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.

6 Ways that Memory & Thinking Change with Normal Aging (& What to Do About This)

by Leslie Kernisan, MD MPH

It’s annoying but unfortunately true: most parts of the body work less well as one gets older and older.

This is even true of the brain, which is part of why it becomes more common to experience a “tip of the tongue” moment as one gets older.

Such age-related changes in how the brain manages memory, thinking, and other mental processes are called “cognitive aging.”

Understanding how aging changes cognitive function is important. It can help you understand what to anticipate when it comes to your own aging. It can also help families better understand the changes they’re noticing in an older person, and whether those are out of the ordinary or not.

Since I’ve often written about changes in thinking that are abnormal and concerning in older adults, I thought it might be helpful for me to write an article outlining what is normal and to be expected.

Specifically, I’ll cover:

How cognitive aging differs from other diseases and conditions that affect memory and thinking
6 ways that memory and thinking change with aging
The difference between crystallized and fluid intelligence
How to tell cognitive aging apart from more worrisome changes, such as mild cognitive impairment and signs of Alzheimer’s and related dementia
Practical takeaways and what you can do

[Read more…]

Vitamin D: What to Know
(& Why to Be Careful About High Doses)

by Leslie Kernisan, MD MPH

Confused by all the back and forth in the media about vitamin D?

That’s understandable. Once touted as the thing to take for health and well-being, vitamin D has actually not been meeting expectations in randomized trials. It’s even been demoted in some expert recommendations.

That said, there is still a pretty easy and straightforward approach that most older adults can take.

In this post, I’ll explain what I recommend to most of my older patients, and why it’s important to be careful about taking higher doses of vitamin D3.

I’ll also address the following vitamin D frequently asked questions:

How much vitamin D to take every day?
What does vitamin D do?
What to know about the symptoms of vitamin D deficiency
The benefits and side effects of vitamin D
Which type of Vitamin D should I take?
Do I need to have my vitamin D blood level checked?
What should one’s vitamin D level be?
Will vitamin D really prevent falls or fractures?
Will vitamin D prevent dementia, cancer, and/or premature death?
I am outside a lot. Do I need a vitamin D supplement?
I heard that a higher level of vitamin D is better for you. How much is too much?

You can also learn more about the surprising risks of too much vitamin D in aging in this video:

Now, when I first wrote this article in 2015, vitamin D supplementation for older adults was recommended by experts — to help reduce the risk of falls and fractures, among other things — although most geriatrics experts did not think the high doses (e.g. 2000 IU daily or more) that many people take are indicated.

(For years now, many people have had unrealistic expectations of what vitamin D can do for them. Sometimes this is because they think it will improve their health. In other cases, it seems to be because their doctors never got around to reducing a higher dose which should’ve only been used for a limited time period. Either way, it’s concerning because taking high doses of vitamin D has been linked to problems, as I explain below.)

Today, experts in geriatrics are reassessing what to recommend for vitamin D supplementation.

This reassessment is in large part driven by the publication of a large randomized trial of vitamin D supplementation in older adults, the VITAL study, plus a few other research studies that have suggested that higher doses of vitamin D supplementation are associated with more falls and hospitalizations.

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Anemia in the Older Adult:
10 Common Causes & What to Ask

by Leslie Kernisan, MD MPH

Have you ever been told that you have anemia, or wondered about anemia symptoms?

Or perhaps you noticed the red blood cell count flagged as “low” in the bloodwork report? Or noticed “low hemoglobin” in a doctor’s report?

Anemia means having a red blood cell count that is lower than normal, and it’s very common in older adults. About 10% of independently living people over age 65 have anemia. And anemia becomes even more common as people get older.

But many older adults and families hardly understand anemia.

This isn’t surprising: anemia is associated with a dizzying array of underlying health conditions, and can represent anything from a life-threatening emergency to a mild chronic problem that barely makes the primary care doctor blink.

Still, it worries me that older adults and families don’t know more about anemia. If you or your relative has this condition, it’s important to understand what’s going on and what the follow-up plan is. (I’ve so often discovered that a patient didn’t know he or she had had anemia!) Misunderstanding anemia can also lead to unnecessary worrying, or perhaps even inappropriate treatment with iron supplements.

Featured Download: What to Ask Your Health Providers About Anemia. Use this free PDF to make sure you ask key questions about your anemia condition, including what’s been done to diagnose the cause, and what the plan is for treatment. Click here to download.

And since anemia is often caused by some other problem in the body, not understanding anemia often means that people don’t understand something else that is important regarding their health.

Fortunately, you don’t have to be a doctor to have a decent understanding of the basics of anemia.

This post will help you understand:

How anemia is detected and diagnosed in aging adults.
Symptoms of anemia.
The most common causes of anemia, and tests often used to check for them.
What to ask the doctor.
How to get better follow-up, if you or your relative is diagnosed with anemia.

You can also watch my video covering Anemia in Aging: Symptoms and Solutions:

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How We Diagnose Dementia: The Practical Basics to Know

by Leslie Kernisan, MD MPH

“Doctor, do you diagnose dementia? Because I need someone who can diagnose dementia.”

A man asked me this question recently. He explained that his 86 year-old father, who lived in the Bay Area, had recently been widowed. Since then the father had sold his long-time home rather quickly, and was hardly returning his son’s calls.

The son wanted to know if I could make a housecall. Specifically, he wanted to know if his father has dementia, such as Alzheimer’s disease.

This is a reasonable concern to have, given the circumstances.

However, it’s not very likely that I — or any clinician — will be able to definitely diagnose dementia based a single in-person visit.

But I get this kind of request fairly frequently. So in this post I want to share what I often find myself explaining to families: the basics of clinical dementia diagnosis, what kind of information I’ll need to obtain, and how long the process can take.

Now, note that this post is not about the comprehensive approach used in multi-disciplinary memory clinics. Those clinics have extra time and staff, and are designed to provide an extra-detailed evaluation. This is especially useful for unusual cases, such as cognitive problems in people who are relatively young.

Instead, in this post I’ll be describing the pragmatic approach that I use in my clinical practice. It is adapted to real-world constraints, meaning it can be used in a primary care setting. (Although like many aspects of geriatrics, it’s challenging to fit this into a 15 minute visit.)

Does this older person have dementia, such as Alzheimer’s disease? To understand how I go about answering the question, let’s start by reviewing the basics of what it means to have dementia.

5 Key Features of Dementia

A person having dementia means that all five of the following statements are true:

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Hospital Delirium: What to know & do

by Leslie Kernisan, MD MPH

“How should delirium be managed in the hospital?”

This question came up during a Q & A session, as we were discussing the Choosing Wisely recommendation to avoid tying down older adults who become confused during a hospitalization.

Delirium is a common and very important problem for all older adults in the hospital. It doesn’t just happen to people with Alzheimer’s or a dementia diagnosis. (And, it’s not the same thing.)

But many family caregivers have hardly heard of hospital delirium. This is too bad, since there’s a lot that family caregivers can do to prevent this serious complication, or at least prevent an older loved one from being physically restrained if delirium does occur.

In this post, I’ll review what older adults and families absolutely should know about hospital delirium. And, we’ll cover some of the things you can do if it happens to your loved one.

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Essential Parts of Medicare: The ABCDs to Know & Tips for Open Enrollment

by Michelle Allen, LCSW

Every year, Medicare has an open enrollment period: October 15 – December 7.

During this time, Medicare beneficiaries can do the following:

Switch from Original Medicare to Medicare Advantage, or vice versa;
Switch from one Medicare Advantage plan to another;
Change Medicare Part D (prescription drug) plan; or
Enroll in a Medicare Part D (a late enrollment penalty may apply).

Medicare health and drug plans can and do make changes each year—things raising premiums, changing benefits, and changing what providers and pharmacies are in their networks. That’s why it’s important for Medicare beneficiaries to review their current plans, options, and needs for the next year.

For FREE help identifying your best Medicare coverage options, Dr. K recommends calling Chapter Medicare Advisory at 771-224-0630, or visit askchapter.org/betterhealth.

Before you can start deciding if and what to change about your Medicare benefits, you have to understand the basics of Medicare.

In this article, I’ll review the basics of Medicare Parts A, B, C (also known as Medicare Advantage) and D. Then, I’ll share some tips on navigating the Medicare Open Enrollment period and how to get help, if you’re considering making a switch or if you need help affording the Medicare premiums.

You can also watch this video, in which Dr. K and I explain what’s most important during Medicare Open Enrollment. (We also share a review of Chapter Medicare Advisory, and explain how it works.)

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Preventing Falls: 10 Types of Medications to Review if You’re Concerned About Falling

by Leslie Kernisan, MD MPH

Have you been concerned about falls for yourself, or for an aging parent?

If so, do you know if any of your medications might be increasing your risk for falls?

In its Stay Independent brochure, the Centers for Disease Control (CDC) recommends older adults do the following four things to prevent falls:

Ask your doctor or pharmacist to review your medicines.
Begin an exercise program to improve leg strength and balance.
Get annual eye check-ups and update your glasses.
Make your home safer.

In this article, we’ll focus on medications for three reasons:

Medications are among the most common causes of increased fall risk in older people.
Medications are usually among the easiest risk factors to change, when it comes to falls in older adults.
Medication-based risks are often missed by busy regular doctors. Older adults and family caregivers can make a big difference by being proactive in this area.

I want you to understand just what types of medications you and your doctors should be looking for, when you address medication review as part of fall prevention. This article will also explain exactly what to do, once you’ve identified any medications that are associated with falls.

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COVID & Aging Adults: 2025-2026 Updates

by Leslie Kernisan, MD MPH

COVID was really bad when it first came on the scene, especially for older adults, who made up the vast majority of people who were hospitalized or died from the virus.

Things are now much better. This is partly because most of us have now had exposure to COVID, either through having it, being vaccinated, or both. This provides most people with significant protection from the worst effects of COVID.

However, as people get older, their immune system ages and works less well.

This means that even if an older person has had COVID before, it can hit them harder than a few years ago (especially if their health has declined).

So COVID will continue to be an important health issue in geriatrics. Fortunately, the vaccine does significantly reduce the risk of hospitalization or death from COVID.

On this page, I’ll be posting updates related to COVID and older adults. I’ll be focusing on important developments and what I think is most important for older adults and their families to know.

I also have a section below on general COVID safety principles for older adults.

Covid & Aging Adults:

Update October 2025: COVID & Fall Vaccines for 2025-2026

In this update, I cover:

COVID so far in 2025
Why fall vaccines matter
COVID vaccines for 2025-26
Moderna mNEXSPIKE and other options
Flu vaccines for 2025-26
What to know about RSV vaccines
How to reduce your chances of getting sick

Related CDC resources:

Also recommended:

Your Local Epidemiologist: Covid-19 vaccine changes: What it means for you

General COVID principles for older adults (that won’t be changing)

Since the pandemic started, a few core principles regarding COVID and aging have held true. Here they are:

1.The risk of being hospitalized and/or dying from COVID goes up with age.

Most people don’t get sick enough to be hospitalized from COVID, and that has been true even of nursing home patients (even before they were vaccinated).

But even though younger people have been hospitalized and even died of COVID, it’s overwhelmingly people over age 65 who have done so. Vaccines have reduced this risk for older adults, but most of the serious breakthrough infections still happen in older adults.

In fact, in the fall of 2021, the risk of death due to COVID was higher in vaccinated people aged 80+ than in unvaccinated people aged 30-49. (I discuss the data on this in-depth in my December 2021 COVID update.)

Unfortunately, this means that older adults will need to be more careful about COVID than others are, even if they are vaccinated.

The coronavirus does not care if you feel like 70 is the new 50. The average 70-year-old will have a markedly higher risk of illness from COVID than the average 50-year-old. (And that average 50-year-old has a higher risk than the average 30-year-old.)

Now, this doesn’t mean permanently restricting all activity and living in fear for the next few years. But it does mean that older adults will benefit from paying attention to what is going on with COVID, and should consider taking additional precautions when surges occur in their communities.

2. COVID is airborne and reducing your chance of catching it is about minimizing inhaling what others are exhaling.

Sure, some COVID variants are more contagious than others. But they are all airborne and mostly transmitted when people breathe in air (usually indoor air) that is carrying COVID particles.

So it’s important to be mindful of the air you are breathing in, especially if COVID rates are currently high in your local area. (Because when COVID rates are high, it’s more likely that someone breathing in the room may be exhaling COVID…and probably doesn’t know it.)

These simple approaches reduce the chance of breathing in COVID:

Wearing a mask. The better the mask, the better your protection. The best masks are N95s, followed by KN95s and KF94s. After that, probably safest is to double mask (a surgical mask covered by a cloth mask). A well-fitting cloth mask does provide some protection, but it’s good to up one’s mask game when there’s a big surge or very contagious variant going around. (Or if you are immunocompromised or at particularly high risk of severe COVID.)
Ventilating indoor spaces. Airborne COVID can definitely float further than 6 feet and can linger suspended in a non-ventilated room for some time. (Think of it like cigarette smoke in a room; it hangs around even after the smoker has left the room.) Opening doors/windows or using a good quality HEPA air filter helps clear the air.
Others wearing masks when they are indoors with you. You will be protected by your own mask, but you get additional protection when others in the room are wearing a mask as well. (Because their mask helps catch any COVID particles or other germs they might be unintentionally emitting.) For public indoors spaces, this often comes down to local rules. For your own home, you get to set the rules and you may want to ask others to remain masked indoors when a surge is going on.
Socializing, eating, and meeting outside when possible. Outside is always safer in that there is way more ventilation and air circulation outdoors, compared to indoors. In many cases, it will be reasonably safe to be unmasked outside. (But of course, it’s safer if you are masked, especially if you are close to someone who is speaking unmasked, or eating.)
Minimizing your time indoors with other unmasked people who are not part of your immediate household. This means minimizing things like indoor dining and other indoor activities in which people are unmasked. Again, this is most important when COVID rates in your community are high. If you must be inside unmasked with others, the fewer the people, the better.

It has slightly surprised me that US public health authorities have not made ventilation and indoor air quality more of a priority. In some countries, such as Japan, carbon dioxide concentrations are posted in public spaces such as movie theaters. (Humans exhale carbon dioxide, so concentrations go up when ventilation isn’t adequate.)

3. If you catch COVID, significant protection against hospitalization and death comes from vaccination. If you are older, you will lose protection unless you stay up-to-date on COVID vaccines.

We now have lots of data. This has held true for all variants so far.

It’s also true for all age groups, but it makes the biggest difference in people who are over age 50, and makes a bigger difference as people get older.

The thing is, the protection from vaccination and boosters does wane, especially when people are older. Protection against catching COVID wanes first (usually within 2-3 months) and protection against severe hospitalization wanes within 6 months.

Hence, it’s essential for older adults to stay up-to-date on their COVID vaccines. (You can learn about the latest COVID vaccine by watching my most recent video update above.)

Also: even shortly after boosting, the vaccine effectiveness against catching COVID may be only 30-40% for older adults. (So far it has been much higher — 70% or more — against hospitalization and severe COVID.)

So you should never assume that if you and everyone else in the room is “fully vaccinated”, or even up-to-date on boosters, that means you are COVID-proof. (Because you are not.)

But the general principle will remain: older adults who are vaccinated and up-to-date on boosters will have a significantly lower risk of hospitalization and death due to COVID than those who are not. (I support COVID vaccines for the rest of us because that helps protect older adults, the immunocompromised, and other vulnerable people among us. Plus reduces our own small risk of severe COVID to virtually nil.)

4. Take more precautions when COVID rates are high or going up.

We don’t want to live constantly in fear, and it’s very costly to live a very restricted life long-term.

So instead, I recommend being ready to take more precautions when the conditions warrant it, such as when COVID rates are going up or are very high.

5. Safety from COVID is not the only thing that is important in life.

Yes, COVID is risky, especially for vulnerable older adults. But the costs of trying to be as safe as possible from COVID can be very high.

We have seen this play out especially in nursing homes, where residents experienced devastating consequences from social and physical isolation during the first part of the pandemic. (It’s also an issue for schools, young adults, and others.)

So as we navigate COVID, let’s keep in mind that safety from COVID is just one of many things to consider. We still need to connect and come together, and we should not let COVID prevent that altogether.

And that’s it for now! Please take care and stay reasonably safe, especially during COVID waves.

Note: For my previous updates regarding COVID vaccines and other developments from the first years of the pandemic, see my original COVID updates page here.

4 Types of Exercise in Later Life: How to maintain strength, balance, & independence in aging

by Leslie Kernisan, MD MPH

It’s one of those cliches that is true: exercise really is very good for your health.

In fact, one expert in applied longevity wrote that:

“Exercise is by far the most potent longevity ‘drug’. No other intervention does nearly as much to prolong our life span and preserve our cognitive and physical function.” — Peter Attia, MD, in his book “Outlive.” (Note: the emphasis there is mine.)

If you’re an older adult: are you exercising regularly? And if so, are you doing enough of the “right” kinds of exercises?

People are often quite interested in “balance exercises for seniors,” especially if they’ve become concerned about preventing falls. Those are great, but there’s really much more to know and do, when it comes to exercise and aging.

Since exercise is such an essential activity that most older adults are under-using, in this article, I’ll explain what’s most important to know about exercising in later life, including what types of exercise to do.

Specifically, I’ll cover:

The benefits of exercising in aging
What to know about walking for exercise
Four types of exercise to make sure you do
Why balance exercises and strength are key to mobility and preventing falls
Protein intake and strength-building
The risks of exercise in aging and what to ask your doctors
How to avoid getting injured

You can also learn more about aging with strength, independence, and vitality in this video:

[Read more…]

Flu Shots for Older Adults: What to Know & Do for 2025

by Leslie Kernisan, MD MPH

It’s that time of the year: fall, which I think of as flu vaccination time.

I always think getting a flu vaccine is a good idea for most older adults. So I agree with the Centers for Disease Control (CDC), which is urging that people get vaccinated against influenza early in the fall (before the end of October 2025).

Now, vaccination against seasonal influenza can seem like a bit of a tricky topic. Many older adults are skeptical of the need to get a yearly vaccination against influenza. They aren’t sure it will help. Or they think that the vaccination will actually give them a mild case of the flu. Or they just don’t like needles.

Or maybe they aren’t sure which type of seasonal flu shot to get: the regular one or one of the newer “stronger” versions, designed for older adults?

And now that we have COVID-19 to contend with, vaccination for seasonal influenza might feel even more confusing for people.

Don’t let yourself be confused. In this article, I will share with you what I know about influenza vaccination and what I’ve learned about influenza in COVID times. I also have updates on the stronger flu vaccines that are now recommended for older adults.

This year, I agree with the CDC that it’s important for people to get their seasonal flu shot, and if you are an older adult, I recommend getting one of the three flu vaccines specifically recommended for older adults. (See below for more on these!)

Note: If you are age 65 or older and it’s been more than 2 months since your last COVID booster, you may be able to get your COVID fall booster shot at the same time.

In “normal” pre-COVID times, the Centers for Disease Control (CDC) estimates that every year, influenza affects 9-45 million Americans, causes 140,000-810,100 hospitalizations, and results in 12,000-61,000 deaths. In most years, influenza vaccination does help reduce hospitalizations and deaths (I go into details below).

So this year, it’s important to do what you can to reduce respiratory illness, to protect yourself, and to protect others. And getting vaccinated against influenza is one of the things we can do.

In fact, I’m about to go get mine. As a healthy woman in her 40s, I’m not that concerned about getting dangerously ill from influenza. Instead, I get my annual flu shot because I want to minimize my chance of getting sick and perhaps exposing my older patients to influenza.

Here’s what I’ll cover in this article:

The basics of influenza and vaccination against the flu
What we know about influenza and COVID-19
What to know about flu shots for older adults & the CDC’s new recommendations specifically for older adults
What’s new and resources for the 2025-2026 flu season
Which influenza vaccination is probably best for most older adults
What to do if your older parent or relative is unwilling or unable to get vaccinated
Whether it’s more important to get a flu shot or a COVID vaccination (or a booster)

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The Geriatrics For Caregivers Blog

5 Key Features of Dementia

Covid & Aging Adults:

Update October 2025: COVID & Fall Vaccines for 2025-2026

General COVID principles for older adults (that won’t be changing)

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