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.

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.

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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:

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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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Why Older People Fall & How to Reduce Fall Risk

by Leslie Kernisan, MD MPH

Why do aging adults fall? To be honest, people don’t usually ask me this.

Instead, they want to know things like “How do I keep my mother from falling?” or “What should I do? I fell recently and am worried it could happen again.”

After all, falls are a scary thing. Most people know that falls are dangerous for older adults.

The Center for Disease Control (CDC) reports that one in five falls causes a serious injury, such as a broken bone or head injury. Fear of falling can also seriously affect an aging adult’s quality of life and, sadly, can keep a person from being active and thriving.

So, many older adults and family caregivers are interested in fall prevention because the risks are so great. (According to Google, “balance exercises for seniors” is a popular search query; I do like balance exercises in aging, especially when combined with strength training and other exercises.)

And the good news is that although it’s not possible to prevent all falls, it almost always IS possible to take actions that will reduce the chance of a bad fall.

And it’s easier to take action once we understand more about why an older person has fallen.

If you want to learn more, you’re in the right place. In this article, I’ll cover:

How understanding why aging adults fall can help you keep an older parent — or yourself — safer,
Why personalized fall prevention plans work better than relying on general fall prevention tips,
The four-step process I use to help older adults prevent falls,
A practical example showing you how to use these steps to avoid falls yourself.

First, understand why older people fall

There are many reasons that aging adults fall. Most older people will be falling due to their own unique combination of reasons.

So how, exactly, should YOU go about reducing fall risk?

Now, you can — and should — try to implement the general tips that are often listed in most fall prevention resources: exercise, medication review with the doctor, vision checks, and home safety reviews.

But if you really want to help an older person avoid falls, I recommend you learn to better understand why he or she, in particular, might fall.

Why? Because when you understand the specific reasons an older person may be falling, you’ll then be able to:

Identify which fall prevention strategies are most likely to help the person you worry about,
Recognize risky situations, and take steps to avoid them,
Know which medical conditions — and which medications — to ask your doctors to look into,
Understand what may have caused a specific fall, which can help you avoid future falls.

In other words, learning why older people fall means that you’ll be able to figure out why an older person is likely to fall — and take steps to help them.

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6 Steps to Better High Blood Pressure Treatment for Older Adults

by Leslie Kernisan, MD MPH

Have you been concerned about high blood pressure (hypertension)? Or are you worried about an older relative having a stroke or heart attacks?

You’re not alone. After all, hypertension is the most common chronic condition among older adults, and medications for blood pressure (BP) are among the most commonly taken drugs in the US.

Even more important: poorly controlled hypertension is a major contributor to the most common causes of death and disability in older adults: strokes, heart attacks, and heart failure.

So it’s certainly sensible for older adults – and for those helping aging parents – to think about lowering blood pressure.

And once you start thinking about high blood pressure, you’ll probably start to wonder.

Are the blood pressure medications you’re taking enough? Is your blood pressure at the “right” level or should you and your doctors work on changing things?

And what about that major research – the SPRINT trial — that made the news in 2015? (In this study, older adults randomized to aim for a lower BP did better than those who got “standard” BP treatment.)

These are excellent questions to ask, so I’d like to help you answer them.

Now, I can’t provide exact answers on the Internet. But what I can do is provide a sensible process that will help you successfully address these questions about lowering blood pressure.

In this article, I’ll share with you the process that I use to:

Assess an older person’s blood pressure management plan, and
Determine whether we should attempt changes.

If you’re an older adult, you can use this approach to get started assessing your own BP management plan. This will help you to better work with your doctors on assessing and managing your blood pressure.

If you are helping an older relative manage health, you can follow these steps on behalf of your relative.

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UTIs and Urine Bacteria in Aging:
How to get the right diagnosis & when to take antibiotics

by Leslie Kernisan, MD MPH

Q: An older friend, who is in her 90s, has been having bacteria in her urine, but no symptoms. Despite treatment with antibiotics, she was still having bacteria in the urine, so the doctor recommended chronic antibiotics and a referral to urology.

What can be done when an elderly woman has bacteria in her urine but no symptoms? Can a urology consultation help?

A: This is a great question. People often think that your friend is having a “recurring urinary tract infection (UTI)” or even a chronic UTI. But actually, you are describing something called asymptomatic bacteriuria, which means having urine bacteria without symptoms.

Every older person and family caregiver should know about asymptomatic bacteriuria. Here’s why:

It’s very common in older adults. This condition is found in an estimated 20% of women aged 80 or older, and also affects older men. The older the person, the more common it is. Asymptomatic bacteriuria is even more common in nursing homes, where it’s estimated to affect 30-50% of residents.

It’s often confused with a urinary tract infection (UTI). This can lead to unnecessary — and potentially harmful — treatment with antibiotics.

It usually does NOT need to be treated with antibiotics. As I’ll explain below, research shows that people don’t live better or longer when asymptomatic bacteriuria is treated. In fact, such treatment can be harmful: one study found that treatment increased the risk of future (real) UTIs, and increased the risk of infection with antibiotic-resistant bacteria.

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How to Avoid Problems Due to Aging Incapacity: The (Better) Durable General Power of Attorney

by Leslie Kernisan, MD MPH

One of the most common concerns I hear from people is “My older parent’s behavior is concerning me and I’m worried about her mental abilities.”

As I explained in a related article: it’s not always dementia but often it is. And unless an older person has done a good job planning ahead, it can be very hard and messy for others to intervene as needed.

But hopefully, that’s not yet your situation.

In which case, you might be wondering: Given that it’s so common for aging adults to eventually start slipping mentally — or to be suddenly disabled due to an accident or serious health crisis — what kind of planning should older adults and families do to avoid this kind of situation?

I’ve done some research on this question, and here’s what I found out.

One of the simplest — and often less expensive — smart planning approaches is for an older adult to complete a general durable power of attorney (POA) document.

Especially if the powers granted are broad — which they often are — a POA can enable the designated person (known as the “agent”) to step in and assist with finances, housing, safety, and anything else covered by the POA .

A durable POA allows an agent to take action once the older person is “incapacitated.” In California, such POAs can be used to move a person with dementia to a different living arrangement.

Now, the durable power of attorney approach isn’t perfect. Over the years, I’ve noticed that two broad categories of problems come up:

Concerns as to whether the agent might be using the POA to financially exploit the situation
Issues related to determining incapacity and whether the older person should be overridden.

In truth, I have occasionally encountered situations in which different doctors had different opinions on whether an older person was incapacitated. This troubles me, because agents should really only be stepping in and overriding older adults if we’re all sure they’ve lost capacity and are making decisions that don’t serve their overall goals, or are hazardous to others.

Still, a general durable POA is an excellent approach to consider. But I would recommend you pay special attention to how the document is drafted, in order to reduce the risk of financial exploitation and to avoid pitfalls related to determining incapacity.

In this post, I will share:

What I’ve learned about general durable power of attorney documents
Why determining incapacitation is often problematic in the real world
Tips on avoiding a common POA weakness
What to know about including third-party accounting and other strategies recommended by the American Bar Association, to reduce the risk of financial exploitation by an agent
Useful resources I’ve found online for more information

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Q&A: How to Diagnose & Treat Mild Cognitive Impairment?

by Leslie Kernisan, MD MPH

Q: I realize that I sometimes have difficulty connecting a name and a face. I presume that this is mild cognitive impairment.

On researching the topic online, I find a variety of suggestions for alleviating it. These include supplements (lipoic acid, vitamin E, omega 3s, curcumin), food choices (fish, vegetables, black and green teas), aerobic exercise, yoga, and meditation.

Do these actually help with mild cognitive impairment? What’s been proven to work?

A: It’s common for older adults to feel they’re having trouble with certain memory or thinking tasks as they get older.

I can’t say whether it’s mild cognitive impairment (MCI) in your particular case. But we can review what is known about stopping or slowing cognitive changes in people diagnosed with MCI.

First, let’s start by reviewing what MCI is, and how it’s diagnosed. Then I’ll share some information on the approaches you are asking about, as well as other approaches for treating MCI.

What is Mild Cognitive Impairment?

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Leg Swelling in Aging: What to Know & What to Do

by Nicole Didyk, MD

Swelling in the lower legs – known as “lower extremity edema” in medical terms – is a problem that often affects older adults.

The good news is that most of the time, it’s annoying, but not terribly dangerous. However, in other cases, swelling in the feet, ankles, or lower legs can be the sign of a new health problem, or a worsening chronic condition.

And, even if it’s “benign” and not related to a dangerous health condition, edema can be a major risk factor for skin breakdown and reduced mobility in aging adults.

Since leg swelling becomes so common as people get older, in this article we’ll demystify leg edema and cover the most important things that older adults and families should know about this condition. In particular, we’ll cover: