Practical information for aging health & family caregivers
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.
In another post, I’ve shared the story of Mrs. F, a very ill older woman with cancer who said she didn’t want to go to the hospital, even though she wasn’t on hospice.
Now, I want to share another true story, about a nonagenarian with cancer. He was DNR and we had planned for comfort care once his symptoms got worse. But when he fell dangerously ill, I ended up advocating for him to go to the Intensive Care Unit. Below is the story, with tips for caregivers at the end.
What should you do if an older person complains of insomnia, or is not sleeping well at night?
Experts do believe that “normal aging” brings on some changes to sleep. (See this post for more on how sleep changes with aging.) Basically, older adults tend to get sleepy earlier in the evening, and tend to sleep less deeply than when they were younger.
So it’s probably not realistic to expect that as you get older, you’ll sleep as long or as soundly as when you were younger.
That said, although aging by itself does change sleep, it’s also quite common for older adults to develop health problems that can cause sleep disturbances. So if you’re older and aren’t sleeping well, you’ll want to make sure you’ve been checked for these. Figuring out what’s going on is always the first step in being able to improve things.
And remember, getting enough good quality sleep helps maintain brain health, physical health, and mood.
In this article, I’ll cover the top causes of sleep problems in older adults. I’ll also tell you about what approaches have been proven to work, to help treat insomnia and sleep problems in older adults.
Last but not least, if you (or your older relative) have experienced the very common combination of waking up to pee at night and difficulty sleeping, I highly recommend listening to this podcast episode, which features a geriatrician who is an expert on this: 092- Interview: Addressing Nighttime Urination & Insomnia in Aging.
Have you ever been told that your heart rate is slow, or maybe too slow?
This is called bradycardia, and it’s fairly common in older adults. Whereas in younger adults, a slow heart rate is often due to being in good cardiovascular shape, with aging, a slower heart rate often reflects changes in the heart’s electrical system. (Medications are another common cause.)
This can be an issue because a slower heart rate can cause symptoms such as fatigue, dizziness, falls, or trouble keeping up with usual activities.
Fortunately, in certain situations, a pacemaker can be an effective treatment that helps older adults feel substantially better.
To help older adults learn more about bradycardia and when to consider a pacemaker, I interviewed cardiologist Cara Pellegrini, MD, who specializes in cardiac electrophysiology. Here’s what’s most important to know, based on our conversation.
(This article is by my colleague Paula Spencer Scott, author of the book Surviving Alzheimer’s: Practical Tips and Soul-Saving Wisdom for Caregivers. I invited her to share an article on this topic, since many in our community are coping with dementia behaviors. — Dr. K)
The odd behaviors of Alzheimer’s and other dementias can be so frustrating and stressful for families.
I’m talking about the kinds of behaviors that try patience, fray relationships, and drive us in desperate search of help:
“First she thinks the caregiver is stealing her sunglasses and now she accused me of having an affair.”
“When I tried to help Dad wash up, he hit me.”
“My husband follows me so closely I can’t stand it. But if I go in another room he’ll wander out of the house.”
“Mom started unbuttoning her shirt in the middle of the restaurant!”
“Just when I’m completely exhausted at the end of the day, he seems to get revved up. He keeps peeking out the windows, convinced that someone is trying to break in. Now he won’t sleep.”
A common approach to sundowning and difficult behaviors is to go right to medicating them with tranquilizers, sedatives, or antipsychotics. But that’s risky and often not what’s best.
In fact, experts recommend trying behavior management first, and for good reasons: It tends to be more effective in the long run than “chemical restraints,” has no dangerous side effects, and leads to a better care relationship. But people often don’t know how to do this.
I’ve learned how.
I’ve lived through five close family members’ experiences with Alzheimer’s and other forms of dementia. Lots of trial and error, and insights from dozens of top dementia experts (whose brains I’ve been lucky to pick as a journalist and dementia educator), got me through regular scenes with…
In this article, I want to share what I wish someone had explained to me early on: the “Why-This, Try-This” approach to dealing with difficult behaviors.
This is a mental framework that can help you get unstuck from unproductive responses that get you nowhere or make things worse.
It can bring calm -– to both of you — whether the issue is verbal or physical aggression, agitation, confusion, wandering, disinhibition, delusions, hallucinations, or a restless or repetitive behavior (like pacing, shadowing, rummaging). It also works well with milder irritants like repetitive questions and indecision.
Then, I’ll boil down the Why-This, Try-This concept to a 7-step process you can use every time. These “7 R”s give you a basic platform for responding to any frustrating behavior:
Yesterday, August 21, was National Senior Citizens Day, a good opportunity to recognize older adults and reflect on what supports healthier aging. Medication safety is an important part of that, since the benefits, risks, and burdens of medications can change as we get older.
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.
Here are the most common problems that I see: [Read more…]
This is the sixth and final post covering the Healthy Aging Checklist, a set of six core activities that will help any older adult maintain the best possible health while aging.
They are:
In this post, I’ll address the last item on the list: advance planning for medical, legal, and financial issues. This includes power of attorney documents, plus much more.
This is a big topic, and it’s not possible to cover everything you could or should do in a single article. You would need a book for that — I suggest three down below — plus it’s best to work with qualified professionals (healthcare providers, eldercare attorneys, and financial planners) before completing any legally binding paperwork.
But every day as I work, I see older adults and families whose health and well-being is being affected by the consequences of their planning — or lack of planning, as the case often is.
So in this post, I will share some practical information that should make it easier for you to address planning that covers some common age-related challenges:
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:
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.
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.
Preventive health services essentially fall into three categories:
This is the fourth in a series of posts covering the Healthy Aging Checklist.
Again, the Healthy Aging Checklist summarizes the six fundamental activities I recommend when asked what to do to maintain the best possible health while aging. They are:
In this post, I’ll cover the fourth item: learning to optimize the management of any chronic conditions.
Now, people are often very interested in “prevention” and in “staying healthy.” But far fewer people seem to be interested in making sure that they and their doctors are doing the right things for any chronic conditions they already have, and — equally importantly — avoiding the wrong things.
This is a serious oversight, because most of the “aging” problems that older adults eventually develop are due to chronic health conditions that have progressed or caused complications.
So optimizing the care of chronic conditions is very important for the prevention of future health deterioration. And it’s also vital to helping older adults feel and function their best in the here and now.
According to Medicare, over two-thirds of beneficiaries have two or more chronic conditions. Here’s a figure from the Medicare Chronic Conditions Chartbook, showing what percentage of older adults are affected by the 15 most common chronic conditions:
I can’t emphasize this enough: these chronic conditions often are the key drivers, when it comes to an older person’s symptoms, health crises, health declines, and the eventual development of disabilities.
Furthermore, I’m sorry to say this but here goes: you should not assume that doctors will provide you with optimal care for chronic conditions. Experts have estimated that patients get only about half of recommended healthcare. A large body of healthcare quality research has repeatedly documented that it is very common for older adults to receive healthcare that varies from “wrong” (e.g. totally counter to guidelines with no documented justification for this) to “sub-optimal” (which means it’s not very deficient but could and should be better).
Later in this article, I will go into more detail on why doctors often provide sub-optimal care, and what you can do about it.
But first, let’s review what’s at stake and why it’s worthwhile to make sure you optimize the healthcare of an older adult’s chronic conditions. I’ll then finish by providing some practical tips to help you be proactive so you can optimize the care of chronic conditions, for healthier aging.
“What’s your biggest frustration with helping aging parents, or aging loved ones?”
This is a question that I periodically ask the readers of my eldercare newsletter.
I ask because in order to provide truly useful information on this website, I feel I should periodically check in and learn more about what you’re finding especially challenging.
Whenever I ask, I receive many replies, I learn quite a lot, and as usual, I find myself inspired by the remarkable efforts you are undertaking.
Now, I hadn’t initially been planning to share people’s answers on the blog. But when a reader wrote to me asking about the results of the “survey,” I realized that many of you may be wondering: “What do other people find most frustrating about helping an aging loved one?”
Below, you’ll find a series of quotes from the responses. I hope you find them as enlightening and inspiring as I did.
“My biggest problem with dealing with my aging parents (both in their 80s) is the delicate “dance” of trying to help them while still respecting their own right to make choices for themselves…My mom had some sudden health issues this summer which, now that they’re pretty much handled, have left her suddenly aged and also with some minor short-term memory problems…It’s tough to know how far to push or how much to do for her…I’m also having to tread lightly about suggesting things [my father] hasn’t thought of…In short, it’s a little tough dealing with the reversal of roles when they aren’t totally reversed.”
This is the third in a series of posts covering the Healthy Aging Checklist.
Again, the Healthy Aging Checklist summarizes the six fundamental activities I recommend when asked what to do to maintain the best possible health while aging. They are:
In this post, I’ll cover the third item: addressing commonly neglected aging health problems that routinely sabotage healthy aging.
These issues are sometimes referred to as geriatric syndromes. They affect health and quality of life, and although they happen more in people who are older or frailer, they affect countless people in their 60s and 70s as well.
Virtually all of these issues affect a older adults’s ability to socialize, be physically active, and take good care of himself or herself. So addressing these is key to enabling healthier aging.
Unfortunately, these issues routinely fall through the cracks of usual medical care. People often suffer from these problems for years without anyone taking effective action.
This may be because many people — doctors, older adults themselves, or family members — assume nothing can be done about these, and that they are just “part of getting old.”
Don’t believe that. We have studied these problems in geriatrics and most of the time, correctly evaluating and then managing these problems helps older adults and their families feel better, live better, and sometimes even live longer.
Remember, healthy aging is not just about preventing problems. It’s also about spotting them and addressing them before they get worse, or drag down the rest of your health and independence.
So for healthier aging, be proactive in checking for these oft-neglected problems.
And then remember: sub-optimal treatment of these problems is all too common. So you’ll need to be proactive about getting them correctly managed — which might mean either seeing a geriatrician (here’s how to find a geriatrician) or making sure your usual doctor is thinking like one.
Here’s what to look for, and how to learn more:
This work by Leslie Kernisan MD & Better Health While Aging LLC is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Based on a work at BetterHealthWhileAging.net.