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.

27 Recommended Preventive Health Services for Older Adults: the Healthy Aging Checklist Part 5

by Leslie Kernisan, MD MPH

This is the fifth in a series of posts covering the Healthy Aging Checklist, which is my list of six fundamental activities that will help any older adult maintain the best possible health while aging.

They are:

Promote brain health and emotional well-being.
Promote physical health.
Check for and address common aging health problems (such as falls, memory concerns, depression, incontinence, pain, isolation, polypharmacy).
Learn to optimize the management of any chronic conditions.
Get recommended preventive health services for older adults.
Address medical, legal, and financial advance care planning.

In this post, I’ll cover recommended preventive health screening guidelines and other prevention services for older adults. These are based on the recommendations of the U.S. Preventive Services Task Force (USPSTF) and also on Medicare’s coverage of preventive health services.

By my count, based on the USPSTF and Medicare guidelines, there are currently 27 preventive health services that older adults should consider. I have a summary list here, and then detailed information on each service starting here.

Get Your Free Preventive Health Cheatsheet! The 27 proven preventive health services for older adults, in a handy PDF checklist that you can print or save. Includes details on who should get each service, and helpful links. Click here now.

But before you read about them, let’s go over the basics of how health screening and other preventive health services work, including why they can sometimes be harmful, or sometimes fall out of favor.

This way, when you review the list of preventive services to consider, you’ll better understand which services are likely to help, and why certain services may not be a good fit for you or your parent.

Understanding Preventive Health Services

Preventive health services essentially fall into three categories:

[Read more…]

5 Questions to Ask Yourself on National Healthcare Decisions Day

by Leslie Kernisan, MD MPH

Since 2008, April 16th has been designated as “National Healthcare Decisions Day” (NHDD).

It’s an initiative meant to “inspire, educate and empower the public and providers about the importance of advance care planning.”

In other words, National Healthcare Decisions Day is meant to get you to think about things like advance directives, living wills, powers of attorney for healthcare.

This means planning for your future…a future time during which you might be ill and others — most likely your family — will have to make decisions about your healthcare.

It’s basically a great opportunity to address end-of-life planning, and equip your family to know what they should do during a medical emergency.

This is not a particularly unlikely scenario. Between the present-at-all-ages possibility of being in a bad accident and the increased likelihood of illness as one gets older, you’d actually have to be quite lucky — or unlucky, depending on how you see it — to reach the end of your life without anyone else ever having to make a medical decision on your behalf.

Still, studies and surveys generally find that many of us have not yet taken the needed steps to “make our wishes known.”

And even among those who have “made their wishes known,” there’s usually more to it than they realize, and they often have skipped an important piece of the process.

[Read more…]

6 Common Medication Problems in Aging, & What You Can Do

by Leslie Kernisan, MD MPH

If you’re helping an older person with health and healthcare, chances are that person is taking at least a few prescription medications, if not several.

Do you ever wonder if he or she is on the right medications? Do you worry about side-effects and interactions?

These are sensible concerns to have. Many older adults end up experiencing “polypharmacy,” which means taking more than 5 medications concurrently.

And although medications do often help maintain health and wellbeing, studies have repeatedly shown that lots of older adults end up suffering from problems related to medication.

Polypharmacy, predictably, increases the risk of problems. (Polypharmacy is usually defined as taking five or more medications concurrently.) But even older adults taking one to three daily medications can encounter problems.

So I want to share a list of common ways that medications affect the health and wellbeing of aging adults. I’ll then explain what you can do, to minimize these problems.

Six Common Medication-Related Problems in Aging Adults

Here are the most common problems that I see: [Read more…]

3 Ways to Prevent Injury From a Fall
(Plus 3 Ways That Don’t Work as Well as You’d Think)

by Leslie Kernisan, MD MPH

Worried about falls in an older person?

You’re right to be concerned, especially if the older person has already experienced a fall. Research suggests that falling once doubles your chance of falling again.

And falls, as everyone knows, can cause life-changing injuries. The Centers for Disease Control (CDC) reports that:

One out of five falls causes a serious injury such as broken bones or a head injury
Each year at least 300,000 older people are hospitalized for hip fractures
More than 95% of hip fractures are caused by falling, usually by falling sideways
Falls are the most common cause of traumatic brain injuries

For these reasons and more, preventing falls is a major focus of preventive care for older adults, and is a big part of what we do in geriatrics. (Learn more about how we do this in this article: Why Older People Fall & How to Reduce Fall Risk.)

But if we want to protect older people from the potentially devastating consequences of falls, it’s not enough to help them reduce falls.

We also need to think about how we can reduce the likelihood of injury from a fall.

In this article, I’ll share with you three approaches that can help reduce fall-related injuries.

Then I’ll address two other approaches that are sometimes tried, but are less likely to help.

3 ways to prevent fractures and other injuries related to falls

[Read more…]

Depression in Aging:
Diagnosis & Treatment When the Golden Years are Blue

by Nicole Didyk, MD

Most of us can relate to feeling sad or blue, sometimes for days at a time. It may be in response to a major life event like losing a job, a break-up, or as part of grief. These sad feelings can lead us to feel less interested in enjoyable activities, make us lose our appetite or disrupt sleep.

Although research shows that people often become happier as they age, sad feelings are also very natural and can be associated with some of the typical transitions and changes of aging. But clinical depression, from a medical point of view, is something different, and should not be considered a normal part of getting older.

In this article, I’ll explain the most important things to know about late-life depression, including:

What’s different about depression in later life?
What are the symptoms of depression and how is clinical depression diagnosed (especially in an older person who may also have medical illnesses that can mimic depression symptoms)?
What does testing for depression look like?
What treatments are recommended for older adults with clinical depression?
What you can do if you’re worried that someone is depressed, and how to help someone with depression.

In an upcoming article, I’ll also cover the special considerations and challenges when it comes to diagnosing and treating depression in those living with dementia, which is a common scenario in my practice as a geriatrician.

Depression in Later Life

[Read more…]

How to Prevent Falls: 4 Proven Approaches To Ask Your Doctor About

by Leslie Kernisan, MD MPH

Worried about falls in an older parent or relative? If so, do you know if their doctor has considered the most useful fall prevention approaches?

Fall risk can be reduced, but it generally takes some thought and effort. That’s in part because most older adults have multiple factors making them vulnerable to falls.

In a related article on this site, I’ve explained that best fall prevention plans involve identifying an older person’s particular risks — especially risks related to health conditions — and trying to counter those.

So for instance, if an older person has diabetes and is having frequent moments of low blood sugar (also known as hypoglycemia), then to reduce falls, addressing the hypoglycemia is as important, if not more, as starting an exercise program.

In other words, I always recommend that aging adults and families learn to tailor their fall prevention plans. You want to focus on what are the most important modifiable risk factors for that individual person.

That said, over the years I’ve noticed that there are four approaches that I find myself using over and over again, in almost all my patients who have had repeated falls.

These four approaches are used often by geriatricians, but much less often by busy primary care doctors. Unless, that is, a proactive family asks about them.

My Four Most-Used Fall Prevention Approaches

[Read more…]

How You Can Help Someone Stop Ativan

by Leslie Kernisan, MD MPH

Have you heard of Ativan (generic name lorazepam), and of the risks of benzodiazepines drugs in older adults? Is an older person you care for taking prescription medication for sleep, anxiety, or “nerves”?

Would you like an easy, practical tool to help someone stop a drug whose risks often outweigh the benefits?

If so, I have good news: a wonderful patient education tool has been created by a well-respected expert in geriatrics, Dr. Cara Tannenbaum. Best of all, a randomized trial has proved that this tool works.

As in, 62% older adults who received this tool — a brochure with a quiz followed by key information — discussed stopping the medication with a doctor or pharmacist, and 27% were successful in discontinuing their benzodiazepine. The brochure includes a handy illustrated guide on slowly and safely weaning a person off these habit-forming drugs.

This is big news because although experts widely agree that long-term benzodiazepine use should be avoided in older adults, getting doctors and patients to work together to stop has been tough. It is, after all, generally easier to start a tranquilizer than to stop it!

But through a patient education brochure, Dr. Tannenbaum’s team was able to make this tricky process much more doable for older adults, their families, and their doctors.

Why it’s important to try to stop lorazepam & other benzodiazepines

[Read more…]

5 Things to Know about Aging Parents & Financial Decline

by Leslie Kernisan, MD MPH

You probably already know that many older adults develop problems managing finances as they age.

Now how would you answer the questions below:

Has your aging parent planned for a decline in financial abilities?
Are you prepared to detect signs of a financial decline?
Do you know what to do if you do notice problems with finances?

Many people, even the ones who are caring and well-informed, will often answer “no” to these questions.

But this post will equip you to start answering yes. And I want you to be able to answer yes, because declines in the ability to manage finances are very common among older adults, and often causes serious health and life problems.

The trouble, of course, is that financial decline is uncomfortable for older adults and their families to think about. Managing money, after all, is one of the ways we maintain autonomy and control over our lives.

So nobody likes to confront the fact that our ability to manage money will — in all likelihood — someday decline. (Research suggests that even aging adults who don’t develop dementia often experience declines in financial ability.) And families are understandably squeamish about monitoring an older relative’s financial abilities.

Fortunately, a little education and guidance can make it much easier to be more proactive about this tough topic.

In this post, I’ll cover

Five warning signs of financial decline
Five important things to know about aging & finances
How to protect aging parents from financial problems
What to do if your aging parent is having trouble managing their finances

I’ll also cover some ways that geriatricians and other healthcare providers can help, both to reduce declines in financial ability and to properly evaluate them when they occur.

5 Warning Signs of Financial Decline

[Read more…]

COVID Vaccination for Aging Adults:
What to Know & Do

by Leslie Kernisan, MD MPH

COVID is an important issue for older adults: they are more likely to be severely affected by COVID, and they represent most COVID deaths.

Luckily, COVID vaccines are effective and significantly reduce the risk of hospitalization and death in older adults. In particular, I want to offer science-based information to help with common questions, such as “Which COVID vaccine is better for seniors?” or “Which COVID vaccine for a 90-year-old?”

This page covers my older science-based updates on COVID vaccines.

For my latest update, see here: Covid & Aging Adults: Current Vaccines & Updates

[Read more…]

Coronavirus Update & Suggestions (7.16.20 Edition)

by Leslie Kernisan, MD MPH

Like many of you, I continue to follow the coronavirus situation closely, for personal and professional reasons.

Given the dismaying surge in COVID cases over the past several weeks, this week I devoted part of my twice-monthly Helping Older Parents members call to this topic, and I have decided to share this part of the call below.

This video covers:

The coronavirus situation today
Are we better at preventing COVID?
Are we better at treating COVID?
Current COVID treatments available in the hospital
My take on hospitalization for frail older adults with COVID
Useful resources and my recommendations for this summer

The video is below, or get the audio-only through the podcast here.
(For those who have asked about transcripts: I wish I could but right now we are too short on funding; transcripts cost $1.25/minute to produce plus more time to format and finalize.)

Please stay as safe as you can, and take care!

Related resources:

[Read more…]

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The Geriatrics For Caregivers Blog

Understanding Preventive Health Services

Six Common Medication-Related Problems in Aging Adults

3 ways to prevent fractures and other injuries related to falls

Depression in Later Life

My Four Most-Used Fall Prevention Approaches

Why it’s important to try to stop lorazepam & other benzodiazepines

5 Warning Signs of Financial Decline

Related resources:

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