Hello and welcome to this blog about geriatrics for caregivers.
I’m Leslie Kernisan, and I’m a geriatrician with a particular interest in enabling family caregivers to better manage the health needs of their older loved ones.
Through my Bay Area geriatrics consultation practice, I work closely with families and geriatric care managers, to improve the health and wellbeing of older adults.
But, I’d like to be able to help even more older adults get better medical care. (This in large part because I have a wonky health policy and quality improvement background, and I love to think about how we as a society and healthcare system can take better care of our aging population.)
So I’m starting this blog, in order to share tips and advice on better medical care for elders with as many caregivers as care to visit the blog.
From personal experience, and because I worked with a caregiving website for five years, I know that lots of family caregivers have questions and concerns about the health and wellbeing of their loved ones. And I know that often doctors don’t have the time, interest, or expertise to provide the guidance and information that caregivers need.
My hope is that this blog will help compensate for the existing – and growing – shortage of geriatricians. (Currently in the U.S. we have 4 geriatricians per 10,000 people aged 75+.)
In this blog, I’ll try to share what I know about managing common health problems that affect older adults. I’ll offer suggestions on how to bring up common concerns with primary care doctors and other clinicians. I’ll try to write out the kind of practical advice that I’ve found myself repeating to my patients and families over and over when I see them in person.
And, since I have a special interest in how new technologies can help us care for aging adults, I’ll occasionally blog about tech tools that might be helpful to caregivers.
Last but not least, I hope this blog will allow me to learn still more from caregivers themselves, who have already taught me so much over the years.
I could go on about what I’m hoping to do with this blog, but I think it would probably be better for me to just get right to it and start trying to share useful information.
The easiest way to get these blog posts is to sign up for my email list – the signup box is at the top of the sidebar on the right. Naturally, you can unsubscribe at any time, and I will never sell or share your email address with anyone else.
Questions welcome!
I have a long list of topics and ideas for this blog, most of which come from the medical problems that I see affecting elders and caregivers over and over again.
Once the blog gets going, I’ll work on organizing the tips and content into topic areas, and hope that caregivers and others will contribute their wisdom.
In the meantime, if you have any particular medical or healthcare questions related to older adults, please feel free to post it below. Or you can email your question to me at info [AT] drkernisan [DOT] net.
Abhijit says
I have visited my cousin’s care center, and I want to know whether/how can we handle an elder person who says NO to bath, eat and also stay clean wear clean clothes. Your views please.
Nicole Didyk, MD says
That can be a common issue in an older person living with dementia. There are some techniques that can help including:
1. Washing one part of the body at a time
2. Allowing the person to be partially clothed during bathing
3. Making the bathing environment as appealing as possible (setting up a “spa” day).
I made a video about this topic which you can watch here: https://youtu.be/FWVoDKqNIBY
Anonymous says
Dr. Kernisan,
This is a very helpful website. Thank you for the work you do for our seniors.
I am my 74 y/o father’s caretaker. I am struggling, mostly emotionally, with how to best care for him while also maintaining his sense of independence.
Since my mother’s death in 1996, my dad has been alone. He never remarried or dated. He has suffered from depression for decades (his brother committed suicide due to depression). He lost his home and all of his belongings in hurricane Katrina which further deepened his depression. He has basically withdrawn from life. Very little brings him any joy anymore.
I moved back home to New Orleans from Atlanta, a little over a year ago to care for him. At the time my dad was living with, and trying to care for, his 65 year old younger brother who is mentally handicapped. Neither of them were in good shape. After Katrina, my father was diagnosed with multiple illnesses, IDDM, Hep C, and COPD. In 2009 he had an MI. He was a 3 pack a day smoker and drank beer regularly (possible long term ETOH???) He was non compliant with his meds, ADA diet and cardiac rehab. He was on a fixed income and couldn’t afford to live on his own anymore. I had begun paying his utility bills. Dad had a couple of falls due to dizziness. He became a recluse, sending my uncle out to buy fast food, beer and cigarettes. We were all concerned but didn’t realize it was as bad as it had become. The breaking point came when he told me that he felt malnourished. After he said that to me, I knew immediately what I had to do.
My dad, son, boyfriend and I moved into a rental home owned by my sister and we moved my uncle into an apt. close by. My siblings are pitching in to help with my uncle but dad’s care is mostly my responsibility since we are in the home together.
9 months after living together, I came home from work to find dad having difficulty breathing while lying flat. After much coaxing, my sister and I finally got him to agree to go to the ER. My sister is an RN and I am a cath lab tech. We knew his symptoms were serious. He was dx with new onset A-Fib and CHF. 1 month after starting warfarin, dad had a GI bleed. We have decided not to restart his warfarin because of several falls due to chronic dizziness and orthostatic hypotension. He has a spot on his liver and a clot in his LV. He is now having incontinence issues. Dad’s health continues to decline. He is also becoming more depressed, anxious and confused. He refuses to bathe or practice good hygiene. He wears the same clothes 24 hrs a day until he soils them.
I work in industry now and travel often. When I am not traveling, I stay home with him only leaving the house for errands or an occasional outing.
This morning, he got up at 4 a.m. and put his coat on. When I asked him what was going on, he said that he wanted to go to the gas station to buy a cigar and a beer. I was tired and fussed at him saying that we couldn’t get beer at this time of day. (He has quit smoking since the CHF but still has cravings.) He said that he would walk to the store himself. We argued about how this wasn’t a reasonable request or a good idea at 4 a.m. He also began to accuse me of taking away his freedom and holding him prisoner in the home. He stated that he still has free will and that just because I have his best interests at heart that isn’t always the best thing for his situation. He further accused me of not “letting” him do what he wants. As a family we invite him and offer for him to participate in everything we do..family gatherings, holidays, movies, dinner, ball games. He regularly refuses. He would rather sleep. I told him I would bring him wherever he wanted to go. He also went on to say that he has been thinking more and more of committing suicide.
I have vowed to myself that as long as he can hold a conversation with me then he will stay in the home with me. I love my father very much and feel awful that his sunset years are going to be so painful for him emotionally. I can administer meds and make sure he is fed and comfortable but I can’t make him happy. I am not sure of what to do to help my father.
Sorry this is so long…
Thanks for reading this.
Leslie Kernisan, MD MPH says
Dear Anonymous,
Wow, what a story, what a situation. Thank you for sharing. I am truly sorry that you are facing such caregiving challenges.
Here are a couple of thoughts/suggestions…some of which you may have already considered.
* Caregiver support: Get help for yourself to the extent you are able. Many caregivers find some comfort in online communities where they can vent and exchange messages with others caring for aging parents. I’m always very impressed by the levels of empathy and compassion, and also by the relationship & life wisdom people share. (Although I’m not always in agreement with the medical suggestions they offer each other.)
You should also consider some respite care if possible. If you can access a good counselor, therapist, or social worker one-on-one, that can also be a big help.
* Your father’s decisions and behaviors: They sound worrisome, especially given all the confusion you’re describing. I would consider the possibility of cognitive impairment or early dementia, and maybe also some extra problems due to an illness. Depression and past drinking may also be part of the issue.
The main issue you may want to get help sorting out is, does he have the mental capacity to make the bad decisions he is making? Or are these bad decisions due to brain changes or depression? For more on navigating this issue, try this Caring.com article I wrote with a colleague in geriatric psychiatry: “How to Make Difficult Decisions When Your Loved One’s Mental Capacity Is Failing”
* Depression and thoughts of suicide: I hope his doctors know about this and are taking this issue seriously. Even if he is developing brain changes, it really sounds as if he feels terrible. You should be able to get help from a suicide hotline (maybe this?), although I don’t know how experienced they are with suicidal thoughts in people who may have cognitive impairment.
* Sorting out all his health issues: The challenge with someone like your father is that everyone can get overwhelmed by the many many different diseases and problems that he has. I think his depression and thinking choices are the most urgent problem, but in general would recommend that you try to get a doctor to sit with you and your father to talk about his health overall, how it might further change over the next months-years, and what your options are. A “goals-of-care” conversation with a palliative care doctor can do this. You want help figuring out what to focus on medically and prioritize over the next few months. Some PCPs are able to do this, but many lack the time, or aren’t comfortable doing this. Palliative care consults are often easier to get during a hospitalization.
For someone with as many health problems as your father, I think it’s essential to talk about the health issues before you talk about what he wants from his medical care and his life…people’s preferences are often strongly influenced by their understanding of their health conditions. It’s also good to know what kinds of health crises might hit, so that your father and you can think about how he’d want them handled.
You want to hope for the best, but prepare for the likely.
Try to not get burned out! Do the best you can, as you are doing.