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.

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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Blood pressure medications linked to serious falls: What you can do

by Leslie Kernisan, MD MPH

Have you had any concerns about an older person falling, or being at risk for a broken hip?

A new clinical research study relevant to millions of older adults was just featured in the news.

The study, completed by a team of geriatrics researchers at Yale, found that in older adults aged 70 or older, taking blood pressure medication was linked to a higher risk of serious falls. (Serious falls as in, falls that caused an ER visit for a fracture, a dislocated joint, or a brain bleed. Serious stuff indeed!)

So, if the person you care for has a diagnosis of hypertension, and if you’ve had any concerns regarding falls or near-falls, these study results should be of interest to you.

In this post, I’ll review the key results of this study. Then I’ll tell you what I think are the most important practical take-aways for family caregivers.

This post will also include some practical tips to help you minimize the risk of your loved one experiencing a serious fall.

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Delirium: How Caregivers Can Protect Alzheimer’s Patients

by Leslie Kernisan, MD MPH

This week’s Q & A call was about how to better manage health and healthcare issues, when you’re taking care of someone with a dementia such as Alzheimer’s.

Most of the caregivers’ questions were about delirium. This is the state of worse-than-usual confusion that people can develop when they are sick or under serious stress.

I love talking to Alzheimer’s caregivers about delirium, because this is a really common problem that family caregivers absolutely can do something about!

The key is to know that people with dementia are especially prone to get delirium when they fall ill (especially in the hospital). And then you’ll want to know the basics on how to spot this problem, and how to get the doctors to address it properly.

A fact I wish more caregivers of elders knew: delirium can be the only obvious sign of a potentially serious health problem, such as a heart attack, a urinary tract infection, or a pneumonia. (Especially when it comes to older people with Alzheimer’s, they often don’t voice focused complaints the way younger people do.)

The trouble is, even though delirium is very common in older adults, studies have shown that it’s often missed by doctors and nurses. This is a important problem in healthcare, for three key reasons:

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2 More Things to Know About Better Healthcare in Alzheimer’s

by Leslie Kernisan, MD MPH

In my last post, I listed three things that I often wish more caregivers knew, about getting better medical care for a loved one with Alzheimer’s or another dementia.

In this post, I’ll list two more important things for dementia caregivers to know. Again, this will be an excerpt from Paula Spencer Scott’s book “Surviving Alzheimer’s: Practical tips and soul-saving wisdom for caregivers.”

But first, a quick word on Paula’s book, which as best I can tell, is really unique. On their own, her tips on handling common everyday problems — such as personality changes, memory glitches, difficult behaviors, and personal care issues — are good enough that I’d recommend her book to family caregivers because I love the practical “Why This, Try This” format she provides. She also offers solid advice on managing caregiver stress and relationship tensions.

Yet what’s really nifty about Paula’s book, is that she combines these practical tips with a section called “The Big Picture: Insights & Inspiration from the Wizards of Alz.” This is a compilation of twelve condensed expert interviews, and yours truly was very honored to be included.

Each expert has a different contribution to make to dementia caregiving. Whereas I focus on how caregivers can better manage the health issues, Bob DeMarco offers advice on “stepping into Alzheimer’s world,” Anne Basting provides guidance on using art therapy and storytelling, Teepa Snow suggests ways to decode the secret language of dementia, Leeza Gibbons encourages caregivers to not forget about themselves, and researcher Dr. Richard Isaacson provides cutting-edge advice on diet and dementia. (To see the full list of experts, you can preview the table of contents here, by clicking “look inside.”)

This creates a really rich and diverse package of perspectives, insights, and practical advice. So if you are looking for help surviving as a caregiver to someone with Alzheimer’s or another dementia, I encourage you to consider Paula’s book. (Note: Paula was my editor at Caring.com, and I also consider her a personal friend. But I wouldn’t tell you I recommend her book unless I really did like it.)

And now, back to what you can do, to get better healthcare for a loved one with dementia.

Two more things I wish caregivers knew about healthcare & dementia

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3 Things Caregivers Should Know About Better Healthcare in Alzheimer’s

by Leslie Kernisan, MD MPH

Having dementia, such as Alzheimer’s, brings on special challenges when it comes to health and medical care.

Last fall, my friend and colleague Paula Spencer Scott interviewed me on what family caregivers can do to improve the health — and healthcare — of a loved one affected by dementia.

The interview turned into a chapter in her terrific new book, “Surviving Alzheimer’s: Practical tips and soul-saving wisdom for caregivers.”

Below, I share three things I wish more caregivers knew about better healthcare for someone with a diagnosis of Alzheimer’s or another dementia. (Read about two more things to know in the follow-up post here.)

3 things I wish caregivers knew about healthcare & dementia

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What should a geriatrician try to teach caregivers?

by Leslie Kernisan, MD MPH

Next Tuesday, on December 17th, I’ll be trying something new: a free Q & A conference call, for caregivers of older adults.

Why? Because after spending the past several years writing articles and blog posts for family caregivers, I’m interested in taking things in a slightly new direction. These Q & A sessions will help me learn more about what kinds of questions caregivers have regarding the health issues of the people they care about.

In fact, I’m considering the possibility of creating some kind of small course or curriculum, to help caregivers learn more about how to manage the health issues of aging adults.

What I have in mind would be similar to a “mini-med school” course, but with the following features:

The topic would be related to some aspect of geriatrics, i.e. health and healthcare that’s adapted for frail and vulnerable aging adults. This means that either I could plan a course about the geriatric approach to a common condition (such as diabetes, or osteoarthritis), or we could address a geriatric “syndrome” such as memory problems, falls, pain, physical declines, etc.
The course would take place largely online. I’m not considering a MOOC; I don’t have the resources to create a “massive open online course.” But I am envisioning a course that would leverage Internet technologies in some way, such as by combining online course material with teleseminars, and maybe even an online forum for the learners.

Now, this upcoming Q & A call is not part of a course. But it should be a good learning experience for those caregivers who call in, and will help me learn more about what topics would be useful in a class for caregivers.

And, I’m really looking forward to doing these calls and working on some kind of course, as I’ve long believed that we geriatricians should be actively teaching caregivers more of what we know. After all, health issues are almost always part of what caregivers end up dealing with, or at least worrying about.

If you’re a caregiver with questions for me, or if you’re otherwise interested in learning how geriatricians approach health issues in aging adults, I hope you’ll join my conference call next Tuesday, December 17th, at 12:30pm Pacific Standard Time.

Can’t make it on Tuesday 12/17 at 12:30pm PST? Those who register for the call beforehand will later have an opportunity to download a recording of the call.

Questions? Comments? You can speak your mind below, or send me an email at info [AT] drkernisan [DOT] net.

A common problem that speeds Alzheimer’s decline, and how to avoid it

by Leslie Kernisan, MD MPH

Earlier this week, while I was listening to a social work colleague (Mary Hulme of Moonstone Geriatrics) give a talk on dementia at the public library, the following question came up:

“How can one keep Alzheimer’s from getting worse?”

Now, Alzheimer’s disease — the most common underlying cause of dementia symptoms — does slowly get worse no matter what. (Given enough years, it will eventually damage the brain to the point of causing a slow death, which is why Alzheimer’s is a terminal disease.)

But on the other hand, we do know that some things tend to slow the progression of brain decline, whereas other things seem to speed up the decline. In other words, the actions we take — and don’t take — can influence a person’s dementia journey.

In my experience, people often have heard about things that might slow down decline (exercise is one of my favorites).

But it seems to me that people are often much less well-informed about the things that can speed up Alzheimer’s decline. This is too bad, because often it is possible to take actions to avoid or minimize things that might cause dementia to get worse faster.

So today I’m going to write about what I think is the most important of these potentially dementia-accelerating problems: delirium.

Delirium: What it is, why it matters

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Tools to Help with End-of-Life Planning

by Leslie Kernisan, MD MPH

Yesterday I did a webinar with Family Caregiver Alliance, on end-of-life issues for dementia caregivers.

(4/10/14: I have just uploaded this powerpoint to Slideshare, so you can see my slides here.)

As you can imagine, this is a big topic that can’t be covered comprehensively in an hour.

So, I focused the talk mainly on something that I often find myself wishing families had spent more time on: advance care planning. Specifically, I talked about how individuals and families can approach planning for future medical care, in the context of a diagnosis of Alzheimer’s or another form of dementia.

Why? Because in my own experience, the last stage of life for a person with dementia is often strongly influenced by what kind of planning did — or didn’t — happen earlier on.

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Upcoming Webinar on Dementia & End-of-Life Planning

by Leslie Kernisan, MD MPH

Are you caring for an older person with Alzheimer’s or another dementia?

Would you like to learn more about planning and managing end-of-life issues?

If so, you might be interested in an online webinar this week that I’ll be doing in collaboration with Family Caregiver Alliance.

It’s scheduled for Thursday, November 7th, at 1pm PST (4pm EST). During the webinar, I’ll review how families can better address end-of-life planning in the context of a dementia diagnosis. I’ll also offer some suggestions as to how to handle common challenges at the end-of-life itself.

I will be taking live questions during the last part of the webinar. This is the part that I’m most looking forward to!

To sign up for the webinar, click here: https://www3.gotomeeting.com/register/764240806

Please note that Family Caregiver Alliance, who invited me to present, is charging $15 for the webinar.

How We Can Get to Better End-of-Life Care

by Leslie Kernisan, MD MPH

What is good care at the end-of-life, and how can we do better as a society?

This is the question that the Institute of Medicine (IOM) is now studying, and they have created a “Committee on Approaching Death: Addressing Key End-of-Life Issues.”

As part of their research into the current state of end-of-life care, the IOM is inviting the public to send them comments via this online comments page. (Comments must be submitted by November 1st, 2013.)

In particular, the IOM wants to hear about the following topics:

Barriers to and opportunities for improving care for individuals and their families,
Patient and family experiences with care, and
Health care provider experiences.

Now, as you can imagine, addressing end-of-life issues is a big part of what we do in geriatrics. Furthermore, I’m thrilled to see the IOM addressing this issue, since their reports are highly respected and often end up influencing policy and funding.

So I was very glad to provide some comments to the IOM, and encourage others — family caregivers, geriatric care managers, clinicians, or really anyone who has had personal experiences with end-of-life situations in the US — to submit comments as well.

The best reports, after all, result from the academics’ expert opinions being informed by the experiences of those of us in the trenches, trying to navigate real end-of-life situations.

My comments on Better End-of-Life Care for Older Adults

Below, I share the comments that I’m submitting in response to the IOM’s questions.

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The Geriatrics For Caregivers Blog

Two more things I wish caregivers knew about healthcare & dementia

3 things I wish caregivers knew about healthcare & dementia

Questions? Comments? You can speak your mind below, or send me an email at info [AT] drkernisan [DOT] net.

Delirium: What it is, why it matters

My comments on Better End-of-Life Care for Older Adults

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