Leslie Kernisan, MD MPH

Important Blood Pressure Studies: What to Know About SPRINT-Senior & Other Research

What should an older adult’s blood pressure be? And what if that older person is over age 75?

It’s an important question to consider, because in some cases, the medical care that is ideal at age 50 is no longer ideal as people get into their 70s, 80s, or 90s.

And high blood pressure — also known as hypertension — is a very common condition, and becomes even more common as people get older.

Fortunately, several years ago, a very well-done randomized trial provided us with answers to these important questions. It was published in the prestigious JAMA journal: “Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years.

When a major study like this is published, people often wonder: does this mean they should change the way their hypertension — or their parent’s hypertension — is being managed? Is their blood pressure (BP) at a good level? Should they be on more medication?

In this post, I review the most essential things to know about these landmark blood pressure research findings. This will enable you to take full advantage of a related post, in which I share with you a step-by-step process you can use, to start to figure out whether an older person’s BP management plan might need to be revised.

Warning: this is one of those medically nerdy posts. But I have to write it, as it’s a foundation for later answering your questions on what your parents’ BP (or your own BP) should be, and whether you should consider a change in medication or treatment. If you just want to know the essentials, skip down to the key takeaways at the end.

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

by Leslie Kernisan, MD MPH

Q: An older friend, who is in her 90s, has been having bacteria in her urine, but no symptoms. Despite treatment with antibiotics, she was still having bacteria in the urine, so the doctor recommended chronic antibiotics and a referral to urology.

What can be done when an elderly woman has bacteria in her urine but no symptoms? Can a urology consultation help?

A: This is a great question. People often think that your friend is having a “recurring urinary tract infection (UTI)” or even a chronic UTI. But actually, you are describing something called asymptomatic bacteriuria, which means having urine bacteria without symptoms.

Every older person and family caregiver should know about asymptomatic bacteriuria. Here’s why:

It’s very common in older adults. This condition is found in an estimated 20% of women aged 80 or older, and also affects older men. The older the person, the more common it is. Asymptomatic bacteriuria is even more common in nursing homes, where it’s estimated to affect 30-50% of residents.

It’s often confused with a urinary tract infection (UTI). This can lead to unnecessary — and potentially harmful — treatment with antibiotics.

It usually does NOT need to be treated with antibiotics. As I’ll explain below, research shows that people don’t live better or longer when asymptomatic bacteriuria is treated. In fact, such treatment can be harmful: one study found that treatment increased the risk of future (real) UTIs, and increased the risk of infection with antibiotic-resistant bacteria.

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Q&A: How to Diagnose & Treat Mild Cognitive Impairment?

by Leslie Kernisan, MD MPH

Q: I realize that I sometimes have difficulty connecting a name and a face. I presume that this is mild cognitive impairment.

On researching the topic online, I find a variety of suggestions for alleviating it. These include supplements (lipoic acid, vitamin E, omega 3s, curcumin), food choices (fish, vegetables, black and green teas), aerobic exercise, yoga, and meditation.

Do these actually help with mild cognitive impairment? What’s been proven to work?

A: It’s common for older adults to feel they’re having trouble with certain memory or thinking tasks as they get older.

I can’t say whether it’s mild cognitive impairment (MCI) in your particular case. But we can review what is known about stopping or slowing cognitive changes in people diagnosed with MCI.

First, let’s start by reviewing what MCI is, and how it’s diagnosed. Then I’ll share some information on the approaches you are asking about, as well as other approaches for treating MCI.

What is Mild Cognitive Impairment?

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Understanding Laboratory Tests:
10 Commonly Used Blood Tests for Older Adults

by Leslie Kernisan, MD MPH

In this article, I’ll address a real mainstay of modern medicine: laboratory tests that require drawing blood.

This is sometimes referred to as “checking labs,” “doing bloodwork,” or even “checking blood.”

Most older adults have been through this. For instance, it’s pretty much impossible to be hospitalized without having bloodwork done, and it’s part of most emergency room care. Such testing is also often done as part of an annual exam, or “complete physical.”

Last but not least, blood testing is usually — although not always — very helpful when it comes to evaluating many common complaints that affect aging adults.

Fatigued and experiencing low energy? We should perhaps check for anemia and thyroid problems, among other things.

Confused and delirious? Bloodwork can help us check on an older person’s electrolytes (they can be thrown off by a medication side-effect, as well as by other causes). Blood tests can also provide us with information related to infection, kidney function, and much more.

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10 Useful Types of Medical Information to Bring to a New Doctor

by Leslie Kernisan, MD MPH

Personal health information to bring to a new doctor

Here’s a situation that comes up for many people: you move in later life.

Or maybe it’s your older mother — or father, or other older relative — who’s moving to a new town, perhaps to be closer to you, or otherwise be somewhere more conducive to aging in place.

Such a move means that you’ll need to establish care with a new primary care provider.

For most older adults, establishing a good working relationship with a new health provider is a challenge. If nothing else, it can take some time to feel that each party knows and understands the other.

But it’s also in many cases a terrific opportunity to review a person’s health and healthcare. Provided, of course, that everyone involved makes an effort, and has good information to work with.

In this post, I’ll share my list of the most useful medical records and health information that you should bring to that first visit with the new primary care provider.

Do you have to bring this information? Of course not. In my own experience, most people bring nothing more than a medication list, if that. And they leave it to the new doctors to request health information from the previous doctors, which often arrives well after that first new patient visit.

But this is a problem, because it makes it quite difficult for that first visit to be truly useful.

Sure, the doctor can interview you, and do a physical exam. Yet for many older adults, that interview and exam is often much more productive if a doctor can combine it with a review of the most useful health information.

I myself used to see a fair number of new older patients, when I was a primary care geriatrician at the Over 60 Health Center. Those first visits often felt like fumbling around in a dark room, feeling the walls and furniture and trying to get a sense of the overall layout.

But occasionally, a new patient would come with useful health information in hand. This generally made a big difference in how quickly we could ensure that our new patient was getting the right medical care from us, and from other involved doctors.

So if you want to have the best start possible with a new doctor — or help your aging parent do so — you’ll need to do a little advance preparation. This often requires some time and energy. But it will pay off, by ensuring that the new doctor has the information he or she needs, to provide you with good healthcare.

Also, if you are in that season of life where you’re starting to be more involved with your aging parent’s health (or think perhaps you should be), this is a great opportunity to learn more about your parent’s health.

10 Useful Types of Medical Information to Bring to a New Primary Care Provider

Here’s my list of what I ask patients and families to bring to me, in order to make that new patient visit most useful.

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5 Top Causes of Sleep Problems in Aging, & Proven Ways to Treat Insomnia

by Leslie Kernisan, MD MPH

What should you do if an older person complains of not sleeping well at night?

Experts do believe that “normal aging” brings on some changes to sleep. (See this post for more on how sleep changes with aging.) Basically, older adults tend to get sleepy earlier in the evening, and tend to sleep less deeply than when they were younger.

So it’s probably not realistic to expect that as you get older, you’ll sleep as long or as soundly as when you were younger.

That said, although aging by itself does change sleep, it’s also quite common for older adults to develop health problems that can cause sleep disturbances. So when your older relatives say they aren’t sleeping well, you’ll want to help them check for these. Figuring out what’s going on is always the first step in being able to improve things.

And remember, getting enough good quality sleep helps maintain brain health, physical health, and mood.

In this article, I’ll cover the top causes of sleep problems in older adults. I’ll also tell you about what approaches have been proven to work, to help treat insomnia and sleep problems in older adults.

Last but not least, if you (or your older relative) have experienced the very common combination of waking up to pee at night and difficulty sleeping, I highly recommend listening to this podcast episode, which features a geriatrician who is an expert on this: 092- Interview: Addressing Nighttime Urination & Insomnia in Aging.

5 Common Causes of Sleep Problems in Older Adults

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Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check

by Leslie Kernisan, MD MPH

Have you been worried about an older person’s memory or thinking abilities?

Maybe your parent has seemed more confused recently. Or you may have noticed that your aging spouse is repeating herself, or struggling to do things that didn’t use to pose much of a problem.

Or you may have noticed false accusations, or irrational worries getting out of control.

These are very common concerns, and they often lead to questions such as:

Is this normal aging or something more significant?
What is wrong?
Could this be Alzheimer’s? Or some other form of dementia?
Can these memory problems be treated or reversed?
What should we do about this??

The answer to the last question is this: if you are worried about memory or thinking, then you should seek out some kind of medical evaluation.

That’s because when families worry about an older person’s cognitive abilities, there often are some underlying health issues affecting the mind’s function.

Those need to be detected, and treated if at all possible. So, you’ll need to request help from a health professional, and in this article, I’ll explain what that initial help should consist of. This way you’ll know what to expect, and what the doctor might ask you about.

Technically, these kinds of problems are called “cognitive impairment.” This is a broad term that means some kind of problem or difficulty with one’s memory, thinking, concentration, and other functions of the conscious brain, beyond what might be expected due to normal “cognitive aging.”

(For more on “cognitive aging” and what types of changes are considered normal aging, see this article: 6 Ways that Memory & Thinking Change with Normal Aging, & What to Do About This.)

Cognitive impairment — which is also called “cognitive decline” — can come on suddenly or gradually, and can be temporary or more permanent. It may or may not keep getting slowly worse; it all depends on the underlying cause or causes.

In this article, I’ll share with you the more common causes of cognitive impairment in older adults.

I’ll then share a list of 10 things that should generally be done, during a preliminary medical evaluation for cognitive decline in an older adult.

You can also watch a subtitled video version of this information below.

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Top 10 Checklist for Better Health & Aging in 2024

by Leslie Kernisan, MD MPH

Do you find yourself taking stock and setting goals around the time of New Year’s?

It is indeed an excellent time to reflect on the past year.

And although one can set goals at any time of year, the start of the calendar year is a time that seems to inspire many people to think about their health and how to thrive over the coming year.

If better health while aging is important to you, here are my top ten suggestions for the coming year.

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COVID & Aging Adults: 2023-2024 Updates

by Leslie Kernisan, MD MPH

Since the COVID-19 pandemic emerged in early 2020, COVID has become one of the top causes of illness and death in the US, and has especially impacted aging adults, for both health and social reasons.

Older age is one of the top risk factors for severe COVID; it’s even a stronger risk factor than vaccination status. So this is an important issue for us to follow in geriatrics.

On this page, I’ll be posting updates related to COVID and older adults, for 2023. I’ll be focusing on important developments and what I think is most important for older adults and their families to know, to be safer and manage these COVID times we are living through.

I also have a section below on general COVID safety principles for older adults.

Covid & Aging Adults: COVID News 2023-2024

COVID winter update December 20, 2023

As anticipated, we are seeing a substantial rise in COVID activity this month. This can be seen in wastewater and we’re also seeing a rise in hospitalizations.

What is a little more worrisome is that a new variant, JN.1, now seems to be taking off in the US. This variant has been active in Europe, where it is causing a marked exponential spike in COVID wastewater levels.

We are also seeing a fair amount of RSV circulating, plus some influenza.

For more on the state of these respiratory viruses, I highly recommend reading this update by epidemiologist Katelyn Jetelina, MPH PhD: State of Affairs: Dec 19, 2023.

All three of these viruses (COVID, RSV, influenza) can hospitalize vulnerable older adults 🙁

So as you consider holiday travel and gatherings, here are my recommendations:

Avoid gathering with others inside if you have cold symptoms (or anything worse). If you need to gather, consider wearing a mask and be sure to ventilate the space with a HEPA air filter (or open windows).
Consider rapid tests for COVID before having a gathering with vulnerable older adults.
Wear a N95 or KN95 when traveling on planes or other forms of crowded public transit.
- Consider a mask when in malls or other crowded indoor spaces.
People over age 65 should get the 2024 COVID vaccine (if they haven’t yet had it), for renewed protection against hospitalization.
- The exception is if you’ve actually had COVID within the past few months; that’s like getting a booster but much more effective.
Paxlovid still works. Older adults should request it if they test positive for COVID.

COVID fall vaccine update September 21, 2023

The CDC announced recently that new COVID vaccines are available for the 2023-2024 season.

They are recommended for everyone over the age of 6 months, and are especially recommended for adults over the age of 65.

This fall, the COVID vaccine is a monovalent vaccine based on the XBB.1.5 subvariant of Omicron (which was the most prevalent variant at the beginning of the summer). Although there are different Omicron subvariants currently circulating, the XBB.1.5 is expected to provide good protection against hospitalization and deaths.

If you are a details and data person, you can find the slides presented at the 9/12/23 CDC meeting here.

Learn more about the new fall COVID vaccines here: CDC: Stay Up to Date with COVID-19 Vaccines.

I highly recommend that adults aged 65+ get this updated COVID vaccine, especially if they have not had COVID in the past 4 months.

I also recommend that aging adults get their annual flu shot (get one of the stronger ones recommended for older adults) and consider the new RSV vaccine for older adults.

Otherwise, my recommendations for how to stay safe in regards to COVID have not changed since my most recent video update from August, which you can view below.

Here is my most recent video update, from August 14, 2023: [Read more…]

Choosing & Using a Home Blood Pressure Monitor, & What to Ask the Doctor

by Leslie Kernisan, MD MPH

In another article, I’ve explained the key reasons that I recommend older adults and their caregivers have a blood pressure (BP) monitor at home.

To very briefly recap:

Many of the problems of older adults (including falls) can be related to blood pressure.
Home blood pressure measurements can help:
- evaluate for drops in blood pressure with standing (a common cause of dizziness in elders)
- check for serious illness, since these often (but not always) cause the blood pressure and pulse to be very different from usual
- follow-up on blood pressure after a change in medication, which can help doctors and families figure out the best medication dosing for an older person much faster. This is safer for seniors.

In this post, I’ll share some tips on choosing and using a home BP monitor.

And don’t worry: I won’t tell you that you have to plan on checking every day for the rest of your lives. Although there are times when it’s great to check daily — like the week after a change in medication — the most important thing is to have a good BP monitor at home and know how to use it at least occasionally.

Tips for choosing a home blood pressure monitor

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What is Mild Cognitive Impairment?

10 Useful Types of Medical Information to Bring to a New Primary Care Provider

5 Common Causes of Sleep Problems in Older Adults

Covid & Aging Adults: COVID News 2023-2024

COVID winter update December 20, 2023

COVID fall vaccine update September 21, 2023

Tips for choosing a home blood pressure monitor

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