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Better Health While Aging

Practical information for aging health & family caregivers

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Choosing & Using a Home Blood Pressure Monitor, & What to Ask the Doctor

by Leslie Kernisan, MD MPH 20 Comments

Omron blood pressure monitorIn another article, I’ve explained the key reasons that I recommend older adults and their caregivers have a blood pressure (BP) monitor at home.

To very briefly recap:

  • Many of the problems of older adults (including falls) can be related to blood pressure.
  • Home blood pressure measurements can help:
    • evaluate for drops in blood pressure with standing (a common cause of dizziness in elders)
    • check for serious illness, since these often (but not always) cause the blood pressure and pulse to be very different from usual
    • follow-up on blood pressure after a change in medication, which can help doctors and families figure out the best medication dosing for an older person much faster. This is safer for seniors.

In this post, I’ll share some tips on choosing and using a home BP monitor.

And don’t worry: I won’t tell you that you have to plan on checking every day for the rest of your lives. Although there are times when it’s great to check daily — like the week after a change in medication — the most important thing is to have a good BP monitor at home and know how to use it at least occasionally.

Tips for choosing a home blood pressure monitor

[Read more…]

Filed Under: Aging health, Geriatrics For Caregivers Blog, Helping Older Parents Articles Tagged With: blood pressure, get better healthcare

4 Steps to Get Better Advice from Doctors

by Leslie Kernisan, MD MPH 38 Comments

Doctor & Older WomanHere’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 1 Comment

Partnering with your doctorHave 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 17 Comments

Loving GranddaugherAll 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 6 Comments

Choosing WiselyLast 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, I’ll review the 2014 list of five Choosing Wisely items that older adults — and their families — should question. 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

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