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 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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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

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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!

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.

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5 Tips to Help You With End-of-Life Planning

by Leslie Kernisan, MD MPH

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

Many older adults have never gotten around to addressing these issues.

Others 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.

In previous posts on this site, I’ve shared two true stories about older adults facing health crises, and possible end-of-life situations. (See here and here.)

In both situations, the older person and his/her family had to weigh their options. We also helped them consider the benefits versus the burdens of the choices available.

It is these kinds of situations that advance care planning is supposed to help us — patient, family, healthcare providers — prepare for.

But I know that many older people haven’t gotten around to completing — or revising — their advance care planning. Which is a shame, since this will make it harder for their family and doctors to provide the right help if a medical emergency arises.

So in this article, I’ll try to make this process easier for you and your family. Here’s what we’ll cover:

What is advance care planning,
The four key steps that should always be part of advance care planning,
Five tips to help you — or your older parent — address advance care planning.

I’ll also tell you about some of my favorite resources available to help seniors with all of this. These can really make it easier for older adults to sort out what they want, and have the necessary conversations with others.

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A Trial of ICU Care: a true end-of-life story

by Leslie Kernisan, MD MPH

This month I am featuring a series of posts about aging, health crises, and (possible) end-of-life situations. Earlier this week, I shared the story of Mrs. F, a very ill older woman with cancer who said she didn’t want to go to the hospital, even though she wasn’t on hospice.

Now, I want to share another true story, about a nonagenarian with cancer. He was DNR and we had planned for comfort care once his symptoms got worse. But when he fell dangerously ill, I ended up advocating for him to go to the Intensive Care Unit. Below is the story, with tips for caregivers at the end.

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5 More Treatments You Should Question in Older Adults

by Leslie Kernisan, MD MPH

Last week, I wrote about the first Choosing Wisely list of 5 treatments that older adults and their doctors should question.

In this post, I’ll cover the 2014 Choosing Wisely list for healthcare in aging adults, which was released by the American Geriatrics Society (AGS) this past February. This 2014 edition of things to question include:

The most popular class of medications prescribed for Alzheimer’s and other dementias,
Breast, colon, and prostate cancer screening,
A common approach to weight loss and poor appetite,
The prescribing of additional medications,
A common — but risky — approach to handling confusion during hospitalization.

As I explained in my last post, Choosing Wisely is a health education campaign meant to help patients and their doctors more easily spot common tests and treatments that are often overused.

For the Choosing Wisely items selected by AGS (my specialty society), I’d say the real problem is that these are healthcare interventions that are usually used before safer alternatives have been tried.

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Choosing Wisely: 5 Treatments You Should Question

by Leslie Kernisan, MD MPH

Did you know that it’s important to think about “Choosing Wisely,” when it comes to healthcare?

It’s true! Choosing Wisely is a health education campaign meant to help patients and their doctors more easily spot common tests and treatments that are often overused. To do this, many medical societies are creating lists of “Five Things Physicians and Patients Should Question.” Consumer Reports is also a partner in this project.

If you’re a caregiver for an aging person, you probably should know about the Choosing Wisely items identified by the American Geriatrics Society (AGS). These are treatments or tests that are:

Commonly given to older adults,
Often unlikely to help aging adults live better, or longer,
Riskier than many patients and caregivers realize.

In other words, these are treatments that older adults often don’t receive, when geriatricians are involved.

Of course, most older adults aren’t under the care of a geriatrician. If this is your family’s situation, learning about the Choosing Wisely items can be a good way to make sure your older relative avoids healthcare that is unnecessary, or even harmful.

In this post, I’ll review the “Five Things to Question” that were identified by the AGS in their intial Choosing Wisely list. (The AGS recently published a second list; I’ll review those items in a follow-up post.) I’ll also share some tips for caregivers, related to each item.

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The Geriatrics For Caregivers Blog

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

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