Older Patients, Wiser Care

The challenges of eldercare, through a geriatrician's eyes

12 Advantages of Old Age

Last updated: September 22, 2016

enjoying fish & chips
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People are often surprised to hear that I've chosen to specialize in medical care for the elderly. "Why geriatrics? Isn't that depressing?" they often ask me.

Well, we certainly get our share of sad moments in geriatrics. Luckily, those are more than outweighed by the many little moments of wisdom and humor that my patients share with me every day.

This week, I'd like to share with you the following list of twelve advantages of being old. It was given to me by 83-year-old Mr. R., who despite his damaged heart and high blood pressure, is still managing to take care of his 98-year-old wife. He brought this list to a follow-up visit, remarking that, thankfully, getting older is not all bad.

12 Advantages of Old Age

  1. You can sleep anytime or anywhere, maybe.

  2. You can drive slow and not be honked at or shot at, maybe.

  3. You can forget to zip up and nobody cares, maybe.

  4. You can reread books a

Better Ways to Make Your Wishes Known

Last updated: June 07, 2011

Mature couple
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Dear Dr. K: "In my written instructions for family and caregivers I've stated: "If I'm living, let me live. If I'm dying, let me die." Is this enough? I'd appreciate some "informed advice" on this, with alternate suggestions."

Let me start by congratulating you on having taken some very important steps that I wish all my patients would complete! First, you've thought ahead to a time when your caregivers may have to make medical decisions on your behalf. Second, you've made the effort to document your wishes; written information in an advance directive or living will can be very helpful to all involved when a crisis hits.

The trouble, however, is that your instructions may be hard to follow. That's because in advanced illness, living and dying often look more like a spectrum, where one slowly shades into the other, rather than like two distinct states that are easy to tell apart. Someon

Why Your Older Loved One May Want to Skip That Cancer Screening

Last updated: February 07, 2011

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Dear Dr. K,

My 82-year-old mom's doctor ordered a mammogram and pap recently even though she has pretty significant dementia. I'm not sure she would even understand a cancer treatment if a problem were found. Are these tests really necessary?

Probably not. Recent studies and expert guidelines have suggested that it's often appropriate to dial back on cancer screening as people age, especially if they have dementia or another condition that's likely to limit life expectancy. Plus, as you so perceptively point out, in the case of Alzheimer's or other dementias, cancer treatments can be a particular ordeal, since the patient often doesn't understand why uncomfortable treatments and procedures are being done.

Ideally, the decision to refer an older woman for cancer screening would be made after the doctor and patient had considered the overall health state of the patient and agreed tha

How to Avoid the Perils of a Too-Soon Hospital Discharge

Last updated: January 31, 2011

Senior Series Discord
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Dear Dr. K,

After my dad's heart attack, I was surprised when the hospital wanted to discharge him after less than a week. He still seemed weak and disoriented and has slight dementia. I was hoping they'd monitor his diabetes and high blood pressure, too, as these had been giving him trouble. Sure enough, the day after he got home he fell in the night and broke his hip! Should I have fought harder to keep him in the hospital -- and if so, how??

Without knowing the specifics of your father's case, it's difficult to say whether it would've been better for him to stay longer in the hospital.

The time right after a hospital discharge is *always * dicey, because it's common for older people to find themselves in a condition similar to your father's:

Weak because they've just survived a major illness, and usually have been much less physically active than when at home.

More conf

There's More Than One Way to Cure Constipation

Last updated: January 20, 2011

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Dear Dr. K.,

What's the best way to treat constipation in an older person? My father has chronic back pain due to arthritis in his spine. Taking a Vicodin tablet three times a day really helps, but it seems to make him constipated. His doctor recommended he take Senna every day, but I've always heard that one shouldn't use laxatives for more than a few days at a time.

Constipation does become more common as people age. So it's unfortunate that all the opiate pain-killers many older adults take (including Vicodin) make constipation worse.

Luckily it's usually easy to find a way to keep the bowels running relatively smoothly, even while taking a transit-slower like Vicodin. And although the packaging of most laxatives implies that one shouldn't use the product chronically, several of them can be used on a very regular basis, without apparent harm to the bowel.

Interestingly, many doct

11 Ways We All Can Counter the "Disadvantages of Old Age"

Last updated: December 27, 2010

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Last holiday season, I shared with you a list of 12 advantages of getting old, which had been given to me by my 83-year-old patient, Mr. R.

A few months ago, I had to say goodbye to Mr. R and many other patients I'd known for years, as I prepared to move my practice from the VA's geriatrics clinic to the Over 60 Clinic in Berkeley, California.

"Doctor, remember that list I wrote for you last year?" Mr. R said at our last visit together. "I came up with a few more points about getting old that I thought you could share with your readers." He pressed a little sheaf of notepaper into my hand.

Despite Mr. R's wry title, some items made me laugh out loud. Better yet, each one reminded me of an * opportunity * we all have to better support an aging relative or friend. So here's his list - and my caregiver twists to them.

The Disadvantages of Old Age, and what caregivers can do about them:

When to Worry About Weight Loss and Poor Nutrition

Last updated: November 22, 2010

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Dear Dr. K,

I'm worried about nutrition for my 84-year-old aunt, who lives alone. She has really bad arthritis, so it's hard for her to get out of the house, and she can't cook the way she used to. She's always been slim, but these days I worry that she's getting even skinnier! Would you recommend that she start drinking something like Boost or Ensure, and would I need a doctor's prescription in order to get it? I can't shake the feeling that she really needs to be eating better than she does.

Unintentional weight loss should always be a red flag for those of us caring for elders, so I'm glad this issue has caught your attention.

For some people, a fortified drink like Boost or Ensure can be really helpful. The key, however, is to first make sure that your aunt's weight issues really are best addressed with this type of nutritional supplement.

To figure this out, you'll want to d

Why the Doctor Sometimes Talks to the Caregiver Instead of the Patient

Last updated: November 08, 2010

Elderly Woman and Younger Woman
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Dear Dr. K,

Why do doctors often avoid talking to older people during primary care visits? I've been bringing my elderly mother to see a doctor whom I've heard is pretty good. But it bothers me that he often ends up peppering ME with questions rather than talking to my mom. She does have some early Alzheimer's, but she's the patient, and I don't think the doctor should be treating her like a child, or like she's not there. Should I think about changing doctors?

It sounds like you're not very comfortable with this doctor's style. It's certainly possible that another doctor might be a better fit for your mother and you.

I'll admit, however, that even as a geriatrician who's used to patients with dementia and who always starts the visit by talking with the patient, I still often end up questioning the caregiver companion. In fact, just the other day, a patient's son frowned at me and ask

How Can I Convince Seniors to Get a Flu Shot?

Last updated: October 25, 2010

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Dear Dr. K,

How can I convince my mom to get a flu shot? I want her to keep up with recommended preventive care, but she's been pooh-poohing me, saying she's already lived through plenty of flu seasons. Also, I've heard there's a new stronger flu shot available for older people this year. If I can talk my mom into getting vaccinated, should I push for her to get this new shot, or the usual one?

I'm not surprised to hear that your mom is skeptical of the flu shot. In my own primary care clinic, patients have often turned me down.

Here are some of the common reasons I hear for resisting vaccination, along with my usual responses:

  • "You can get the flu from the flu shot."

    No, you can't get the flu from the flu shot, because the injected flu vaccine contains only killed influenza virus. (The nasal vaccine does contain a weakened live virus, but that vaccine has never been recommende

To Pull or Not to Pull? Deciding Whether to Get Late-Life Dentures

Last updated: September 27, 2010

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Dear Dr. K,

My 89-year-old father has been having pain and difficulty when he chews for quite some time. He has partial upper and lower dentures. An oral surgeon recommends extracting all his teeth and getting a full set of dentures. But he's also warned us that it will take weeks for the swelling to go down, and Dad can't get fitted for his new dentures until then.

Should we go ahead with getting all Dad's teeth pulled? We're all "“ Dad included -- a bit nervous about him having to go through a procedure with such a long recovery time.

Your father's situation is relatively common, and an important issue for caregivers to pay attention to. Being able to eat comfortably is a vital aspect of one's quality of life, and to maintain health and nutrition. Too often, however, dental care is neglected in older adults, especially since Medicare doesn't usually cover it.

But is pulling out t

About Older Patients, Wiser Care
  • As a San Francisco geriatrician, I'm one of only 7,500 American doctors specializing in the unique needs of aging minds and bodies. That's not nearly enough. So the burden of our elders' healthcare needs falls to their stressed, inexperienced caregivers. My goal for Older Patients, Wiser Care: to help you "think more like a geriatrician" yourself. I want you to know key insights about aging issues, like pain, meds, falls, and dealing with multiple health issues -- insights that quality of life depends upon, and that doctors who aren't trained in aging care often miss.

    You can reach me at drkernisan@caring.com

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