Search Results for: delirium

How to Make Hospitalization Better & Safer in Aging

Dr. Stephanie Rogers UCSF Inpatient Geriatrics

As you may know, hospitalization is actually somewhat risky for older adults.

This is sometimes surprising to older adults and families. After all, hospitals are supposed to be places where people who are ill or injured can get the medical supervision and services that they need, to recover and be restored to health.

Well, it’s certainly true that hospitalization is often the only way for a person to obtain more substantial care from nurses and doctors. (There actually is an alternative called Hospital at Home, but it’s not widely available.)

If you’ve broken a hip, or have developed really significant shortness of breath from pneumonia, or otherwise are too unwell to be safely treated in the outpatient setting, hospitalization is often necessary. And since aging increases one’s vulnerability to a variety of health problems, older adults get hospitalized at higher rates than younger people do.

The problem, however, is that although hospitalization is intended to help patients, we’ve also realized that it tends to stress the body and mind in many ways. This is hard on every patient, but especially affects older adults. For instance:

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086 – Interview: Creating Age-Friendly Health Systems at UCSF

by Leslie Kernisan, MD MPH 2 Comments

Better Health While Aging

086 - Interview: Creating Age-Friendly Health Systems at UCSF

00:00 / 1:02:55

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

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073 – Anticholinergic Medications & Protecting Brain Health

by Leslie Kernisan, MD MPH Leave a Comment

Better Health While Aging

073 – Anticholinergic Medications & Protecting Brain Health

00:00 / 27:18

In This Episode:

Dr. K explains what older adults and families should know about anticholinergic medications and their negative impact on brain health. Many commonly used over-the-counter and prescription medications are anticholinergic, and on the Beer’s List of Medications Older Adults Should Avoid or Use With Caution. She covers:

What it means for a medication to be anticholinergic
The evidence linking anticholinergics with confusion, delirium, and dementia
Seven commonly used types of medication that are quite anticholinergic
Why it’s important to minimize anticholinergics if you’re worried about memory or have been diagnosed dementia
How you can determine whether you or your parent’s medications are anticholinergic
What to do, if you or an older person you care for is taking an anticholinergic medication

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7 Steps to Managing Difficult Dementia Behaviors
(Safely & Without Medications)

by Paula Spencer Scott

(This article is by my colleague Paula Spencer Scott, author of the book Surviving Alzheimer’s: Practical Tips and Soul-Saving Wisdom for Caregivers. I invited her to share an article on this topic, since many in our community are coping with dementia behaviors. — L. Kernisan)

The odd behaviors of Alzheimer’s and other dementias can be so frustrating and stressful for families.

I’m talking about the kinds of behaviors that try patience, fray relationships, and drive us in desperate search of help:

“First she thinks the caregiver is stealing her sunglasses and now she accused me of having an affair.”

“When I tried to help Dad wash up, he hit me.”

“My husband follows me so closely I can’t stand it. But if I go in another room he’ll wander out of the house.”

“Mom started unbuttoning her shirt in the middle of the restaurant!”

“Just when I’m completely exhausted at the end of the day, he seems to get revved up. He keeps peeking out the windows, convinced that someone is trying to break in. Now he won’t sleep.”

A common approach to difficult behaviors is to go right to medicating them with tranquilizers, sedatives, or antipsychotics. But that’s risky and often not what’s best.

In fact, experts recommend trying behavior management first, and for good reasons: It tends to be more effective in the long run than “chemical restraints,” has no dangerous side effects, and leads to a better care relationship. But people often don’t know how to do this.

I’ve learned how.

I’ve lived through five close family members’ experiences with Alzheimer’s and other forms of dementia. Lots of trial and error, and insights from dozens of top dementia experts (whose brains I’ve been lucky to pick as a journalist and dementia educator), got me through regular scenes with…

My father-in-law, who needed a walker to move yet spent hour after hour for several days straight hauling all his clothes and toiletries from his room to our driveway, insisting that his (imaginary) new wife was about to pick him up
My dad, a formerly sharp dresser who wore the same shirt and pants every day no matter how dirty
My grandmother, who insisted on going “home,” when she was home
And other relatives, in dozens of similar scenes.

In this article, I want to share what I wish someone had explained to me early on: the “Why-This, Try-This” approach to dealing with difficult behaviors.

This is a mental framework that can help you get unstuck from unproductive responses that get you nowhere or make things worse.

It can bring calm -– to both of you — whether the issue is verbal or physical aggression, agitation, confusion, wandering, disinhibition, delusions, hallucinations, or a restless or repetitive behavior (like pacing, shadowing, rummaging). It also works well with milder irritants like repetitive questions and indecision.

Then, I’ll boil down the Why-This, Try-This concept to a 7-step process you can use every time. These “7 R”s give you a basic platform for responding to any frustrating behavior:

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067 – Interview: Managing Difficult Alzheimer’s Behaviors Without Medications

by Leslie Kernisan, MD MPH Leave a Comment

Better Health While Aging

067 – Interview: Managing Difficult Alzheimer's Behaviors Without Medications

00:00 / 1:01:06

In This Episode:

Dr. K talks with Paula Spencer Scott, a family life expert and the author of Surviving Alzheimer’s: Practical Tips and Soul-Saving Wisdom for Caregivers. They discuss:

Paula’s personal experiences caring for her father and her in-laws affected by dementia
Why she didn’t write a memoir, and instead opted to focus on featuring Alzheimer’s experts and practical caregiving how-tos
The “Why-This, Try-This” approach to troubleshooting challenging dementia behaviors
Why it’s so important to learn to better respond to dementia behaviors, and only use medication as a last resort
A 7-step process that you can use to safely manage difficult Alzheimer’s behaviors
Why it’s important to “be kinder than you feel” (and be kinder to yourself)

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Why the Flu is Often Missed in Older Adults
(& What to Do About This)

by Leslie Kernisan, MD MPH

elderly flu symptoms You’ve likely already heard the news: the flu is pretty bad this year, with the Centers for Disease Control (CDC) confirming a higher than usual level of illnesses, hospitalizations, and even deaths.

You also probably know that older adults (and certain other groups of people) have a higher risk of falling very ill from the flu, and have the highest death rates from flu.

But what many people don’t know is this: influenza is easily — and often — missed in older adults.

What do I mean by missed? I mean:

Older adults (or their family members) may not realize an older person has the flu, because many older people don’t develop “typical” influenza symptoms.
Health professionals often fail to test older people for influenza, even when they are sick enough to be hospitalized. This phenomenon was confirmed in a recently published study.

This is a very serious issue, especially when the flu virus is causing a lot of severe illness, as it is now.

The main problem is this: delayed — or entirely missed — recognition of influenza means that older adults often don’t get treated early — or at all — with anti-influenza drugs such as oseltamivir (brand name Tamiflu).

Particularly for those older adults who have chronic illnesses (especially those affecting the heart or lungs) or are frail, you don’t want to miss that chance to take anti-influenza drugs. They can’t guarantee an older person will avoid a hospitalization or death from influenza, but they do improve one’s chances.

And anti-influenza drugs are most likely to work when they are given within 48 hours of a person falling ill from influenza, with earlier being better.

So when flu activity is widespread, families need to be prepared to recognize potential flu.

And, you should be prepared for the possibility that the health providers might not think to test for influenza, unless you ask about it.

This article will help you learn to do these things. Here’s what I’ll cover:

What are the usual symptoms of “influenza-like illness”
Common symptoms of influenza in older adults
Why older adults may not show typical influenza symptoms
What we know about older adults & influenza testing
What the CDC currently recommends, regarding influenza diagnosis and treatment
What to do, if an older person falls ill during influenza season

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058 – Avoiding Missed Flu in Older Adults

by Leslie Kernisan, MD MPH Leave a Comment

Better Health While Aging

058 – Avoiding Missed Flu in Older Adults

00:00 / 43:03

In This Episode:

Dr. K explains why influenza is easily missed in older adults and what families can do, to help their older loved ones get diagnosed and treated before it’s too late. She covers:

Recently published research finding that hospitalized older adults often aren’t tested for the flu virus
Why it’s important to not miss the flu in older adults
The usual symptoms of “influenza-like illness”
Common symptoms of influenza in older adults
Why older adults may not show typical influenza symptoms
What the CDC currently recommends, regarding influenza diagnosis and treatment
What to do, if an older person falls ill during influenza season

[Read more…]

How Exercise Helps Aging Adults:
Key benefits (and disappointments) from a landmark study

by Leslie Kernisan, MD MPH

Have you ever wondered whether it’s worth your while to encourage an older person to start exercising?

In 2014, the top-notch journal JAMA published the results of a fantastic research project: a study in which 1635 sedentary older adults (aged 70-89) were assigned to get either a structured exercise program, or a program of “successful aging” health education. The researchers called it the Lifestyle Interventions and Independence for Elders (LIFE) study. (You can read the full study here.)

During the LIFE study, the two groups were followed for a little over 2.5 years. And by the end of the study, guess which group of volunteers was more likely to still walk a quarter of a mile (without a walker)?

That’s right. When it came to avoiding “major mobility disability” — which the researchers defined as becoming unable to walk 400 meters or more — a structured exercise program was better than a program of healthy aging education.

Specifically, the researchers found that 30% of the exercisers experienced a period of major disability, compared to 35.5% of the seniors enrolled in the healthy aging education program.

This is a very encouraging finding! That said, it’s also a bit sobering to realize that even with exercise, almost 1 in 3 older adults experienced a period of limited mobility, of which half lasted 6 months or more.

In this post, I’ll share some more details on this study, because the results provide a wonderful wealth of information that can be helpful to older adults, family caregivers, and even geriatricians such as myself.

Want to know how often the exercisers experienced “adverse events”? (Hint: often!) Wondering just what the structured exercise program involved? (Hint: more than walking!)

Let’s dig into the details! At the end of this post, I’ll share my list of key take-home points for older adults and family caregivers.

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041 – UTIs and Urine Bacteria in Aging:
How to get the right diagnosis & avoid unneeded antibiotics

by Leslie Kernisan, MD MPH 4 Comments

Better Health While Aging

041 – UTIs and Urine Bacteria in Aging:
How to get the right diagnosis & avoid unneeded antibiotics

00:00 / 32:44

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

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Q&A: Hospice in Dementia, Medications, & What to Do If You’re Concerned

by Leslie Kernisan, MD MPH

Q: Dear Dr. K,

With all the news about opioids and benzodiazepines, and their risk of death, I would love to hear your take on the use of these drugs in hospice.

We’ve had two family experiences now (my Mom and my Aunt) who were given these drugs right away when they went on hospice…without hospice trying anything else first that would be less dangerous. My Mom was up and about walking one day at her memory care facility, even laughing. The next day, when hospice put her on morphine and Ativan, she was in a coma. She died 13 days later without ever regaining consciousness. When I protested and asked why she wasn’t waking up, the hospice nurse said, “It’s not the drugs, it’s the disease.” (Mom had dementia.) The nurses wouldn’t let us give her fluids (“you don’t want your mother to aspirate, do you?”) or feed her (“you don’t want your mother to choke, do you?”).

With my Aunt, she had also been in the memory care facility and got to the point of needing a two-person assist. Her power of attorney (POA) was given the choice of moving my Aunt into a nursing home or bringing in hospice. Hospice immediately gave her morphine and Ativan, then backed off the Ativan and gave her morphine every two hours until she died 3 days later.

Now the third sister, also with dementia, has been in hospice for two months and counting. She is lucid most days, eating/drinking, comfortable—all without the opioid/benzo drug combo, because of our experience.

How can family members identify a hospice that doesn’t use this troubling combination of drugs from the start, without first trying something less dangerous, to make a patient “comfortable”?

A: Thanks for sending in this question. I’m very sorry to hear that your experiences with hospice have left you concerned.

It is indeed extremely common for hospice to use morphine and lorazepam (brand name Ativan) to treat end-of-life symptoms. That’s because many people on hospice are suffering from troubling symptoms that these medications can relieve, such as pain, shortness of breath, anxiety, and agitation.

Still, these medications are not always necessary. They are supposed to be prescribed and used as required to relieve the dying person’s symptoms, not by default. So the situation you describe with your mother and your aunt does sound potentially concerning. At a bare minimum, the hospice personnel should have done a better job of discussing their proposed care plan with your family.

Now let me be clear: I cannot say if the way they prescribed morphine and lorazepam was inappropriate or not, because it’s impossible for me to know the specifics of your mother and aunt’s medical situation.

Still, we can certainly review some basics about hospice care for people with Alzheimer’s and related dementias, as well as recommended best practices, when it comes to using opioids and benzodiazepine sedatives.

Here’s what I’ll cover:

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Search Results for: delirium

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