Geriatric Care Management Blog

One of my geriatric care clients, an 80-year old widow who lives in an independent living center, came to me with what she felt to be an embarrassing story.  Since it is about fraud, I offer it now during a season when we all may feel the spirit of giving and we also can be duped by thieves. 

My client received a telephone call from “her favorite grandson.”  At least that is how the caller introduced himself and my client inadvertently gave in to the urge to guess the caller’s name as her eldest of five grandsons.  She readily admits she has no favorites, but she gave in to what seemed to be a tease from her grandson, a fully grown young man with a family of his own.  Her “grandson” then proceeded to relate a story of a bit of partying with coworkers on a business trip to Canada that resulted in his incarceration.  He desperately needed $3,000 for bail.  He wished to avoid informing his wife or parents until he could return to relate the unfortunate events in person.  My client agreed to this conspiracy...

As geriatric care managers we regularly do “prescription audits” for our clients to look for problems that can come from their many medications.  As you work with an older adult, you should always have them bring a list of all their medications with them to each visit to their health care provider, and this includes the over the counter meds like vitamins or herbs.  Let me explain. If one pill can take care of one of our “health problems,” and another pill can take care of another of our “health problems,” and so on, it does not take much imagination to see where all the prescribing can take us.  Referred to by some as “America’s other drug problem,” polypharmacy – prescribing which results in a patient being on two or more medications - has become the problem that has been spawned by the multiplicity of “cures” and the marketing machines behind them. 

According to IMS Health, a company that follows prescribing of medications, Americans alone spent more than $218.8 billion dollars on prescription...

About 50% to 70% of Americans will die without a will.  So, you can imagine that the percentage without a “living will” or other type of “advance directive” is even larger.  I attended a program last month in which a local lawyer specializing in elder law, Eric Parker, shared a lot of useful information about the types of advance directives and answered some common questions people have about them. With the holidays coming and everyone getting together, I get a lot of questions as a geriatric care manager about how to help an older adult or someone else with special needs.  The holidays may be a good time to have some discussions about what an older loved one really wants.  In very plain terms, this conversation – while potentially awkward – will help assure that others do not make the critical health care decisions for an older adult.  And, of course, these are discussions we do not have to be “old” to begin to have. ...

Making decisions on behalf of a loved one is not always easy.  Yet the challenge can be eased with information.  The most common questions I get as a geriatric care manager revolve around: 1. What should a caregiver do to address their loved one’s need? 2. How does a caregiver make choices among alternatives to help their loved one?

To help with both of these decisions there are a good many free resources available to everyone.  Your older family member or someone else with special needs may be in Chicago and you may live in Nashville, but you can get good information from all your own nearby healthcare providers, legal advisers, financial consultants, or other experts.  These individuals should be able to direct you to their own national member organizations or associates they personally know in another city.  Local hospital discharge planners can be very helpful, because it is their job to get at least medical help for individuals who are preparing to return to their homes after a hospital stay.  Just remember that their job ends at the hospital door for discharged patients, so they do have limitations.  ...

It isn’t always a surprise or a “bolt out of the blue”. It can be a gradual awareness that “things aren’t quite right” or “something is off” with your older loved one. Trust your instincts. Follow the “little voice” that tells you to act.  You may not see the unexpected coming, but you can prepare for the unexpected. You can be ready for the life altering events as your loved ones age and their needs and capabilities change.

A Geriatric Care Manager is educated and certified to deal with these life changes.  With or without the help of a GCM, you can help identify a problem in the making and develop a strategy and plan to address it.  Crises can and will occur.  By taking the steps establish a dialogue with your loved one you will lay the groundwork for the more difficult conversations and decisions that will follow in the future.  

My experience with elders and my years as a parent, a daughter, and a daughter-in-law,...

Acetaminophen (Tylenol) is everywhere within mainstream medicine these days.  It is used by itself for fever or pain as well as in combination with other medicines for flu, moderate to severe pain, cold symptoms or insomnia. 

But acetaminophen and a lot of other medications don’t simply go from the mouth to where they are needed in the body; they must be absorbed through the digestive tract and into the blood stream.  Acetaminophen along with many other meds are then metabolized through the liver.  If too many medications are being processed through the same site in the liver, liver function can be compromised.  It does not have to be multiple agents that create this liver logjam; it may simply be the amount of a single agent like acetaminophen that can cause problems.  Older patients will be able to process even less through their “slower livers.”

Historically, patients have been cautioned not to exceed 4,000 mg of acetaminophen a day as the potential for liver failure can follow from that daily...

Independence is as much about the caregiver as it is the older adult or special needs individual who receives the care.   The principal goal of a Geriatric Care Manager is to optimize independence for seniors or others with special needs as safely as possible, for as long as possible and with the maximum quality of life for the whole family.  In an earlier blog on making home a secure and safe place, I briefly discussed some ways to make home safer.  And there is a host of other services available to help keep the house in order, food on the table and mom or dad living well.  You can look to both light and heavy housekeeping, sidewalk and grounds services or meals delivered.  If more personal care is needed, home health or companion care are available.  Yet there is another important need to consider - your own needs as a caregiver.  Being a caregiver to an older adult or someone with special needs can be a significant...

I talked aobut Alzheimer's disease in my last posting.  Maria Shriver, the First Lady of California has experienced Alzheimer’s close up with her father, and she worked closely with the Alzheimer’s Foundation to produce an important report.  With the release of “The Shriver Report: A Woman’s Nation Takes on Alzheimer’s,” there has been a lot of buzz about Alzheimer’s. 

I have not taken a real opinion poll, but from feedback I get as a geriatric care manager from my clients what scares them most is not the prospect of dying. It is the prospect of losing their mental abilities. Alzheimer’s disease is high on the list of “feared medical conditions" even though it is down at number seven on the list of overall causes of death among Americans. With “National Memory Screening Day” coming up on November 16, I thought it would be a good time to share a few perspectives on Alzheimer’s and related cognitive conditions.