to Take Note of if You Think Someone Might Have Alzheimer’s

by Leslie Kernisan, MD MPH

Have you been worried about an older person’s memory or thinking skills? If so, you’ve probably found yourself wondering if this could be Alzheimer’s, or another dementia.

What to do next? If you look online or ask people, the advice is generally this: tell the doctor.

This advice isn’t wrong, but it’s incomplete. Yes, you should tell the doctor. But you’ll dramatically improve your chances of getting to the bottom of things if you come to the doctor with useful information on what you’ve observed.

In fact, research has found that interviewing family members about the presence or absence of eight particular behaviors can be just as effective, when it comes to detecting possible Alzheimer’s, as certain office-based cognitive tests.

8 Alzheimer’s Behaviors to Track

For each of these behaviors, try to make note of the following:

Whether there’s been a decline or change compared to the way your parent used to be
Whether this seems to be due to memory and thinking, versus physical limitations such as pain, shortness of breath or physical disabilities
When you – or another person – first noticed problems, and what you observed
What kinds of problems you see your parent having now

If you don’t notice a problem in any of the following eight areas, make a note of this. (E.g., “No such problem noted.”) That way you’ll know you didn’t just forget to consider that behavior.

Have you noticed:

Signs of poor judgment? This means behaviors or situations that suggest bad decisions. Examples include worrisome spending, or not noticing a safety issue others are concerned about.
Reduced Interest in Leisure Activities? This means being less interested and involved in one’s usual favorite hobbies and activities. You should especially pay attention if there isn’t a physical health issue interfering with doing the activity.
Repeating Oneself? Has your parent started repeating questions or stories more than he used to?
Difficulty Learning to Use Something New? Common examples include having trouble with a new kitchen appliance or gadget. This can be a tricky one to decide on, given that gadgets become more complicated every year. But if you’ve noticed anything, jot it down.
Forgetting the Year or Month? Especially once one stops working, it can be easy to lose track of the date or day of the week. But if you notice your parent forgetting the year or month, make a note of this.
Difficulty Managing Money and Finances? Common examples include having trouble paying bills on time, struggling to balance the checkbook, or otherwise having more difficulty than one used to have managing finances.
Problems with Appointments and Commitments? If you’ve noticed that your parent is having more trouble keeping track of appointments and plans, make note of this.
Daily Struggles with Memory or Thinking? It’s normal for older adults to take a little longer to remember things, since many brain functions do slow a bit with aging. But it seems that your parent often can’t remember things that happened, or otherwise seems to be more confused with thinking, make note of this.

For more on diagnosing Alzheimer’s and other dementias

If you’re worried that your older relative might have dementia, I recommend you learn more here: How We Diagnose Dementia: The Practical Basics to Know
My book, “When Your Aging Parent Needs Help“, also comes with worksheets to help you check for signs of dementia, a handy checklist of what information to bring to the doctors, and more.
In this Youtube video I share 10 early warning signs of Alzheimer’s Disease that often catch my attention, and what to do if you’ve noticed these warning signs.

In this Youtube video, I cover 21 signs and behaviors that families sometimes assume are “normal aging,” but in fact are usually signs of a brain health disorder. It includes the 8 behaviors listed in this article, and many more.

Remember, being proactive usually leads to better results and less stress overall!

4 Practical Health & Aging Highlights from 2014

by Leslie Kernisan, MD MPH

Happy New Year!

In this post, I want to share four notable 2014 developments related to better health for older adults. They all struck me as practical information that should be useful to those of you helping an aging person with health and wellbeing.

In no particular order, here are my four geriatrics health highlights from 2014:

1. Two Separate One-Time Pneumococcal Vaccines Now Recommended for Older Adults

For several years now, the CDC and other experts have recommended that all seniors aged 65 or older get a one-time pneumonococcal vaccine. The particular vaccine recommended for older adults was the “23 valent” type (which means it protects against 23 subtypes of pneumococcal bacteria), branded as Pneumovax. Another vaccine, a “13 valent” branded as Prevnar, was recommended for children and some adults with weakened immune systems.

In September 2014, the US Advisory Committee on Immunization Practices (ACIP) published its recommendation that all adults aged 65+ get both types of pneumococcal vaccination (Prevnar and Pneumovax). This recommendation was based on their review of scientific studies.

For the ACIP’s technical statement explaining this recommendation, see “Use of 13-Valent Pneumococcal Conjugate Vaccine and 23-Valent Pneumococcal Polysaccharide Vaccine Among Adults Aged ≥65 Years: Recommendations of the Advisory Committee on Immunization Practices (ACIP).” This document was obviously not written for the lay public, but it provides a lot of important detail for those who want to dig into the nitty-gritty. (You can find a basic CDC page on this topic here.)

I’ll admit that I’ve read the ACIP’s statement and I don’t yet feel I clearly understand just how much extra protection an older person should expect, if she has already been vaccinated with Pneumovax and now should get Prevnar. (I do tend to err on the side of following guidelines unless I have good reason to believe that the likely harms outweigh the proposed likely benefit.)

Key things you should know: Yes, there are now two one-time “pneumonia” vaccines that are recommended for older adults. You should also know that these are not supposed to be given at the same time. For more information on how to space out these vaccines, talk to your doctor or take a look at the ACIP document mentioned above.

2. Benzodiazepines Linked (Again) to Higher Alzheimer’s Risk

Benzodiazepines are sedatives/tranquilizers that are often prescribed to treat anxiety or insomnia. Commonly used benzos include lorazepam, alprazolam, and diazepam (Ativan, Xanax, and Valium respectively).

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3 Links to Help You With Aging & Caregiving

by Leslie Kernisan, MD MPH

This month, I spotted a few useful online articles and resources that should come in handy for many of you. And if you’re joining your family for the holidays, these might spark some helpful conversations.

1. Caregiver Self -Assessment Questionnaire, from HealthInAging.org

What it is: A 1-page questionnaire about how you’ve been feeling, as you help a parent or other caree. It comes with a short list of resource websites for family caregivers.

Why I like it: It’s mostly yes/no questions, so it’s fast. This is a good way to check on yourself (or another family member who’s been doing a lot of helping). If you’re struggling, it’s important to get help sooner rather than later. To get help, try bringing a copy of this completed questionnaire to your doctor, or even to your older loved one’s doctor. You can also visit HealthinAging.org’s caregiver health webpage.

2. Video: 3 Easy Balance Exercises to Prevent Falls, from DailyCaring.com

What it is: 3 videos demonstrating easy balance exercises for seniors: the single-leg stand, the “arm-and-leg” raise, and the heel-to-toe walk.

Why I like this:

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How To Be An Engaged Patient or Caregiver

by Leslie Kernisan, MD MPH

Have you ever wondered what it means to be an “engaged patient,” or an engaged caregiver?

This is a hot topic right now within healthcare. The basic idea is simple: people get more from their healthcare when they are active participants, especially when they are proactive about their health. (Such people are sometimes called “e-patients,” with the “e” standing for engaged, enabled, equipped, and educated.)

This means doing things like asking questions, researching your health problems online, connecting with others facing similar health challenges, and most of all: making sure the healthcare providers know what’s important to YOU.

For instance, you should be actively involved in developing the medical plan, meaning that at a minimum, you should let the doctors know whether what they’re proposing sounds ok to you. And, you should be able to let them know if the treatment plan isn’t working out well for you.

Now, one big problem is that we’re often feeling sick when we’re involved with the healthcare system, especially when it comes to hospitals. Which is why family caregivers are very important, when it comes to being proactive and involved with healthcare. When a person has a family member or friend helping them be proactive, getting better healthcare is much more likely.

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The Geriatrics For Caregivers Blog

“How Geriatrics Can Help You – Even If You’re Not Yet ‘Old-Old‘”

Why We Should All Understand What Geriatrics Is

Are You Regularly Informed of Non-Drug Treatment Options?

8 Alzheimer’s Behaviors to Track

For more on diagnosing Alzheimer’s and other dementias

1. Two Separate One-Time Pneumococcal Vaccines Now Recommended for Older Adults

2. Benzodiazepines Linked (Again) to Higher Alzheimer’s Risk

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