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Better Health While Aging

Practical information for aging health & family caregivers

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042 – Why Healthcare is Flawed & How to Improve It:
The Work of Dr. Lawrence Weed

by Leslie Kernisan, MD MPH 10 Comments

Better Health While Aging
Better Health While Aging
042 – Why Healthcare is Flawed & How to Improve It:
The Work of Dr. Lawrence Weed
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00:00 / 46:55
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In This Episode:

The patient must have a copy of his own record. He must be involved with organizing and recording the variables so that the course of his own data on disease and treatment will slowly reveal to him what the best care for him should be.” — Dr. Lawrence Weed, “Your Health Care and How to Manage It” (1975)

Dr. K discusses the flaws of healthcare and how medicine could be improved, per the insights of visionary healthcare reformer Dr. Lawrence Weed, who died earlier this month at age 93. She covers:

  • What is optimal medical care, and why doctors often fail to provide it to their patients
  • Why usual medical care — which relies mainly on doctors using their own internal knowledge and mental processes — leads to disorderly healthcare and frequent errors in diagnosis and management
  • Dr. Weed’s seminal insight that “Any system of care that depends on the personal knowledge and analytic capabilities of physicians cannot be trusted.“
  • Why Dr. Weed believed that healthcare professionals should use “knowledge couplers” and other more reliable tools to guide the process of evaluation and diagnosis, instead of relying on their own mental processes
  • Dr. Weed’s belief that the patient should be much more involved in his or her care, and that doctors should help patients make choices, rather than choose for them
  • Why Dr. Weed advocated for a better medical record, and why he wanted patients to have access to it
  • Dr. Weed’s lifelong advocacy for a healthcare system that would be orderly and reliable for evaluation, diagnosis, and documentation, but then would be flexible and individualized when it comes to treatment for individual patients
  • Tips on how older adults and their families can get better care from their doctors, and support the improvements that Dr. Weed envisioned
[Read more…]

041 – UTIs and Urine Bacteria in Aging:
How to get the right diagnosis & avoid unneeded antibiotics

by Leslie Kernisan, MD MPH 4 Comments

Better Health While Aging
Better Health While Aging
041 – UTIs and Urine Bacteria in Aging:
How to get the right diagnosis & avoid unneeded antibiotics
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In This Episode:

Dr. K explains why having bacteria in one’s urine does NOT mean one has a urinary tract infection (UTI) that requires antibiotics. In fact, as people get older, they may have bacteria in the urine but no UTI symptoms or other signs of infection. This condition, called “asymptomatic bacteriuria” is common, and is often inappropriately treated with antibiotics. In this episode:

  • How to know if one has asymptomatic bacteriuria versus a UTI that warrants antibiotics
  • Why having asymptomatic bacteriuria becomes more common as people become older
  • Why the Infectious Disease Society of America and others have repeatedly urged doctors to NOT treat asymptomatic bacteriuria
  • The challenge of correctly diagnosing UTIs in people with dementia
  • How one can be harmed by using antibiotics to try to eliminate bacteria in the bladder
  • What to do if you’re worried about urine bacteria — or  a possible UTI — in an older person
[Read more…]

040 – Dehydration in Older Adults:
How to Prevent It, Detect It, & Treat It

by Leslie Kernisan, MD MPH Leave a Comment

Better Health While Aging
Better Health While Aging
040 – Dehydration in Older Adults:
How to Prevent It, Detect It, & Treat It
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In This Episode:

Dr. K explains how to prevent, detect, and treat dehydration in aging adults. She covers:

  • What is dehydration and what causes it
  • Why older adults are at higher risk for dehydration
  • How dehydration can be correctly diagnosed
  • Why several commonly-used tests for dehydration are often inaccurate in older adults
  • Symptoms of dehydration
  • Health consequences that may be associated with mild versus more severe dehydration
  • How dehydration can be treated
  • How to prevent dehydration, including how to help older adults stay hydrated
  • What to known about dehydration and possible urinary tract infections
  • Tips for family caregivers who are concerned about an older person’s hydration
[Read more…]

039 – Interview: Creating Age-Friendly Health Systems

by Leslie Kernisan, MD MPH Leave a Comment

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Better Health While Aging
039 – Interview: Creating Age-Friendly Health Systems
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In This Episode:

Dr. K talks with Amy Berman, RN, about a major new initiative to create “age-friendly health systems.” Amy is a Senior Program Officer at the John A. Hartford Foundation (JAHF), which focuses on improving the health of older adults. They discuss:

  • Four goals of an age-friendly health system
  • The four “Ms” that an age-friendly health system should address: what matters, mentation, mobility, and medications
  • Why delirium prevention is such an important part of addressing mentation
  • How the age-friendly health systems initiative builds on proven models of better care for older adults
  • How JAHF and its partners are planning to develop and expand age-friendly health systems
  • How older adults and families can find age-friendly care
  • 10 benefits you can expect from age-friendly health systems
[Read more…]

038 – FAQs On “Incompetence” & Losing Decision Capacity

by Leslie Kernisan, MD MPH 2 Comments

Better Health While Aging
Better Health While Aging
038 – FAQs On "Incompetence" & Losing Decision Capacity
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In This Episode:

Dr. K addresses frequently asked questions about older adults and decisional capacity. She also provides practical advice on what you can do if you’re concerned that an older person is making “bad” decisions. She covers:

  • What does the term “capacity” mean when it comes to decision-making?
  • What is the difference between incapacity and incompetence?
  • How is capacity determined?
  • Does capacity have to be determined by legal professionals? Is it a “legal decision” whether someone has capacity?
  • Do I have to have a legal or clinical determination of incapacity for a specific decision before I override the decision of an older person with dementia?
  • Do I need a legal or clinical determination of incapacity before I take the car keys away from an older parent who has dementia and is an unsafe driver?
  • Is neuropsychological testing required to assess capacity?
  • What to do if you’re worried about an older person’s capacity, or actions

Related episodes:

013 – Interview: Solving Hard Problems in Helping Aging Parents
037 – Interview: Using Powers of Attorney to Help Older Adults

Related Resources:

  • Incompetence & Losing Capacity: Answers to 7 FAQs
  • American Bar Association Ten Legal Tips for Caregivers
  • Assessment of Capacity in Older Adults (American Bar Association/American Psychological Association)
  • Respect for Autonomy (Alzheimer’s Association)
  • Driving and Dementia (Alzheimer’s Association)
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037 – Interview: Using Powers of Attorney to Help Older Adults

by Leslie Kernisan, MD MPH Leave a Comment

Better Health While Aging
Better Health While Aging
037 – Interview: Using Powers of Attorney to Help Older Adults
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In This Episode:

Dr. K talks with elder law attorney Harry Margolis, founder of Margolis & Bloom LLP and ElderLawAnswers.com. They discuss common questions related to the durable general power of attorney as a tool to help older adults, including:

  • Why durable general power of attorney (POA) documents can be very helpful to older adults
  • What can be done if an older person objects to the actions of his or her agent
  • How to use transparency and communication to minimize family conflicts
  • Whether POA documents should be effective immediately or only upon incapacity
  • Why it’s important to put family care agreements in writing
  • What you can do if you’re concerned the POA is abusing his or her power as an older person’s agent
  • The pros and cons of appointing two people to be your agent on a POA
  • Why trusts can work better than a POA
  • What can be done when a POA tries to prevent other family members from visiting
[Read more…]

036 – Interview: Minimizing Family Conflicts & Supporting Aging Parents

by Leslie Kernisan, MD MPH Leave a Comment

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Better Health While Aging
036 – Interview: Minimizing Family Conflicts & Supporting Aging Parents
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In This Episode:

Dr. K talks with Janet Benvenuti, a family caregiving expert who is the founder of Circle of Life Partners and the author of “Don’t Give Up on Me: Supporting Aging Parents Successfully.” They discuss:

  • Janet’s experience becoming responsible for her parents’ financial affairs and medical care
  • How Janet and her siblings negotiated caregiving roles and conflicts
  • An exercise to help you map out your family’s resources to build a caregiving team
  • Why Janet wishes her family had done more advance planning related to housing
  • The role of personal care agreements and compensation in family caregiving
  • Janet’s tips on how boomers can set up a game plan for their own aging
  • How to use Janet’s book to help your family plan for aging
[Read more…]

035 – Interview: Aging in the Right Place

by Leslie Kernisan, MD MPH Leave a Comment

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Better Health While Aging
035 – Interview: Aging in the Right Place
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00:00 / 58:32
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In This Episode:

Dr. K talks with Stephen Golant, PhD, Professor of Geography at the University of Florida and the author of “Aging in the Right Place.” Dr. Golant has a doctorate in social gerontology and social geography, and is a well-known expert on the housing and long-term care needs of older adults. They discuss:

  • What is environmental gerontology, and why environment is so important to aging adults
  • How one’s housing, neighborhood, and community affect one’s ability to age well
  • Why older adults like to remain in their own homes
  • The problems many older adults encounter when they try to age in place, and what it means to “age in the right place”
  • A definition of successful aging
  • Why we shouldn’t reflexively promote aging in place, and what to encourage instead
  • How to determine where is the right place to age, and which questions older people should ask themselves
  • Why it may be better for seniors to live in a neighborhood of people their own age
  • Dr. Golant’s plan for where to live as he ages
[Read more…]

034 – Preventing Falls: 10 Types of Medication to Reconsider

by Leslie Kernisan, MD MPH 1 Comment

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Better Health While Aging
034 – Preventing Falls: 10 Types of Medication to Reconsider
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00:00 / 38:13
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In This Episode:

Dr. K explains ten types of medications that may be associated with falls in aging adults. These are the medications that experts including the Center for Disease Control (CDC) recommend that doctors address during a medication review for fall prevention. This episode covers:

  • The four actions the CDC recommends that older adults do, to prevent falls
  • Why it’s so common for older adults to be on medications that may increase the risk for falls
  • What doctors are supposed to do, if an older person is taking one of these medications
  • Generic and brand names of the more commonly used medications that may be linked to falls
  • Tips on what to ask your doctor, if you or your older relative are taking any of these medications
[Read more…]

033 – Safer Treatments for Insomnia in Aging

by Leslie Kernisan, MD MPH 4 Comments

Better Health While Aging
Better Health While Aging
033 – Safer Treatments for Insomnia in Aging
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In This Episode:

Dr. K explains how to safely treat insomnia in older adults, and why most seniors should avoid sleeping pills. She covers:

  • Why it’s essential to identify the cause(s) of sleep problems, before starting or continuing to use sleeping pills
  • Why over-the-counter or prescription sleep aids, such as diphenhydramine, benzodiazepines, and “z-drugs” such as zolpidem, are bad for memory and balance
  • Three proven insomnia treatments that are effective and safer than pills
  • Where to find cognitive-behavioral treatment for insomnia online
  • Approaches to treating sleep problems in people with Alzheimer’s and other dementias
[Read more…]
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