• Home
  • Geriatrics Blog
    • Helping Older Parents Posts
  • Helping Older Parents
  • Podcast
    • Better Health While Aging Podcast
    • Helping Older Parents Podcast
  • Testimonials
  • About
    • About Better Health While Aging
    • About Leslie Kernisan, MD MPH
  • Courses & More

Better Health While Aging

Practical information for aging health & family caregivers

  • Popular Topics
    • Preventing Falls in Aging Adults
    • Medication Safety
    • Dementia, including Alzheimer’s
    • Advance Care Planning & End-of-Life
  • Why Geriatrics
  • Are you a caregiver?
  • How to use this site

4 Steps to Get Better Advice from Doctors

by Leslie Kernisan, MD MPH

Doctor & Older Woman

Here’s an uncomfortable truth that every family should be aware of:

You shouldn’t assume your doctor is providing you with optimal medical advice.

By optimal, I mean advice that is:

  1. Grounded in the most recent medical knowledge.
  2. Adapted to your preferences and values.
  3. Made after helping you consider the various options, along with their risks and benefits.

Doctors are generally trying their best. But it’s hard for a single person to keep up with all the latest knowledge, plus doctors tend to get into practice habits that aren’t necessarily in your best interest.

Are You Regularly Informed of Non-Drug Treatment Options?

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog Tagged With: being a savvy patient, get better healthcare

How To Be An Engaged Patient or Caregiver

by Leslie Kernisan, MD MPH

Partnering with your doctor

Have you ever wondered what it means to be an “engaged patient,” or an engaged caregiver?

This is a hot topic right now within healthcare. The basic idea is simple: people get more from their healthcare when they are active participants, especially when they are proactive about their health. (Such people are sometimes called “e-patients,” with the “e” standing for engaged, enabled, equipped, and educated.)

This means doing things like asking questions, researching your health problems online, connecting with others facing similar health challenges, and most of all: making sure the healthcare providers know what’s important to YOU.

For instance, you should be actively involved in developing the medical plan, meaning that at a minimum, you should let the doctors know whether what they’re proposing sounds ok to you. And, you should be able to let them know if the treatment plan isn’t working out well for you.

Now, one big problem is that we’re often feeling sick when we’re involved with the healthcare system, especially when it comes to hospitals. Which is why family caregivers are very important, when it comes to being proactive and involved with healthcare. When a person has a family member or friend helping them be proactive, getting better healthcare is much more likely.

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog Tagged With: being a savvy patient, e-patients, get better healthcare

How to Use a Personal Health Record to Improve an Older Person’s Healthcare

by Leslie Kernisan, MD MPH

Loving Granddaugher

All family caregivers want their older loved ones to get the right medical care. But doctors are often lacking key medical information at the time they see your aging relative.

The solution: setting up and using a personal health record (PHR).

This is a big step up from what many families do, which is to create an “in-case-of-emergency” packet. Such medical information packets usually include a list of medications, chronic conditions, and allergies, along with the names of next-of-kin and perhaps a POLST form.

I’ve reviewed such medical information packets, and they are certainly better than nothing. But in general, they don’t help older adults avoid these very common — and potentially serious — problems with their medical care:

  • Delays in treatment/action because test results aren’t available. Often doctors need test results in order to know how to proceed medically. If tests have been done but the results aren’t available, the doctor’s options are to fly blind, re-order the tests, or plan to request the test results and then see you again once the results are available.
  • Getting worse care in the emergency room, or in urgent care. An urgent medical problem often means seeing new doctors. Those doctors have to offer help quickly, but if they are lacking detailed medical information, it’s generally harder for them to offer the right medical management.
  • Suboptimal medication prescribing. Whenever medications  are prescribed without first considering all other medications being taken, a senior’s health is being put at risk. Although bringing an up-to-date medication list (or better yet, all the medication bottles) is very helpful, it’s also valuable for doctors to understand why another doctor prescribed a medication.
  • Suboptimal care from a new primary care provider (PCP). Adults in late life often move and have to establish care with a new PCP. Especially when a senior has multiple chronic conditions or a complicated health history, delays in getting medical information means it often takes the new PCP months to get up to speed so that he or she can properly help the older person with his or health concerns.
  • Inadequate help from a specialist or consultant. Aging adults are often referred to specialists, but studies have found that specialists often don’t receive enough information to do their work. Again, at best this means delays and inconvenience for you; at worst this can lead to serious health problems if a senior gets the wrong care, or gets the needed care too late.

Fortunately,  even a very basic and low-tech PHR can help your older loved one avoid the problems listed above.

At a minimum, you’ll save yourself hassle and the extra appointments that get scheduled because the doctor didn’t have the needed medical information the first time around. You’ll also spare your loved one the discomfort and expense of enduring duplicate testing.

More importantly, properly maintaining and using a personal health record (PHR) will go a long way to ensuring that your loved one gets better, safer medical care. It can also help you avoid potentially life-threatening medical mishaps.

The key is to learn what medical information to put into this PHR, and how to use it effectively for care coordination.  This post will tell you what you need to know, to set up and use a PHR.

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog, Helping Older Parents Articles Tagged With: being a savvy patient, get better healthcare, personal health record

5 More Treatments You Should Question in Older Adults

by Leslie Kernisan, MD MPH

Choosing Wisely

Last week, I wrote about the first Choosing Wisely list of 5 treatments that older adults and their doctors should question.

In this post, I’ll cover the 2014 Choosing Wisely list for healthcare in aging adults, which was released by the American Geriatrics Society (AGS) this past February. This 2014 edition of things to question include:

  • The most popular class of medications prescribed for Alzheimer’s and other dementias,
  • Breast, colon, and prostate cancer screening,
  • A common approach to weight loss and poor appetite,
  • The prescribing of additional medications,
  • A common — but risky — approach to handling confusion during hospitalization.

As I explained in my last post, Choosing Wisely is a health education campaign meant to help patients and their doctors more easily spot common tests and treatments that are often overused. 

For the Choosing Wisely items selected by AGS (my specialty society), I’d say the real problem is that these are healthcare interventions that are usually used before safer alternatives have been tried.

Many older adults and their caregivers are never told that a safer alternative exists. People often also have an overly optimistic understanding of the likely benefits, but haven’t been properly informed of the risks.

Aren’t doctors supposed to offer the safest alternatives first? Of course they are. However, many doctors haven’t been trained in modifying healthcare to better fit the needs of aging adults. And it’s often hard for a busy clinician to keep up with the latest recommendations from experts in geriatrics.

By learning about the Choosing Wisely recommendations, you can prepare yourself to be a “smarter” patient or caregiver, and you can be more proactive about making sure the healthcare you get is a good fit for your family’s needs. That’s why Choosing Wisely is supported by Consumer Reports, which makes the recommendations available on their website.

In this post, Iโ€™ll review the 2014 list of five Choosing Wisely items that older adults — and their families — should question. Iโ€™ll also share some tips for caregivers, related to each item.

Five (More) Things to Question for Healthcare in Aging Adults

1. Donโ€™t prescribe cholinesterase inhibitors for dementia without periodic assessment for perceived cognitive benefits and adverse gastrointestinal effects. In other words, after starting a dementia medication such as donepezil (brand name Aricept), don’t forget to follow-up! You’ll want to make sure that the drug is making thinking or behavior better, and that the side-effects are tolerable. Other cholinesterase inhibitors include rivastigmine and galantamine (brand names Exelon and Razadyne, respectively).

Why: Although these drugs are often prescribed in Alzheimer’s, clinical studies suggest that the likely benefits are smaller than many people realize. Also, although these drugs may improve cognitive symptoms for a minority of patients, they are not “disease-modifying” and don’t truly slow the progression of Alzheimer’s. (Want to avoid acceleration of Alzheimer’s? See this post.)

A comprehensive review in 2008 described the benefits of these medications as “clinically marginal,” especially since it’s been hard to prove that these drugs improve quality of life or overall life function. Another review calculated that 12 people have to be treated with these drugs, in order for one person to experience marginal improvement or better; the same review noted that about 1 in 12 people will experience a significant side-effect (usually diarrhea or stomach-related).

Because some clinical trials suggest that the drugs work better for some people than others, many experts now recommend a time-limited trial of these medications: if a patient or family notice an improvement, the drugs should be continued. If not, the care team should consider stopping them.

Tips for caregivers: The main thing to realize is that it’s not at all guaranteed that these medications will help in Alzheimer’s. In fact, it’s fairly common for these drugs to seem to have no effect at all, and sometimes they do cause uncomfortable diarrhea or stomach upset. If you don’t see much improvement, know that it’s reasonable to consider stopping these medications, especially if you want to reduce costs or pill burden.

That said, I find that these drugs tend to cause fewer side-effects and risks than many of the other drugs older adults often take; generally the greatest harm from Aricept is to the wallet. Although all medications should come with a plan to assess effectiveness and side-effects regularly, these types of medications are usually lower on my priority list. They likely aren’t helping as much as people think they are, but at least they aren’t very risky. (Whereas antipsychotics and benzodiazepines — commonly used for difficult Alzheimer’s patients — are risky; they are on the original Choosing Wisely list.)

2. Donโ€™t recommend screening for breast or colorectal cancer, nor prostate cancer (with the PSA test) without considering life expectancy and the risks of testing, overdiagnosis and overtreatment. This means that doctors shouldn’t automatically refer older adults for cancer screening. Instead, doctors and patients should consider life expectancy and the risks of screening, before deciding whether to proceed.

Why: Cancer screening is an important part of preventive health. But most people do reach a point at which their age, or their chronic illnesses, make it unlikely that cancer screening will be beneficial. That’s because research suggests that cancer screening is most likely to help those who are likely to live another 10 years or more. Furthermore, screening for cancer does harm some patients, due to overdiagnosis or complications of procedures such as colonoscopy.

Cancer screening used to be reflexively recommended for most adult patients, no matter what their age or health status. But today, experts recommend that people first weigh the likely benefits and risks. This is called individualized cancer screening.

At this time, US Preventive Services Task Force (USPSTF) recommends against routine colon cancer screening in adults older than 75 years. Breast cancer screening is recommended for women aged 50-74.

Tips for caregivers: If your older loved one is older than 75, or is in declining health, be sure to ask questions if cancer screening is recommended without first having a thoughtful conversation.

Wondering how long your loved one is likely to live? A team of UCSF geriatricians offers access to mortality calculators at ePrognosis.org. I find the life-expectancy graphs here to be especially helpful.

 3. Avoid using prescription appetite stimulants or high-calorie supplements for treatment of anorexia or cachexia in older adults; instead, optimize social supports, provide feeding assistance and clarify patient goals and expectations. In other words, for older adults who are losing weight or seem to not be eating well, don’t start by requesting medication, or a nutritional drink such as Ensure. Instead, make sure the person gets any help he or she needs with grocery shopping and meal preparation. You’ll also want to talk to the doctor about the health status; if weight loss is due to a medical problem such as depression, or cancer (a cause of cachexia), you’ll need to discuss goals and management options before you turn to stimulants and supplements.

Why: Weight loss and malnourishment are fairly common in older adults, and it’s very important to spot these issues and address them. However, research studies have found that prescription appetite stimulants often don’t provide a lot of benefit, and can cause problematic side-effects.  Nutritional supplements such as Ensure or Boost are safer in that there’s usually little risk of side-effects. But comprehensive reviews of clinical research suggest that the benefits are usually slim.

Tips for caregivers: If you’re worried about appetite or weight loss in an older person, start by asking for help assessing the underlying cause — or causes — of the problem. For instance, some aging adults develop difficulty getting and preparing food, due to physical disabilities (such as crippling arthritis) or memory problems. In other cases, the problem is an underlying medical problems, such as depression, heart failure, lung disease, or cancer. You should also make sure an oral evaluation is done; tooth pain or chewing problems can affect nutrition.

 4. Donโ€™t prescribe a medication without conducting a drug regimen review. This recommendation is pretty straight-forward. Before accepting a new prescription for a medication, always make sure the clinician has an up-to-date medication list, and has reviewed it.

Why: Polypharmacy (the taking of multiple medications) raises the risk of potentially dangerous medication interactions. Older adults also tend to be more vulnerable to side-effects of medications. A 2011 study estimated that seniors experienced over 250,000 emergency room visits per year, due to medications. People aged 80+ were especially likely to need hospitalization.

Tips for caregivers: This is a common-sense recommendation that can still be tricky to implement, because many clinicians are used to handing out prescriptions fairly quickly. You’ll want to be prepared, by making sure you always have an up-to-date medication list handy. And then be ready to be gently persistent: if the doctor doesn’t ask to review all medications, ask that she does so. You may also want to ask if the new drug is on the Beer’s List of medications to be used with caution.

For tips on maintaining an up-to-date medication list, read this post.

For a link to a free online drug interaction checker, see this post.

5. Avoid physical restraints to manage behavioral symptoms of hospitalized older adults with delirium. This means that if your older loved one becomes confused and difficult during a hospitalization, don’t let the staff tie him or her down, unless all other options have failed.

Why: It’s very common for older adults to develop delirium — a state of worse-than-usual confusion — during a hospitalization. While confused, people may pull at IVs, thrash around in bed, or try to get up when they are too weak to do so safely. This understandably looks dangerous, and historically hospital staff have responded by tying patients’ arms down. However, research has found that this approach does not improve outcomes. Feeling tied down can increase an older person’s confusion and panic, and people often still manage to struggle partly out of bed despite restraints. A more effective approach is for hospital staff to use comprehensive approaches that soothe restless patients and minimize stressors.

Tips for caregivers: If an older person becomes restless and confused in the hospital, be sure to bring it to the attention of the doctors. Studies have found that delirium is often missed by busy hospital staff. To prevent — and to help treat — delirium, it often helps to have family at the bedside, to provide reassurance and support.

To learn more about how delirium is treated, including tips on what you can do as a caregiver, see here.

Delirium is especially common in people with Alzheimer’s and other dementias; for more information and resources, see this post.

Questions or comments about these Choosing Wisely recommendations? Iโ€™d love to hear from you in the comments below.

Filed Under: Aging health, Geriatrics For Caregivers Blog Tagged With: being a savvy patient, get better healthcare

Choosing Wisely: 5 Treatments You Should Question

by Leslie Kernisan, MD MPH

Balancing benefits & burdens

Did you know that it’s important to think about “Choosing Wisely,” when it comes to healthcare?

It’s true! Choosing Wisely is a health education campaign meant to help patients and their doctors more easily spot common tests and treatments that are often overused. To do this, many medical societies are creating lists of “Five Things Physicians and Patients Should Question.” Consumer Reports is also a partner in this project.

If you’re a caregiver for an aging person, you probably should know about the Choosing Wisely items identified by the American Geriatrics Society (AGS). These are treatments or tests that are:

  • Commonly given to older adults,
  • Often unlikely to help aging adults live better, or longer,
  • Riskier than many patients and caregivers realize.

In other words, these are treatments that older adults often don’t receive, when geriatricians are involved.

Of course, most older adults aren’t under the care of a geriatrician. If this is your family’s situation, learning about the Choosing Wisely items can be a good way to make sure your older relative avoids healthcare that is unnecessary, or even harmful.

In this post, I’ll review the “Five Things to Question” that were identified by the AGS in their intial Choosing Wisely list. (The AGS recently published a second list; I’ll review those items in a follow-up post.) I’ll also share some tips for caregivers, related to each item.

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog Tagged With: being a savvy patient, get better healthcare

Yours Free: The Quick Start Guide to Checking Older Parents for Health & Safety Problems

Action Plan - Pencil and Checklist

Enter your email to download this free Quick Start Guide

Get The Guide Now ยป

No spam ever! We collect, use and process your data according to our Privacy Policy.

Find It Here

Disclaimer

The material on this site, including any exchanges in the comments section of the blog, is for informational and educational purposes only.

Any comments Dr. Kernisan may make regarding an individual’s story or comments should not be construed as establishing a physician-patient relationship between Dr. Kernisan and a caregiver, or care recipient.

None of Dr. Kernisan’s website or group information should be considered a substitute for individualized medical assessment, diagnosis, or treatment.

Please see the full Disclaimer for more information.

Please also carefully read our Terms & Conditions of Use, before using this site.

Creative Commons License
This work by Leslie Kernisan MD & Better Health While Aging LLC is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Based on a work at BetterHealthWhileAging.net.

Privacy Policy & Disclosures

Your privacy is very important to us. Your information will never be sold to anyone, whether you browse the site, sign up for email updates, or register for an event.

Pleae read our complete Privacy Policy for more information and for Dr. Kernisan's financial disclosures.

© 2025 Better Health While Aging, LLC ยท Terms & Conditions ยท Disclaimer ยท Privacy Policy ยท Contact Us