Leslie Kernisan, MD MPH

Practical advice to help caregivers help aging adults

Medical caregiving for elderly

3 Things Caregivers Should Know About Better Healthcare in Alzheimer’s

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Having dementia, such as Alzheimer’s, brings on special challenges when it comes to health and medical care.

Last fall, my friend and colleague Paula Spencer Scott interviewed me on what family caregivers can do to improve the health — and healthcare — of a loved one affected by dementia.

The interview turned into a chapter in her terrific new book, “Surviving Alzheimer’s: Practical tips and soul-saving wisdom for caregivers.”

Below, I share three things I wish more caregivers knew about better healthcare for someone with a diagnosis of Alzheimer’s or another dementia. (I’ll share two more items in my next blog post.)

I’m also planning on focusing my next Q & A call on  better medical care of people with dementia. If that’s a topic of interest to you, I hope you’ll join the call on February 25th.  (Those who sign up will be able to listen to the call afterwards.)

5 things I wish caregivers knew about healthcare & dementia

(Note: The following is an excerpt from Paula Spencer Scott’s new book “Surviving Alzheimer’s – Practical tips and soul-saving wisdom for caregivers.” I’ve added a few links to her text.)

A geriatrician urges you to shift how you think about medical care after an Alzheimer’s diagnosis; it can make a world of difference for your loved one and you. [Read more…] about 3 Things Caregivers Should Know About Better Healthcare in Alzheimer’s

More Tips to Avoid Medication Mishaps in Aging Adults

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Many thanks to those family caregivers who joined me on the Q & A call about medications earlier this week!

In this post, I’ll provide a little more information related to some of the questions that came up on the call.

How to check for risky interactions between different drugs

One caller asked me if I knew of any ways she might be able to check an older person’s medication list for problematic interactions. (I myself use an interaction-checker embedded in UpToDate, but this is a subscription service that costs money and is designed for healthcare professionals.)

After the call, I looked online to see what is available to the general public. Naturally, I turned to Google, searched “drug interaction checker,”  and found that several interaction-checkers are available for free.

Having briefly tried the top three search results, here is my current top choice: [Read more…] about More Tips to Avoid Medication Mishaps in Aging Adults

6 Common Medication Problems in Aging, & What You Can Do

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If you’re helping an older person with health and healthcare, chances are that person is taking at least a few prescription medications, if not several.

Do you ever wonder if he or she is on the right medications? Do you worry about side-effects and interactions?

These are sensible concerns to have. Although medications do often help maintain health and wellbeing, studies have repeatedly shown that lots of older adults end up suffering from problems related to medication.

Since my upcoming Geriatrics for Caregivers Q&A call will be about medications, today I want to share a list of common ways that medications affect the health and wellbeing of aging adults. I’ll then explain what family caregivers can do, to minimize problems.

Six Common Medication-Related Problems in Aging Adults

Here are the most common problems that I see: [Read more…] about 6 Common Medication Problems in Aging, & What You Can Do

What the new blood pressure guidelines mean for older adults

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Are you caring for an older person with hypertension, also known as high blood pressure? Or does your parent take medication to lower blood pressure?

If so, then you should definitely learn more about the new guidelines for the treatment of high blood pressure, which were released by a well-respected expert committee on December 18, 2013.

This week, I wrote an article for you, explaining the key points of the new guidelines, and listing what caregivers can do to make sure their older loved ones aren’t being over-treated for high blood pressure (BP).

In my experience, many frail older adults are taking more BP medication than they need. This can cause falls or dizziness due to orthostatic hypotension, and one of the most common medication changes I implement as a geriatrician is the cutting back of blood pressure medications. (For more on orthostatic hypotension, see this article at HealthinAging.org, and also this FAQ I wrote about why elderly people get dizzy when standing up.)

If you want to read my full article on this topic, it was published yesterday on AgingCare.com, and you can find it by clicking this link:

What the New Blood Pressure Guidelines Mean for Caregivers

AgingCare.com only publishes articles that won’t be published elsewhere on the web, so I can’t post the whole thing here. But here are the highlights related to the new BP guidelines:

  • A higher target BP for adults aged 60 or older. The recommended goal BP is now less than 150/90, instead of less than 140/90 (which was the target recommended in prior guidelines, published in 2003).
  • A higher target BP for people with diabetes and/or kidney disease. The recommended goal BP is now less than 140/90, instead of less than 130/80.

What does this mean for you, if you’re caring for aging parents or other older persons? It means you should check on how their BP has been doing.  If it’s been much lower than the numbers above, you should consider discussing the BP medications with your parent’s doctor. This is especially important if you’ve had any concerns about falls or balance.

For specific recommendations on how to make sure your older loved one isn’t getting too much blood pressure medication, read my full article at AgingCare.com. I also offer tips on checking BP in this post: Why I Love Home Blood Pressure Monitors.

[Update March 2014: A recently published study found that older adults on BP medications have more serious falls. You can read my blog post about it here.]

Questions about medications in aging adults?

Would you like to learn more about how geriatricians manage medications in older adults? Or, do you have more questions about blood pressure medications in the elderly?

This month, I’ll be doing a free Q & A call on how geriatricians manage medications in aging adults. The call is scheduled for Tuesday, January 28th, at 12:30pm PST/3:30pm EST. Not sure you can join the call? Sign up anyway, and you’ll be able to listen to a recording of the call afterwards.

Q & A Highlight: Not all urine bacteria needs antibiotics

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Here’s an interesting question that came up during this week’s Geriatrics for Caregivers Q&A call:

What can be done when an elderly woman has bacteria in her urine but no symptoms, and how might a urology consultation help?

According to the caller, a friend in her 90s had been having bacteria in her urine, but no symptoms. Despite treatment with antibiotics, she was still having urine in the bacteria, so the doctor had recommended chronic antibiotics and a referral to urology.

(Now, these Q&A sessions — and these blog posts, for that matter — are for health education purposes only, so it’s not possible to make specific recommendations on how this elderly woman should be treated. The doctors involved are able to talk to her, examine her, and review her medical history, and that will affect what kinds of recommendations they make.)

On the call, I shared some of what I know about this topic in general: that although urine is usually sterile, some people do develop chronic bacteria without having a urinary tract infection (UTI), and that we call this having a “colonized” bladder. I also noted that unless there are symptoms of a urinary tract infection (UTI), it wasn’t clear to me that treating the bacteria repeatedly would be helpful.

We went on to discuss the kinds of questions that a family could ask a doctor, to make sure that all the appropriate treatment options had been considered, and to better understand why the doctor was recommending a urologist. We also talked about applying a “benefits vs burdens” approach to going through the options with the doctor.

But after the call, I decided to look up the problem of “asymptomatic bacteriuria,” which is the technical term for having bacteria in the urine but no signs of UTI. (“Asymptomatic” means no symptoms.)

As often happens when I look things up, I learned some useful things!  Below are the highlights, which I hope will be helpful to older adults and caregivers (and even doctors!) who encounter this health issue.

[Read more…] about Q & A Highlight: Not all urine bacteria needs antibiotics