Nancy, that is very considerate of you to think about how your family might need to navigate your estate management for you someday! And very proactive.

I’m not a lawyer, and it may vary from state to state, but it is likely that a durable POA could be assigned to more than one person. It could be set up so that one person may be appointed as primary attorney and a second as alternate (who acts only if the first is unavailable)y. Or, two or more persons can be named to act together (jointly) and/or independently (severally). My understanding of a “jointly” situation, you and your sister would need to agree on an action. “Severally” indicates that you can act separately from one another.

My question is: can a Durable POA be assigned to two persons who work well together?

If I had more power in our affairs, I would have been able to mitigate some of the conflicts and stay ahead of a conservancy (which ended up costing us thousands of dollars in court fees). Essentially, the difficulties arose from a lack of transparency — I’m a much more open communicator than my sister, and lean toward mediation when there are problems.

Example: I found a lawyer to help us, but then was excluded from the meetings. The lawyer did not consider me to the the client and would not talk to me, and my sister went along with this. During a court action, I was in the courtroom and my sister was in South Dakota. The lawyer called her for a decision on a issue and didn’t inform me. I was actually asked for information in court, and had the issue sprung on me without my knowledge – I was sitting right next to the lawyer, and he never mentioned he had just talked to my sister. I didn’t find that out until I got out of court and called her. There are more examples like this… you get the idea.

The suggestion that the POA be ;monitored by a third party would probably work okay. Perhaps that is the best we can hope for.

The reason I’m asking is because I am starting to work on my own estate planning, for the benefit of our daughters, who will get the pleasure of dealing with us when/if we become incapacitated!

I’m sorry that you’re feeling scared and it’s great that you’re thinking about how to be proactive.

Dr. K has some great resources about white matter change, also known as small vessel disease, on the website. You’ll find advice about what to do here: Cerebral Small Vessel Disease Affects Most Aging Brains (Here’s what to know & do) , and this podcast: 048 – How Cerebral Small Vessel Disease Affects Most Aging Brains

There are definitely ways to reduce the risk of small vessel disease, including exercise, healthy eating and talking to your doctor about your blood pressure and cholesterol. I hope that as you learn more, you’ll feel empowered to make the best choices for your brain!

Hello Sally and thank you for your wonderful comments!

As a practicing Geriatrician, I fully agree with you. Getting a diagnosis is just a first step, and the journey is different for every person and their caregivers and families.

I’m sorry you lost your husband and I admire that you’re involved in making the lives of people with dementia and their families better. Thanks for sharing the website with those who may benefit.

Brian, it means so much to Dr. K to have a reader leave a kind comment like yours. I’m so glad you find the articles useful!

I’m so happy to hear that you found the article understandable and helpful, Marilyn!

This article was focused on the new vaccines, but I completely agree that there’s more to avoiding illness than just getting a shot!

Here’s what the CDC has to say about getting more than one vaccination at a time: https://www.cdc.gov/vaccines/vpd/rsv/hcp/older-adults.html#administration-other-vaxs

Basically, it’s ok, but may increase the chance of having a side effect like fever, sore arm, and so on.

Here’s what the CDC has to say about getting more than one vaccination at a time: https://www.cdc.gov/vaccines/vpd/rsv/hcp/older-adults.html#administration-other-vaxs

Basically, it’s ok, but may increase the chance of having a side effect like fever, sore arm, and so on.

I’m glad you find the information valuable!

It doesn’t sound like you’re in a high risk group, but if you’re concerned about getting the virus from your grandchildren, the RSV vaccine is totally reasonable. It’s a “talk to your doctor” moment!

Great idea! I hope you are safe if you’re in an area affected by wildfires.

Here’s what the CDC has to say about getting more than one vaccination at a time: https://www.cdc.gov/vaccines/vpd/rsv/hcp/older-adults.html#administration-other-vaxs

Basically, it’s ok, but may increase the chance of having a side effect like fever, sore arm, and so on.

Thanks for sharing your story and for letting Dr. K. know how much the website has helped you!

Glad you found the article helpful and thanks for leaving a comment!

Thank you, Teresa! It means so much that you took the time to leave a comment and I’m really impressed that you have a “Dr. Kernisan” folder! Great idea.

I’m sorry to hear that the cost isn’t covered by your insurance. If you’re in a hgih risk group for RSV illness, your pharmacist might be able to advise you about any special programs that could subsidize the vaccine for you.

I’m glad the article was helpful. Please share it with your friends if you think they might be interested.

I’m so glad you find the article valuable! Thanks for taking the time to leave a comment.

You are most welcome and I’m glad the information was timely for you!

Furthermore, in geriatrics, we find that the likely type of dementia does not help us manage symptoms and care. Most medications that are FDA-approved for dementia can be used for the various types (and none works very well). Generally, the best way to provide care is to focus specifically on whatever symptoms or difficulties the person with dementia is experiencing.

I was the primary caregiver for my husband who died January 2023 of “mixed dementia”. During this time, 2015-2023, I was involved with two caregiver support groups and so many people seemed so desperate for a diagnosis that strategies for dealing with symptoms and behaviors got short shrift. In addition in many cases the medical team seemed to think that their job was done once there was a diagnosis (not so true for Geriatricians, but there are still so few).
What you are doing is so important and helpful. I have been involved in the Village movement and a member of the Pasadena Village for ten years and have referred many friends both my age and younger to your website.
Thank you so much.

I appreciate the time/effort you go to to research and write your articles. Thank you again, Teresa

This summer, I had my 82nd birthday, something I never expected to experience. I am a foster care alum – spent my teen years in a group home in upstate New York. That experience did not give me a lot of confidence about life. But I made it through a BA and a PhD and my surviving foster care story is available on Amazon.

My thanks for your help and your attention. Enough about me! Stay well, and know your work is appreciated.

Susan DuMond, PhD

Also should there be a 2 week period between shots?

Hello Mae, and I’m sorry that you’re having these difficulties.

It very well may be a “mental” or brain-related issue that’s causing the change in behavior you describe. When you mention that there are periods of settling in between episodes, it reminds me of the pattern we see in delirium. Delirium symptoms fluctuate: they get better for a while, then worse again. Here’s an article about delirium that might help: 10 Things to Know About Delirium

If this is a drastic change from how your husband usually behaves, it’s worth getting an opinion from a medical professional about next steps to rule out delirium, depression, dementia, or some other underlying condition.

Hello Julie and thank you for your kind feedback!

I’m so happy to hear that your daughter is involved in your life in a supportive way. She may be interested in the website as well, or in Dr. K’s Helping Older Parents course.

More info about the HOP course is available here: Dr. Kernisan’s Helping Older Parents Membership Program

Thank you,
Mae

Deep thinking and self examination are good activities, but can be distracting! I’m glad you haven’t had a concerning fall.

By the way, we call grabbing onto household structures instead of using a cane or walker (or another gait aid) “furniture walking”!

That’s a great example of how a fall can be a sign of another problem! I’m glad you have stayed fall free!

Multifocal glasses (bifocals, progressives, or multifocals) have lenses with different strengths, whereas single vision lenses don’t. Mulitfocals can cause some distortion at the place where the lenses change, or can make some objects appear blurry if seen through the incorrect lens.

I found this article about single lenses, and it does seem as though single lenses are better at preventing falls on those who do a lot of outdoor activity. The article goes on to indicate that for those with a low level of outdoor activity, multifocals might be better.

So, for sure, getting vision assessed is important , and based on your needs and lifestyle, your optometrist should be able to help you decide which lenses are best.

This is great advice for a lot of conditions that affect older adults. Relaxation can promote better concentration and attention, both of which are important for balance and stable walking.

I’m glad you found the suggestions to be excellent!

Exercise or training of any kind is an important part of falls prevention. It sounds like you’re using cognitive training, which is very interesting, and absolutely preferable to falling. Thanks for sharing your success.

Was a year ago and haven’t fallen!

I’m glad you found the information helpful!

The vaccine for the Respiratory Syncytial virus (RSV) has been approved for use in adults over age 60 in the US and Canada. The goal with the vaccine is to prevent the complication of pneumonia (or lower respiratory tract infection) after an RSV infection.

The RSV vaccine will be for those over 60 with a medical issue like lung or heart disease, diabetes, or kidney, liver or blood diseases, or those living with frailty or in a nursing home.

Based on the current evidence, the vaccine appears to be effective in preventing pneumonia but there’s no data on whether it reduces the risk of hospitalization or ventilatory support. You can check out this article for more data: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10360650/

I don’t know if Dr. K is planning to cover the RSV vaccine ina future article or video, but thanks for the suggestion!

Thanks for sharing your perspective, and I respect your point of view. I know Dr. K is far from ageist and goes to great effort to avoid sounding patronizing.

Nonetheless, I get what you’re saying about having one’s problems discussed as though we don’t exist. In fact, with HIPPA legislation, medical staff cannot talk about a parent’s health without permission! Check out this article for more: 045 – HIPAA: Key Basics & 5 FAQs for Family Caregivers

I also agree that kids don’t need to be responsible for aging parents, but most want to help if they can. I made a YouTube video about this, which you can watch here: https://www.youtube.com/watch?v=hJOmaxlud30

Melatonin is a supplement used to help with insomnia. It’s a chemical that we produce naturally, but when used as a supplement, it has a mild effect on helping a person fall asleep.

I found this article debating the pros and cons of melatonin for older adults: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699865/

While, I haven’t heard of melatonin causing death, it’s worth noting that it can be difficult to know what you’re actually getting in a supplement. The regulation of supplements are not as strict regarding “dosage”, and one study of melatonin supplements found that there was a range of between −83% to +478% of the label claim in the actual tablet.

I’m also not sure if a supplement can be given in an “unlimited” quantity to a resident in long-term care. Any compound given in a huge quantity can be hazardous (including water!).

I think it’s good to ask questions about what medications and supplements are being given, and a pharmacist is a good resource.

But I do find them a little ageist and patronizing to older people!
Why should children be responsible for their parents?

I am 81 but would go flip if I ever learned that my medico was discussing my health problems with my children! Just because we are older does not mean we have lost our ability to reason or make responsible decisions in our lives!

That must have been a very frightening experience for you, Mary Jo and thanks for sharing it.

I agree that delirium awareness is important, especially when an older adult is admitted to hospital. This is an article that Dr. K wrote about hospital delirium: https://betterhealthwhileaging.net/hospital-delirium-what-to-do/

Considering you had COIVD in the last six months, it would be reasonable to wait and get the newer booster when you return.

Of course, your decision might also depend on your other health issues and what the rate of infection is like where you’re traveling to. I hope you have a relaxing, healthy trip down east!

I’m sorry to hear about your mom’s anxiety.

Some types of dementia don’t have memory loss as the main symptom (Alzheimer’s usually does, though). Dementia with Lewy bodies for example, can cause hallucinations and falls; and frontotemporal dementia is more likely to create problems with language and personality changes.

Sometimes, though, memory changes and anxiety can go hand in hand. If someone has troubling remembering a conversation about bill paying they might ask the same question repeatedly and get worked up about it. This article discusses dementia and anxiety and how to approach it: https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/anxiety-dementia

If you’re wondering about the dementia diagnosis, this article will be helpful: https://betterhealthwhileaging.net/how-to-diagnose-dementia-the-basics/

Thank you for your kind remarks! I know Dr. Kernisan does put a lot of work and time into creating the articles and it’s so nice to have that recognized!

I’m glad you found the information helpful! Thanks for taking the time to comment.

I can understand feeling frustrated by the gaps in the healthcare system. By the way, in our socialized system here in Canada, similar issues are common.

One of my colleagues suggested that giving vaccines as a gift for a birthday or Christmas might be appreciated by an older family member. A good idea if your family can afford it and they want to give a gift that will “keep on giving”.

Absolutely would say that my audiology colleagues are valued professionals in caring for older adults!

Also appreciate the update about testing for hearing loss – we still learn the tuning fork and whisper test in medical school. They can be a good screening test for the office when we don’t have more sophisticated tools.

I agree that prevention and proactivity are trendy – and have been so for a while. Unfortunately medical education and medical practice can lag behind the latest knowledge, although I think that’s improving with technology and culture change.

Thanks for sharing your perspective, and the tidbit about peppers!

New Zealand! That’s wonderful! I’m so glad you enjoyed the article, thanks for taking the time to leave a comment!

Thanks for sharing your experience and I’m sorry to hear about the frustration.

Most of us doctors like when patients are engaged and interested in their health, but sharing decision-making about medical issues can be a bit of an art! I found this guide from the National Institute on Aging about talking to your doctor: https://order.nia.nih.gov/sites/default/files/2021-06/talking-with-your-doctor.pdf. You may find it useful.

Acknowledging your doctor’s expertise and sharing info from a credible source (like a printout of Dr. K’s article) can be strategies for getting your point across.

Also, Audiologists have not used tuning forks in distinguishing between sensorineural and conductive hearing loss since probably the 50’s-60’s. We are able to determine the type of hearing loss based off a combination of the subjective tests (comprehensive hearing evaluation, which includes the air conduction & bone conduction pure-tone audiogram) and tympanometry (one of the objective tests we run).

Also, whisper tests have not been used for many years and are not considered a valid test of hearing sensitivity. There is no standardized way to do one, it is not frequency specific, and has no means of objective calibration.

Overall, thank you for this discussion and also bringing up the Medicare coverage. This is an important topic which is why I dedicated my entire life to it as an AuD.

Thanks for sharing this tip, Judith.

There can be some trial and error in finding the best incontinence product for one’s specific needs.

I wish you a speedy recovery from your surgery.

I can understand feeling like you’re taking too many medications, and in fact, we geriatricians usually stop more medications than we start! You might enjoy this article about deprescribing: https://betterhealthwhileaging.net/deprescribing-how-to-be-on-less-medication-in-aging/

Wow! Those are great questions but would take me a long time to answer thoroughly!

There is a lot of research about lifestyle changes in early and mid-life to stay disease and disability free longer. Most of the research that I’m aware of looks at the risk of a specific condition and how lifesrtyle can affect it. An example is the “Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (Livingston et.al. 2020)”, which you can look at here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30367-6/fulltext

I agree that a broad focus on various aspects of healthy living is more likely to pay off, and may have synergistic effect. It can be difficult for people to do “everything all at once” so starting with one domain and building towards a fuller lifestyle transformation can often lead to more long term success.

My understanding of a wellness plan is that it’s an action plan to support a person’s physical, mental, spiritual, and emotional health. I expect this would be very individualized, and may need to be developed over time. I don’t have a specific template that I recommend, but I think it’s a great tool for setting goals and moving towards them!

I’m so glad that you’re exercising regularly! All of the activities you mention can be great for strength, flexibility and balance.

There’s evidence that tai chi can also reduce the risk of falls and may also help with osteoarthritis, Parkinson’s disease, and cognition. You can read about the scientific evidence here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9844554/

Whatever you choose to do, I think your point about keeping it interesting is well taken! The best exercise is the exercise that you stick with.

I’m glad you’re exercising regularly! Older muscle can fatigue more quickly and take longer to recover compared to that of younger people, but there shouldn’t be significant, persistent pain.

I don’t the statin is an issue in your symptoms.

If you’re getting advice from a physiotherapist or kinesiologist, I would check in with them to see if you need to adjust your posture or some other aspect of your strengthening moves.

Good point about the challenges of sorting through all of the data about diet and exercise when it comes to brain health!

I’m glad to hear that you’re active and have heathy activity habits!

I don’t recommend salt tablets, but would continue with drinking fluid and getting adequate salt in your diet. The best thing is to avoid overdoing it on activity when the conditions are extremely hot and humid. The CDC website has some info about exertional heat illness, whcih you can check out here: https://www.cdc.gov/disasters/extremeheat/faq.html#:~:text=Should%20I%20take%20salt%20tablets%20during%20hot%20weather%3F,way%20to%20do%20this%20is%20through%20your%20diet.

I had a physical therapist for a while after a fall who worked with me on balance, flexibility, strength (esp. core strength) coupled with walking (endurance?). Now that I “graduated,” she encouraged me to keep working on these attributes but move forward from the exercises she had given me into one of these regimens to develop further while making it more interesting. She saw those three as having attributes she thought would help me and figured I needed to pick one that seemed enticing enough so I would continue to do it.

I’m currently trying beginning yoga.

Best of luck on your new adventure, Victoria! I hope you continue to find the articles to be useful and it’s so kind of you to take the time to leave such nice feedback!

Thanks for your feedback, Virginia. As a doctor, I do try to use language that the patient or client can understand, and this is sometimes easier in a face-to-face encounter. It’s more difficult to tell a person’s language skills in a written exchange.

Many of the terms we use, such as “cognitive impairment” are explained on the site (for example here: Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check).

In your case, antibiotics might have been needed, I really don’t have enough information to say.

However, you’d probably be interested in this article by Dr. K about asymptomatic bacteriuria, at: https://betterhealthwhileaging.net/urine-bacteria-without-uti-in-elderly-trending/

Sometimes a positive urine culture doesn’t require treatment and a foul smell isn’t very reliable as a UTI indicator.

Thank you, Margaret!

I’m sorry to hear that you’re one of the 15% of people who have symptoms after their COVID infection has resolved.

It’s true that currently there are no proven treatments recommended for long COVID, but many experts are working on a solution, such as the Post-COVID Task Force here in Canada: https://science.gc.ca/site/science/en/office-chief-science-advisor/initiatives-covid-19/post-covid-19-condition-canada-what-we-know-what-we-dont-know-and-framework-action-pre-report

In the meantime, taking precautions to prevent re-infection, as you have, is the best strategy.

Thank you for the update from England!

I work in a hospital as well and we are no longer required to mask in most settings and most are happy about that.

I’m sorry you had COVID and glad it wasn’t too severe. We’ll be following the news about the inquiry you mention.

Tavor is one of the brand names for lorazepam, common in the UK

You make some very good observations about edema, Margarete: Sitting makes it worse and lying down makes it better!

Elevating the legs above the level of the heart helps the leg veins get the blood back to the heart, rather than staying in the legs and feet and causing swelling. I advise people with edema due to chronic venous insufficiency to put their feet up for 20-30 minutes a few times a day.

Sounds like you did the right thing advocating for your mom, but I’m sorry she had to go to the ER.

Congestive heart failure (CHF) can be a difficult diagnosis to make based on a physical examination alone, and is often missed, but usually very treatable. I’m glad that things worked out in the end and thank you for sharing your story.

I’m sorry to hear about the ageism you’ve experienced, and those are good examples of how it can get in the way of good health care.

I’m hopeful that patients will be more informed of their health data in the future, such as through a portal or other technology.

You might be interested in this article about how to interpret common lab tests according to a person’s age:Understanding Laboratory Tests: 10 Commonly Used Blood Tests for Older Adults

Thanks for sharing your experience, which is a common one unfortunately.

In medicine, especially in hospital or “acute care”, we often have a knee jerk response to certain conditions. This can lead to a battery of tests ordered almost automatically. The truth is, it can take a lot longer to discuss other options and clarify goals of care with family members, including documenting those discussions, than just going ahead with the typical approach.

Strong advocacy from family members can help steer the management plan in a more patient-centered direction. I’m sorry you had those experiences, but your wife is fortunate that you’re such a thoughtful and compassioante caregiver.

Thanks for reading from Australia!

Here in Canada, Geriatricians are specialists who focus on specific areas in collaboration with primary care. In the US (and perhaps Australia) the Geriatrician can be the primary care provider and look after all of the older adult’s needs.

I find that the best role for a Geriatrician is when there are syndromes, such as falls, cognitive changes, complex medication regimens, incontinence and frailty. Age isn’t a good criteria since many “young” older adults are very much in need of a Geriatrician, whereas some of the oldest old do very well without a geriatric specialist.

Check out this article about Geriatric care and how to find it (in the US anyway!): https://betterhealthwhileaging.net/how-to-find-geriatrics-medication-review/

That does sound frustrating for both of you. Ideas can include offering him a urinal or bedside commode so the trips are less complicated.

Scheduled toileting during the day might promote an empty bladder at bedtime, for example getting him to go every 2 hours while awake.

I’d also look at his medications to see if he’s taking a “water pill” or diuretic in the afternoon, and if that could be switched to the morning.

Finally, if there is any way to get overnight help, even once in a while to give you a break, I’m sure it would make a big difference.

I appreciate the need to rule out possible conditions, but, physician’s do not seem to take into account those patients with dementia and consider the impact of spending an entire day and, even, night in a hospital on such a patient. (and what about the costs of all those tests?) Fortunately, my wife, even with her dementia, is a pretty laid back gal and suffered no anxiety or other difficulties but patients with more problematic dementia may suffer more from a difficult stay in a hospital. When in a more “palliative care mode”, how does one fit that into the equation?

Thank you for being an avid reader and for letting us know that the information is helpful, Beth!

There are many “young” and healthy older adults in my practice! They’re often surprised to be referred to me, thinking they don’t need a geriatrician “yet”. They may not be the most complex patients I see, but we can usually find some recommendations to try to prevent disability and promote health.

I would check out the “Find a Geriatrics Health Professional” link at HealthinAging.org: http://www.healthinaging.org/find-a-geriatrics-healthcare-professional/

Here in Canada, I refer clients to the Canadian Hearing Society. They have hearing consultants (whose services are free), who can explain the various devices that can be used intermittently in cases where a hearing aid isn’t needed all the time. In the US, try the Hearing Loss Association of America at https://www.hearingloss.org/

I hope your mom is feeling better and out of hospital soon, Nancy.

When I hear that the person “found themselves on the floor” with no warning, I want to make sure I’ve ruled out syncope, which can be caused by a heart or neurological condition.

I’m glad the article was helpful and you get some answers about how to prevent future falls.

It can be frustrating when a therapy plan doesn’t seem to be appealing to an older parent. Balance exercises are great for fall prevention, but if your mother has vertigo, there’s therapy for retraining the vestibular system (inner ear) that might be more targeted.

I’m glad to hear that your mom got a diagnosis and a plan for how to treat it. Parkinson’s symptoms can improve with L-dopa, a chemical that’s deficient in the disease. You’re right that the timing can be critical, as most forms of L-dopa medication are short-acting and need to be taken several times a day.

Thanks for sharing this great tip!

Thank you for sharing your story! I’m sure this will give other readers ideas as to how they can work around hearing loss.

Thanks for mentioning cochlear implants. They can be an excellent hearing option for certain individuals, however they are more of an advanced therapeutic option, used after hearing aids have been correctly tried. This article is mostly geared towards helping older adults take the initial steps towards addressing hearing loss, so 2nd line therapies are beyond the scope of what is covered.

Also, Medicare had extremely limited coverage of cochlear implants until Sept 2022. Coverage has been expanded but still requires that the beneficiary fail to get adequate benefit from hearing aids. The Medicare coverage criteria are:
– Diagnosis of bilateral moderate-to-profound sensorineural hearing impairment with limited benefit from appropriate hearing (or vibrotactile) aids;
– Cognitive ability to use auditory clues and a willingness to undergo an extended program of rehabilitation;
– Freedom from middle ear infection, an accessible cochlear lumen that is structurally suited to implantation, and freedom from lesions in the auditory nerve and acoustic areas of the central nervous system;
– No contraindications to surgery; and
– The device must be used in accordance with Food and Drug Administration (FDA)-approved labeling.

I do think we’ll see increased numbers of older adults with cochlear implants, especially if more people start attending to their hearing loss in midlife or in their 60s-70s. I imagine we’ll also see some motivated individuals in their 80s taking advantage of this technology…it does seem like a good option for those who can tolerate the procedure and have the stamina and cognitive ability to go through the extensive rehab that is required.

Wow. You hit the nail on the head. Same with my Mom who was diagnosed w severe hearing loss ten years ago. She tried hearing aids for ONE DAY, and said they were not for her and she was fine. Now, I avoid her and so do her former friends. The shouting is so stressful to everyone:

Our early years were spent on the farm with wood heat, so much of the year I was using a chainsaw without ear protection. Now I’m profoundly deaf, but hearing aids do benefit in most situations. I can listen to the TV directly, and with my most recent pair I also bought a microphone for my wife to wear. She has a very soft voice and without the mike I don’t hear anything she says all day. I ask her to repeat when she looks like she expects a response, but that often takes 3 or 4 tries before I hear and understand. Not very pleasant.

The microphone is a nuisance to wear, quite big and heavy to pin on a blouse or sweater, but when she does it’s heaven. Recently it stopped working full-time and I have to turn it back on every few minutes, but it’s a small price to pay.

I do have the ear-brain disconnection that makes understanding more difficult, but as long as people are willing to speak slowly and articulate I will understand. Thetrelephone, however is pretty well a loss and I don’t bother answering. I’m almost always on the net and folks know email will be responded to promptly so most family and friends do that.

Thanks for up-to-date and informative advice. At 87 I do appreciate it.

The two facebook groups i am in for cochlear implants share stories of people in their 70s and 80s. And a lot of us (including me) are in our mid to late 60s. As long as one has the capacity to spend time doing the exercises (and listening to audible books and podcasts), it is a great solution.

Oh, this is wonderful, I’m so happy for you! Thank you for sharing your story. I hope others are able to find a similar experience for their care.

Thanks for sharing your story. Unfortunately it’s not a regional crisis, it’s a national crisis!

I wish I had an easy solution to offer but I’m afraid there is none…as a society we have opted to let mainly market forces determine how healthcare is provided, and for various reasons, the market does not value PCPs much.

I see an internist as a PCP. But I am 76 and thinking about finding a geriatrician. I have many issues that my current doctor seems to blow off. Also, she talks to me with her back turned, and I think she knows I can’t hear well. I am going to need a new doctor anyway because she’s retiring.

Any suggestions for those of us who don’t yet need a geriatrician (almost 70), but want an internal
medicine doc who is informed about aging issues? Are there any organizations for doctors who
have geriatric training or interests, but are not board certified? Or any other strategies for
finding a good internal med provider with experience in geriatrics? My wonderful internist will likely retire in the next couple of years.

Thank you.

This is a very significant weight loss. Please be sure to bring it up to your doctor. Good luck!

So sorry that you are going through this. I hope you have been able to find a good doctor to evaluate her…ideally a geriatric psychiatrist, but if not available, hopefully a geriatrician. Good luck!

Whether the brain changes show up as hypodensities (lighter than usual) or hyperdensities (darker than usual) depends in part on the type of scan and contrast that was used. I wouldn’t worry about the distinction too much. If you have more white matter changes than usual for your age, it’s important to manage BP, choleseterol, diet, exercise, and other vascular risk factors, as you are doing. Good luck!

Hm, I’m not sure why this would be happening. I would recommend working with your doctor to evaluate the palpitations and see if you can find another way to treat the vitamin B12 level. You could potentially consider injections?

It’s possible that he is developing some cognitive impairment. You can learn more about the causes and how to have it checked here: Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check

Yes, a normal multi-vitamin does not have enough to correct a vitamin B12 deficiency. I would look for a pill that has at least 1000mcg if you are trying to correct a deficiency.

It certainly helps to eat foods high in vitamin B12, however if one’s stomach or intestines have gotten worse at absorbing vitamin B12, it may still be necessary to take the higher doses available in supplements.
You can find a list of foods high in vitamin B12 here: https://ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional/

I think of sublingual vitamin B12 as a version of oral therapy; as far as I know, studies have found that they are equivalent in effectiveness: Replacement therapy for vitamin B12 deficiency: comparison between the sublingual and oral route.

As I explain in the article, the main advantage of injections is to be sure the person gets the therapy (this is esp useful if the person is older, has memory problems, and lives alone), or to get the level up faster.

Vitamin B12 deficiency can be associated with hypothyroidism, but I have not heard of vitamin B12 supplements negatively affecting the thyroid. I would check with an endocrinologist for more help resolving your health situation. Good luck!

Yes, proton pump inhibitors such as Protonix do affect vitamin B12 absorption. In general, it’s recommended that people avoid long-term use of PPIs unless it’s absolutely necessary, so I’m glad you’ve gotten off the PPI. Your vitamin B12 absorption may now be better, but the safest is to have your level checked. If it’s low, your doctors can work with you on a suitable plan to get the level back up quickly.

Sublingual is fine!

We usually do not tell people to stop B12 supplements before testing them. Also, the methylmalonic acid confirmatory test should still be able to identify whether the body is feeling deficient or not.

Thank you for sharing your story. Yes, celiac disease is believed to be more common than many doctors realize, and it can certainly be a cause of intestinal malabsorption. Glad you found a good doctor to evaluate you and figure out what was going on.

Normally the panel should list serum vitamin B12 level, if this test was checked. The confirmatory test is methylmalonic acid.
Good luck!

Thanks for sharing your story. There is indeed evidence that vitamin B12 and possibly other B vitamins can be very helpful when a person has high homocysteine, as B vitamin supplementation tends to lower homocysteine. Lower homocysteine levels are associated with better health outcomes. I’m glad the dermatologist pointed you towards the B vitamins.

Sublingual B12 is fine, as far as I know. good luck!

Hm, this is an interesting question. I would think you could make any recipe more high calorie by adding some high-quality fats to it, such as avocado or nuts. Organic whole fat greek yogurt might also be good. Good sources of protein include tofu, eggs, poultry, and fish. There are also protein powders that can be added to shakes. Good luck!

Thanks for sharing your story. I’m sorry you are facing these challenges. They are very common in dementia, but that doesn’t make them easy to navigate.
Re vetoing POA: in principle she can do it when she wants to, provided she has “decision-making capacity” when she does it. If she has dementia and is operating under delusions or confusion, she may not have the legal capacity. However, you might have to involve a lawyer to help determine this. What I would recommend is keeping detailed notes regarding her difficulties and trying to get other people (e.g. her doctor) to confirm her confusion and delusions.

In terms of other ways to protect her assets: I would recommend consulting with a local Aging Life Care Professional (also known as a geriatric care manager), for help navigating this type of complex situation.

We do also coach families through navigating this in Helping Older Parents with Early Memory Loss (which includes QA sessions with me and with geriatric care managers), and you can learn more about that program here: https://betterhealthwhileaging.net/helping-older-parents/

Good luck!

Hello Kathryn,
Dr. Didyk is on leave for a bit, so I will jump in. In my experience, the types of strange beliefs your grandmother is experiencing can be associated with other cognitive symptoms. They can sometimes be caused by electrolyte imbalances or other medical issues. Her memory or cognition may or may not be fine. If you want to check for other concerning cognitive signs, I have a whole list of them in my book When Your Aging Parent Needs Help.
The book also has lots of tips and suggestions on how to get an older person evaluated.
You might be able to get it for free through your local library. Or you can purchase it and a few dollars of your purchase will help support BetFiery.
Good luck!

Mary, you should probably get 2 separate medical opinions on replacing your knees. “General” outcomes are not useful: different people in the same age range may have very different levels of knee health and of overall health in general. You definitely do not want to wait much longer without getting evaluations, since at some point the option of knee replacement may no longer be a good one. Also, it’s safer to have each knee replaced separately: the risk of bilateral infection otherwise is too late.

One of the reasons knee replacements are done is to reduce knee pain, as well as to increase mobility. No surgeon is going to replace your knees if he/she does not think that long-term your knee pain will be reduced as compared to pre-surgery! Short-term, you should expect to receive pain medication and therapy that are safe to control your pain and to begin to increase your mobility.

Hi Dr. Didyk,

It’s me again! My grandmother is doing much better now that we have gotten two new aides (one for weekends and one during the week).

BUT she is still experiencing some delirium (though much less than before). When she is out or at our house she is perfectly fine, and she rarely says anything unusual (with the exception of saying something like “well the institution I’m at…). When she is home, though, she thinks she is living in an institution of some sort (or a hotel). I don’t know if it’s because there is a strange person sleeping at her house, or what. She constantly has at the back of her mind that someone is either selling her house, or renting it out to other people, and she will bring it up that she’s very worried about it.

She knows her address, and sometimes she knows she is at home, but rarely. She also seems to think that there are multiple people in the house, not just one. She is afraid that shenanigans are constantly going on in her front room – strip shows, puppets, a dog that was snuck in, etc. It’s so strange because she has lived in the house since she was about 10 years old, so it is absolutely the most familiar place to her.

I’m pretty sure at this point that it is all psychological. She has no cognitive or memory issues at all. We took her to her PCP and she is as healthy as a horse in terms of her bloodwork, and said nothing unusual. Besides the fact that she needs to gain weight, the doctor saw nothing out of the ordinary.

We took her to the eye doctor and he diagnosed her with Charles Bonnet syndrome, which means that some of the things she sees she really is seeing. Now that she has a diagnosis she knows when she sees something strange it is not real and can make it go away (for a while anyway).

But none of that points to why she is thinking such strange things are going on, or why she doesn’t think she is home a lot of the time.

What do you think? Could there be some other physiological issue that I am not addressing or haven’t thought of? Could it be that is all psychological and a response to stress (she also had a lot of trauma in her childhood)?

If so, how do I convince my mother that she should be taken to a geriatric psychiatrist for at least an evaluation?

Thank you again for your help. I can’t tell you how much I appreciate it.

I agree that what you are observing is concerning, and so I think it’s a good idea to pursue more evaluation. I explain some next steps you can take in my book, When Your Aging Parent Needs Help: A Geriatrician’s Step-by-Step Guide to Memory Loss, Resistance, Safety Worries, & More.

orally. How do you feel about the B12 that is put under the tounge?

Due to several serious health problems i receive complete panel blood test every quarter. Which specific test is the one which indicates problems with B12 deficiency? I cant find one in my latest test report. I have no idea whether or not i have a B12 deficiency but i do have Chronic Disease Anemia so it may be a possibility. I do have a Vitamin D defiency and take a 2000 Unit Vit D pill every day. Thank you.

I have read in several articles about the need of stopping B 12 supplements 3 -6wks prior to testing as it seems laboratories only test circulating levels, so they are incorrect if recent supplements given. Id say you are not ‘cured’ but ask for a repeat within 3months or just happily take the supplement

Intramuscular and Intravenous routes are a hassle, painful, expensive and time consuming (setting up appointments and transportation). I rarely hear sublingual advised which makes me think most of these articles are just rewritten versions of
previously written articles.

Sorry to hear of your mother’s symptoms. I agree they are concerning and I would recommend you keep trying to find a way to get her evaluated. I offer lots of suggestions on how to do this in my book, “When Your Aging Parent Needs Help.”

Regarding a support group for aging parents: you can try calling your local Area Agency on Aging, to find out what’s available near you. I also run an online program called the Helping Older Parents Membership; it’s not currently open to the public, but if you sign up for my email list, you will be notified next time it opens. (We have many people in situations similar to yours!)

Good luck!

I would recommend letting your doctor know about this symptom. They will be able to help you figure out whether it’s likely to be a side effect of the medication, versus simply venous stasis. (If it started when you started the amlodipine, it may be a side-effect of this medication, and your provider may want to try switching you to a different type of BP medication.)

You are right that there is often a large grey area, when it comes to incapacity. Capacity is supposed to be considered dynamic and should be specific to the type of decision, but POA documents are not designed to accommodate this type of gradations.
There is now a movement to encourage “supported decision-making”, which is intended to provide more of this “as much support as is needed”, but it’s not clear to me how it will fit in with existing POA laws. (It’s also very time and labor intensive to help someone with supported decision-making, especially if they are developing mild dementia.)
I have more on decision making capacity in this video: How to Know if Your Aging Parent Can Still Make Decisions

It sounds like he might be having visual hallucinations. In people of his age, this can definitely be related to changes in memory and thinking. (That said, sometimes it’s solely due to vision changes.) I would consider it a warning sign, and I would recommend he get more evaluation to check on his memory and thinking. Good luck!

Thank you for sharing these thoughts. As you may know, people who are “very elderly” are especially unlikely to survive a resuscitation attempt. In principle, it should be possible to be DNR and still get lots of attentive care as long as you aren’t found down without a pulse. In practice, it’s true that some providers will interpret a DNR as a broader directive to minimize more intensive interventions. To get around this, you might consider a POLST-type document, in which you can express a wish to be DNR (if that fits with your preferences) while adding a lot of information about the level of care you expect for anything short of being found without a pulse. I have more on POLST here: POLST: Resources & Tips on Avoiding Pitfalls.
Hope this helps!

This is a great question. Unfortunately, I don’t have a good answer. By far, the number one source of support for aging adults is family: generally first the spouse, then adult children, then others (e.g. siblings, cousins, nieces/nephews, etc). For those without family (or those who don’t want to count on family), another option is to designate a good friend as power of attorney for healthcare.

As a society, we have not come up with good options for those who don’t have family or friends available…there are professional fiduciaries, but they are expensive. And then for really dire situations, there are public guardians…but that usually comes after lots of problems have occurred.

Cultivating a support network in later life can be a valuable approach. Good luck!

Thank you for your comment! I’m so glad you are finding my site helpful. I hope you can find a geriatrician soon…or look for a clinic specializing in older adults. I have more ideas here: How to find geriatric care — or a medication review — near you

Sorry to hear that you’ve noticed these concerning symptoms in your friend. She’s very lucky that you are paying attention and trying to help.
If you think she’s being abused or taken advantage of by others, I would definitely recommend contacting Adult Protective Services (APS) for your county or metro area. It also sounds like she might qualify as suffering from “self-neglect” (it’s considered a form of elder abuse), so you can let APS know about that as well.

For other things you can do: I walk through many options in my book, “When Your Aging Parent Needs Help.” You may be able to get it for free at your local library. Or you can purchase it from Amazon (or your preferred online bookseller) and your purchase will help support BetFiery. Good luck!

So true, it’s very valuable to create some peace of mind for oneself and one’s family. Glad you found this helpful!

My siblings and I have been trying to provide support to my increasingly paranoid mother lately who will be 70 in August. She has always been a caregiver for others, is active, independent and takes care of everything for her household and various other family members. Recently she has been complaining of various sounds of animals or people trespassing in her house at night and hiding in the house. It started as concerns about homeless people trespassing and squatting in her house coming in through the window, which actually seemed somewhat plausible, so we spent a lot of time boarding up windows and putting up motion detecting cameras all around the house. Things seemed ok for a few weeks and now she’s hearing animals in the house. She and my dad have put up animal traps and they have caught nothing. My dad has said that he hears and has heard absolutely nothing of what she has been describing at all. He is a bit hard of hearing, but it does make me wonder if any of these potential root causes mentioned of paranoia might be true. She hasn’t gone to get a doctor check up in years, so who knows if there is an underlying medical issue happening. Additionally, psychosis does run in the family, so there is a predisposition. She has also been seemingly more stressed about things lately. It’s really hard to know exactly where to go from here, but your description has given me some ideas. Any other thoughts you might have would be welcome. I’m also interested in finding a support group specifically for aging parents and various issues that might emerge. Any thoughts on where I might find this kind of a group.

Thanks so much in advance!

Hi Linda and I’m sorry to hear about how difficult it’s been lately for your husband and you. Dementia symptoms can definitely be exacerbated by delirium, multiple transitions (home to hospital to rehab to nursing home, for example) and head trauma. Usually the person has an underlying dementia, such as Alzheimer’s, and sustains “insults” to the brain from those other issues. Head injury increases the risk of person having memory issues by about 28%. As your husband recovers from his recent hospitalizations, remember that there are things you can do to prevent a recurrence of delirium, as Dr. K discusses in this article: https://betterhealthwhileaging.net/delirium-how-caregivers-can-protect-alzheimers/

Glad you found it helpful!

I think we’re in the early days of connecting the dots between inflammation and dementia, and I found a good scientific review, here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7895800/. Elevated inflammatory “markers”, like C-reactive protein, are fairly non-specific, and I wouldn’t suggest screening for cRP in everyone in middle age. I would advise that early and mid-life is a good time to try to reduce inflammation by exercising, eating healthy food and avoiding toxic exposures like smoking and stress. Healthy habits are almost always worth the effort!

Thanks for sharing your story, Helen! I agree that focusing on the scale number alone is not the whole story. It’s good to look for trends (rapid, significant weight gain or loss), or the presence of any other symptoms like fatigue, fever, pain, or bleeding for example.

Oh Carol, you have a lot on your plate! But this is a common story.

First, I recommend that you check out Dr. K’s new book: “When Your Aging Parent Needs Help: A Geriatrician’s Step-by-Step Guide to Memory Loss, Resistance, Safety Worries, & More”. You can learn more here: https://betterhealthwhileaging.net/education-and-support/when-your-aging-parent-needs-help/

Dr. K also has the Helping Older Parents Membership which is an amazing resource and community for those like yourself caring for a parent with age-related health challenges. Click on this link to find out how to join: https://betterhealthwhileaging.net/hop-membership-invited/

I think you’ll find those resources very helpful in navigating the helping journey. It’s very complicated when your parents seem to be making choices that affect their health, and that of the other parent. For decades, likely, your parents have had each other’s backs, naturally stepping in and protecting each other when one of them is failing. This loving bond can interfere with getting needed help, especially when there’s dementia.

Unfortunately, sometimes there has to be a crisis for parents to accept help, from family or professionals. Your idea of a crisis may be very different to that of your dad or mom, and that’s frustrating.

In terms of being involved with their health providers, your parents may not want their doctor to share information with you, but you can certainly share your observations and impressions with the doctor. Consider writing a letter and sending it to the office. I get communication like that all the time and find it very enlightening.

My father recently has lost control of his stool and urine. He presently has a temporary Foley in place for his urine and nothing is being addressed for the loss of stool control. He refuses to wear adult diapers and insists that my 90 year old mother must clean him. She dutifully does but it is a mess and she is confined to a transport chair 90 percent of the time. Consequently, the floor is not cleaned correctly. His stool accidents have decreased in recent weeks, but still a huge concern. Although he sees his general practitioner regularly, he feels that the good doctor is GOD and will not tell him everything that is happening or can’t remember everything. My mother has the beginning stages of Alzheimer’s and does not remember much about the visit to the doctor. She fell and broke her left leg seven months ago, was in the hospital for nearly 3 weeks because of the onset of sepsis and pneumonia, and was put into rehab for 6 weeks. My father had her removed from rehab prematurely because she cried to him and said she wanted to come home. They have no in home nurse or care provider. My father has cared for her basic needs. Sometimes she goes for weeks without showering. She no longer cooks because she doesn’t remember or has no interest in doing it. She no longer takes Donepezil because my father says it makes her too sleepy. My mother and father are in charge of taking their own medication.

I live 3 blocks away. I have pleaded with them to let me help them cook, clean, take care of yard, run errands, handle their medication, and attend doctor appointments. They refuse! I know that their doctors get only half the necessary information and do not see what is really happening. My father can come off as put together but give him a few minutes of conversation and he will recite the same story over and over. I have asked several times for them to go into assisted living, but that is met with anger and flat out refusal. I have asked to be put on their paperwork at doctors offices as a person to speak to and again that is a loud NO! My father is very proud and will not let anyone help. I am one of four children, but the rest are too far away to get involved or tell me to stop getting Dad angry.

How can I speak to their GP and specialists if they won’t allow me to be involved?

Yes, in geriatrics we would be very cautious about using lorazepam in someone like your husband.
Melatonin seems to help some people, and is probably not very risky. It’s reasonable to try it, and see if it helps. Good luck!

My understanding is that a finding of incapacity relates to a specific decision – like whether to have an operation, move to a nursing home, or get married. It’s usually not possible to declare a person globally incapable, unless they have a sever cognitive impairment or are very ill, such as in a coma.

It’s really up to you as a family, based on your knowledge of your mom’s personality, preferences, and life history, as to how much supervision she would want. Whatever her living situation, whether at home or in an assisted living setting, there will be risks and benefits. You might be interested in this video about “Living with Risk” : https://youtu.be/A-nugANRenE

I can’t speak to what Adult Protective Services will do, as it can vary from region to region. There’s usually some leeway for choice, unless it’s an emergency or crisis.

It’s been my experience as well that there’s a wide range of skills and levels of professionalism when it comes to hiring help for an older adult. Even within agencies there is some variability, depending on the type of training and screening that the employee has to undergo.

Like anything, good communication can alleviate a lot of problems down the road.

Thanks for sharing that and thank you for your important work.

You’re right that supporting older adults and their family members isn’t easy and the more psychological skills you have, the better! You might relate to this video about the qualities that lead someone to work in Geriatrics: https://youtu.be/oU3_1Nc39-k

Don’t worry too much as long as you see your doctor for checkups, etc.

Sudden changes in continence like this, with no burning or pain, that sounds a little less common.

For a sudden change in urinary continence, I would definitely recommend getting an evaluation with a health provider, including a physical examination and possibly also a pelvic examination. Be sure ask the health providers to explain what they think might have caused this relatively quick change in your ability to hold urine. Good luck!

Thanks for sharing your family’s story. Yes, Medicaid is supposed to help pay for long-term care services, but even once one qualifies for Medicaid and applies, it can still be very difficult to obtain quality services. Unfortunately, the US has never been very good at investing in safety net services, nor is there much inclination towards public investment in services that most people will need (e.g. eldercare). I am hoping this will change as the boomers age, but we’ll see.
It sounds like your sister is muddling through…I hope she finds more of the support she deserves soon.

Know of one wonderful, trustworthy and committed caregiver (hired directly, but no paperwork check or legal stuff done) was outstanding but at the end of the day not a legal resident in the US. It all came crashing down when she was deported.

Know of another similarly hired direct (not via an agency) who worked from my friend’s family, caring for the parents and then mother once the husband passed. He was like family, a live in, trusted for 10 years; but it turns out he was a bad apple. It was not until the mother passed, that the adult children (one of my friends) learned he was embezzling all along. So yes, not good to give them any “financial power” to pay, write checks, use the family credit card, etc. That guy was arrested and now is in jail.

Another friend hired privately a wonder man when her husband was failing with cancer. He was wonderful, never any issues and remains a friend of the family.

There are great aides from agencies and not so great ones. Another friend with a broken pelvis and early stage dementia has aides 8 to 5 pm Monday-Friday while her husband works. Some have been great, attentive and helpful. One — I witnessed while visiting — slept the entire time and would not get up to answer the phone (my friend with the broken pelvis could not walk). Needless to say the “sleeping aide” was asked to not come back; and the agency sent another.

It can be a crap shoot or great. But tracking, checking and getting the right legal paperwork done can give you some protection.

Thanks for sharing your family’s experience and I’m so sorry that this happened. Many of the features you mention are “red flags” for romance scammers, like falling in “love” very quickly, two-timing, and avoiding in-person meetings (especially with concerned family). Your dad is probably having mixed feelings, and may still believe that it was true love, while also feeling ashamed of being duped. You sound like a very supportive family, and I would suggest working with your dad to see if he wants to report her or sue for his money back. It may be best to cut the losses and stay close to your dad so that he won’t be afraid to share with you if another “sweetheart” tries to fleece him.

That sounds frustrating, especially when you’re trying to help.

I would recommend a couple of resources. First, the Helping Older Parents Membership, which is the only online educational resource for children caring for older parents offering sessions with a geriatrician, Dr. Kernisan. There’s also a wonderful community of support as well as downloadable resources. Check it out here: https://betterhealthwhileaging.net/education-and-support/helping-older-parents-membership-waitlist/

Also, Dr. K has recently written a book: When Your Aging Parent Needs Help: A Geriatrician’s Step-by-Step Guide to Memory Loss, Resistance, Safety Worries, & More. You can get it here: https://www.amazon.com/Aging-Parent-Needs-Step-Step/dp/173615320X. It’s very practical and covers issues similar to the one you’re describing.

In terms of the odour coming from your dad’s place, it might be a good idea to call the Health Department about that, especially if you’re worried that it might be affecting his health. Unfortunately, it sometimes takes a “crisis” to get services in if there’s a longstanding pattern of isolation. The “system” usually respects a person’s right to make choices for themselves and there’s a high bar for them to force an intervention.

I hope the above suggestions are helpful and you’re able to make some progress with your father.

I’m so happy that you enjoyed the article! Thanks for taking the time to comment.

Great, informative article. Thank you!!!

As our understanding of the brain and its illnesses grows, we are finding that all of the factors you describe are very important in mental health. Here’s a report on the determinants of mental health by the World Health Organization: https://apps.who.int/iris/bitstream/handle/10665/112828/9789241506809_eng.pdf. The social, economic and environmental issues that you’re living with are absolutely mental health issues.

Most of the time the solutions to these issues are complex and have multiple facets, but they can make a difference. It seems that social interaction is a big part of mental wellbeing for older adults. I wonder if there are any opportunities to make social connections in your area – especially now that COVID restrictions have eased?

You might also be interested in this podcast about loneliness in later life: https://betterhealthwhileaging.net/podcast/bhwa/loneliness-in-aging-carla-perissinotto/

My depressions comes from real issues…greatly lessened mobility, infections that are not receiving good treatment due to being vague , living in a neighbor hood that offers littlie the way of healthy social interactions. Aging animals. House and up keep getting more challenging. No family members, except for one distance with mental health issues. Expenses now only covered by one SS. I can not see how these are mental health issues, although they greatly affect ones mental health

Thanks for sharing your experience and it sounds like it’s been a positive one for you.

You’re correct that “biomarkers” or levels of certain protein in the CSF (cerebrospinal fluid) can support the diagnosis of Alzheimer’s disease, along with an assessment of symptoms and overall health. Lumbar puncture, aka spinal tap isn’t as accessible as it could be, and similarly, analysis of CSF for those biomarkers isn’t available in a widespread way. Most guidelines about dementia diagnosis and treatment don’t include CSF biomarkers as part of the criteria to make a diagnosis. There’s a good scientific article about that, that you can check out here: https://www.sciencedirect.com/science/article/pii/S1552526016329636#:~:text=Therefore%2C%20the%20diagnostic%20criteria%20for%20AD%20dementia%20established,underlying%20cause%20of%20a%20dementia%20syndrome%20is%20AD.

In addition to those limitations, there are those who argue that finding Alzheimer’s earlier is not worthwhile, since we don’t currently have a medical treatment that will reverse or cure Alzheimer’s. I appreciate hearing your perspective that you were grateful for this information, though and we need to consider the views of patients and families as we decide how to diagnose and treat Alzheimer’s and other dementias.

In the future, CSF testing might be a bigger part of dementia diagnosis, but currently, it’s mostly on the sidelines. Thanks again for weighing in with your story and I wish you all the best.

Well, there are definitely gaps in our knowledge about many aspects of medicine! I use the term “holistic” to describe an approach that looks at the whole person: their biological, social, cultural and other aspects, to assess and manage health conditions.

If you’re worried about your mother’s capacity, you might be able to get your sister-in-law removed from the financial transactions. A lawyer would be best to advise you about that.

If you have a relationship with your mom, it’s probably worth trying to talk to her first before taking legal action. It sounds like a tough situation and I hope you’re able to get some help.

I’ve mentioned CBTi (Cognitive Behavioural therapy for Insomnia) before and I think this might be something to try. It’s not easy but doesn’t have the same potential side effects as medications and the effects don’t create a tolerance like zopiclone can. A good resource is http://www.mysleepwell.ca.

Many of my patients take melatonin for sleep, which has fewer side effects to zopiclone and other “sleeping pills”. This is non-prescription and your pharmacist can give you advice about dosage and whether it will interact with any of your other medications.

Also, remember to avoid daytime naps, late night fluid consumption, exercise too close to bedtime and watching the clock. Keep your room cool and dark, and don’t go to bed until you’re tired. And most importantly, get up at the same time every morning, no matter when you fell asleep.

I’m sorry that you’re having these difficulties in your relationship with your parents. You don’t mention if your mom or dad have cognitive impairment, but these kinds of behaviours can common in dementia. On the other hand, if your mother has had anxiety about your dad’s “relationships” for many years, then it may be part of a more longstanding personality or mental health issue.

There’s probably not much you can do to reduce your family members’ anxieties, other than validate their feelings and experiences, and encourage them to look after their own health needs. Most likely, you’ll have opportunities to get involved with helping your parents in the future, especially if there is a dementia.

Witnessing the effects of delirium in a family member can be so frightening and even heartbreaking.

Check out this article about Hospital Delirium and see the section on the Hospital Elder Life Program (HELP): https://betterhealthwhileaging.net/hospital-delirium-what-to-do/. If your dad isn’t enrolled in the program, I would request that, if he qualifies (in some cases, a person is too delirious or ill to participate).

Most times delirium improves, and it can be frustrating to watch the fluctuations and complications along the way. Thanks for sharing your experience and I hope things get better soon.

Hives and a rash suggest an allergic reaction. I would ask your doctor if you should have another booster or not, but I would lean towards not, although I don’t know anything else about your risks for COVID or health history so can’t give advice. See your doctor anyway, as you may want to find out if you had an allergic reaction to something else, in case the vaccine was just a coincidence.

It sounds like you have a lot of healthy habits, which I would advise continuing!

Trulance, or plecanatide, acts on the small bowel to add fluid to the stool and promote movement. It appears to be safe and effective, but does sound costly.

Baking soda is OK at the level you mention: 1 tsp is about the same as a couple of glasses of soda pop. The only thing to watch with Gatorade is the sodium content (about 320 mg in a 20 oz bottle), keeping in mind that for older adults, about 1500 mg a day of sodium is enough.

Senna and bisacodyl are both stimulant laxatives. There are some patients who need to use senna daily (it’s milder than bisacodyl) and for most, it’s safe. An example would be someone who is on an opioid (like morphine) or other medication that slows the bowel. Restoralax, or PEG 3350, can be used daily, but you’re correct that it can disrupt electrolytes in some conditions.

In terms of your struggle to get your mind off your bowels, you’re not alone. I have many patients who are very distracted by their bowel habits, sometimes to the point that it gets in the way of quality of life. One thing that might help is CBT, or Cognitive Behavioural Therapy. Here’s a paper about it: https://bpsmedicine.biomedcentral.com/articles/10.1186/s13030-021-00226-x. This is a type of psychological therapy that often includes mindfulness, and can relieve anxiety and depression symptoms.

Good luck on your bowel journey.

It’s so difficult to be far away from a friend you’re worried about!

It’s reassuring that your friend is being followed by her doctor and a gastroenterologist. Ongoing diarrhea and vomiting isn’t normal though, and 40 kg is a low body weight.

I agree that getting a referral to a dietician is a great idea, as well as a review of medications to see if any of them are interfering with weight maintenance.

I often wonder if holistic refers to the practice theory being full of holes?

This really resonated with me as my 80 year old father is currently in hospital and as he has Multiple System Atrophy, has a vulnerable brain and also being in the spectrum, finds the sensory overload if hospital traumatic.

He told us very calmly that the night before, mercenaries had stormed the ward, lined everyone up and then ordered them all to bed … he was surprised it had not been on the news! He does like to read books along the lines of Jack Reacher so I am wondering if reality and fiction have become blurred in his confused mind. It is very distressing so thank you for such a clear article

I do not normally react to vaccines. Thank you.

I have purchased your mask recommendations, thanks for that. Quick question: Do you have a recommendation for a mask with an exhalation valve?

I appreciate your perspective and for the thoughtful comment, Dr. Didyk. One doesn’t need to subscribe to a religious tradition to realize taking on a companion in a marriage is cheating. A medical professional must remember when proposing such advice that in many states across the US, adultery isn’t just a crime in the eyes of your spouse. Taking on a companion while still legally married is considered cheating – and is against the law, punishable by a fine or even jail time. Medical professionals still are required to take an oath to do no harm, which sadly lies in a gray area as far as ethics and morals.