Geriatric Care Management Blog

As any physician or person with insulin-dependent diabetes can tell you, it is a medical condition that is easy to live with so long as you control the diabetes and do not let the diabetes control you.  It is when a diabetic’s normal routine is interrupted that rethinking control can be very important.  Here are six travel tips that can help keep control and make travel the fun that it should be for older adults with diabetes..or travelers of any age for that matter. Paperwork for Travel.  To avoid any issues with security in a heightened alert age, get a current prescription from your provider.  Also, ask for a short document that describes all the pills, needles, test devices, vials and such that are part of your regimen. Stay in Motion.  True, travel by air is by way of a plane in motion, but if you are a diabetic it is very important to stay in motion as well.  Diabetes is a condition that affects the micro-vascular systems, and they also are more prone to clots.  Get up – when the captain allows...

Over the past couple years on more than one occasion I have talked about what a geriatric care manager (GCM) is.  Even though the national association that accredits professional geriatric care managers (NAPGCM )is about 30 years old, the question of what we are still comes up.  But there is more you should know about a care manager if you are one of the caregivers or family members looking to engage a geriatric care manager to help with your loved one.  Here are eight questions I recommend you ask anyone you are considering for your circle of care.

What are your credentials? A GCM should also have other training or credentials like a rehabilitation degree, nursing diploma or social worker license in addition to being certified as a GCM.  Ask about that. Are you certified or licensed? Are they a certified geriatric care manager or simply providing services to older adults? Just as you would not want a lawyer who did not pass the bar or an accountant...

In an age of high tech health care, it is really gratifying to know that something as simple and personal as human touch can make a difference in the life of an older person.  By stimulating the receptors that are just beneath skin, massage can bolster an individual’s immune system, reduce their stress level and generally improve their mood and sense of well-being.  Gentle massage of an older person also will improve their blood circulation, ease their aches or pains and enhance their emotional outlook. Anyone who has raised kids knows that sometimes it is just a hug, a kiss, or a gentle touch that takes away the stress or hurt of an infant.  And we all know that holding hands, a pat on the back or a kindly touch conveys so much in the way of a feel good to another person with whom we want to connect.  So, if you have an older person in your orbit, try one of these four approaches to enhance their health and well-being: Compression and Release – starting at the wrist and working your way up a person’s...

    This marks the 100th posting on our blog since its inception October, 2010, and it gave me pause to stop and reflect on what one learns at 100.  So, whom better to ask than people who have had 100 birthdays, made it to that milestone and have been paying attention along the way.  I have gathered together here a short compilation of wisdom from some centenarians whom I felt had something to offer the rest of us.  You tell me what you think.

    Ruth offers advice on life and style.  Appreciate that Ruth lifts weights everyday and practices Pilates weekly, an activity she just picked up when she was 92.  Perhaps her most memorable piece of advice is about time and age; she says, “Don't look at the calendar just keep celebrating every day.”  This, from a lady who does not wear blue jeans and makes herself get up and out every day for at least a short walk.  (And she is a real believer in the values of...

Health care providers call them decubitus ulcers, but most people know these pressure wounds on the skin as bedsores.  Although bedsores as a medical condition are not tracked by the Centers for Disease Control, it is generally estimated that about two million Americans suffer with these ulcers any given year.  The vast majority of pressure ulcers occur among adults in their 70’s or 80’s, but the real cause is not age; it is lack of mobility.  An unfortunate – and high profile – case in point was the late actor, Christopher Reeve.  He did not succumb to his paralysis, per se.  He died of a systemic infection that began in a pressure ulcer in 2004. But older adults are the more common victims of bedsores for a lot of reasons.  They have more fragile skin to begin with, a natural outcome of aging.  They also tend to be less hydrated and have relatively poorer nutrition, both conditions which make for less healthy skin and for poorer circulation and healing if there is a wound.  Elders who may be bed ridden or...

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...

If you take a straw poll of any gathering of older adults or their caregivers you are likely to find that what they fear most is not their death, but their loss of their mental faculties.  Yet, about one in every four persons who begins to manifest that cloudy thinking we all fear is some form of dementia may actually have a reversible condition.  And this condition may be brought on by allergy medications or some other prescriptions as well as some over the counter medications. Researchers from the Alzheimer’s Association have reviewed studies from large clinics around the country and report up to 25 percent of people who come to specialists fearing they have dementia really are suffering from bad medicine instead.  Most often the culprit is a family of drugs referred to anticholinergics, drugs that are common to a wide range of medications ranging from anti-depressants and pain killers to antihistamines.  And the cloud that they create in a person’s mind usually is the result of side effects of the medications....

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....

You may have heard about some surgical procedures that are considered risky, but did you know that a number of surgical procedures are even riskier for nursing home residents than they are for non-institutionalized older adults. Research reported by Dr. Emily Finlayson, a surgeon at the University of California, San Francisco, and her colleagues in The Annals of Surgery says exactly that.  If you are a caregiver to an older adult, particularly one who may now live in a nursing home, you need to be an informed advocate on behalf of that person.     Dr. Finlayson and her colleagues used data reported by Medicare on patients 65 and older to compare surgical patients who lived in nursing homes and those who did not.  The samples for each group were impressively large – nearly 71,000 nursing home residents and over a million 65+ year olds who did not live in a nursing home.  The doctor matched both samples on their actual ages and the numbers of other chronic medical conditions they had prior to their surgeries.   ...

It is probably safe to say that some of the fun has gone out of flying in the past decade or so.  And that is if you are physically fit and/or do not fly frequently.  Anyone who has tried to help an older parent or someone else with special needs get from point A to point B by flying can tell you that it can be daunting, but let me share nine suggestions based on what I have found. Plan ahead.  This is first, because it will help with everything else on an elder’s trip if you make plans and special requests well ahead of the flight date, some of these as the reservation itself is made. When booking a flight also make as many requests as you can think of, extra leg room, expedited boarding or wheelchair assistance. Even if your elder does not need a wheelchair, many of the larger airports have carts that will help transport the flier to their gate or between gates when connecting.  If you call at least 48 hours in advance, some of the airlines will actually assign one of their staff as an escort for and older or physically-challenged flier.  There may be a charge for the service, but it can be very much worth the fee....

You may have heard about the glories of the “only child,” you know….the stories about not having to share with other siblings, about being mom and dad’s favorite.  Well, those of you who have been raised as only children know that it is probably not all that great all the time.  And when it comes to being the only caregiver to older parents, being the only child goes from being special to being on your own.  But it does not have to be. The recession we have experienced over these recent years combined with other social forces makes the one child family the fastest group type of family according to the U.S. Census.  There are currently 20 million families in America today that have only one child, and the percentage of American women having only one child has more than doubled in the past twenty years.  But I am not writing about raising a solo child today; I am looking at the burden of caregiving that falls upon the only child when mom and dad get older and need help. IF you are in the category of...

February gives us Valentine’s Day, and February also is American Heart Month, a really good time to talk about cardiovascular wellness. The average human heart beats more than 100,000 times a day and pumps about 1,800 gallons of blood in the process.  Working that hard, it may be little surprise that cardiac-related conditions represent about 27 percent of all deaths in Americans.  That percent increases to 40 percent of all mortality for those ages 65 to 74 and as high as 60 percent of the deaths of people 80 years or older. Aging sets in motion some trends which help explain the increase in mortality:

As arteries age, they become less flexible which can increase blood pressure Mitral valves in the ventricles of older hearts close more slowly which contributes to a slower flow rate The resting heart rate slows and the exercise capacity of the heart decreases with age as well Older hearts do not squeeze as efficiently and the heart actually enlarges as the cells themselves expand...

As older parents increase elect to “age in place” caregivers may face challenges on two fronts.  It is partly the aging of the older parent you need to be mindful of, and the other part is about the condition of the aging home as that adult lives there more years.  Since many older adults for whom some of you may be caregivers may be living in multi-level homes, please allow me to offer some pointers on how to avoid falls, particularly on stairs. Lighting.  The easy part is to check that the maximum wattage bulb is in place in the stairway to give an older adults’ eyes a chance to clearly see the steps.  Beware not to exceed the recommend wattage for the fixture, but don’t skimp by placing low wattage in an area that may not get any other ambient light.   When you have installed the optimum wattage check out the stairway from all angles to be sure there is no glare from certain positions that would make it difficult for an older person to see and therefore navigate the steps.  Consider also installing switches at both the top and bottom of ...

With this posting, I am introducing a colleague and guest blogger, Pamela Holtzman, who is a therapist I know locally.  Pamela is an R.N and L.C.S.W. who combines her medical background with a combination of cognitive therapy, traumatic release with EMDR and EFT and integrative psychotherapy, to facilitate wholeness and wellness, in her clients. Her perspectives on being well while getting older are worth sharing:  “Have you had that birthday yet which made you suddenly realize that you really are getting older? I don’t mean older in a decrepit, breaking down way. I mean older in a wiser, stronger, and more mature way. I had discovered that I had reached that phase during my recent 60th birthday “initiation by storm” as I came face to face with IRENE, the Class 3 hurricane that wreaked havoc at the doorstep of our home in the Bahamas. What followed was a week-long power outage, and a chance to do a lot of soul searching. As...

It’s a subject I come back to frequently, because each year almost a million adults over age 65 are treated in hospital emergency rooms for injuries in their own homes.  Many of these injuries could have been prevented.  Just as you never wanted to get F’s in school, you do not want these two F’s in an older adult’s home.  These are preventable:  Falls and Fires.  If you are a caregiver to a senior living independently, please give this a read...and grade appropriately. FIRES:  Regarding fires, some of the places at home that would have been safe when a person was younger can become life-threatening hazards as one becomes older.  Older parents may be living in older homes and feeling some of the draft and cold that were never problems when they were younger, so they do the obvious.  They place space heaters in specific locations in the house where they may feel drafts and cold.  As a rule, that may not be a real problem.  But recall from some of my earlier postings that older adults are not as nimble on their feet and stray cords or the heaters themselves may be obstacles as they move from room to room.  ...

For those of you with a loved one who suffers from dementia of any sort, it is hard to see them fade in their ability to remember familiar surroundings, important experiences from the past or even remember you.  And as if that is not enough to manage as a caregiver, your loved one may also at times become inexplicably angry or aggressive.  So what can you do when dementia becomes violent? It is really critical that you always remember that the dementia is not about you, and it is not even really about the parent who once walked you to school, or down the aisle if you are married, or any of the countless other wonderful episodes in your collective life.  It is about the dementia and you cannot reason with it.   The Alzheimer’s Association, an organization founded to provide optimal care and services to individuals confronting dementia, and to their caregivers and families, offers some very helpful advice.  When you are with a person suffering from dementia, and they become aggressive...

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...

    If you will be heading home for any of these seasonal holidays you will find that it can be a wonderful trip back in time as you revisit your own family history in the context of your mom’s or dad’s house.  But when you visit, take a closer look at how safe that house may still be for your older parent living there.  Some parts of the home interior landscape may be just like you remember them, but they may now pose hazards to your older parents.     Start with electrical fixtures.  Check for where the cords to lamps or telephones and other household appliances are.  If they are in the flow of traffic, consider arranging furniture differently.  Also, remember that extension cords are really only meant for temporary use, so it is a good idea to move fixtures to be closer to outlets.  If you must use an extension cord, place it against a wall to reduce the trip hazard. If there are electrical cords under furniture, check for wear on the insulation to avoid fire risks.  Cords under...

    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.”...

It has been over a year since my first posting when I started this blog by talking about why a person should call a Geriatric Care Manager (GCM).  Since I have answered this question with almost everyone of the calls I get from people looking for our help, it seemed like a good idea to revisit our “job description.”  GCMs are:

Local professionals who know what resources are appropriate for your older loved one and which are most appropriate.  What I often tell people is that we are “option-makers” for the decision-maker.” 

Eyes and ears that can help long distance caregivers be aware of any changes that may affect an older parent’s independence or well-being.  The long distance family caregiver may have bought mom the walker, but the local GCM can be there to see whether mom is using it.

Bridges to help an older family member make life transitions from fully independent living through home assistance and ultimately to assisted living at the appropriate...

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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If you or someone you know is approaching the “landmark age” of 65 expecting that Medicare coverage means that worries about covering health care are over, I have some bad news for you.  Even if you have Medicare coverage, you will need what is called supplemental health care insurance.  And this supplemental policy in the form of Medigap or Medicare Advantage is not likely to cover all the deductibles or dental, eye or hearing care.  Approaching age 65, you should begin planning for what the annual costs are likely to be so that you make the best choices among your insurance options. How much more will a person spend on health care expenses after they retire?  According to the Benefit Research Institute women will need an average of $93,000 to cover their added health care costs beginning at 65 and over their life time.  In part because they simply will not live as long as women men will need an added $65,000 to cover their retirement health care expenses. About half of the women turning 65 this past year...

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...

It is National Hospice Month, and I thought that it would be a great opportunity to debunk five myths about hospice care, an aspect of health care that is always on the radar of a geriatric care manager.  A lot of folks think of hospice care right up there with a funeral home.  While that may be partly true, it is really critical for everyone who has an older parent or aging spouse with terminal issues to recognize that hospice care is really about taking care of quality of life.  So, please allow me to walk you through the five common notions people have about hospice care…and the real deal. 

“Hospice” is where people are sent when they have no options.

Hospice is where one turns when they want something more than just letting things run their course.  It is about a “comfort-oriented” approach to care.  Think of it as another mode of therapy…and yes, it may be more appropriate when one has a terminal condition.  But, it is not about giving up…it is about taking care of the patient...

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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Illinois long term care has been ranked at about number 24 out of the 50 United States on a number of dimensions by AARP, The Commonwealth Fund and The Scan Foundation.  So, does that mean that Illinois’ long term care glass is half full or half empty?  Let me share my perspective as a geriatric care manager on some of the details of this national study so that you can be the judge not just about the national study, but also about facilities you may be investigating for an elder or other special needs individual in your orbit. The report is enlightening in how it rates and ranks what it refers to as long-term services and supports (LTSS) on four important dimensions.  And this is the first of its kind multi-dimensional scorecard on state-level performance.  When I mentioned that Illinois ranks number 24, that is an average across all four dimensions.  In reality, the state ranks:

Number 12 in affordability and access which they calculate based on a numberof indicators such as the private pay...

With a lot of talk these days about children moving back in with parents and intergenerational homes, it is easy to overlook the huge growth in “distance caregiving” in America.  In 1997 the number of distance caregivers - family who are caring for an older parent in another location – was about 7 million; it has since doubled to an estimated 14 million today.  I came across a study on distance caregiving by a nurse oncologist, Polly Mazanec, that addressed a lot of the issues I see as a geriatric care manager with my own clients.  We often get a call from a son or daughter (and yes, it is more often a daughter), because they are concerned about some life issue of an older parent who still resides here where we work.   It can be a change for the worse in a chronic medical condition, a sense that the parent is “confused,” a progression of a cancer, a fall or a home security concern.  But almost without exception,...

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...

Scientists have reported exciting research on Alzheimer’s disease that points to risk factors which, if reduced by 25%, could cut the world-wide prevalence of Alzheimer’s by ten percent.   If these findings are supported by future research, the reduction could translate into more than three million fewer cases of 34 million cases of Alzheimer’s reported globally.  Reducing the risky conditions or behaviors by even ten percent could reduce the number of cases of Alzheimer’s world-wide by about 1.1 million. In my experience as a geriatric care manager, one of the hardest medical conditions that I help families with is Alzheimer’s or other forms of dementia.  This is truly hard not just on the patient who loses their mental faculties and with them the ability to maintain quality of life, but it also very much affects the caregivers who watch their loved ones simply fade away.  But researchers from the University of California, San Francisco, have reported...

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...

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...

Even the Centers for Disease Control and Prevention have documented that providers are spending less time with patients in their offices, only an estimated 15 to 20 minutes.  If you are a caregiver, you can help your elder or other special needs loved one make the most of their next office visit as well as their hospital stay where providers also may have limited time with each patient.  As a geriatric care manager in this role, I always work to be well-prepared for a visit in any of these clinical settings and also to take careful notes that I can reference later when I am in “care planning” mode.  Here are some ways that those of you who are caregivers can also be more effective care managers and care planners. First step before a visit to a physicians’ office or hospital is to be prepared with all appropriate medical emergency information which will include “Medic Alert” information on allergies, special medical conditions or implants or other...

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...

Legal trusts can help a disabled individual get added help beyond what government programs like Medicaid offer and without sacrificing what these programs do offer.  You may recall Gordon Gault, a Chicago attorney who specializes in trusts, wills and probate among other legal areas, who spoke with me some time ago about guardianship.  Recently we also talked about trusts available for elders or others with special needs.  Gordon explained that the concept behind a special needs trust is that a person can qualify for Medicaid, Social Security and other government programs while at the same time having money set aside for supplemental services or benefits.  In Illinois a trust can be handled in one of three ways. 

A special needs trust means that the benefits are not for room and board, but for special, or supplemental, needs.  This trust is established by some one other than the disabled person so that the disabled person can receive  government benefits to which...

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:...

This is my last posting of our three-part series with John Wank, President of the Illinois Guardianship Association.  He concludes our series with these answers to some final questions.

What are the limits, liabilities and responsibilities of guardianship? Guardianship is a public legal proceeding, with all cases beginning with the filing of a detailed medical report that will be viewed by the judge, a guardian ad litem and others.  Personal and financial information of all kinds may then become a subject of the guardianship proceeding and open to public view.  Persons with the ability to plan often consider the establishment of health-care proxies (powers of attorney, living wills) and other legal alternatives such as the trusts, joint ownership accounts, estate plans, and the like. Guardianship is always available for those who cannot plan or fail to do so. Can there be separate guardians for financial, health and other needs? Yes....

I started in my last posting with a Q and A with John Wank, President of the Illinois Guardianship Association.  He continues this second with his answers to our questions in this the second in a three-part series. You are General Counsel and Director of Program with the Illinois Guardianship and Advocacy Commission. What does the Commission do? As the largest public guardian in the United States, the Office of State Guardian (OSG) handles personal or financial decisions for more than 5,000 disabled adults.  Nearly all OSG wards are indigent persons, with costs of care paid by public entitlements. Nearly all OSG front-line staff are Registered Certified Guardians (RCG) under the program administered by the Center for Guardianship Certification.

Legal Advocacy Service (LAS), is the statewide public agency that provides court-appointed legal counsel and representation to vulnerable children and adults with mental...

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...

In my last posting I spoke to ways to improve the safety and accessibility of the bath for seniors who choose to age in place at home.  Some of the same preventive measures can apply to the kitchen, but the kitchen also poses some of its own unique hazards. 

As with the bath, beware of scatter rugs in front of sinks or food preparation areas.  Areas that may be targets for water or grease spills should have non-slip mats or nothing at all.   Check all thresholds leading to and from the kitchen to be sure there is nothing that may be trip hazard to individuals whose stride may be devolving to a shuffle.  For individuals who may be unsteady on their feet, consider grip bars in key spots as well as check the walkways in and around dining areas to make sure there is enough clearance for easy mobility.  Also look for electric cords or clutter on the floor.

As with all areas of the house, check to see how much wattage can be accommodated by fixtures, and maximize the light while also minimizing the shadows...

I promised in my last posting to talk more specifically about what can be made safe for seniors who wish to age in place – room by room.  I am going to start with the room in the home where most accidents happen, the bath.  The bathroom for most elders represents the perfect storm of a confined space with potentially slippery surfaces.  Nearly one-third of seniors over age 65 fall each year, and the majority of these falls happen in the bathroom.  With basic planning and potentially some retrofitting, however, the bath can be made more safe and accommodating to an older person’s limited mobility and range of motion.  Let’s start with surfaces.

There may already be a rug near the shower or bath area, but make certain it has a sticky, non-slip back to minimize falls when an elder enters or leaves the tub.  If your older loved one uses a floor mat in the tub area when showering, make sure that the suction cups still offer good sticking poser.  You may consider adhesive decals that stick to the porcelain tub...

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...

As a geriatric care manager, we have knowledge of Alzheimer’s Disease and its progression, less about its causes and its treatment, but we cannot know Alzheimer’s like a patient with the condition can.  I recently was introduced to the writings of an “expert” who has gained his insights by being an Alzheimer’s patient since he was first diagnosed with dementia which has been presumed to be Alzheimer’s at age 58.  Now 65 years old, Richard Taylor, Ph.D., a psychologist, has written a book titled Alzheimer’s from the Inside Out, and he issues a monthly newsletter on the subject.  The following is an excerpt from his most recent newsletter.  For those who are caregivers or family members of a patient with Alzheimer’s, this may offer some sense of living with the condition from the patient’s point of view:

“I am Richard, an individual living with the symptoms of dementia, probably (maybe) of the Alzheimer's type. This is my monthly newsletter for February, the month of my birth (Chicago, Illinois/Jackson Park...

Deciding on whether to move and then deciding which senior residential option is best can be stressful for a senior and a caregiver, and then comes the move.  It is not as easy as packing a son or daughter off to college, because relocating an older adult is really about packing up the possessions of a lifetime.  Moving day and its run-up can be challenging with all there is to organize and coordinate, but fortunately there actually are experts trained in helping to make the move smoother and less stressful.  These professionals know that the move and its associated packing is more than just moving furniture.

As a geriatric care manager I am not only called on to help facilitate good choices of a facility, but also to lend a hand or an ear in my role as resource, counselor, advocate, and local friend throughout a move.  There also is the National Association of Senior Move Managers (NASMM); check out their web site.  NASMM (pronounced NAS-em) is – in their words - a not-for-profit, professional association of organizations dedicated to assisting older adults and families with the physical and emotional demands of later life living including downsizing, relocating, or modifying their homes.

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When your loved one comes to you about a possible move to senior residential living, it is like when you helped a son or daughter apply to and select a college – except, of course, that the community has a higher average age and you do not need to focus on a major.  This parallel of selecting a college actually offers some insights into how one can productively have that conversation and sort through the selections when it comes to helping an elder decide how to move from their home of 30+ years to a whole new world. 

As a geriatric care manager I am often called on to help select the “right senior community” for an elder in the family, and most times there are options.  So, it is like picking the “right college,” the number and variety of choices can be daunting.  As a caregiver, you need to make sure that moving is your loved one’s choice, and you also should identify what is motivating a move.  Typical “motivators” include:

Seeking a residence with less maintenance (mowing lawns, etc.) ...

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...

As a geriatric care manager, I often find clients who are on the right medications, but they are overwhelmed by the numbers and schedules of their meds.  Older adults consume an average of four or five prescription medications a day along with two more over the counter (OTC) drugs. While adults over the age of 65 represent only about 13% of the U.S. population, they consume about 30% of the prescriptions written in America today.  I wrote about this last November, and talked about the potential for drug-drug interactions and the unique challenges to the health of an older person’s slower metabolism and lower hydration.  I also discussed how one of the important tasks for a caregiver is to ask for a pharmacist or geriatric care manager to do a “medication audit” to be assured that the older patient is not at risk for adverse drug events or interactions. What I did not devote much space to in that earlier blog is how multiple medications very simply present a real challenge to an older...

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...

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.   ...

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. ...

February is American Heart Month.  Despite the fact that we hear a lot of news about cancer, cardiovascular disease is the number one killer in America today, accounting for just a bit over one-third of all deaths in the most recent reporting year.  To raise awareness and encourage better “heart health” each year since 1963 the American Heart Association along with the Centers for Disease Control and Prevention, the National Institutes for Health and some other government agencies compile the latest statistics on heart disease and stroke. Cardiovascular disease is important to me as a geriatric care manager (GCM), because it disproportionately targets older adults.  In 2007 – the most current year for which we have data – 251.2 of every 100,000 Americans died of cardiovascular...

Elisabeth Kubler-Ross introduced her five steps of grieving for a loved one who has died four decades ago in her book On Death and Dying.  A couple of new authors, Barbara Okun and Joseph Nowinski, have revised these five steps in light of our present day experience of dying which tends to be a more protracted process.  As a geriatric care manager, I find myself spending more time helping caregivers prepare for the death of a loved one than helping them after death has occurred.  The very practical fact is that people simply do not die in the same way they did nearly half a century ago.  We do not hear of folks just “dropping dead” as much as ultimately succumbing to a terminal disease from which they have been suffering for some time.  Modern medicine has given us more warnings of life-threatening conditions and more tools to forestall the assault of terminal conditions like cancer or heart and lung disease.  With that change in how we die has come a need to address the anticipatory trajectory...

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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I have been hearing that the web resources I have been offering in my postings have been informative and helpful.  I am regularly reminded that one of my principal roles as a geriatric care manager is to be a resource directing people to others.  And that those “others” are not just health care providers.  In keeping with that notion, I have compiled some web resources here that may prove useful for elders and others with special needs who may also be on limited budgets. These are just a few of the sites that you may find .useful, but may not always pop up in a web search engine when you are looking for answers to your elder law questions:

AARP has a program called Legal Counsel for the Elderly (LCE).  You may wish to join AARP – if you have not already – to get full access to this program, but it has much to offer individuals who wish to understand their rights as well as how to get legal paperwork for an elderly family member or loved one in order: Legal Council for the Elderly.

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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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I have talked in some of the recent blogs about when decision-making may transfer to another person from an individual whose own faculties may be failing.  Such is the case with powers of attorney as well as guardianships.  There also are decisions which need to be facilitated by a caregiver, but we need to know the difference between deciding for the older loved one or individual with special needs versus facilitating their own good decision.

In my role as a GCM I had a conversation with one of my clients recently about her car.  She is an 84-year old woman who has been living on her own since her husband died about six years ago.  Her husband had surrendered driving responsibilities to her some several years before his demise, and it was his initiative and his choice.

Recently, she asked me what I thought about her giving up driving.  The fact that she brought it up suggested to me that there may have been a precipitating event...

As a geriatric care manager, I have the chance to work with all manner of caregivers and the elders or others with special needs for whom they care.  Sometimes a caregiver becomes significantly more than the person who may help a loved one with shopping, cleaning or other personal needs.  There are occasions when that individual becomes sufficiently frail or mentally compromised that they need the support and control of a guardian.

I recently spoke with an attorney, Gordon Gault, who specializes in trusts, wills and probate among other legal areas.  We talked about what a guardianship means and when it is appropriate as well as how it comes about.  Gordon first explained that a guardian is substantially different from just a caregiver in that a guardian must be appointed by a circuit court judge.  That appointed guardian is then able to act on behalf of the individual who is either under the age of 18 or is deemed disabled in some other way. ...

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...

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.

Earlier this month I had a chance to talk about some of the questions I most often get asked as a geriatric care manager.  In Chicago, there is a radio talk show on Chicago senior care and other topics that are relevant to elders.  It is called – appropriately – AgingInfoRadio, and the program airs every Thursday.

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.

Everyone's abilities and needs change as they age, but home may still be the same physical space it was twenty or more years ago. It's important not to wait until there is an accident to make changes that can help accommodate an older person's changing needs. It is easy to get ahead of where you need to be by presuming that the decision is about whether the best place for a loved one is home or an assisted living facility, a skilled nursing facility or some other new residence.

This is one of the most emotionally-charged questions I hear when I am called by a family member who is concerned for the well-being of their older parent/s living alone at home. There is a lot of emotional attachment to “home sweet home,” “home as castle” and more that has been learned over time. The question of whether home is still the best or safest place for an aging loved one is not just about the physical space.

This is the first of my blog series on the challenges faced by those who help elders or others with special needs.  We have heard it said that it takes a village to raise a child.  In my experience as a Geriatric Care Manager, I have found that it takes a village to care for our elders and others with special needs as well.