Helping Older Parents Articles

Wondering whether you should worry? Having trouble getting parents to accept help? Overwhelmed by challenges and concerns?

This part of the site is especially for you! It includes our hand-picked articles, tips, & resources for people helping older parents.

Heart Failure in Aging: Symptoms, Types, Causes & Treatments

by Leslie Kernisan, MD MPH Leave a Comment

Have you been told that you — or someone important to you — has heart failure?

This wouldn’t surprise me, as this is one of the most common heart conditions affecting older adults. People are sometimes alarmed by the term “heart failure”; does it mean the heart is about to stop working? Luckily, that’s not usually the case.

Heart failure actually means that the heart is not pumping or filling as well as it should. This can affect how well blood moves through the body, and it can lead to symptoms such as shortness of breath, fatigue, swelling, and reduced ability to exercise.

Heart failure can be serious, and it is important to take it seriously. But it is also a condition that many older adults live with for years, especially when it is properly diagnosed and treated.

In this article, I’ll explain:

What heart failure means
The main types of heart failure
Common causes in older adults
Symptoms to watch for
How heart failure is diagnosed
How it is treated and managed
What to know if an older person is frail
Questions to ask the doctor

This information is based on a Better Health While Aging video podcast conversation with cardiologist Cara Pellegrini, MD, who is a professor at UCSF.

What Is Heart Failure?

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How to Help Doctors Notice What’s Wrong: The story of the missed pelvic fracture

by Leslie Kernisan, MD MPH 20 Comments

Once upon a time, the ER missed a pelvic fracture in one of my older patients.

Actually, this kind of thing has happened more than once, and perhaps it’s happened to your family too.

As much as we’d like to believe that our older loved ones will get the right care when they are sick or injured, the truth is that our healthcare system is imperfect, and it’s fairly common for serious problems to be missed.

Unless, of course, a proactive family caregiver knows to help the doctor focus on what’s newly wrong.

Here is a true story about why geriatricians pay attention to “changes in function” and why it’s essential that you help doctors spot any changes in function or ability.

The case: unable to walk after a fall

My patient with Alzheimer’s dementia, 85-year-old Mr. C., sat down short of his easy chair at home and fell. Within minutes, his daughter found him on the floor. She helped him to the chair, and they watched some TV. But half an hour later, he was unable to get up again and walk. She took him to the emergency room for evaluation.

“I’m fine. Nothing hurts,” Mr. C. told the busy ER staff more than once. “I just want to go home.” X-rays of his hips and pelvis revealed nothing, and so — after an exam that probably lasted only a minute or two — he was discharged.

Back home, however, he still couldn’t walk. He still insisted nothing hurt. “I’m a tough old bird,” he told his daughter. Later that night, though, she noticed that he grimaced every time he rolled over in bed. She knew something was wrong. But what?

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Incompetence & Losing Capacity:
Answers to 8 FAQs

by Leslie Kernisan, MD MPH

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Have you ever been concerned about an older relative who seems to be making bad decisions?

Perhaps your elderly father insists he has no difficulties driving, even though he’s gotten into some fender benders and you find yourself a bit uncomfortable when you ride in the car with him.

Or you’ve worried about your aging aunt giving an alarming amount of money to people who call her on the phone.

Or maybe it’s your older spouse, who has started refusing to take his medication, claiming that it’s poisoned because the neighbor is out to get him.

These situations are certainly concerning, and they often prompt families to ask me if they should be worried about an older adult becoming “incompetent.”

In response, I usually answer that we need to do at least two things:

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How to Manage Sleep Problems in Dementia

by Leslie Kernisan, MD MPH

Sleep problems are common in Alzheimer’s and other dementias. They also commonly drive family caregivers crazy, because when your spouse or parent with Alzheimer’s doesn’t sleep well, this often means that you don’t sleep well.

To make matters even worse, not getting enough sleep can worsen the thinking or behavior of someone with dementia. Of course, this is true for those of us who don’t have Alzheimer’s as well: we all become more prone to irritation and emotional instability when we’re tired. Studies have also shown that even younger healthy people perform worse on cognitive tests when they are sleep-deprived.

Hence getting enough sleep is important, for people diagnosed with dementia, and for their hard-working caregivers. Now, sleep problems do often take a little effort to evaluate and improve. But as I explain below, research has found that it is often possible to improve sleep problems in dementia.

The key is to know what common causes to look for, and then come prepared to provide useful information to the doctor. In this article, I’ll cover:

Common causes of sleep problems in Alzheimer’s and other dementias,
How sleep issues should be evaluated
Proven approaches that help improve sleep in dementia
What to know about commonly tried medications for this problem

Common Causes of Sleep Changes and Problems in People with Dementia

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Understanding Diabetes in Aging

by Leslie Kernisan, MD MPH

Have you ever wondered how diabetes (or prediabetes) affects older adults?

Or whether your blood sugar numbers are cause for worry?

These are reasonable concerns, given that diabetes is pretty common in later life.

So in this post, I’d like to help you better understand diabetes in later life. Specifically, I’ll cover:

The basics about blood sugar, insulin, and diabetes
Signs and symptoms of diabetes in older adults
The risks of high and low blood sugar in older adults
How diabetes is diagnosed
Treating older adults for diabetes
Treating prediabetes
What to do if you’re concerned about diabetes in an older person

Blood Sugar Basics: What Is Glucose and Insulin?

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Hiring In-Home Caregivers for Aging in Place: What to Know

by Leslie Kernisan, MD MPH

This article is by Michelle Allen, LCSW. Michelle is an experienced social worker and geriatric care manager based in Atlanta and is a featured expert providing guidance in our Helping Older Parents programs.

At some point, you may need to have someone help your older parent – or perhaps you – with care in the home.

So, what do you do when you need some more hands to help with housekeeping, meal preparation, dressing, transportation, medication management, etc.? How do you find qualified, reliable, kind, and trustworthy people?

About two-thirds of all help comes from unpaid caregivers — such as daughters, sons, and friends — and about one-third of all help comes from paid caregivers.

It is easy to understand how you get a family member or friend to help — you usually just ask. But hiring a paid in home caregiver can be a bit more daunting.

In this article, I’ll explain what you need to know, to better understand your options and get the care that is needed.

Home Care vs. Home Health

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How to Review Medications for Safety & Appropriateness in Aging

by Leslie Kernisan, MD MPH

By now you’ve probably heard that older adults are often taking “too many” medications.

You also hopefully know that older people are often prescribed medications that may be harmful, or no longer necessary. The CDC has estimated that adverse drug events send older adults to the emergency room 600,000 times per year.

Why does this happen? Research has shown that “inappropriate prescribing” is common in older adults. Meaning that, when patient charts are carefully reviewed, experts often find that older adults are receiving medications that are ineffective, duplicate the effect of another medication, or otherwise lack a basis for being prescribed.

So what can you do?

To reduce the chance of being harmed by inappropriate medications, the answer is not to look for a super doctor. The answer is to regularly conduct a methodical medication review, in which all medications are reviewed for appropriateness and safety. This is part of a process called “deprescribing.”

Scheduling such regular medication reviews is becoming more common in well-run primary care clinics. But if your doctor’s office doesn’t yet offer this service, you can ask for it.

Geriatricians are trained to do this, but if you can’t find a geriatrician, you should be able to get a decent review from the primary care doctor.

But before you go in, it pays to do a little homework on your own. That’s because the input of a patient and her caregivers is actually crucial to determining whether each medication is appropriate for her.

To help you complete this background preparation for a medication review, just follow the 5-Step process I describe below. This will free up some time when you’re actually seeing the doctor — which might mean more time for questions or discussion — and can help you spot safety issues that a non-geriatrician might otherwise not notice.

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Financial Exploitation in Aging: What to Know & What to Do

by Leslie Kernisan, MD MPH

Here’s an upsetting situation that comes up a lot, and may have come up for you: is someone financially taking advantage of Mom or Dad?

It’s a pretty legitimate concern to have. To begin with, most people know that there are plenty of “scammers” out there, phoning or mailing older adults with deceptive information designed to hoodwink them out of some of their savings.

But there’s actually another form of exploitation that may be more common, and is often harder for families to address.

That would be exploitation perpetrated by a someone the older person knows and has a personal relationship with.

Sometimes the person suspected of exploitation is relatively new to the older person’s life, such as a new romantic interest, friend, or paid caregiver.

In other cases, family members become concerned that someone in the family – such as one of the older person’s children – is beginning to take financial advantage of things.

Exploitation in the context of personal relationships is often especially tricky for families to address. The older person may be quite attached to – or otherwise feel dependent on – the person that others perceive as suspicious or problematic. Or there may be concerns about stirring up family dramas and conflicts, by voicing concerns about a sibling or another relative.

People are often unsure of what exactly constitutes illegal activity, and what can be done if they are concerned about financial exploitation.

So in this article, I’ll cover the key things you should know, so that you can better evaluate and address a worrisome situation, should one arise.

Specifically, in this article I’ll explain:

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Age-Related Hearing Loss (Presbycusis):
What to Know & What to Do

by Leslie Kernisan, MD MPH

Have you noticed that an older relative seems to be having trouble hearing you at times?

Or perhaps you’ve realized that sometimes YOU are the one saying “What?”

These situations are extremely common. Sometimes the issue is that one is trying to communicate in a noisy place and there is no need for concern.

But in many cases, these kinds of issues can indicate that an older person (or even a middle-aged person) is being affected by age-related hearing loss. (The medical term is “presbycusis”)

You probably already know this: chronic hearing impairment becomes very common as one gets older. The National Institute on Aging reports that one in three adults aged 65-74 has hearing loss, and nearly half of those aged 75+ have difficulty with hearing.

Hearing loss also affects a significant number of people earlier in life. A 2011 study on the epidemiology of hearing loss documented hearing loss in 11% of participants aged 45-54, and 25% of those aged 55-64.

In short, research confirms that quite a lot of people experience hearing loss. But sadly, research also confirms that hearing loss is often under-recognized and inadequately addressed.

This is a major public health issue, for older adults and also for the many middle-aged adults experiencing hearing loss. At this point, we know quite a lot about: [Read more…]

How to Plan for Decline in Alzheimer’s Dementia:
A 5-Step Approach to Navigating Difficult Decisions & Crises with Less Stress

by Leslie Kernisan, MD MPH

Q: My mother is 76 and has Alzheimer’s disease. She had a couple of unavoidable stays last year in the hospital (due to falls). This accelerated her decline due to delirium, which was treated as if she was just being an unruly and difficult patient. Once my sister and I understood what was going on due to this site’s information, we have been able to protect and support her.

Right now things are stable and quiet, so we are trying to plan ahead.

How should we go about planning for the years of decline my mother may experience before her actual last moments near death? It’s hard to imagine this possibility and I need help facing the (to me) not so obvious.

We have a will, power of attorney, and health care proxy in place.

A: Great question, and especially good that you’re taking advantage of a “quiet period” to address these issues.

It’s a little tricky to answer this question without knowing more about your mother’s current ability to participate in decision-making and in planning for her future care.

Since you say she’s declined after hospitalizations for falls and delirium, let me assume that she has moderate Alzheimer’s and can’t manage more than perhaps expressing some of what she likes and doesn’t like. (For more on the stages of Alzheimer’s and related dementias, see here.)

At this point, you’ve been through some health crises already, and you’ve seen her decline. You’ve also probably gotten a sense of just how many decisions have to be made on her behalf. Some are about her medical care and some are about other aspects of her life, like where she lives and how she spends her days.

Planning ahead is an excellent idea. Obviously, it’s simply not possible to anticipate and plan for every decision that will come up.

But let me offer you an approach that you can use both now as well as “in the heat of the moment” when specific issues arise. This is a framework to help you navigate all kinds of care decisions and future crises that you may encounter.

The following five steps will give you a foundation for anticipating, processing, and reacting to the complications and problems of later-stage Alzheimer’s, with less anxiety and more confidence. These steps are:

[Read more…]

Helping Older Parents Articles

What Is Heart Failure?

The case: unable to walk after a fall

Common Causes of Sleep Changes and Problems in People with Dementia

Blood Sugar Basics: What Is Glucose and Insulin?

Home Care vs. Home Health

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