Practical information for aging health & family caregivers
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.
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.Â
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.Â
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 white matter 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:
Confused by all the back and forth in the media about vitamin D?
That’s understandable. Once touted as the thing to take for health and well-being, vitamin D has actually not been meeting expectations in randomized trials. It’s even been demoted in some expert recommendations.
That said, there is still 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 it’s important to be careful about taking higher doses of vitamin D3.
I’ll also address the following vitamin D frequently asked questions:
You can also learn more about the surprising risks of too much vitamin D in aging in this video:
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 problems, as I explain below.)
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, plus a few other research studies that have suggested that higher doses of vitamin D supplementation are associated with more falls and hospitalizations.
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:
In this post, I’ll address the last item on the list: advance planning for medical, legal, and financial issues. This includes power of attorney documents, plus much more.
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 well-being 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:
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:
In this post, I’ll cover recommended preventive health screening guidelines and other prevention services for older adults. These are based on the recommendations of the U.S. Preventive Services Task Force (USPSTF) and also on Medicare’s coverage of preventive health services.
By my count, based on the USPSTF and Medicare guidelines, there are currently 27 preventive health services that older adults should consider. I have a summary list here, and then detailed information on each service starting here.
But before you read about them, let’s go over the basics of how health screening and other 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.
Preventive health services essentially fall into three categories:
This is the fourth in a series of posts covering the Healthy Aging Checklist.
Again, the Healthy Aging Checklist summarizes the six fundamental activities I recommend when asked what to do to maintain the best possible health while aging. They are:
In this post, I’ll cover the fourth item: learning to optimize the management of any chronic conditions.
Now, people are often very interested in “prevention” and in “staying healthy.” But far fewer people seem to be interested in making sure that they and their doctors are doing the right things for any chronic conditions they already have, and — equally importantly — avoiding the wrong things.
This is a serious oversight, because most of the “aging” problems that older adults eventually develop are due to chronic health conditions that have progressed or caused complications.
So optimizing the care of chronic conditions is very important for the prevention of future health deterioration. And it’s also vital to helping older adults feel and function their best in the here and now.
According to Medicare, over two-thirds of beneficiaries have two or more chronic conditions. Here’s a figure from the Medicare Chronic Conditions Chartbook, showing what percentage of older adults are affected by the 15 most common chronic conditions:
I can’t emphasize this enough: these chronic conditions often are the key drivers, when it comes to an older person’s symptoms, health crises, health declines, and the eventual development of disabilities.
Furthermore, I’m sorry to say this but here goes: you should not assume that doctors will provide you with optimal care for chronic conditions. Experts have estimated that patients get only about half of recommended healthcare. A large body of healthcare quality research has repeatedly documented that it is very common for older adults to receive healthcare that varies from “wrong” (e.g. totally counter to guidelines with no documented justification for this) to “sub-optimal” (which means it’s not very deficient but could and should be better).
Later in this article, I will go into more detail on why doctors often provide sub-optimal care, and what you can do about it.
But first, let’s review what’s at stake and why it’s worthwhile to make sure you optimize the healthcare of an older adult’s chronic conditions. I’ll then finish by providing some practical tips to help you be proactive so you can optimize the care of chronic conditions, for healthier aging.
This is the third in a series of posts covering the Healthy Aging Checklist.
Again, the Healthy Aging Checklist summarizes the six fundamental activities I recommend when asked what to do to maintain the best possible health while aging. They are:
In this post, I’ll cover the third item: addressing commonly neglected aging health problems that routinely sabotage healthy aging.
These issues are sometimes referred to as geriatric syndromes. They affect health and quality of life, and although they happen more in people who are older or frailer, they affect countless people in their 60s and 70s as well.
Virtually all of these issues affect a older adults’s ability to socialize, be physically active, and take good care of himself or herself. Â So addressing these is key to enabling healthier aging.
Unfortunately, these issues routinely fall through the cracks of usual medical care. People often suffer from these problems for years without anyone taking effective action.
This may be because many people — doctors, older adults themselves, or family members — assume nothing can be done about these, and that they are just “part of getting old.”
Don’t believe that.  We have studied these problems in geriatrics and most of the time, correctly evaluating and then managing these problems helps older adults and their families feel better, live better, and sometimes even live longer.
Remember, healthy aging is not just about preventing problems. It’s also about spotting them and addressing them before they get worse, or drag down the rest of your health and independence.
So for healthier aging, be proactive in checking for these oft-neglected problems.
And then remember: sub-optimal treatment of these problems is all too common. So you’ll need to be proactive about getting them correctly managed — which might mean either seeing a geriatrician (here’s how to find a geriatrician) or making sure your usual doctor is thinking like one.
Here’s what to look for, and how to learn more:
This is the second in a series of posts explaining my Healthy Aging Checklist.
Remember, for the healthiest aging, we need to do the things that optimize health — and health care — so that the brain and body work at their best for now, and for the future.
I’ve identified six broad actions to take:
The Healthy Aging Checklist:
In this post, we’ll cover proven ways to promote and maintain physical health as one ages.
Here are the six “healthy living” actions that I recommend, for promoting physical health in all older adults. They all have a solid track record (which cannot be said for everything I see recommended online). They are also good “bang-for-the-buck,” in part because they provide real benefits to just about everyone who adopts them. And they help whether or not an older person has already developed chronic illnesses.
“Doctor, what do you recommend for healthy aging?”
“My mom is getting older and I want to help her stay healthy. What should we be doing?”
On this site, I usually write about how to manage or avoid specific aging health challenges. But in real life, I often get asked the questions above. After all, many people want advice on how to be healthier, or stay healthy.
That’s because we all intuitively know that maintaining good health (including cognitive function) is key to maintaining what is most important to us as we age: our ability to be physically and mentally capable, so that we can remain active, engaged in our lives, and as independent as possible.
We also know that poor health can bring on pain and other symptoms, as well as disabilities that can jeopardize how we live our usual lives. In fact, most “aging” problems that older adtuls and families struggle with — like difficulties with mobility, memory, or independence — Â track back to underlying health problems.
So it’s good to know how to maintain one’s health as one ages, in order to keep our minds and bodies working well for as long as possible.
Furthermore, healthy aging isn’t just about forestalling aging or disability. It’s also about knowing how to make the best of things even once you do have chronic diseases or chronic disabilities of the mind or body. I call this optimizing health, for better health while aging.
It means optimizing one’s health — and health care — so that the brain and body work at their best for now and for the future. And the beauty of this is that the same key things work, whether you are a “healthy” older person with no particular health problems versus someone who has chronic conditions or even an “uncurable” disabling disease such as Alzheimer’s.
In this series of posts, I’m going to tell you how to do this.
For the healthiest aging, do this:
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.