The Better Health While Aging Podcast

Get practical health tips from a geriatrician and other experts! We discuss common health problems that affect people over age 60, the best ways to prevent and manage those problems, and we also often address common concerns and dilemmas that come up with aging parents and other older loved ones.

045 – HIPAA: Key Basics & 5 FAQs for Family Caregivers

by Leslie Kernisan, MD MPH Leave a Comment

Better Health While Aging

045 – HIPAA: Key Basics & 5 FAQs for Family Caregivers

00:00 / 42:49

In This Episode:

Dr. K explains what all family caregivers should know about the HIPAA Privacy Rule, and your options for getting doctors to share information about an older relative’s health. She covers:

Why it’s so common for families to need health information from a relative’s doctors
What is the HIPAA Privacy Rule
When are doctors allowed to disclose health information to family members and others
When are doctors required to disclose health information
What is a HIPAA release or authorization, and when is it necessary?
Options for communicating with doctors despite an older person’s objections or refusal
When to consider an older person’s decision-making capacity
How a durable power of attorney for healthcare can enable a family member to obtain information
Practical tips for family caregivers

[Read more…]

044 – Hospice Medications & What to do if You’re Concerned

by Leslie Kernisan, MD MPH 4 Comments

Better Health While Aging

044 – Hospice Medications & What to do if You're Concerned

00:00 / 40:02

In This Episode:

Dr. K addresses a reader’s concerns about the morphine and lorazepam (brand name Ativan) that were given to her relatives with dementia, while on hospice. She covers:

Common end of life symptoms, and which symptoms are common in people with advanced Alzheimer’s
How morphine is usually used at the end of life, to manage problems such as pain and shortness of breath
Why it’s usually possible to use morphine to control symptoms without “hastening” death
Why it’s unclear that lorazepam should be used as often as it is, in hospice care
How to choose a good hospice provider
How to be proactive, to avoid problems and misunderstandings with the hospice team
What you can do, if you’re concerned about the care a loved one is receiving while on hospice

[Read more…]

043 – How Hospice Helps at the End of Life, & Hospice for Alzheimer’s

by Leslie Kernisan, MD MPH 4 Comments

Better Health While Aging

043 – How Hospice Helps at the End of Life, & Hospice for Alzheimer's

00:00 / 38:00

In This Episode:

Dr. K explains the basics of hospice care, with a special focus on hospice for people with Alzheimer’s disease and related dementias. She covers:

The difference — and relationship — between hospice and palliative care
What kind of services and benefits you can get through hospice
How hospice eligibility is determined by Medicare
The difference between severe Alzheimer’s disease and “terminal” Alzheimer’s
How to know when someone with Alzheimer’s might be eligible for hospice
Why some people with dementia “recover” and may be discharged from hospice
Common misconceptions people have about palliative care and hospice
Why hospice is a good choice for most patients and families facing the end of life

[Read more…]

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

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

00:00 / 46:55

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

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

00:00 / 32:44

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

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

00:00 / 45:48

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

Better Health While Aging

039 – Interview: Creating Age-Friendly Health Systems

00:00 / 38:07

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

038 – FAQs On "Incompetence" & Losing Decision Capacity

00:00 / 41:09

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

037 – Interview: Using Powers of Attorney to Help Older Adults

00:00 / 44:55

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

Better Health While Aging

036 – Interview: Minimizing Family Conflicts & Supporting Aging Parents

00:00 / 1:07:32

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…]

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