Helping Older Parents

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.

Flu Shots for Older Adults During COVID Times: What to Know & Do for 2020

by Leslie Kernisan, MD MPH 110 Comments

Usually, I update this article in October, which I think of as flu vaccination time.

But this is 2020 and things are different, so I am writing this in September. In particular, due to COVID-19, the Centers for Disease Control (CDC) is urging that people get vaccinated against influenza early in the fall (before the end of October 2020).

Vaccination against seasonal influenza has always been 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 newest high-dose vaccines available for older adults.

But let me share the bottom line with you right now. In general, I have always supported the CDC’s usual recommendation that everyone over the age of 6 months should get their seasonal flu shot.

This year, I agree with the CDC that it’s especially important for people to get their seasonal flu shot, as soon as you can, and if you are an older adult, I recommend getting one of the higher-dose vaccines.

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).

And now this fall, we will also have COVID-19 to contend with. As of September 2020, at least 190,000 Americans have died of this disease. We don’t know for sure what will happen this fall, but since COVID seems to spread more when people are indoors and in proximity to the exhalations of others, COVID is likely to get worse this fall.

So this year, more than ever, it’s important to do what you can to reduce respiratory illness, to protect yourself, and to protect others. We don’t yet have a COVID vaccine, but we do have influenza vaccines.

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
What’s new and resources for the 2020-2021 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

(Prefer to listen to my key points about flu shots for aging adults? Click here to jump down to my subtitled audio with searchable transcript!)

[Read more…]

Q&A: What to Do About Unintentional Weight Loss

by Leslie Kernisan, MD MPH 87 Comments

Q: My 88-year-old father lives in his own home about 100 miles from us. He’s been living alone since my mother died five years ago. I thought he looked rather thin last time we saw him. I’m starting to feel worried about his nutrition. Should I be concerned? Would you recommend he start drinking a supplement such as Boost or Ensure?

A: This question comes up a lot for families. It is indeed very common for older adults to experience unintentional weight loss at some point in late-life.

The brief answer is that yes, you should be concerned. But I wouldn’t recommend you jump to purchasing Boost or Ensure.

Now, in most cases, some nutritional supplementation is in order. But before focusing on this, you should first get help figuring out why your father is losing weight.

For doctors, unintended weight loss is a major red flag when it comes to the health of an older person.

So in geriatrics, we usually recommend that an older person — or their caregivers — monitor weight regularly. This enables us to spot weight loss sooner rather than later.

Once we’ve spotted unintentional weight loss, the next step is to figure out what might be causing it. And then we’re in a better position to recommend a treatment plan, which might well include a nutritional supplement.

In this post, I’ll go over each of these steps in more detail.

Why you should monitor for unintentional weight loss

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Q&A: How to Prevent, Detect, & Treat Dehydration in Aging Adults

by Leslie Kernisan, MD MPH 51 Comments

Q: How can we get my older mother to drink more water? She is susceptible to urinary tract infections and seems to be often dehydrated no matter what we do. We were also wondering if coffee and tea are okay, or should they be avoided to reduce dehydration?

A: Dehydration is indeed an important problem for older adults. It can be common even when it’s not hot outside.

Helping an older person increase her fluid intake, as you’re trying to do, is one of the best ways to reduce the risk of dehydration.

Now how to actually do this? Studies — and practical experience — suggest that the best approaches include: [Read more…]

Coronavirus Update & Suggestions (6.11.20 Edition)

by Leslie Kernisan, MD MPH 14 Comments

Like many of you, my daily life has been changed by the coronavirus situation, for personal and professional reasons.

So I’ve recorded another video commentary to share with our Better Health While Aging community.

This video covers:

The coronavirus situation today
Key points on what I’ve learned about COVID so far (and what we’re still trying to figure out)
Updates on testing & reducing COVID transmission
If you’re wondering “Is it safe to…?”
COVID & Older Adults: the tradeoffs we’re facing
Nursing homes and COVID
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:

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10 Things to Know About HIPAA & Access to a Relative’s Health Information

by Leslie Kernisan, MD MPH 95 Comments

Have you ever had questions about what might be going on with an older loved one’s health? But then you find that your older relative is unable — or unwilling — to let you in on the health details?

Such questions come up often for the family caregivers of aging adults. Common situations include:

An older parent who starts to act in ways that are strange or worrisome, such as becoming paranoid or delusional.
An older adult who seems to be physically or mentally declining, but seems reluctant to discuss the situation
A hospitalization or emergency room visit
A hospitalized older person becoming confused (this would be delirium) and becoming no longer able to explain to family what the doctors have said

In these situations, family caregivers often find themselves grappling with issues related to the HIPAA (Health Insurance Portability and Accountability Act) Privacy Rule.

Why all the grappling?

Well, although most people — and all clinicians — have heard of HIPAA, its rules and requirements are often misunderstood. So for instance, families may assume they can’t report a relative’s worrisome behavior to the doctor, because their relative hasn’t given them permission to do so.

Even worse: doctors and other clinicians sometimes refuse to disclose any information to families, and will incorrectly claim that HIPAA doesn’t allow them to do so. This can create extra confusion and stress for families, or can even sometimes put an older person at risk for harm.

If you’ve been concerned about an aging parent’s health, or are otherwise helping someone with their health concerns, then it can be very helpful to understand HIPAA better.

In fact, the American Bar Association includes “Know your rights of access to health information” among its Ten Legal Tips for Caregivers.

The detailed ins and outs of HIPAA can indeed be hard to fully understand. But, it’s not too hard to learn some practical basics, especially since the US Department of Health and Human Services (HHS) provides a Summary of the Privacy Rule here, and maintains a truly useful set of online FAQs about HIPAA here.

In this article, I’ll explain five useful key basics to help you understand HIPAA better, especially when it comes to getting information as a family caregiver.

I’ll also address five questions I’ve often heard family caregivers ask about HIPAA.

At the end, I’ll share some of my favorite online HIPAA resources, as well as some final tips to keep in mind.

5 Key Basics About HIPAA

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Helping Older Parents

Why you should monitor for unintentional weight loss

Related resources:

5 Key Basics About HIPAA

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