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.

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).

[Read more…]

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:

[Read more…]

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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Q&A: How to Feel Closer to A Spouse with Alzheimer’s

by Leslie Kernisan, MD MPH

Dear Dr. K,

I live with my wife, who has Alzheimer’s.

I don’t argue or try to correct my wife when she misremembers or confabulates but this makes for two different worlds – hers and mine – and so we have less in common and grow apart. Is this the only option or have you better advice? — D.T.

First and foremost, I want to thank you for everything you’ve done, and are doing, for your wife with Alzheimer’s. It’s not an easy journey, and she’s very fortunate to have you involved.

Your question really speaks to the relationship issues that arise in Alzheimer’s caregiving. As the disease changes your wife’s brain, this is going to change the way you and she relate to each other.

I’m glad you are looking for advice on this topic, because maintaining and improving your emotional connection can yield big benefits for both of you, in the short-run and in the long run. In fact, it’s quite possibly the most important thing that you can do for yourself and your wife.

Why maintaining an emotional connection is so important in Alzheimer’s

Feeling more connected will reduce stress for you both. This leads to three very important benefits:

It will help your wife have the best brain function possible;
It will help you manage caregiving challenges a little better;
It will improve your health and well-being.

In my opinion, reducing stress and improving emotional connection can probably do more for her brain health than most dementia medications, and most conventional medical interventions. (Avoiding delirium, however, might be equally valuable.)

The mind-body-heart connection is that important!

Plus, it’s a win-win, since what improves your relationship will help reduce the stress that caregiving can put on your own health.

So, my opinion as a doctor is that this is important enough to your health, and your wife’s health, that you should seriously consider investing time — and possibly money — in this nurturing of your relationship.

How to counter the way Alzheimer’s tends to drive couples apart

[Read more…]

What’s Hardest About Helping Aging Loved Ones

by Leslie Kernisan, MD MPH

“What’s your biggest frustration with helping aging parents, or aging loved ones?”

This was the question that I emailed last month to the readers subscribed to Geriatrics for Caregivers.

I asked because in order to provide truly useful information on this website, I felt I should check in and learn more about what you’re finding especially challenging.

In response to my inquiry, I received a number of replies, I learned quite a lot, and as usual, I found myself inspired by the remarkable efforts you are undertaking.

Now, I hadn’t initially been planning to share people’s answers on the blog. But when a reader wrote to me asking about the results of the “survey,” I realized that many of you may be wondering: “What do other people find most frustrating about helping an aging loved one?”

Below, you’ll find a series of quotes from the responses. I hope you find them as enlightening and inspiring as I did.

[Many thanks to the respondents for giving me permission to share their insights!]

What Readers Say is Hard About Helping an Older Loved One

“My biggest problem with dealing with my aging parents (both in their 80s) is the delicate “dance” of trying to help them while still respecting their own right to make choices for themselves…My mom had some sudden health issues this summer which, now that they’re pretty much handled, have left her suddenly aged and also with some minor short-term memory problems…It’s tough to know how far to push or how much to do for her…I’m also having to tread lightly about suggesting things [my father] hasn’t thought of…In short, it’s a little tough dealing with the reversal of roles when they aren’t totally reversed.”

[Read more…]

Blog Update

by Leslie Kernisan, MD MPH

Dear readers,

Since I started the Geriatrics for Caregivers Blog a little over a year ago, I’ve done my best to post regularly to this blog. I hope the information has been helpful. Most of all, I’ve really appreciated the comments and feedback I’ve gotten from you.

I want to let you know that over the next few months, I’m going to be posting less often to this blog. That’s in part because I’m trying to finish an ebook. But it’s also because I’m working on better ways to bring you the information you need to help your loved ones.

For these reasons, the Geriatrics for Caregivers Q&A calls will be on hold until further notice.

But rest assured: I love making practical geriatrics health information available to caregivers like you, and I don’t plan to give it up!

Furthermore, I’d like to remain available to answer your questions via this site. So if you have a question about better health and wellbeing for an older person, please send it to me via the contact form below.

Although I can’t promise to address every question I receive, I will do my best to post answers to your questions, right here on this blog.

Thank you so much for your interest in learning about better health for aging adults!

How to Use a Personal Health Record to Improve an Older Person’s Healthcare

by Leslie Kernisan, MD MPH

All family caregivers want their older loved ones to get the right medical care. But doctors are often lacking key medical information at the time they see your aging relative.

The solution: setting up and using a personal health record (PHR).

This is a big step up from what many families do, which is to create an “in-case-of-emergency” packet. Such medical information packets usually include a list of medications, chronic conditions, and allergies, along with the names of next-of-kin and perhaps a POLST form.

I’ve reviewed such medical information packets, and they are certainly better than nothing. But in general, they don’t help older adults avoid these very common — and potentially serious — problems with their medical care:

Delays in treatment/action because test results aren’t available. Often doctors need test results in order to know how to proceed medically. If tests have been done but the results aren’t available, the doctor’s options are to fly blind, re-order the tests, or plan to request the test results and then see you again once the results are available.
Getting worse care in the emergency room, or in urgent care. An urgent medical problem often means seeing new doctors. Those doctors have to offer help quickly, but if they are lacking detailed medical information, it’s generally harder for them to offer the right medical management.
Suboptimal medication prescribing. Whenever medications are prescribed without first considering all other medications being taken, a senior’s health is being put at risk. Although bringing an up-to-date medication list (or better yet, all the medication bottles) is very helpful, it’s also valuable for doctors to understand why another doctor prescribed a medication.
Suboptimal care from a new primary care provider (PCP). Adults in late life often move and have to establish care with a new PCP. Especially when a senior has multiple chronic conditions or a complicated health history, delays in getting medical information means it often takes the new PCP months to get up to speed so that he or she can properly help the older person with his or health concerns.
Inadequate help from a specialist or consultant. Aging adults are often referred to specialists, but studies have found that specialists often don’t receive enough information to do their work. Again, at best this means delays and inconvenience for you; at worst this can lead to serious health problems if a senior gets the wrong care, or gets the needed care too late.

Fortunately, even a very basic and low-tech PHR can help your older loved one avoid the problems listed above.

At a minimum, you’ll save yourself hassle and the extra appointments that get scheduled because the doctor didn’t have the needed medical information the first time around. You’ll also spare your loved one the discomfort and expense of enduring duplicate testing.

More importantly, properly maintaining and using a personal health record (PHR) will go a long way to ensuring that your loved one gets better, safer medical care. It can also help you avoid potentially life-threatening medical mishaps.

The key is to learn what medical information to put into this PHR, and how to use it effectively for care coordination. This post will tell you what you need to know, to set up and use a PHR.

[Read more…]

POLST: Resources & Tips on Avoiding Pitfalls

by Leslie Kernisan, MD MPH

In this post — the last in a 4-part series on better planning for health crises and end-of-life care — I want to tell you about a document that I wish more families knew about: POLST.

POLST (which stands for Physician Orders for Life-Sustaining Treatment) is a legal document meant to tell healthcare professionals what you want done, in the event of a medical emergency. It’s kind of like a pre-hospital DNR (do-not-resuscitate), but much much better. (For starters, you don’t have to be DNR to use a POLST form.)

Note that POLST is not an advance directive, although when doctors ask if there is an advance directive, they are often thinking of POLST as well. (Because what they are really asking is, is there any pre-existing documentation that can help us understand what we should and shouldn’t do?)

And it’s not a perfect approach to making sure older adults get the care they want and need, when a health crisis hits. If you have heard of POLST, you may very well have heard some negative things; I’ve certainly heard some complaints over the years about POLST forms, or about how something didn’t quite work out despite the presence of a POLST.

Still, I really like POLST, and discuss POLST forms with many of the older adults and families that I work with. In California, POLST has largely replaced the pre-hospital DNR forms that some older adults used to have.

Furthermore, a study published in 2014 confirmed that in Oregon, where the POLST approach was first pioneered, POLST forms have helped get end-of-life wishes honored more often. (The New Old Age Blog published a related post recently, titled “When Advance Directives Are Ignored.”)

If you’re caring for a frail older person and you live in one of the many states with a POLST program — click here to find out if your state has POLST — I highly recommend you incorporate this tool into your loved one’s advance care planning. In most cases, a surrogate medical decision-maker can complete a POLST form.

In this post, I’ll share some resources on learning to use POLST to better plan for health crises and end-of-life care.

I’ll also offer some tips on avoiding common pitfalls, such as completing POLST without first addressing the learning and conversing parts of advance care planning.

[Read more…]

The Geriatrics For Caregivers Blog

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

Why maintaining an emotional connection is so important in Alzheimer’s

How to counter the way Alzheimer’s tends to drive couples apart

What Readers Say is Hard About Helping an Older Loved One

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