Healthy Aging

These articles explain how best to maintain the health and wellbeing of older adults. We cover proven ways to prevent age-related declines, common senior health problems that are easily missed, and much more.

Top 10 Checklist for Better Health & Aging in 2023

by Leslie Kernisan, MD MPH 49 Comments

Do you find yourself taking stock and setting goals around the time of New Year’s?

It is indeed an excellent time to reflect on the past year. (And wow, quite a lot to reflect on for 2022!)

And although one can set goals at any time of year, the start of the calendar year is a time that seems to inspire many people to think about their health and how to thrive over the coming year.

If better health while aging is important to you, here are my top ten suggestions for the coming year. [Read more…]

How to Address Cardiovascular Risk Factors for Better Brain Health:
12 Risks to Know & 5 Things to Do

by Leslie Kernisan, MD MPH 96 Comments

cardiovascular risk factors A while back, I wrote an article on cerebral small vessel disease, a very common condition in which the small blood vessels of the brain develop signs of damage.

If you’re an older adult and you’ve had an MRI done of your brain, chances are pretty good that your scan showed signs of at least mild signs of this condition; one study of older adults aged 60-90 found that 95% of them showed signs of these changes.

These are basically like teensy strokes in the brain. Most are un-noticeable to people, but if you have enough of them, you can certainly develop symptoms, such as cognitive impairment, balance problems, or even vascular dementia.

To date, the cerebral small vessel disease article has generated over 100 comments and questions from readers. A common theme was this: “My MRI shows signs of this condition. What can I do?”

As I explain in the article and the comments, the first thing to do is to work closely with your doctors to understand what is the likely cause of the damage to the brain’s small blood vessels.

Now, when you do this, you may well find that your doctor just shrugs, or waves off the question.

That’s because in most people, cerebral small vessel disease is thought to be in large part a result of atherosclerosis (more on this term below) affecting the smaller arteries of the brain. And atherosclerosis affects just about everyone as they age, because it’s related to many basic cardiovascular risk factors that become very common in late-life.

So in many cases, asking the doctor why you have signs of cerebral small vessel disease may be like asking why you might have high blood pressure, or arthritis. These are common conditions and they are usually due to medically mundane causes and risk factors, including sub-optimal “lifestyle” behaviors and the general “wear and tear” on the body that is associated with aging.

(However, in some people, damage to the small vessels in the brain may be related to one or more particular medical conditions. Younger people, in particular, seem more likely to have a particular condition or risk factor that may be causing most of the damage.)

Whether you are younger (i.e under age 60) or older, always start by asking your doctors what they think are the most likely causes for any cerebral small vessel disease, and what they recommend you do to slow the progression.

And for most people, the main advice will be this: evaluate and address your cardiovascular risk factors.

“Vascular,” as you probably already know, means “blood vessels.” And blood vessels are critical to the function of every part of the body, because blood vessels are what brings oxygen and nutrients to every cell in the body. They also carry away waste products and toxins. So, blood vessel health is key to brain health.

This article will help you better understand how to address blood vessel health. Specifically, I’ll cover: [Read more…]

Vitamin D: the Healthy Aging Dose
(Plus Answers to 7 FAQs)

by Leslie Kernisan, MD MPH

Confused by all the back and forth in the media about vitamin D?

Don’t be. There’s actually a pretty easy and straightforward approach that most older adults can take.

In this post, I’ll explain what I recommend to most of my older patients, and why.

I’ll also address the following frequently asked questions:

Which type of Vitamin D should I take?
Do I need to have my vitamin D blood level checked?
What should one’s vitamin D level be?
Will vitamin D really prevent falls or fractures?
Will vitamin D prevent dementia, cancer, and/or premature death?
I am outside a lot. Do I need a vitamin D supplement?
I heard that a higher level of vitamin D is better for you. How much is too much?

Now when I first wrote this article in 2015, vitamin D supplementation for older adults was recommended by experts — to help reduce the risk of falls and fractures, among other things — although most geriatrics experts did not think the high doses (e.g. 2000 IU daily or more) that many people take are indicated.

(For years now, many people have had unrealistic expectations of what vitamin D can do for them. Sometimes this is because they think it will improve their health. In other cases, it seems to be because their doctors never got around to reducing a higher dose which should’ve only been used for a limited time period. Either way, it’s concerning because taking high doses of vitamin D has been linked to health problems.)

Today, experts in geriatrics are reassessing what to recommend for vitamin D supplementation.

This reassessment is in large part driven by the publication of a large randomized trial of vitamin D supplementation in older adults, the VITAL study. [Read more…]

Addressing Medical, Legal, & Financial Advance Care Planning:
The Healthy Aging Checklist Part 6

by Leslie Kernisan, MD MPH 6 Comments

This is the sixth and final post covering the Healthy Aging Checklist, a set of six core activities that will help any older adult maintain the best possible health while aging.

They are:

Promote brain health and emotional well-being.
Promote physical health.
Check for and address common senior health problems (such as falls, memory concerns, depression, incontinence, pain, isolation, polypharmacy).
Learn to optimize the management of any chronic conditions.
Get recommended preventive health services for older adults.
Address medical, legal, and financial advance care planning.

In this post, I’ll address the last item on the list: advance planning for medical, legal, and financial issues.

This is a big topic, and it’s not possible to cover everything you could or should do in a single article. You would need a book for that — I suggest three down below — plus it’s best to work with qualified professionals (healthcare providers, eldercare attorneys, and financial planners) before completing any legally binding paperwork.

But every day as I work, I see older adults and families whose health and wellbeing is being affected by the consequences of their planning — or lack of planning, as the case often is.

So in this post, I will share some practical information that should make it easier for you to address planning that covers some common age-related challenges:

The three key steps involved in all advance planning for aging
5 common problems every older adult and family should consider planning for
What a recent study revealed about older adults and planning for the future (hint: that they are counting on their kids even though they usually don’t talk much to their families about this)
5 key steps for advanced planning in healthcare
4 key steps for advance planning for legal and financial issues
Tips for adult children, including what to do if you’re concerned about mental capacity or undue influence

[Read more…]

26 Recommended Preventive Health Services for Older Adults:
the Healthy Aging Checklist Part 5

by Leslie Kernisan, MD MPH 24 Comments

This is the fifth in a series of posts covering the Healthy Aging Checklist, which is my list of six fundamental activities that will help any older adult maintain the best possible health while aging.

They are:

Promote brain health and emotional well-being.
Promote physical health.
Check for and address common senior health problems (such as falls, memory concerns, depression, incontinence, pain, isolation, polypharmacy).
Learn to optimize the management of any chronic conditions.
Get recommended preventive health services for older adults.
Address medical, legal, and financial advance care planning.

In this post, I’ll cover recommended preventive health services for older adults, based on the recommendations of the U.S. Preventive Services Task Force (USPSTF) and also Medicare’s coverage of preventive health services.

By my count, based on the USPSTF and Medicare guidelines, there are currently 26 preventive health services that older adults should consider. I have a summary list here, and then detailed information on each service starting here.

Get Your Free Preventive Health Cheatsheet! The 26 proven preventive health services for older adults, in a handy PDF checklist that you can print or save. Includes details on who should get each service, and helpful links. Click here now.

But before you read about them, let’s go over the basics of how preventive health services work, including why they can sometimes be harmful, or sometimes fall out of favor.

This way, when you review the list of preventive services to consider, you’ll better understand which services are likely to help, and why certain services may not be a good fit for you or your parent.

Understanding Preventive Health Services

Preventive health services essentially fall into three categories: [Read more…]

Healthy Aging

Understanding Preventive Health Services

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