Geriatric Care Management Blog

In addition to plans for turkey, pumpkin pie and football, if you are a caregiver, you may anticipate using some of your holiday time with older parents to talk about their changing needs.  Especially if you live at some distance from mom or dad, you may see some changes in your parents when you visit them or they visit you for a holiday get together.  Here are four issues that you may want to be at least prepared to consider if you are one of the sandwich generation who is assuming greater responsibilities for your parents at the same time you are raising or launching your own children. Your parents may be in good physical health, so you think that there is nothing to talk about - no medical issues to tackle this holiday, but that may be just the time to talk with mom or dad about long term care insurance.  There is a wide range of options for long term care insurance that can be used to cover the costs of home care as well as institutional stays, if needed.  And as with any health or life insurance, it...

Alzheimer’s Disease is the most common form of dementia, affecting about 5.3 Americans, and it is expected to grow to 15 million Americans with this disease by the middle of this century.  Almost everyone has heard about the condition, and we even see advertisements on television for medicines that may be able to slow the progression of the disease.  What we probably do not hear a lot about is that Alzheimer’s commonly is accompanied by other neurological problems that caregivers and Alzheimer’s patients’ providers should be looking for. While challenging to diagnose in patients with Alzheimer’s or other dementias, depression reportedly affects as many as 20 to 32% of dementia patients.  It is particularly common with those who manifest vascular dementia.  It is hard for providers to diagnose, because the confusion or lack of focus common to depression also are frequently the hallmark of dementia as well.  As a caregiver, be alert to insomnia or hypersomnia as well as agitation or suicidality in patients...

I have written in past blogs about some of the inevitable decline of physical capabilities associated with aging, and a lot of them are not really a surprise.  We all walk more slowly, we see and hear less clearly, and strength and endurance just are not what they may have been at age thirty by the time we hit seventy.  But we do not always think about the sense of smell becoming less acute with age, and there are really important medical and safety risks when a person’s sense of smell begins to fail. Research reported some time ago in the Journal of the American Medical Association documented that people’s olfactory acuity slips as they age, so much so that it may surprise you to know that 62.5% of persons over age 80 had “impaired olfaction.”  Only about 15% of men and women over age 80 were even aware of their shortfall.  So what, you may say?

Elders who age in place also are typically living in older...

It's Breast Cancer Awareness Month, and I had a question from one of my clients about why should she worry about breast cancer “at her age?”  We devote a lot of press to mothers and daughters and sisters and spouses, but what about grandmothers and great-grandmothers?  What I am going to share with you in this posting may seem a bit of a surprise, because we tend to focus a lot of our attention on women who are in their prime when we think about breast cancer.  We may even think that older - and very post-menopausal - women need not be as concerned about a medical risk often associated with hormonal activity. There has been research at Memorial Sloan-Kettering that basically says that regular testing works as well if not better for older patients as it does for younger patients, because if the cancer is caught early – and therefore small – these women have a very favorable prognosis.  In other research at Beth Israel Deaconess Medical Center in Boston doctors followed about 65,000 women who had been diagnosed...

What do hearing aids, exercise, support groups and travel have in common?  They all are ways that individuals suffering from Alzheimer’s Disease, specifically, or dementia, generally, can fight these diseases’ progression.  Even more important, they help to fight the personal isolation that accompanies these frightening conditions. We often associate dementias with older adults and the stereotypic confusion that can characterize the individuals with the diagnoses.  But it is not just a condition of older adults as the recent public disclosure of The University of Tennessee women’s basketball coach, Pat Summit, highlights.  Ms. Summit is just 59 as she goes public with her diagnosis, and it helps others to understand that it can happen as early as 30 and 40 years of age.  Younger onset Alzheimer’s Disease technically speaking is the manifestation affecting those under age 65, and there are 250,000 new cases in America every year.  Yet, there are ways to fight the downward spiral of dementia.

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Everyone who is a caregiver to an elder or other person with special needs has to be an advocate also.  In my first blog posting, I spoke about what a geriatric care manager does on behalf of the elder or their families, and one of the principal duties is to advocate on behalf of our clients.  In this posting, I offer a few of the ways that all caregivers can advocate on behalf of their loved one to assure the best healthcare and quality of life. As an advocate for an elder, you need to be more than just the person who gets an older parent to and from a provider’s health care appointment.  As long as the elder confirms that you can attend the appointment, you can be present, and you should use that opportunity to take notes and ask questions. 

As an advocate, you will want to be as knowledgeable as possible about any medical issues that affect your loved one, and that includes asking questions of physicians and others as well as doing...

In past blog postings I have talked about transitions that challenge older adults and their children.  High on the list are refitting a home to accommodate the diminishing capabilities of an older adult who still can live independently.  Also, I have talked about how to make the decision to move to a senior residential facility and leave home altogether.  In this posting, I would like to share with you what I have learned as a geriatric care manager in the form of suggested steps you may consider as you have “the talk” about your older adult’s driving.

The first step for you as a caregiver anticipating this conversation is to simply start thinking concretely about how you would like to be approached with the subject.  This is a real role reversal in the parent-child relationship, and it requires sensitivity, and it can be helpful to think about how you would want to be approached if you were in your parent’s shoes.  You may also recognize that this is not just a conversation you can have with your...

It’s a disease that affects about 26 million Americans.  If untreated it will kill these people.  And more than a third of patients who have been diagnosed with it and counseled about it do not even know they have chronic kidney disease; it's a disease that nobody sees.  That is not a typo; I did say they do not know they have the disease, at least according to research recently conducted at Vanderbilt University and reports from the specialists who treat kidney disease.  Kidney disease is a concern to me as a geriatric care manager, because it affects disproportionately more older adults and because it can be an outcome of poorly controlled of diabetes or high blood pressure and just more birthdays.

A research team headed by Dr. Kerri Cavanaugh of Vanderbilt surveyed 401 patients with various stages of chronic kidney disease.  The patients were being treated at the university’s nephrology clinic, and the majority had actually...

I have written in earlier blog postings about dementia: “preventing” Alzheimer’s Disease, Alzheimer’s from the inside out,  maternal genetic links to Alzheimer’s, and women’s predisposition to Alzheimer’s.  I would like to share some research that shows dementia to be tied to a number of other chronic conditions we often find among the elderly.  This posting is about monitoring and managing other medical conditions in order to reduce the chances of developing dementia, and it underscores one of the most important parts of geriatric care management...

In my experience as a geriatric care manager, I field a lot of questions from people who are suddenly faced with caring for an older parent or spouse.  For people who become caregivers overnight after a parent has a fall or experiences a significant medical setback of some sort, it can be an overwhelming responsibility.  Where does one go to learn how to be a caregiver for an older adult or someone else with special needs?  It is easy to tell a person how to become certified as a geriatric care manager (not as easy getting certified) or even a paramedic (again, not as easy getting certified), but how do you become a caregiver right away? 

As much as some folks may have a predisposition for being “good with people,” being a caregiver poses some unique challenges and an aspiring caregiver can benefit from some special training.  One of the resources I featured last month, Julie Northcutt – President of CaregiverList.com, talked about using summer visits...

In many of my postings on family caregivers I have talked about the really hard job of caring for an older adult or someone else with special needs.  At the personal level it truly is an enormous responsibility with great demands on a person’s time and their emotional well-being.  The most recent report on family caregiving published by AARP, however, really provides a sense of the huge and important work that caregivers are providing for their families in America today.  It is required reading for caregivers and their families. In AARP’s snapshot of caregiving in America, they estimate that as many as 42.1 million people in 2009 were providing some sort of help with activities of daily living to an older adult.  That number jumps about 50% when you look at all the people engaged in some sort of caregiving at any point during the year: 61.6 million people.  And these individuals are offering their support as unpaid caregivers. ...

In my past two blog postings I have talked about some recent warnings from the Food and Drug Administration (FDA) that concern me as a geriatric care manager, and they should concern caregivers and the elders in their charge as well.  This most recent and third warning was about some of the dosing for drugs that are used for people who may be anemic or suffer from chronic kidney disease or be on chemotherapy of some sort.  As you may suspect, this is a relatively smaller segment of the adult population, and as you will see here, it gets even smaller as we are mainly talking about people with chronic kidney disease.  But one of these medications has been part of one of my client’s standard monthly routine for some time, so it struck closer to home.

You may know these drugs by their brand names if you or a loved one has one of the conditions.  The brand names are Procrit, Epotin or Aranesp, and they help the body increase the red blood cell count for people with some types of anemia.  These drugs, referred to as erythropoiesis-stimulating agents or ESAs, are also now known to increase patients’ risk of cardiovascular events.  As with the other two warnings I have posted, these risks only became known over time as more and more people were given these medications.  This is because the actual cardiovascular events they can cause are still fairly rare.

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In the first of my present series of postings on recent Food and Drug Administration (FDA) warnings, I had talked about new evidence of long term health risks from some pain medications that are available both in prescription and over the counter (OTC).  In this posting, I am going to share with you another FDA warning, this one for prescription medications that lower cholesterol.  The “family” of medications is commonly called statins and includes some very well known brands that many of you have seen advertised on television and in magazines.  Others of you or the people you care for may also be taking these medications. All Americans have been alerted to the risks posed by increasingly high levels of cholesterol many of us have in our bloodstreams owing to eating foods high in fats or just plain eating too much.  One way to address the elevated “bad cholesterol” or low density lipids (LDLs) is through diet and exercise.  But for people with persistently...

Within the past two weeks the Food and Drug Administration (FDA) has issued a number of warnings that concern me as a geriatric care manager, and they should concern caregivers and the elders in their charge as well.  The FDA has announced new warnings for three different classes of medications, those for pain and inflammation, those that lower cholesterol and those that help treat anemia in some patients.  In my next three postings, I am going to tackle each, so that you will have a clearer picture of how to safeguard your own health as well as the health of an elder for whom you may be a caregiver.

I am going to start with a group of drugs commonly called non-steroidal anti-inflammatory drugs or NSAIDs.  You would recognize the brand names, Aleeve, Motrin, Advil, or Nuprin as well as their generic names, naproxen or ibuprofen, and a lot of people use them to good effect.  Many people use these...

Caregiving has some obvious costs in time, money and other resources, but one cost that does not get enough attention is the toll it can take in the form of caregiver depression.  As a geriatric care manager, one of my principal points of contact is the member of the family who has been delegated or who has defaulted into the role of caregiver for an older adult or other person with special needs.  And while we are all about the business of planning for the older parent, it also is critical to address the individual who is providing the care.  The sad irony is that the caregiver feels guilty about even talking about the dark cloud that seems to be hanging over them, guilty that they do not feel the fulfillment of taking care of the parent who once took care of them. 

More than 20 million Americans suffer from depression, and caregivers are more likely than the average person to get something that is not just the “blues.”  We all recognize the time and work that a caregiver puts in to help an older adult,...

According to research reported in the New England Journal of Medicine, approximately one in five Medicare beneficiaries discharged from a hospital will end up back in the hospital within thirty days.  It usually is for the same reason they were admitted originally.  This means that it not only is bad for the patient who has to go back to the hospital, but it typically represents an expense that could have been avoided.  And it is these sorts of statistics that give me a chance to talk about a question I get asked a lot: “What is it that geriatric care managers do?”  Let me explain.

The typical picture of an older patient who is readmitted is one without a lot of social support locally, and this older patient:

May not fully understand their discharge instructions. May not be taking their medications as instructed. May have complications they cannot handle. In most of these cases, if the patient had had someone to be the information processor,...

We have come a long way since “help, I have fallen and I can’t get up” and the “panic button” technology.  I have written in the past about my work as a geriatric care manager in helping to make home safer from falls and easier to access for adults who choose to “age in place” in their own homes, and technology now takes us to a whole new age of medical safety and security.  Some experts already are talking about a day not too far off when medical technology and artificial intelligence will combine to actually predict emergencies in the home before they happen. The panic button is now being replaced by home monitoring devices that can call when the button is depressed to allow the elder to speak with someone to determine what kind of emergency response will be most appropriate.  Such devices now also can be linked with “integrative care platform” software that will take vital signs and transmit to a provider.  They also link to interviews tailored to the elder’s chronic condition – COPD, diabetes,...

I have written in past postings about some of the interactions between medicines that older adults may see if they are placed on multiple medications for their multiple ailments.  But it is not just interactions that should get our attention.  As a geriatric care manager I am increasingly focused on my clients’ medication even if they are on only one prescription.  The reason for my renewed focus is in that flimsy sheet of paper with the really small type that you will find included with every prescription a pharmacist dispenses; it is called the package insert.  And beyond reminding you how and when to take the medicine, it gives the patient and their caregiver some important warnings about the potential for side effects that particular medicine has. Dr. Jon Duke of Indiana University and some colleagues reported recently in the Archives of Internal Medicine on the startling rise in the number of side effects that...

Because health care – particularly long term care – can be expensive for elders and others with special needs, it is critical that anyone looking for Medicaid qualification take action before June 14, 2011.  As a geriatric care manager, we help elders and special needs individuals as well as their caregivers to navigate Medicare, Medicaid and the other entities that provide safety nets for those who qualify.  There are changes in store for Medicaid that may affect who qualifies and how they qualify after June 14 of this year.  I had the benefit of sitting in recently on a presentation by an elder law attorney in the Chicago area, Janna Dutton, who helped shed some light on the subject.

Medicaid is mandated by the federal government, but the details of how it applies and how it is financed are the domain of state government.  I will be talking in this posting about what we know now about Illinois law as well as what we do not know.  So, let’s start with an individual who is seeking...

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to Charlotte Bishop. , geriatric care manager Chicago, geriatric care Chicago

I have written in other postings about how “staying active” can be tremendously important for older adults or others with special needs.  Everyone – no matter what their age – can be active, and it does not even require going to a gym or spa to do it.  Elders and others should be encouraged to use everyday items around their homes to help them maintain range of motion and strength.  All of what I am sharing here should be cleared with a personal physician to be sure that it is within an acceptable range of activity for the elder or other special needs person in your orbit.  The following are just some examples, and your imagination is the only limit to how a person can workout at home.

For building strength, instruct your elder to use a sturdy chair with arm rests.  Approach as if to sit, but while still in a crouch with hands firmly on each arm, lower yourself to the point of almost sitting, and then rise up using the arms to lift as high as possible.  Lift up and down slowly like this as...

We may not be hearing QUITE as much about health care reform of late, now that the political debate has quieted.  But as “reform” is being implemented one of its principal cornerstones is the same as that of geriatric care management – “care coordination”.  I thought this might be an opportunity then to address a question I still hear a lot:  What does a geriatric care manager do? 

I often describe what we do as geriatric care managers to be working as “option-makers” to facilitate the “decision-makers.”  The decision-makers are the elder or other person with special needs along with the families and caregivers.  That has a lot in common with what health care professionals and policy makers under the “new” health care are referring to as the medical home or accountable care models. Last March the second Annual Care Coordination Summit was held in Las Vegas under the sponsorship of consulting firm, Dorland Health.  Some of what they...

Elders have more health care issues and have more doctors’ office visits and more hospitalizations than their younger counterparts.  Where about one in four 18-44 year olds report no visits to a health care professional in the past year, two out of three 75+ year old patients have seen a health care professional four or more times in that same time.  More than a quarter of 75+ year olds report in excess of ten visits a year.  What may not be as obvious is that seniors also require more and different recovery help from their medical episodes, especially those that have required hospitalization.

Hospitalization can be the “perfect storm” for older patients, because they have potentially more medical issues in the first place.  Second, everyone is discharged as soon as possible from hospitals these days, because insurance typically pays for the condition, not the days.  Some in the hospital business refer to this kind of logic as “discharging sicker quicker.”  A third factor can also be added, and that is the mental processing ability of an older patient is more challenged by the assault of a hospitalization, especially the discharge process.  In a study recently published in the Journal of General Internal Medicine, and reported by UPI, a researcher named Lee Linquist and colleagues followed a group of 200 patients 70 years and older.  Although all these patients lived independently in their own communities and none had been diagnosed with dementia or other cognitive medical issues, fully one-third were diagnosed with low cognition post-discharge.  The good news is that with special post-discharge care, nearly three-fifths of these same patients improved in the areas of orientation, registration, repetition, comprehension, naming, reading, writing and calculation.

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May is National Stroke Month according to the American Stroke Association, but in one regard this month is just like every other month of the year.  More than 66,250 Americans will experience a stroke, and for three in four stroke victims it will not have been their first stroke.  I am devoting some time to stroke in this blog, because strokes disproportionately affect older adults. 

Nearly three of every four strokes occur to individuals 65 years of age and older.  The best thing you can do if you are a caregiver for an older adult is get them to emergency care as soon as possible after the first signs of a stroke.  And, of course, the best way to be able to do that is to be able to recognize the warning signs of the onset of a stroke. As you look for signs of the onset of stroke, appreciate that strokes can run a gamut from a “mini-stroke” or transient ischemic attack full blown hemispheric strokes which can compromise the function of a person’s entire right or left side.  The only difference between the mini and the major stroke is that the former tend to be temporary.  The warning signs also can run the gamut from modest signs of something wrong to dramatic changes in a moment.  All the warning signs carry a common element, and that is that they have a sudden onset.  The American Stroke Association offers five warning signs:...

As a geriatric care manager, I work with court-appointed guardians.  You may recall from a blog last December, Caregiver or Guardian, we talked about guardianship.  I had the really good fortune to speak with John Wank, President of the Illinois Guardianship Association.  Mr. Wank also is General Counsel of the Illinois Guardianship and Advocacy Commission, a state agency.  He answered a lot of the questions I have heard from our clients.  This is going to take a few postings to get through them all.  Here are some questions and his answers for a start. What is a guardian? A guardian is a person appointed by a court to make personal or financial decisions for another person who has been found by the court to be incapacitated (a disabled person, under the Illinois definition) and unable to make decisions.  All guardianship in Illinois is governed...

One of the most common health issues that seniors deal with is depression.  According to the National Institutes of Mental Health, the prevalence of depression among the elderly is 1 to 5 percent overall.  Yet, it is not a “normal” part of aging; the incidence of depression increases to 11.5% of the hospitalized elderly and 13.5% of older individuals receiving home care.  As a caregiver, I get calls from caregivers and clients who are dealing with not just sadness, but real depression.  While some of these older adults will respond to anti-depressants, it is perhaps even more important to address what may really be just situational depression.  As a geriatric care manager, I am not a diagnostician and I cannot prescribe medications, but I can prescribe some changes in activities that can help the situational sadness that a lot of seniors may experience.

Seniors – along with...

The trees are budding and blooming, the bulbs have forced their way to the surface in beautiful blossoms and the birds are twittering and nesting.  Time to put away your winter coats, wool scarves and mittens, right?  Well, partly right. 

Your winter mittens have another useful purpose that can help you make home an easier place for your older loved ones.  As our bodies age, certain of our nerve pathways begin to fail, and the human anatomy uncannily reroutes many of the circuits as they stop firing.  But with age, more and more of those pathways may slow or fail for a variety of reasons, and it just makes it harder for older adults to do the simple manual tasks they used to do without even a thought. 

Turning a door knob, turning on a lamp or taking the lid off a jar become challenging, maybe even impossible.  It is hard for those of you who may be in the prime of your lives to really get this, no matter how empathetic, so I recommend an easy exercise to help you experience what this erosion of...

Your older loved one does not have to move to a senior residential community to have the security and peace of mind of a safer home environment.  As a geriatric care manager I often have conversations with families and elders in which moving is not an option they are considering.  Sometimes it may be an option, but the move won’t be happening right away, and they are looking for advice on minimizing risks to their loved ones still at home.  One of the greatest risks to an older adult aging in place is a fall and the possibility of fracturing a bone.  For an elder living alone, risks are magnified, because no one will be there to summon help if it is needed.  For the next several postings I am going to go down a checklist of what you can do for a loved one or what you can have done fairly inexpensively with some help to retrofit the home.

As you or your loved “inspect” the home overall, look for fall risks because an unsteady gait or...

We all know that an object at rest tends to stay at rest, and that is as true of older adults as it is younger ones if you look at the frightening statistics on the obesity epidemic in America.  Habits developed over the long run tend to be harder to break, but the fact is that appropriate exercise for older adults can get easier and easier just by the simple fact of dong it.  Because the corollary to my first scientific law is that objects in motion tend to stay in motion.  And exercise gets easier.  Doubtful? 

Here are nine reasons:

Starting a new exercise routine may feel clumsy at first, but so did dancing, riding a bike and a lot of other physical work we have all gotten better at with time.  Muscle memory will help, because your body will make new nerve pathways to make your exercise easier with time.

Blood flow improves when you exercise at any age.  The smallest vessels actually can increase in number fueling all parts of your body as your heart rate routinely...

Scientists have long known that Alzheimer’s Disease has a hereditary component, but new research suggests the predisposition is more often passed on from the maternal side than from the dad who has had Alzheimer’s.  This, according to research reported in the March 1, 2011, issue of the journal, Neurology.   One of you who are following my blog had asked about Alzheimer’s recently, so the timing could not have been better.  As a geriatric care manager, I often counsel sons and daughters of elder parents who have been diagnosed with Alzheimer’s.  I now will tell them that in addition to age of onset, gender of the older parent also is a factor when considering one’s own future.  But I can also report that there is very good reason for hope. The researchers whose work was published studied 53 mentally healthy individuals, some of whom had a mother diagnosed with Alzheimer’s, some...

Older adults with a “rosy” outlook are not just more fun to be around; they will also be around longer than a pessimist, even if they have heart disease.  Research reported in the Archives of Internal Medicine  this week caught my attention as well as the attention of most of the national news services.  The research authored by Drs. Gramling and Epstein really just repeated what a lot of medical researchers around the world have been reporting for a lot of years.  In their specific case, the authors, however, could say with statistical confidence that patients who had had cardiovascular events, but who were also optimistic, tended to outlive their more pessimistic counterparts. This was a study of older adults who had experienced a cardiovascular event, and the researchers followed nearly 3,000 of these people over 15 years to see how they fared.  Even with substantial heart issues still in...

It’s about community.  I was just reminded of a very important aspect of senior residential options that can get overlooked in conversations between caregivers and the elders with whom they discuss their residential options.  As a geriatric care manager, I often am asked to facilitate the discussion that a family will have with mom or dad or other loved one as they consider moving out of what can be their lifelong home. 

Let’s start with the stuff we always address.  Surveys among older adults usually tell us there are three important touchstones for seniors making these decisions:

Safety – Older adults can become a bit fearful about going out at night or live in fear of break-ins and more.  Senior residential options offer a very safe alternative, often with security personnel and gated grounds.

Helping Hands – Seniors have had a lifetime of cleaning up the house, mowing the lawn, and more.  Senior residential communities can give them the independence...

Okay, so it has been five days since you received that box of chocolates from your sweetheart on Valentine’s Day.  And if you did not consume truly massive quantities of chocolate all at once, how do you feel?  The answer is you should feel the calm that comes from lower blood pressure.  This, according to a group of physicians headed up by Dr. Dirk Taubert who did a clinical study on generally healthy people who had elevated blood pressure to find out what happens to their blood pressure if they eat dark chocolate over a period of time.  Very simply, they found that it statistically significantly lowered the people’s blood pressure.  I bring this up because as a geriatric care manager, a lot of the clients I see have blood pressure that is above what it should be.  And I can tell them that the doctors say they should have a diet that regularly includes some amount of dark chocolate.  People with dietary restrictions, however, need to check with their physicians.

This dietary recommendation does not take...

One of the most challenging conversations I help facilitate as a geriatric care manager is to address the prospect of nursing home care among elders and the family members who care for them.  Much of the discussion comes down to point of view and what a caregiver may find important versus what the prospective resident will find important.  In future postings I will also talk about timing and when to consider nursing home care as an alternative to independent living and the options in between.  Let’s first look just at everybody’s points of view for a moment. An article that recently appeared in Seniors Housing and Care Journal compared the opinions of residents and families as well as state agencies on the quality of nursing home care across 89 nursing homes.  We all appreciate that nursing homes are regulated, and that the state surveyors that monitor the nursing home quality of care in most states use a fairly standard report card.  This report card is called the Online Survey, Certification and Reporting...

As a geriatric care manager, I speak with my older clients who wrestle with weight gain as much as anyone younger.  No surprise, obesity has become a recognized, global epidemic in the developed world, and it shows little sign of slowing in its progression toward greater individual bulk and poorer health.  Yet, recently reported research in the Journal of the American Geriatrics Society summarized in an article in Medscape on Aging and Obesity suggests that overweight older adults may have very similar mortality to normal weight older adults.

In a study of about 9,000 Australian men and women aged 70 to 75 years old, researchers tracked the mortality of individuals categorized by their Body Mass Index (BMI).  BMI is a measure of the estimated body fat of an individual based on their height, weight and waistline.  What they found shows that overweight individuals who are older do not seem to have worse mortality than their normal BMI counterparts. ...

In the past two postings I have been talking about the warning signs of caregiver burnout as well as what caregivers can do to care for themselves.  At the center of a lot of what can be done for the caregiver is a very simple philosophy:   “Don’t try to do it all alone.”  As a Geriatric Care Manager, this is where I often get the call.  The caregiver or someone close to the caregiver needs somebody to help make decisions, take over some of the workload, stand up for an elder or other individual with special needs or counsel the caregiver on self-care.

There are other resources that can provide decision-making support, take on some of the caregiving responsibilities, advocate for an elder or caregiver and offer professional counsel on just coping with the responsibilities of caregiving.  There are services to help caregivers in most communities, and the cost is often based on ability to pay.  Look to programs such as adult day care centers, home health aides, home-delivered meals, respite care, transportation...

As a Geriatric Care Manager (GCM), I am often involved in helping the caregiver as much as lending assistance and resources to the elder or other person with special needs.  Sometimes it is as simple as helping a caregiver recognize in themselves the signs and symptoms of burnout as I discussed in my last blog posting.

Starting out with first things first:  Who should attend to the caregiver?  There are external supports that can be as basic as just giving a break to what some have characterized as a 36 hour day that many caregivers live.  But the other side of this is to watch for your own symptoms as a caregiver and be as good for yourself as you are for your loved one who depends on you.  Do you see the signs?  Are you missing a lot of work?  Are you not able to pay certain bills?  Are you not exercising and instead eating a lot of unhealthy foods?  Are you having nightmares or disturbing dreams?  Are you feeling lethargic or maybe even depressed?  Are you angered by minor issues, or are you impatient...

As a Geriatric Care Manager, I have seen caregiver “burnout” and the toll that caregiving can have on a loved one.  When I am working alongside a family member who shoulders a big share of the care for an older adult or someone with special needs.

Quite often, however, caregivers try to hide what they are feeling as a response to the stress of their physical and emotional workload. It is really important, however, to distinguish stress from burnout.  Experiencing stress is not the same as burnout, although stress that is not relieved can certainly lead to burnout.  Let me give you a few contrasts and then some signs to look for in a family member who is the caregiver or even in yourself if you have taken on the role of caregiver:

Stress makes a person “hyper-involved,” but burnout encourages disengagement from others. Stress leads to emotional overdrive, but burnout makes all your emotions duller. Stress can lead to anxiety about doing enough, but burnout more typically results in...

One of my clients recommended a web resource recently, and I am so impressed by it that I am passing it on to you.  So often in the process of caring for an elder or other person with special needs we come up against medical language that can be difficult for someone who is not a trained professional to grasp.  We can always look up a word in the dictionary, for sure, but the specific way words are used when speaking of geriatric and related issues can be rather esoteric.  So, when I can across the glossary of terms offered at the Silverado web site, I just had to pass it along.  Please check out: Silverado Glossary.  You will get a quick grasp of the differences between amyloid and aneurysm or between dementia and delirium.  It also offers really helpful suggestions on the early warning signs of Parkinson’s or Alzheimer’s and more.

The same site also is a wonderful compilation of other web resources that can be very helpful for the caregiver trying...

Dr. Oliver Sacks explains neuroplasticity in his editorial, “This Year, Change Your Mind,” in the New Year’s Day editorial page of the New York Times.  As a geriatric care manager, I have encountered clients whose injuries have induced deficits of some sort from which recovery plans are designed and executed.  Physical injuries such as lost limbs, vision, hearing or others have fairly clear rehabilitation trajectories, and the injured individual can learn and work through them to recover as much of a productive life as possible. Neurological injuries like those Dr. Sacks offers as examples require remolding an organ that we do not see from injuries that also may be invisible.  As Dr. Sacks explains, neuroplasticity offers the means by which the brain can remold itself to overcome a deficit.  For a geriatric care manager, the deficits do not have to be as dramatic as a spinal cord injury, the onset of blindness or even a stroke.  We see every day the consequences of older adults’ inactivity and the cumulative deficits that can grow out of the under stimulated life.  The brain does lose some of its pathways through natural attrition, and it is critical for a vibrant life for the aging individual to keep working in order to maintain the pathways they already have as well as to create new ones as some of those may become unavailable.  A colleague likens it to commuting in the brain.  There may be detours and rerouting, but an active individual will always find a route home.

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In my role as a geriatric care manager, I recently had a conversation with one of my clients, and she brought up some questions and misconceptions about salt intake, especially among elders.  She really is one of those “salt of the earth” types, but she had a few incorrect notions about sodium…the most common form of salt we consume is sodium chloride. 

These are some of the misconceptions about salt that she and I talked about. "Our bodies need sodium."  While true, the real challenge is in adjusting to how much salt we really need.  For young, healthy individuals the upper bound of safe salt intake is about 2.3 grams a day.  The national average intake according to the Centers for Disease Control and Prevention is closer to about 3.5 grams.  How much sodium do our bodies really need?  The experts at CDC say somewhere at or less than 0.8 grams of sodium daily. "Food does not taste as good without salt."  This...

It is the season where we hear about “making a list…and checking it twice.”  My kids think I get a little too carried away making lists, but having the right list at the right time can save the day when the unexpected occurs.  Life has a habit of throwing the unexpected at us, but even then we can be prepared.  As a geriatric care manager, I regularly coach families of an older loved one or someone with special needs in list-making, especially if that loved one lives alone.   You may recall in an earlier blog, I started with a list of activities of daily living to use as a way to inventory the functional capacity of a loved one.  Once we see the deficits it becomes easier to develop an action plan. But think ahead to the phone call you may one day receive that your loved one has fallen or had a stroke or some other debilitating incident.  The first responders or a neighbor may know enough to call you, but now you have to be the voice for the incapacitated loved one.  Do you know their meds and daily doses?  Do you know where they keep their medications?  Do you know who their primary care physician is or if they have a cardiologist, neurologist, or other health care provider who should be called?...

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...

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...

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...

Medicine today is full of miracles.  But Aging Well magazine (Jan/Feb, 2009) reports that although the over 65 set in America constitute only about 13% of the population they account for about 30% of all prescriptions filled.  Their share of over the counter (OTC) drugs is estimated to be closer to 40%-50% of all retail meds sold.  The report goes on to say that nearly two in five hospitalizations each year are a result of medication issues associated with elders.  The elderly are fully half of all prescription drug-related deaths annually.