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.

Why the Flu is Often Missed in Older Adults
(& What to Do About This)

by Leslie Kernisan, MD MPH

You’ve likely already heard the news: the flu is pretty bad this year, with the Centers for Disease Control (CDC) confirming a higher than usual level of illnesses, hospitalizations, and even deaths.

You also probably know that older adults (and certain other groups of people) have a higher risk of falling very ill from the flu, and have the highest death rates from flu.

But what many people don’t know is this: influenza is easily — and often — missed in older adults.

What do I mean by missed? I mean:

Older adults (or their family members) may not realize an older person has the flu, because many older people don’t develop “typical” influenza symptoms.
Health professionals often fail to test older people for influenza, even when they are sick enough to be hospitalized. This phenomenon was confirmed in a recently published study.

This is a very serious issue, especially when the flu virus is causing a lot of severe illness, as it is now.

The main problem is this: delayed — or entirely missed — recognition of influenza means that older adults often don’t get treated early — or at all — with anti-influenza drugs such as oseltamivir (brand name Tamiflu).

Particularly for those older adults who have chronic illnesses (especially those affecting the heart or lungs) or are frail, you don’t want to miss that chance to take anti-influenza drugs. They can’t guarantee an older person will avoid a hospitalization or death from influenza, but they do improve one’s chances.

And anti-influenza drugs are most likely to work when they are given within 48 hours of a person falling ill from influenza, with earlier being better.

So when flu activity is widespread, families need to be prepared to recognize potential flu.

And, you should be prepared for the possibility that the health providers might not think to test for influenza, unless you ask about it.

This article will help you learn to do these things. Here’s what I’ll cover:

What are the usual symptoms of “influenza-like illness”
Common symptoms of influenza in older adults
Why older adults may not show typical influenza symptoms
What we know about older adults & influenza testing
What the CDC currently recommends, regarding influenza diagnosis and treatment
What to do, if an older person falls ill during influenza season

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New High Blood Pressure Guidelines Again:
What the Cardiology Hypertension Guidelines Mean for Older Adults

by Leslie Kernisan, MD MPH

And once again, high blood pressure is making headlines in the news: the American Heart Association and the American College of Cardiology (AHA/ACC) have just released new guidelines about hypertension.

Since this development is likely to cause confusion and concern for many, I’m writing this post to help you understand the debate and what this might mean for you and your family.

By the way, if you’ve read any of my other blood pressure articles on this site, let me reassure you: I am not changing my clinical practice or what I recommend to others, based on the new AHA/ACC guidelines.

The core principles of better blood pressure management for older adults remain the same:

Take care in how you and your doctors measure blood pressure (more on that here),
Start by aiming to get blood pressure less than 150/90 mm Hg, as recommended by these expert guidelines issued in 2017 and in 2014,
And then learn more about what are the likely benefits versus risks of aiming for more intensive BP control.

Perhaps the most important thing to understand is this: treatment of high blood pressure in older adults offers “diminishing returns” as we treat BP to get lower and lower.

Scientific evidence indicates that the greatest health benefit, when it comes to reducing the risk of strokes and heart attacks, is in getting systolic blood pressure from high (i.e. 160-180) down to moderate (140-150).

From there, the famous SPRINT study, published in 2015, did show a further reduction in cardiovascular risk, when participants were treated to a lower systolic BP, such as a target of 120.

However, this was in a carefully selected group of participants, it required taking three blood pressure medications on average, and the reduction in risk was small. As I note in my article explaining SPRINT Senior, in participants aged 75 or older, pushing to that lower goal was associated with an estimated 1-in-27 chance of avoiding a cardiovascular event. (The benefit was even smaller in adults aged 50-75.)

SPRINT did not include people who have certain common conditions, including diabetes, heart failure, past stroke, or dementia. Hence it’s not clear that the (small) benefits of intensive blood pressure control would apply to those older adults who would not have qualified for the SPRINT trial.

I will come back to the SPRINT study later in the article, since it undoubtedly influenced the recent AHA/ACC guidelines. But first, a little on why the new guidelines are notable.

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How Exercise Helps Aging Adults:
Key benefits (and disappointments) from a landmark study

by Leslie Kernisan, MD MPH

Have you ever wondered whether it’s worth your while to encourage an older person to start exercising?

In 2014, the top-notch journal JAMA published the results of a fantastic research project: a study in which 1635 sedentary older adults (aged 70-89) were assigned to get either a structured exercise program, or a program of “successful aging” health education. The researchers called it the Lifestyle Interventions and Independence for Elders (LIFE) study. (You can read the full study here.)

During the LIFE study, the two groups were followed for a little over 2.5 years. And by the end of the study, guess which group of volunteers was more likely to still walk a quarter of a mile (without a walker)?

That’s right. When it came to avoiding “major mobility disability” — which the researchers defined as becoming unable to walk 400 meters or more — a structured exercise program was better than a program of healthy aging education.

Specifically, the researchers found that 30% of the exercisers experienced a period of major disability, compared to 35.5% of the seniors enrolled in the healthy aging education program.

This is a very encouraging finding! That said, it’s also a bit sobering to realize that even with exercise, almost 1 in 3 older adults experienced a period of limited mobility, of which half lasted 6 months or more.

In this post, I’ll share some more details on this study, because the results provide a wonderful wealth of information that can be helpful to older adults, family caregivers, and even geriatricians such as myself.

Want to know how often the exercisers experienced “adverse events”? (Hint: often!) Wondering just what the structured exercise program involved? (Hint: more than walking!)

Let’s dig into the details! At the end of this post, I’ll share my list of key take-home points for older adults and family caregivers.

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Q&A: Hospice in Dementia, Medications, & What to Do If You’re Concerned

by Leslie Kernisan, MD MPH

Q: Dear Dr. K,

With all the news about opioids and benzodiazepines, and their risk of death, I would love to hear your take on the use of these drugs in hospice.

We’ve had two family experiences now (my Mom and my Aunt) who were given these drugs right away when they went on hospice…without hospice trying anything else first that would be less dangerous. My Mom was up and about walking one day at her memory care facility, even laughing. The next day, when hospice put her on morphine and Ativan, she was in a coma. She died 13 days later without ever regaining consciousness. When I protested and asked why she wasn’t waking up, the hospice nurse said, “It’s not the drugs, it’s the disease.” (Mom had dementia.) The nurses wouldn’t let us give her fluids (“you don’t want your mother to aspirate, do you?”) or feed her (“you don’t want your mother to choke, do you?”).

With my Aunt, she had also been in the memory care facility and got to the point of needing a two-person assist. Her power of attorney (POA) was given the choice of moving my Aunt into a nursing home or bringing in hospice. Hospice immediately gave her morphine and Ativan, then backed off the Ativan and gave her morphine every two hours until she died 3 days later.

Now the third sister, also with dementia, has been in hospice for two months and counting. She is lucid most days, eating/drinking, comfortable—all without the opioid/benzo drug combo, because of our experience.

How can family members identify a hospice that doesn’t use this troubling combination of drugs from the start, without first trying something less dangerous, to make a patient “comfortable”?

A: Thanks for sending in this question. I’m very sorry to hear that your experiences with hospice have left you concerned.

It is indeed extremely common for hospice to use morphine and lorazepam (brand name Ativan) to treat end-of-life symptoms. That’s because many people on hospice are suffering from troubling symptoms that these medications can relieve, such as pain, shortness of breath, anxiety, and agitation.

Still, these medications are not always necessary. They are supposed to be prescribed and used as required to relieve the dying person’s symptoms, not by default. So the situation you describe with your mother and your aunt does sound potentially concerning. At a bare minimum, the hospice personnel should have done a better job of discussing their proposed care plan with your family.

Now let me be clear: I cannot say if the way they prescribed morphine and lorazepam was inappropriate or not, because it’s impossible for me to know the specifics of your mother and aunt’s medical situation.

Still, we can certainly review some basics about hospice care for people with Alzheimer’s and related dementias, as well as recommended best practices, when it comes to using opioids and benzodiazepine sedatives.

Here’s what I’ll cover:

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Our Podcasts & How to Listen

by Leslie Kernisan, MD MPH

I’m very happy to announce that the new Helping Older Parents Podcast is now live and available for you to listen, alongside the existing Better Health While Aging Podcast!

You can find all the new Helping Older Parents Podcast episodes here, and over 100 existing Better Health While Aging Podcast episodes here.

Leslie Kernisan Podcast Cover With Subtitle 320px

And now, let me answer some of the questions people have already asked me about the shows and about listening to podcasts.

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3 Guides to Help With “The Talk” With Aging Parents, & More Useful Resources

by Leslie Kernisan, MD MPH

It’s that time of the year again: first Thanksgiving, and then winter holidays. Which means this is the time of the year when families are most likely to get together with older parents.

Ideally, this means a time for families to bond and spend joyful times together. And no matter what is going on in your older relative’s life, bonding and joy are always possible. So I hope this holiday season brings you many opportunities to enjoy your aging relatives.

But there are two more challenging things that tend to happen during the holidays:

Families — especially adult children who don’t see their parents often — may find themselves concerned about an older relative’s health or safety or well-being.
Families often use the holidays as a time to get together and have “the talk.” Or otherwise try to plan and “get things in order.”

Nobody likes addressing these two situations. But they do come up a lot at this time of year.

In case any concerns or planning needs come up for you during the holidays, here’s what I’ll be sharing in this post:

3 useful guides, to help you address common aging and caregiving concerns
Tips on what to do if you’re worried about an older relative
6 common problems that worry families, with resources on addressing them

3 Guides to Help You Have “The Talk” With Aging Relatives

Here are three online guides that can help you. They all include a printable PDF version.

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What Is Geriatrics & Why It’s Not Just for the “Old-Old”

by Leslie Kernisan, MD MPH

Pop quiz: Can you define geriatrics? And did you know that it’s not just for the “old-old”?

If you hesitated with these two questions, don’t feel bad. Most people know that geriatrics has something to do with the elderly, but beyond that there’s a lot of confusion about what it is, who it can help, and how it’s different from gerontology.

To clear up the confusion and help all seniors — whether younger or older — understand how to benefit from geriatrics, I’ve written an article for NextAvenue.org:

“How Geriatrics Can Help You – Even If You’re Not Yet ‘Old-Old‘”

In this article, I explain:

What is geriatrics
Why geriatrics, similar to pediatrics, involves a medical knowledge base along with an approach that’s better for certain age groups
What is a geriatrician
What is gerontology, and how it’s different from geriatrics
Why you do need geriatrics but probably don’t need a geriatrician

Why We Should All Understand What Geriatrics Is

I wrote this article because geriatrics has wonderful things to offer when it comes to the health of older adults, just as pediatrics offers wonderful benefits to children. (Kids need healthcare that’s adapted to their growing minds and bodies. Older adults need healthcare that’s adapted to their aging bodies and minds.)

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4 Things to Do When an Older Person Resists Help

by Leslie Kernisan, MD MPH

“Doctor, my mom needs help but she won’t accept it and she won’t listen.”

Sound familiar? As several of you commented last fall, older relatives often seem reluctant to accept the help we think they need.

Now, I don’t have a magic formula for making this easy. But I do have a new article published on NextAvenue.org, that addresses this very issue:

“4 Things To Do When Your Parents Are Resisting Help“

In this article, I explain four approaches that I always recommend to families, when they are struggling to get older parents to make changes.

They aren’t silver bullets. But they should make it a little easier to get through difficult situations with older loved ones.

So take a look, and let me know what you think.

How to Check an Older Adult for Common Health & Safety Problems

by Leslie Kernisan, MD MPH

Worried about an older relative, but not quite sure what to do?

Common concerns I hear include:

Are my parents safe living on their own?
Could my mom be getting Alzheimer’s disease?
How can I find help for my father who lives alone?
I’m worried my mom might fall at home and get hurt.
I’m worried that my dad isn’t taking good care of himself.
Is it time to move to assisted living?

To help people turn their worries into a practical action plan, I’ve created a special new resource. You can download it here:

Helping Older Parents Quick Start Guide: Check Your Parents in 5 Key Areas

This guide is modeled on the mental checklists that I use when I first assess an older adult who lives at home.

Specifically, this is a quick version of how I initially check for the most common “don’t miss” health and safety red flags. It includes practical tips, such as who to ask for help, as well as a list of useful online resources.

If you’ve been concerned about an older adult who lives at home or in assisted-living, I hope you’ll take a look!

8 Behaviors to Take Note of if You Think Someone Might Have Alzheimer’s

by Leslie Kernisan, MD MPH

Have you been worried about an older person’s memory or thinking skills? If so, you’ve probably found yourself wondering if this could be Alzheimer’s, or another dementia.

What to do next? If you look online or ask people, the advice is generally this: tell the doctor.

This advice isn’t wrong, but it’s incomplete. Yes, you should tell the doctor. But you’ll dramatically improve your chances of getting to the bottom of things if you come to the doctor with useful information on what you’ve observed.

In fact, research has found that interviewing family members about the presence or absence of eight particular behaviors can be just as effective, when it comes to detecting possible Alzheimer’s, as certain office-based cognitive tests.

8 Alzheimer’s Behaviors to Track

For each of these behaviors, try to make note of the following:

Whether there’s been a decline or change compared to the way your parent used to be
Whether this seems to be due to memory and thinking, versus physical limitations such as pain, shortness of breath or physical disabilities
When you – or another person – first noticed problems, and what you observed
What kinds of problems you see your parent having now

If you don’t notice a problem in any of the following eight areas, make a note of this. (E.g., “No such problem noted.”) That way you’ll know you didn’t just forget to consider that behavior.

Have you noticed:

Signs of poor judgment? This means behaviors or situations that suggest bad decisions. Examples include worrisome spending, or not noticing a safety issue others are concerned about.
Reduced Interest in Leisure Activities? This means being less interested and involved in one’s usual favorite hobbies and activities. You should especially pay attention if there isn’t a physical health issue interfering with doing the activity.
Repeating Oneself? Has your parent started repeating questions or stories more than he used to?
Difficulty Learning to Use Something New? Common examples include having trouble with a new kitchen appliance or gadget. This can be a tricky one to decide on, given that gadgets become more complicated every year. But if you’ve noticed anything, jot it down.
Forgetting the Year or Month? Especially once one stops working, it can be easy to lose track of the date or day of the week. But if you notice your parent forgetting the year or month, make a note of this.
Difficulty Managing Money and Finances? Common examples include having trouble paying bills on time, struggling to balance the checkbook, or otherwise having more difficulty than one used to have managing finances.
Problems with Appointments and Commitments? If you’ve noticed that your parent is having more trouble keeping track of appointments and plans, make note of this.
Daily Struggles with Memory or Thinking? It’s normal for older adults to take a little longer to remember things, since many brain functions do slow a bit with aging. But it seems that your parent often can’t remember things that happened, or otherwise seems to be more confused with thinking, make note of this.

For more on diagnosing Alzheimer’s and other dementias

If you’re worried that your older relative might have dementia, I recommend you learn more here: How We Diagnose Dementia: The Practical Basics to Know
My book, “When Your Aging Parent Needs Help“, also comes with worksheets to help you check for signs of dementia, a handy checklist of what information to bring to the doctors, and more.
In this Youtube video I share 10 early warning signs of Alzheimer’s Disease that often catch my attention, and what to do if you’ve noticed these warning signs.

In this Youtube video, I cover 21 signs and behaviors that families sometimes assume are “normal aging,” but in fact are usually signs of a brain health disorder. It includes the 8 behaviors listed in this article, and many more.

Remember, being proactive usually leads to better results and less stress overall!

Helping Older Parents Articles

3 Guides to Help You Have “The Talk” With Aging Relatives

“How Geriatrics Can Help You – Even If You’re Not Yet ‘Old-Old‘”

Why We Should All Understand What Geriatrics Is

8 Alzheimer’s Behaviors to Track

For more on diagnosing Alzheimer’s and other dementias

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