Better Health While Aging

Latest Episodes:

092- Interview: Addressing Nighttime Urination & Insomnia in Aging May 30, 2019

Show notes

In This Episode:

Dr. K talks with geriatrician Shachi Tyagi, MD, Assistant Professor of Medicine at the University of Pittsburg. Her research focuses on two common issues in older adults, insomnia and having to urinate at night (nocturia). They discuss:

Why nocturia becomes common as we age
Common health problems that may be related to nocturia
The relationship between nocturia and sleep problems
How nocturia should be assessed and how it can be managed
“Brief behavioral treatment” and other recommended insomnia treatments that can also improve nocturia
Why sleep medications should be avoided in aging
How to reduce the risk of nighttime falls related to nocturia
Options for addressing nocturia and sleep issues in dementia
Tips on tracking bladder and sleep symptoms, and how to get help from your health providers

Related episodes:

032 – 5 Top Causes of Sleep Problems in Aging

088 – Interview: Avoiding Inappropriate Prescribing in Aging & What to Know About the Beers Criteria

Related Resources:

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091 – Interview: Reducing the Risk of Power of Attorney Abuse May 16, 2019

Show notes

In This Episode:

Dr. K speaks with senior attorney David Godfrey, JD, of the American Bar Association Commission on Law and Aging, about drafting better power of attorney documents so as to reduce the risk of abuse. David works closely with the National Center on Law and Elder Rights and authored an issue brief in 2018 that covers advance planning and how to avoid exploitation. They discuss:

What is a general durable power of attorney (POA) and why every person should complete one
Common reasons why older adults may need someone else to transact business for them, such as temporary or permanent incapacity
Why court intervention may be necessary if an older person does not have a POA
How POAs can be used for financial exploitation, and how drafting protections in the POA document can reduce the risk of abuse
6 key precautions to take, when drafting a general durable power of attorney
How requiring third party accounting can reduce family conflict
Why it’s a good idea to require a second signature for major transactions
The benefits of granting the power to revoke the POA to a third party
How older adults can find affordable legal assistance, for help drafting a POA
Options for older adults who have no close family available to serve as an agent
Resources to help guide agents to manage power of attorney duties

Related episodes:

037 – Interview: Using Powers of Attorney to Help Older Adults

070 – Interview: Addressing & Preventing Financial Exploitation in Aging

Related Resources:

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090 – More on Avoiding Risky Medications & on Using the 2019 AGS Beers Criteria May 02, 2019

Show notes

In This Episode:

Dr. K provides more information on what’s included in the 2019 update of the American Geriatrics Society AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults, with a focus on which drugs she thinks are most important to avoid. She also addresses which medications are associated with falls, cognitive impairment, and other key conditions. She covers:

How the 2019 Beers Criteria is organized
Options for accessing the 2019 update
Which medications should be avoided in people with memory problems, per the Beers Criteria
Which drugs to avoid or use with caution if you have a history of falls or fractures
Other common risky medications to be aware of
What to know about opioid painkillers and the 2019 Beers Criteria
5 things you can do to be proactive about medications safety in aging
Where to find consumer brochures that can help you discuss deprescribing for the most common risky medications

Related episodes:

088- Interview: Avoiding Inappropriate Prescribing in Aging & What to Know About the Beers Criteria

073- Anticholinergic Medications & Protecting Brain Health

031- Choosing the Safest Over-the-Counter Painkiller in Aging

046- Interview: Deprescribing & Reducing Risky Medications in Aging

034- Preventing Falls: 10 Types of Medication to Reconsider

Related Resources:

Better Health While Aging
Healthinaging.org
Canadian Deprescribing Network
The EMPOWER Brochures (from the Canadian Deprescribing Network):
- Anti-inflammatory medications like ibuprofen (Non-steroidal anti-inflammatory drugs or NSAIDs)
- Antipsychotic medication as sleeping pills or for Dementia
- Medications for allergies and itchiness (First-generation antihistamines)
- Medication for type-2 diabetes (Sulfonylurea diabetes medication)
- Sleeping pills & anti-anxiety medication (Sedative-hypnotic medication, such as Ativan, Ambien, and others)
- Stomach pills for acid reflux (Proton-pump inhibitors)
Daily Aspirin Therapy: Understand the Benefits & Risks

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089 – Giving Yourself (And Your Family) a Gift on National Healthcare Decisions Day Apr 18, 2019

Show notes

In This Episode:

Dr. K shares a personal story and explains why it’s so important to take the time to talk with others and make plans to provide others with guidance, since most of us will at some point be unable to make our own healthcare decisions. She covers:

The importance of National Healthcare Decisions Day
What “advance care planning” means, and why it’s more than completing legal forms
Four key steps in advance care planning
Why it’s essential to have conversations with others, including with healthcare providers and with family
Two free online tools you can use to guide you through reflection, conversations, and completing paperwork
Five common pitfalls to avoid if possible
Five questions you can ask yourself, every April when it’s National Healthcare Decisions Day

Related Resources:

National Healthcare Decisions Day Website
PrepareForYourCare.org
- Easy-to-Read Advance Directives (available for almost every state!)
The Conversation Project
- List of Starter Kits (available in multiple languages and also for Alzheimer’s and related dementias)
Advance Directive for Dementia (from Barak Gaster, MD)
5 Questions to Ask Yourself on National Healthcare Decisions Day
Other BHWA articles on advance care planning and end-of-life

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088 – Interview: Avoiding Inappropriate Prescribing in Aging & What to Know About the Beers Criteria Apr 04, 2019

Show notes

In This Episode:

Dr. K talks with geriatrician Dr. Michael Steinman, Professor of Medicine at UCSF and an expert on medication safety in older adults. He recently served on the expert panel that authored the American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults, which lists medications that older adults should avoid or use with caution. They discuss:

What is “inappropriate prescribing” and why it affects an estimated 50% of older adults
How ageism can affect medication prescribing
How inertia, hospitalizations, and other factors lead to medications “accumulating”
Why it’s not safe to assume that all your medications are being prescribed for a good reason
How to be proactive about asking your health providers to review whether all medications are still necessary and appropriate
What is the Beer’s Criteria list and how does the Expert Panel decide what should be on it
Why older adults become more vulnerable to medications as they age
Some key Beers Criteria medications older adults should know about
What you can do if you’re taking a medication on the Beer’s Criteria list
How pharmacists can help, and other tips on ensuring safer medication use in aging

Related episodes:

046 – Interview: Deprescribing & Reducing Risky Medications in Aging

073 – Anticholinergic Medications & Protecting Brain Health

034 – Preventing Falls: 10 Types of Medication to Reconsider

Related Resources:

(Note: To date, HealthinAging.org and the American Geriatrics Society have not made the full 2019 Beers Criteria available for free to the public. For a full list, an option is to purchase the pocketcard, which we link to below.)

From HealthinAging.org:
About the 2019 Beers Criteria Update:
Other Related Articles by Michael Steinman:
- What is this drug for? Prescriptions without indications
- Beyond the Prescription: Medication Monitoring & Adverse Drug Events in Older Adults
How to Taper Benzodiazepines (Helpful consumer handout with sample tapering schedule)
Related Better Health While Aging Articles:

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087- Interview: Coping with Difficult Older Parents Mar 21, 2019

Show notes

In This Episode:

Dr. K talks with family caregiving expert Barbara Kane, LCSW, co-author of “Coping With Your Difficult Older Parent: A Guide for Stressed-Out Children.” She is a co-founder of Aging Network Services, which provides geriatric care management and psychotherapy services. They discuss:

What it means to be a “difficult” older person, and why most such older parents have been “difficult” their entire lives
Categories of difficult behavior, including dependent, “turnoff”, self-centered, controlling, self-destructive, and fearful behaviors
How Aging Network Services helps adult children examine and improve their own interactions with their aging parents
Why age-related challenges are especially hard on “difficult” people
Why adult children must often learn to tolerate an older parent’s unhappiness
How it can help to stop arguing, stop “trying to fix,” and stop “trying to please”
Tips on boundaries and setting limits with an older parent
How bringing in a geriatric care manager can help an aging parent accept needed help
Strategies for better communication with siblings when discussing plans for aging parents

Related episodes:

069- Evaluating Memory & Thinking Problems: 10 Causes & 10 Things to Check

028- When Older Parents Resist Help: 4 Tips for Better Talks

Related Resources:

Coping With Your Difficult Parent: A Guide for Stressed-Out Children
Aging Network Services
Aging Life Care Association: What You Need To Know
Related articles on Better Health While Aging:
- 6 Ways that Memory & Thinking Change with Normal Aging (& What to Do About This)
- Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check

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086 – Interview: Creating Age-Friendly Health Systems at UCSF Mar 07, 2019

Show notes

In This Episode:

Dr. K talks with Dr. Stephanie Rogers, MD MPH, about creating Age-Friendly Health Systems at UCSF, and the specific programs they’ve developed to make hospitalization safer and better for older adults. They discuss:

What are Age-Friendly Health Systems, and why do older adults need them?
Why Age-Friendly Health Systems emphasize the “4 Ms”: mobility, mentation, medications, and what matters
How an Age-Friendly Health System differs from usual healthcare
Why hospitalization is often so risky for older people
What are Acute Care for Elders (ACE) units and how they help prevent problems such as falls, delirium, and loss of independence
How UCSF’s Hip Fracture Co-Management Service provides better care and improves recovery
UCSF’s Delirium Reduction Campaign, which uses a tool called “AWOL” to check every hospitalized patient for delirium
How delirium can be prevented, and what UCSF recommends that families do
How UCSF uses Patient and Family Advisory Councils to improve care
How to find an Age-Friendly Health System near you

Related episodes:

039 – Interview: Creating Age-Friendly Health Systems

062 – Interview: Preventing Hospital Delirium & Maintaining Brain Health

Related Resources:

About Age-Friendly Health Systems:
- Creating Age-Friendly Health Systems – A vision for better care of older adults
- Institute for Healthcare Improvement Initiatives: Age-Friendly Health Systems
UCSF Geriatric Inpatient Services:
- Welcome to UCSF’s Acute Care for Elders Unit
- UCSF Hip Fracture Protocol
- UCSF Delirium Reduction Campaign (includes information on how families can help!)
About UCSF’s “AWOL” Delirium Screening Tool
Related articles on Better Health While Aging:
- Hospital Delirium: What to know & do
- 10 Things to Know About Delirium

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085 – Understanding Lab Tests: 4 Common Blood Tests for Older Adults Feb 21, 2019

Show notes

In This Episode:

Dr. K explains four “panels” of blood tests ordered for older adults, and what to keep in mind when blood tests are ordered. She covers:

What is a complete blood cell count (CBC)
What is a basic metabolic panel (also known as a basic electrolyte panel) and what is a comprehensive metabolic panel
What is a lipid panel
Common reasons that health providers order these panels, and what they can tell us about an older person’s health
Medications that often affect electrolytes
Why it’s important to request copies of your laboratory results
Key questions to ask, when lab tests are ordered or when you review abnormal results with your health provider

Related episodes:

007 – How a Personal Health Record Helps You Be Proactive

023 – Anemia in Aging: 10 Common Causes & What to Ask

031- Choosing the Safest Over-the-Counter Painkillers in Aging

Related Resources:

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084 – Interview: Understanding White Matter Changes in the Aging Brain Feb 07, 2019

Show notes

In This Episode:

Dr. K talks with neurologist Fanny Elahi, MD PhD, about cerebral small vessel disease and other issues related to white matter changes in the brain. Dr. Elahi sees patients and conducts research at UCSF’s Memory and Aging Center, and is an Assistant Professor of Neurology at UCSF. They discuss:

What is the white matter in the brain, and why it often changes or is damaged with aging
The relationship between white matter changes and cerebral small vessel disease
How white matter changes can be thought of as a form of “scarring” in brain
Why these brain changes can affect memory, thinking, and/or falls
What we know about the prevention and treatment of these changes
How white matter changes relate to vascular dementia, Alzheimer’s and other causes of dementia
How the UCSF Memory and Aging Center evaluates white matter changes
What is vascular parkinsonism
What to consider for younger people with white matter changes on MRI
Her recommendations on maintaining the brain and its blood vessels
Ongoing research projects at UCSF and elsewhere that listeners may be able to participate in

Related episodes:

078 – Interview: The Biology of Aging & Longevity

072 – Cognitive Aging: How Memory & Thinking Change as One Gets Older

048 – How Cerebral Small Vessel Disease Affects Most Aging Brains

Related Resources:

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083 – Interview: Disrupting Dementia and Creating Dementia-Friendly Communities Jan 24, 2019

Show notes

In This Episode:

Dr. K talks with Kavan Peterson, editor and co-founder (with Dr. Bill Thomas) of ChangingAging.org. He is also the Chief Operation Officer for the Minka House Project. They discuss:

How Kavan met Bill Thomas and why they founded ChangingAging.org
How approaches to aging have improved over the past decade
Why the ChangingAging Tour emphasizes listening sessions, and the top two concerns they hear about
Why multi-generational interaction is so important
Why ChangingAging decided to focus on disrupting dementia
The Village of Hope project and the creation of dementia-friendly communities
How technological innovations can help care for aging adults
What’s next for ChangingAging, Minka and MAGIC in 2019
How and why you should get involved in creating age-friendly communities

Related episodes:

082- Interview: Bill Thomas on Housing & Communities as Engines of Independence in Aging

074 – Interview: How the Village Model Supports Aging in Place & Community

055 – Interview: Bill Thomas on Ageism & Innovations to Improve Aging