Do you have an elderly loved one who needs you to look after them? Are you aware which danger signs to look for in their behavior or physical state? Join us in conversation with geriatrician Dr. Leslie Kernisan who has a great list of tips to share. Enjoy the show!
My guest today is Dr. Leslie Kernisan who is a medical doctor in the field of geriatrics. On her website she talks about the health issues that we are facing as older adults. Welcome, Leslie.
Thank you for inviting me.
I’m really happy to have you here. We’ve got a large community of women over 60, and many of them have parents that perhaps need some help as they get older.
I know you have prepared a guide for people who are concerned about their ageing parents. Many of them might need professional advice, and as a geriatrician you’ve got the guidance for them. Can you tell us about your guide?
It’s called the Quick Start Guide to Checking Older Parents. I first started writing about geriatrics for the public about ten years ago, and it was particularly for boomers who were worried about their ageing parents.
Over the years, people have often approached me with this concern, “My mother is living at home alone. Should she be doing that?” or, “I’ve been worried about my parents. How do I know when they need to move?”
The answer to these questions isn’t set in stone. Rather, it depends on a lot of factors. Still, when I thought about it, I realized that when I get asked about that for somebody that I’m going to visit as a geriatrician, I actually have a whole list of red flags and health and safety issues that I check for them that help me assess how the person is doing, on a global scale
I thought that I can’t turn family caregivers into geriatricians, but I could create a list of things that they could go and check for that would help them turn all those vague worries into some specific red flags. Then, they can bring them up to the doctor and start to problem solve. That was the genesis for the quick start guide.
The guide is really helpful and very easy to read. It’s not complicated, and it’s not using medical vocabulary.
Now, we know that women over 60 have been through a lot in their lives. They know how to cope with a bucketful of problems. Yet when it comes to doing the right thing for their ageing parents, it’s a delicate emotional balance for them, too. Tell us more about the red flags we should bring up with the doctor.
I do encourage people to think about these red flags so that when they approach their parent they might have some specifics in mind instead of, “I’m worried about you, you shouldn’t be living that way.”
The red flags are organized into five key areas that I use to check people in. First, we have the basic life tasks that show us how well a person is able to do. In medical terms, we call them activities of day-to-day living and instrumental activities.
Those include life tasks that everybody learns to do in childhood, such as walking and getting around, getting dressed, getting to and from the bathroom, feeding yourself. There are also the ones that we learn as teenagers, that is, managing the finances, transportation, shopping and cooking.
We really like to know about those in geriatrics because they highlight where a person might need some help. If a person is struggling in any of those areas, we follow up with analysis, “What underlining problem is that about? Is that something we need to diagnose and evaluate?”
Second, I have listed some safety red flags, although people should know that it’s very hard to guarantee that somebody is going to be safe. A very common one even in people who don’t have dementia is, “Are there concerns of financial abuse?”
The list continues with, “Is there concern about elder abuse or someone otherwise taking advantage? Has the person been wandering? Have they been falling? Are you concerned about the driving?” These are some of the most important safety red flags.
Taking the keys away is a tough one.
It totally is, and people ask me, “Should I do it?”
I see you are addressing real issues.
What you should do really depends on many factors. You have to get a background, big-picture sense of what’s going on, and then you should make a decision.
In third position I have placed some physical health red flags. These include repeated trips to the emergency room, repeated falls, etc. Many older adults have complicated health histories, but there are some flags that mean something needs to be done more urgently.
Then, there is a longer section on mood and brain health. These all begin with, “Have you noticed…?” I have listed a bunch of specific things that people can check off, starting with, “Have you noticed that the person seems to be depressed? Or has lost interest in going out and doing things?”
Perhaps they are lonely and feel isolated? Or maybe they’ve become paranoid, or have strange beliefs? Have they become forgetful? Do they have trouble manipulating things?
If somebody brought me this kind of information, that would really help me zero in on what might be happening with a person. It would be much faster than having to start at that time the process of gathering information.
It’s doing your homework before going to a geriatrician to get some practical advice.
Exactly. You could also bring it in when you go see a generalist. If you can make it easier for that busy generalist to see that the person has been forgetting things, has been having delusions or has been having falls, you are that much further ahead.
Briefly, the fifth section of my list concerns medication management and safety because it’s such a common source of difficulty for older adults. In fact, lots of older adults are hospitalized for medication errors.
So, if we can flag any of the above as an area where we need to help out, that can be helpful.
Those are five really clear flags. You have to determine whether it’s a red flag or a yellow flag depending on the specific circumstances.
As you were talking, I realized that a lot of the items on your list could be used for self-analysis. I know for myself that as I get older I start to wonder whether I should do certain things by myself or request assistance. Do you think your list could be used for self-evaluation?
Well, it wasn’t particularly intended for that, but I’m sure some people have looked at it and turned an eye towards themselves. To be honest, this is a list of things that often become problems for older people.
So, an older person could use the list to see for themselves if they are having a certain problem. Or, if you are in a planning frame, you could ask yourself, “What would I do if I started having that kind of difficulty?”
You could go even further, “What would I want my friends or adult children to do if they noticed I was having this kind of difficulty?” What’s important to understand is that these are all common problems.
Using this guide doesn’t mean that people will necessarily know exactly what to do. What it will help with is to narrow things down to certain flags.
In the guide I’ve included some suggestions on what kind of professional might be able to help with certain types of problems. I’ve also added links to a lot of resources that might tell you more about how to get a certain type of problem looked into. It’s a starting point that helps you know what you need, which then gives you a place and direction to follow.
You are doing a real service with your guide. It is unique, and I haven’t seen anything quite like it. It is available on your website along with all kinds of resources.
In addition to giving advice and helping older people as a geriatrician, you also help older adults prepare for their own aging problems like chronic illness and so on. All of this is super helpful.
Now I think that people should be informed that geriatricians are very rare, so not everybody can have access to one. I think you mentioned the ratio was really low.
Yes, you’re right. There are about 7500 geriatricians, and we get fewer every year, because doctors retire and not enough younger people are going into the field. As a contrast, we have so many older adults, and the ratio is startling. There is about one geriatrician for every 2700 people age 75 or older, or about one for 800 people 85 or older.
There aren’t enough of us to provide hands-on care to everybody, but so much of what we do know can be useful to older adults. We can even help adults who aren’t so old that they think of themselves as being old.
People in their 60s already should be paying attention to avoiding medications that we know are often harmful or could affect your balance or your thinking.
My goal in starting my website was spreading valuable information. With the Internet handy, people become so much more interested in learning about their health and well-being and becoming pro-active.
In geriatrics we have all this knowledge and understanding of how to help people live their best or how to tackle really common age-related health problems. I really wanted to share that with people so that they could learn a little bit more and have a better sense of what questions to ask the general practitioner.
I would really recommend people to have a look at your site. That’s where you have your checklist and a whole lot of other information that people who are planning to look after their aging parents can find useful.
Your guide will give them some tips that, when they go to the general doctor, they could have all necessary information handy. Then, if a geriatrician is the only person who can help, the GP would send the patient there.
All in all, it’s a process of identifying what the challenge is, or what the red flags might be, and then escalating to someone who can help you. I’m glad you’re there. I’m glad you are one of the people who can help those over the age of 75. I really appreciate your time, Leslie. It’s been great chatting with you.
Thank you for inviting me.
It’s my pleasure. Thank you.
Are you currently looking after your aging parent(s)? Which danger signs have you noticed that you now know you should pay attention to? Have you met with a geriatrician and how difficult was to set up an appointment? Please join the conversation below!