Geriatric Care Management Blog

We all have heard it said that we are what we eat, but something that many of us do not always think about is how the foods we eat may not mix with the medicines we take.  And this becomes the potential for a perfect storm of medicines and foods among older adults.  Their bodies do not eliminate food or drugs as quickly; they typically have a lower body weight; and they have lower water content in their bodies.  All of these magnify the problems that younger adults may face, because anything they ingest becomes more concentrated.   It also is an even more likely to be an issue with older adults because research shows that four out of five people over age 57 are on at least one prescription, and half also are taking some medicine or herbal supplement they have bought over the counter.  Thirty percent of older adults take more than five prescription drugs.   Computerized medical records make it a lot easier for health care providers today to avoid drug-drug interactions in their patients, but not all of them warn...

Who becomes a caregiver by accident?  In geriatric care management I often am asked to intervene in a situation where an aging individual has been relying on the favors of friends and neighbors for a time, but they may have progressed to the point that more comprehensive caregiving may be needed.  A case in point is an 85 year old woman I know who has two loving children, but they live some distance from mom.  One is nearly 650 miles away and the other nearly 800 miles away. And both have work and family obligations in their own homes.  This is not the type of situation where the kids can be counted on to pick up some groceries on the way home from work or to help with minor repairs around the apartment on the weekend.  What happened in this particular woman’s case is that she had the good fortune of many friends or neighbors who would step up for that occasional errand or ride to the store but eventually they just could not be everything that the older individual needed.  They had become accidental caregivers....

It may surprise you to learn that as many as one in five caregivers are lending their help to an older adult who is still working a nine-to-five job.  A lot of my writing has been about what we sometimes call the old-old, that is individuals who are advanced significantly above our traditional cut-off of 65 years of age defining someone as old.  But there has been a steady advance over the past two to three decades in the portion of the labor force that is 65 years of age or older.  In 1985, fewer than one in nine workers was over 65, but that figure has increased to almost one in five workers now who is over 65 years of age. So much for the talk about taking care of a frail, elderly parent.  Yet, older workers can benefit every bit as much from a caregiver’s help as someone who fits the more classic picture we have of taking food to an elderly shut-in.  As a caregiver, encourage the following adaptations to the workplace: At least every two hours take a short break to stretch and flex the...

    We are fortunate to have a new contribution from a good friend and colleague, Julie Northcutt of Caregiverlist.com.  Julie offers a caution in this contribution about the scams that seek to prey on older adults, so please give her warning a read...      “Holidays are a magical time, but unfortunately they are also a time when law enforcement sees a spike in online and telemarketing fraud, especially directed against the elderly. According to the Federal Trade Commission, nearly 25 million Americans are victims of consumer fraud each year. Senior citizens continue to be a rapidly increasing segment of the population. Why are seniors especially vulnerable? Seniors are seen as easy marks with “nest eggs” that make them attractive to con artists. According to the F.B.I., “people who grew up in the 1930s, 1940s, and 1950s were generally raised to be polite and trusting. Con artists exploit these traits, knowing that it is difficult or impossible for these individuals to say "no" or just hang up the telephone.”...

Caregiver survival starts with what I call the Golden Rule of Caregiving:  “Do something for yourself so that you are able to do something for another!”  Translated, if you take care of yourself, you will be better able to take care of someone else…and the opposite will hold true as well.  If you do not take care of yourself as a caregiver, it will hurt your ability to take care of someone else.  Lending help to the caregiver is important so that the caregiver is able, in turn, to lend their helping hand to an older person. In the spirit of the holiday giving that is upon us, let me suggest five gifts that will help you as a caregiver in providing the care you do:

Give yourself credit for the hard work you have done.  You should thank yourself with as much heart as the person for whom you care.  If you are not being thanked – as sometimes can happen in cases like dementia – then there are therapists who can help you to find the tangible appreciation for what you are doing for a loved one.

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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...

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...

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 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 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,...

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

Caregiving in this century is not just handholding; it combines the latest technologies with caring to allow virtually anyone to be virtually anywhere they are needed.  As a geriatric care manager I often am in the role of the “person who knows resources” that caregivers and their loved ones can rely upon. 

A new study produced by a partnership between the National Alliance for Caregiving and United Healthcare offers results of a nation-wide online survey of caregivers who are leveraging their caregiving with web-based and mobile technologies.  The survey was based on the responses of 1000 Caregivers at least 18 years of age, who provided at least five hours of unpaid care to an adult relative or friend and had already used some form of technology to assist them in their caregiving.  To see the full report, please go to The e-Connected Family Caregiver: Bringing Caregiving into the 12st Century.   ...

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...

In my last posting, I talked about how a caregiver can facilitate an older adult’s decision around when it is time to surrender driving their own car.  As I said in that blog, it is important as a caregiver to help facilitate the older adult’s decision about something like driving a car versus retiring a car rather than make the decision for them.  It is no less true of decisions on living at home versus moving to a senior residential community. 

Let me help you with some of what I have learned in talking with hundreds of older adults who have wrestled with this decision. Let me start by saying that yes, it is in part a decision based on financial means.  Even selling one’s home and the financial windfall that sale can represent may not provide enough funds for a couple or individual to move into a senior residential community – especially some of those that feature resort-like amenities in the Sun Belt or elsewhere.

Research among individuals who are “age-qualified” to reside in a senior residential facility offers some amazingly consistent findings.  First, only about one in twenty to one in ten individuals with enough income and assets actually want to live in a community of seniors.  What attracts these few to senior communities is fairly consistent. 

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