Better Health While Aging

Latest Episodes:

Dr. Lawrence Weed and Dr. Leslie Kernisan — **042 – Why Healthcare is Flawed & How to Improve It: The Work of Dr. Lawrence Weed** Jun 29, 2017
Show notes

In This Episode:

The patient must have a copy of his own record. He must be involved with organizing and recording the variables so that the course of his own data on disease and treatment will slowly reveal to him what the best care for him should be.” — Dr. Lawrence Weed, “Your Health Care and How to Manage It” (1975)

Dr. K discusses the flaws of healthcare and how medicine could be improved, per the insights of visionary healthcare reformer Dr. Lawrence Weed, who died earlier this month at age 93. She covers:

What is optimal medical care, and why doctors often fail to provide it to their patients

Why usual medical care — which relies mainly on doctors using their own internal knowledge and mental processes — leads to disorderly healthcare and frequent errors in diagnosis and management

Dr. Weed’s seminal insight that “*Any system of care that depends on the personal knowledge and analytic capabilities of physicians cannot be trusted.*“

Why Dr. Weed believed that healthcare professionals should use “knowledge couplers” and other more reliable tools to guide the process of evaluation and diagnosis, instead of relying on their own mental processes

Dr. Weed’s belief that the patient should be much more involved in his or her care, and that doctors should help patients make choices, rather than choose for them

Why Dr. Weed advocated for a better medical record, and why he wanted patients to have access to it

Dr. Weed’s lifelong advocacy for a healthcare system that would be orderly and reliable for evaluation, diagnosis, and documentation, but then would be flexible and individualized when it comes to treatment for individual patients

Tips on how older adults and their families can get better care from their doctors, and support the improvements that Dr. Weed envisioned

**Related episodes:**

006 – Interview: Surviving Cancer & Better Healthcare Through Being an e-Patient
018 – High Blood Pressure Treatment in Older Adults: Research Findings & Practical Tips

Related Resources:

Medicine in Denial (2011)

Medicine in Denial Review: A book on how to really leverage technology to improve healthcare (Geritech.org)

4 Steps to Get Better Advice from Doctors

Dr. Lawrence Weed, Pioneer in Recording Patient Data, Dies at 93

Dr. Lawrence L Weed, MD (Burlington Free Press Obituary)

The Heroism of Incremental Care (New Yorker article by Atul Gawande)

Larry Weed’s 1971 Internal Medicine Grand Rounds

Dr. Weed & Dr. K, in Vermont in 2013.
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041 – UTIs and Urine Bacteria in Aging: How to get the right diagnosis & avoid unneeded antibiotics Jun 15, 2017

Show notes

In This Episode:

Dr. K explains why having bacteria in one’s urine does NOT mean one has a urinary tract infection (UTI) that requires antibiotics. In fact, as people get older, they may have bacteria in the urine but no UTI symptoms or other signs of infection. This condition, called “asymptomatic bacteriuria” is common, and is often inappropriately treated with antibiotics. In this episode:

How to know if one has asymptomatic bacteriuria versus a UTI that warrants antibiotics
Why having asymptomatic bacteriuria becomes more common as people become older
Why the Infectious Disease Society of America and others have repeatedly urged doctors to NOT treat asymptomatic bacteriuria
The challenge of correctly diagnosing UTIs in people with dementia
How one can be harmed by using antibiotics to try to eliminate bacteria in the bladder
What to do if you’re worried about urine bacteria — or a possible UTI — in an older person

Related episode:

014 – Delirium & Hospital Confusion

Related Resources:

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040 – Dehydration in Older Adults: How to Prevent It, Detect It, & Treat It Jun 01, 2017

Show notes

In This Episode:

Dr. K explains how to prevent, detect, and treat dehydration in aging adults. She covers:

What is dehydration and what causes it
Why older adults are at higher risk for dehydration
How dehydration can be correctly diagnosed
Why several commonly-used tests for dehydration are often inaccurate in older adults
Symptoms of dehydration
Health consequences that may be associated with mild versus more severe dehydration
How dehydration can be treated
How to prevent dehydration, including how to help older adults stay hydrated
What to known about dehydration and possible urinary tract infections
Tips for family caregivers who are concerned about an older person’s hydration

Related Resources:

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039 – Interview: Creating Age-Friendly Health Systems May 18, 2017

Show notes

In This Episode:

Dr. K talks with Amy Berman, RN, about a major new initiative to create “age-friendly health systems.” Amy is a Senior Program Officer at the John A. Hartford Foundation (JAHF), which focuses on improving the health of older adults. They discuss:

Four goals of an age-friendly health system
The four “Ms” that an age-friendly health system should address: what matters, mentation, mobility, and medications
Why delirium prevention is such an important part of addressing mentation
How the age-friendly health systems initiative builds on proven models of better care for older adults
How JAHF and its partners are planning to develop and expand age-friendly health systems
How older adults and families can find age-friendly care
10 benefits you can expect from age-friendly health systems

Related episodes:

019 – Interview: How Foundations Are Improving Health & Aging
025 – Interview: Palliative Care to Live Well with Cancer

Related Resources:

Age-Friendly Health Systems: How Do We Get There? (HealthAffairs.org)
New Grants Totaling $5.5 Million Begin Charting a Course to Age-Friendly Health Systems (John A Hartford Foundation)
Institute for Healthcare Improvement: Creating Age-Friendly Health Systems
How Health Systems Can Provide Better Care For Seniors
If ACE Units Are So Great, Why Aren’t They Everywhere?

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038 – FAQs On “Incompetence” & Losing Decision Capacity May 04, 2017

Show notes

In This Episode:

Dr. K addresses frequently asked questions about older adults and decisional capacity. She also provides practical advice on what you can do if you’re concerned that an older person is making “bad” decisions. She covers:

What does the term “capacity” mean when it comes to decision-making?
What is the difference between incapacity and incompetence?
How is capacity determined?
Does capacity have to be determined by legal professionals? Is it a “legal decision” whether someone has capacity?
Do I have to have a legal or clinical determination of incapacity for a specific decision before I override the decision of an older person with dementia?
Do I need a legal or clinical determination of incapacity before I take the car keys away from an older parent who has dementia and is an unsafe driver?
Is neuropsychological testing required to assess capacity?
What to do if you’re worried about an older person’s capacity, or actions

Related episodes:

013 – Interview: Solving Hard Problems in Helping Aging Parents
037 – Interview: Using Powers of Attorney to Help Older Adults

Related Resources:

Incompetence & Losing Capacity: Answers to 7 FAQs
American Bar Association Ten Legal Tips for Caregivers
Assessment of Capacity in Older Adults (American Bar Association/American Psychological Association)
Respect for Autonomy (Alzheimer’s Association)
Driving and Dementia (Alzheimer’s Association)

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037 – Interview: Using Powers of Attorney to Help Older Adults Apr 20, 2017

Show notes

In This Episode:

Dr. K talks with elder law attorney Harry Margolis, founder of Margolis & Bloom LLP and ElderLawAnswers.com. They discuss common questions related to the durable general power of attorney as a tool to help older adults, including:

Why durable general power of attorney (POA) documents can be very helpful to older adults
What can be done if an older person objects to the actions of his or her agent
How to use transparency and communication to minimize family conflicts
Whether POA documents should be effective immediately or only upon incapacity
Why it’s important to put family care agreements in writing
What you can do if you’re concerned the POA is abusing his or her power as an older person’s agent
The pros and cons of appointing two people to be your agent on a POA
Why trusts can work better than a POA
What can be done when a POA tries to prevent other family members from visiting

Related episodes:

036 – Interview: Minimizing Family Conflicts & Supporting Aging Parents
013 – Interview: Solving Hard Problems in Helping Aging Parents

Related Resources:

AskHarry.info: Answers to Your Estate Planning Questions
- You can ask attorney Harry Margolis your questions on this site
How Many Agents Should You Name on Your Durable Power of Attorney?
ElderLawAnswers.com
How to Avoid Problems Due to Senior Incapacity: The (Better) Durable General Power of Attorney

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036 – Interview: Minimizing Family Conflicts & Supporting Aging Parents Apr 06, 2017

Show notes

In This Episode:

Dr. K talks with Janet Benvenuti, a family caregiving expert who is the founder of Circle of Life Partners and the author of “Don’t Give Up on Me: Supporting Aging Parents Successfully.” They discuss:

Janet’s experience becoming responsible for her parents’ financial affairs and medical care
How Janet and her siblings negotiated caregiving roles and conflicts
An exercise to help you map out your family’s resources to build a caregiving team
Why Janet wishes her family had done more advance planning related to housing
The role of personal care agreements and compensation in family caregiving
Janet’s tips on how boomers can set up a game plan for their own aging
How to use Janet’s book to help your family plan for aging

Related episodes:

015 – Interview: Practical Advice for Family Caregivers & Next Step In Care
017 – Interview: Paying for Long-Term Care & Other Family Caregiving Challenges
013 – Interview: Solving Hard Problems in Helping Aging Parents

Related Resources:

Circle of Life Partners: A community that supports the health and wellbeing of families and aging parents.
- Sign up for the free newsletter here: Join Circle of Life Partners
- For Janet’s HIPAA app, sign up for the newsletter or email info@circleoflifepartners.com
Don’t Give Up on Them: Janet’s website for her book.

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035 – Interview: Aging in the Right Place Mar 23, 2017

Show notes

In This Episode:

Dr. K talks with Stephen Golant, PhD, Professor of Geography at the University of Florida and the author of “Aging in the Right Place.” Dr. Golant has a doctorate in social gerontology and social geography, and is a well-known expert on the housing and long-term care needs of older adults. They discuss:

What is environmental gerontology, and why environment is so important to aging adults
How one’s housing, neighborhood, and community affect one’s ability to age well
Why older adults like to remain in their own homes
The problems many older adults encounter when they try to age in place, and what it means to “age in the right place”
A definition of successful aging
Why we shouldn’t reflexively promote aging in place, and what to encourage instead
How to determine where is the right place to age, and which questions older people should ask themselves
Why it may be better for seniors to live in a neighborhood of people their own age
Dr. Golant’s plan for where to live as he ages

Related Resources:

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034 – Preventing Falls: 10 Types of Medication to Reconsider Mar 09, 2017

Show notes

In This Episode:

Dr. K explains ten types of medications that may be associated with falls in aging adults. These are the medications that experts including the Center for Disease Control (CDC) recommend that doctors address during a medication review for fall prevention. This episode covers:

The four actions the CDC recommends that older adults do, to prevent falls
Why it’s so common for older adults to be on medications that may increase the risk for falls
What doctors are supposed to do, if an older person is taking one of these medications
Generic and brand names of the more commonly used medications that may be linked to falls
Tips on what to ask your doctor, if you or your older relative are taking any of these medications

Want to learn more about preventing falls? Click here to learn more about the upcoming Personalizing Fall Prevention Workshops

Related episodes:

004 – What to Do If You’re Worried About Falls

005 – Interview: Otago & Proven Exercises for Fall Prevention

Related Resources:

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033 – Safer Treatments for Insomnia in Aging Feb 23, 2017

Show notes

In This Episode:

Dr. K explains how to safely treat insomnia in older adults, and why most seniors should avoid sleeping pills. She covers:

Why it’s essential to identify the cause(s) of sleep problems, before starting or continuing to use sleeping pills
Why over-the-counter or prescription sleep aids, such as diphenhydramine, benzodiazepines, and “z-drugs” such as zolpidem, are bad for memory and balance
Three proven insomnia treatments that are effective and safer than pills
Where to find cognitive-behavioral treatment for insomnia online
Approaches to treating sleep problems in people with Alzheimer’s and other dementias

Related Resources:

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