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Eight Questions You Should Ask a Geriatric Care Manager
Over the past couple years on more than one occasion I have talked about what a geriatric care manager...
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June 22, 2012
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In the Caregiver's Words

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It is November, and for most of us that means gearing up for the holidays, family and memorable events. The first two are true of almost everyone, but the third one - memorable - can be a huge challenge to caregivers and patients with Alzheimer's Disease. Caregivers to a loved one whose mental faculties are declining from Alzheimer's Disease can face a lot of challenges, not the least among them the guilt that can come from hosting a holiday get together when things just cannot be the way they used to be. Here are some tips for caregivers to a loved one with Alzheimer's or any of the dementias that may affect memory:
1. Take care of the caregiver: The person whose needs most often are at the bottom of the list is the caregiver to an AD patient. Do something for you, and it will make it easier to do all those other things for all those other people.
2. Be realistic: We all tend to have a notion about what the "holiday is supposed to be." That may not be feasible when a loved one has Alzheimer's, so work within the capabilities and the comfort zones of all concerned.
3. Include everyone in the plan: If you talk over plans for the holiday with all the family, it can help all to enjoy the event. Everyone will have had a say in what happens and expectations will be better met.
4. Avoid over-doing the alcohol: There is a great deal of loneliness in being a caregiver to a loved one in decline, so avoid the inclination to self-medicate. If you as a caregiver already feel melancholy, alcohol will only fuel the depression.
5. Let visitors know: If visiting family does not know exactly what to expect from a loved one with AD, they probably will not act appropriately. Help them to understand about talking and living in the moment.
6. Let your loved one know: For patients with early onset AD, there can be moments of lucidity as well as confusion. Help them to also be in the moment and not lapse into the sadness or even the angry outbursts that can come from AD's confusion.
7. Manage the environment: AD can be confusing enough without exacerbating the challenge with a noisy environment. Helping your loved one to engage people in quieter surroundings can help everyone communicate better.
As you navigate through the holidays, appreciate that they may not be as they once were before the intrusion of Alzheimer's, but you are making new memories for you and the rest of the family. With attention to some of these tips, you will find that the new experiences will help everyone's holidays to be their own new memories to cherish. Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care 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 info@creativecaremanagement.com.
I have had the good fortune to connect with Jennifer Mesko, Managing Editor of a great website and resource, Drugwatch.com. When I asked about the latest on dangerous medications or medical devices for those who are caregivers or in geriatric care management, she offered these comments.
Nearly every senior in the United States relies on one or more drugs or medical devices to improve their lives. Most of the time, these drugs and medical devices help them deal with pain or a medical condition, and keep up an active lifestyle –and they can even save their lives. Sometimes, however, drugs and medical devices do more harm than good. When a manufacturer fails to disclose the risks of its products, people can end up getting much worse instead of getting better. As a caregiver, you likely play a key role in someone else’s medical care and may be responsible for making sure medicine is taken on schedule – or that surgery is scheduled when necessary. Here are a few products you should be aware of: Dangerous Drugs Just like prescription drugs, some over-the-counter drugs can be dangerous. Tylenol, for example, is taken by millions of people every day. Just recently, however, reports of serious liver problems have come to light. The problem occurs when someone overdoses on Tylenol, often by accident. If one of your patients is taking cold medicine in addition to Tylenol, for example, you need to check to make sure the cold medicine does not also contain acetaminophen (the active ingredient in Tylenol). If more than 4,000 mg of Tylenol is taken within 24 hours, the drug builds up in the body and can overload the liver and cause organ damage or even death. Carefully monitor your loved one’s medications to ensure he or she is not taking too much acetaminophen at once. Another drug that caretakers should be especially careful with is Pradaxa. The drug is a blood thinner that reduces the risk of blood clots. Unfortunately, because the blood is thin, patients can experience uncontrollable bleeding after a minor scrape or cut. There is currently no antidote to this bleeding, which can lead to death. Reports show that Pradaxa side effects such as heart attack and uncontrollable bleeding led to more than 500 deaths in 2011. More than 1,000 patients and family members have filed lawsuits after Pradaxa injuries. Talk to the patient’s doctor to discuss what to do in a bleeding emergency. Dangerous Devices Your loved one may require a joint replacement, just like hundreds of thousands of others do each year. Most of the time, this type of surgery helps relieve pain and restore mobility. Unfortunately, not all hip and knee implants are safe or effective. Before the surgery, talk to the surgeon about which implant will be used. Some hips, including the Biomet M2a Magnum and Depuy ASR, can create problems because they have two or more metal parts. As the components rub against each other during normal activities, the implant sheds metal particles into the body. This can lead to metal poisoning, which requires revision surgery. Knee implants can also be problematic. Patients have reported numerous complications from the Zimmer NexGen Flex Knee system, including loosening, dislocation, implant failure and intense pain. Artificial knee joints are expected to last 10-15 years, but Zimmer NexGen implants can fail after just a couple of years. Drugs and medical devices are an important part of everyday life for most seniors. As a caregiver, it’s vital that you find out as much information as possible before dispensing medications or agreeing to a medical device for your loved one. Do your research, talk to the doctor and make sure that the ones you love avoid these dangerous outcomes. Jennifer Mesko is the managing editor of Drugwatch.com, a consumer advocacy website. She keeps consumers informed about prescription drugs and medical devices that could put them at risk.
Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are senior care management professionals, geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecaremanagement.com.
We do a lot of postings on dementia, in no small part because adults rank it as their number one concern, just above running out of money or dying. I have again asked our Vice President, Steve Steiber, Ph.D., to talk to us about what we may not know - but should know - about the evolving science around Alzheimer’s disease and treatment options. Steve has over twenty years of experience as a consultant to the pharmaceutical and biologic industry prior to joining us at Creative Care Management. He reports in this post on what may be a "light at the end of the tunnel we call Alzheimer's disease. What is the first thing you learn when you are admitted to a hospital, and this can be for outpatient or inpatient procedures? ONE SIZE DOES NOT FIT ALL! That applies to Alzheimer’s disease as well. There has been no blockbuster fix for Alzheimer’s, to date, but on closer examination of how people with different genes or with different make-ups respond, scientists are finding they react differently to medications. We already have seen this in cancer treatment, and it is a broad and promising side of medical care called genomics…sometimes called pharmacogenomics when referring to medicines and nutrigenomics for foods or supplements. When physicians look to a person’s specific genes, they can find people who may respond a lot better than someone without those genes. They call it “personalized medicine,” and it is showing some real promise. Let's start with a clinical failure that may actually be something else altogether: tramiprosate (an antiaggregation of amyloid agent). Earlier this year results from a phase 3 clinical trial (this is the final phase for a drug to be up for possible approval by FDA) for tramiprosate showed no appreciable improvement, on average, for Alzheimer’s subjects in the trial versus those on placebo. I said, “On average.” When scientists later looked more closely at the genetic makeup of patients in the trial, they found that those patients with two copies of the APOE4-gene had markedly better results than those with only one or no copies of this gene. Scientists are reassessing how these patients and those with the APOE3 gene respond, especially since these latter are at greater risk for developing Alzheimer’s disease. Worth a second look, for sure. I also mentioned nutraceuticals. In a European study some time ago, there seemed to be some promise for vitamin D as a protective agent against Alzheimer’s. As scientists looked specifically at the patients with two copies of the APOE4 gene and taking vitamin D, they found those patients had better memory scores than those on placebo or without the gene. Vitamin D in the absence of the two gene copies did not seem to do as well. Scientists are also looking more closely at omega-3, what we sometimes refer to as fish oil (it is only in the fish oil, because that is where it is stored after fish eat the algae that contain the omega-3). And there are multiple types of omega-3, two of which are particularly “brain-healthy.” Scientists have a couple challenges here. One, the brain’s absorption of the healthy omega-3 takes a few years, and there also is a difference in the genes I mentioned above. This may take longer to get good evidence, but it also is promising. There also is research into limiting environmental risk for developing Alzheimer’s that is linked to both the APOE4 gene and the presence of pesticides like DDT and its metabolic cousin, DDE. While DDT has been banned in America for some time, its metabolite, DDE, is still around. Preliminary research suggests that it is not just the DDE or just the APOE4 gene, but the presence of both that is associated with higher incidence of Alzheimer’s. While these early findings will not tell you what to ask your physician about diet or medications, it is a cautionary note for all who live in or near agricultural regions. The lesson learned again is that we likely have just begun to tap the genotypic profiles that may lend themselves to less versus more risk or less versus more success. The oncology field has begun to get better and better results in their fights across a number of cancer types by paying attention to genes that can predispose individuals to either greater risks or to better outcomes. It just may be that Alzheimer’s disease can follow the same model. Creative Care 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 info@creativecaremanagement.com
Gregory Peebles is a Certified Senior Advisor (CSA), Certified Dementia Practitioner (CDP) and trained Medicare Counselor, whose work focuses on helping aging adults and folks with limited independence by providing resources and support to help them discover and lead their best life. Gregory has been a key member of the CCM team for over a decade. – Charlotte This is the second installment in a three-part series to help clear up some common misconceptions about Medicare. Medicare isn’t intentionally confusing, but with all the cross-talk surrounding Medicare, even if understanding it isn’t as intuitive as “1,2,3”, it’s at least as easy as “A, B, D.” In the last post, I discussed the structure of Medicare, and its division into two main parts (A & B) and a supplemental part (D). In review, the major portions of the program look like this:
- Part A – “Original Medicare”, covers in-patient stays (including hospital stays, or stays in rehab facilities, etc.)
- Part B – “Original Medicare”, covers physician visits (including Primary Care Provider visits, or referrals)
- Part D – added under the Medicare Modernization Act of 2003, covers select prescription drugs.
Let me start with some of Medicare’s surprising omissions of coverage. Again, the way the public thinks that the service works and how the service functions in practice are not the same. For example, Part A is designed for stays in medical facilities, but not all stays, and not all facilities are covered. The same can be said for Part B, which does not cover all physician office visits. How does this work? While most traditional, scheduled physician visits are covered, you shouldn’t expect to be covered by Medicare Part B for:
- Most dental care
- Eye exams related to prescribing glasses
- Dentures
- Cosmetic surgery
- Acupuncture
- Hearing aids and exams for fitting them
- Routine foot care
Which facility stays are not covered under Medicare Part A?:
- Long-term care
- “Custodial” care
It may come as a shock to many, but Medicare does not pay any part of the cost for permanent residence in a Skilled Nursing Facility (commonly called a Nursing Home). Without long-term care insurance, many aging adults find themselves unsure how to manage to pay for extended, custodial care. Next week, we’ll talk about options to close the “gaps” in coverage and how folks covered by Medicare are planning for themselves with the help of Medicare Counselors. Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.
When we speak of dementia, it almost invariably is about Alzheimer’s Disease, but there are multiple types of cognitive decline that fall under the heading of dementia. In fact, the second most common dementia – accounting for 15-20 percent of all dementia cases - behind Alzheimer’s Disease actually has an important attribute that its more common and better known sibling does not have. Vascular dementia actually can be prevented in much the same way that cardiovascular disease can be prevented…through diet. Over the past decades, we have radically improved lifestyle and health style understanding of what causes heart disease. By extension we also have improved our understanding of vascular health which means we are better able to prevent heart attacks/myocardial infarctions as well as strokes. Most people, if asked, can tell you what their good cholesterol (HDL) and bad cholesterol (LDL) numbers are or at least if they are “good” or “bad.” Surgeons have become quite talented at eliminating blockages around the heart and also in addressing some of the potential vascular threats that could become strokes. They have not become quite as good at preventing or removing the threats of mini- or major strokes. But the vascular element that is shared across the types of strokes could be lumped into two categories of diet that we could refer to as “heart healthy” and “head healthy.” But just as there are people who don’t pay much attention to their diet and exercise as ways to live healthier by being thoughtful of their heart health, there may also be a shortage of people who will work to maintain “head health.” Scientists in France examined a large sample of over 1,600 people whose mean age was 72.3 years and 63% of whom were women. They looked for diet differences that could predict “cardiovascular disease burden” (CVD) which, in turn, could predict vascular dementia. People who were under 75 years of age who also consumed two to three portions of fish weekly helped reduce their CVD risk for vascular dementia as much as having hypertension increased the risk of vascular dementia. For people over 75 years of age the effects were not as strong. So, what does this tell us? First, one has to start early in a healthy diet to have a significant effect on brain health. But it likely is never too late to change diet for the better. You just get more return on your dietary investment before age 75. Something for both you and your older loved ones to “chew on.” Charlotte Bishop is a Caregiver Coach, an Aging Life Care Advisor, a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.
There is an epidemic going on, and it involves that butterfly shaped gland in the neck call the thyroid. Since 2002 the prevalence has doubled in the US, but this is not because twice as many people have developed hypothyroidism as it is that the professional society that represents endocrinologists established new standards. The new standards for defining hypothyroidism have reduced the TSH (thyroid-stimulating hormone) range to be .3 to 3.0 from the earlier standard that had been about .5 to 5.0. And this is not just a trivial matter of definitions when what had been about 15 million people with hypothyroidism suddenly becomes about 27 million Americans. This is about one in ten Americans, and the prevalence of hypothyroidism is about twice as high among women over 60 years as it is for their younger counterparts. (Just for what it's worth, this is more people than the number diagnosed as diabetic in America.) Hypothyroidism is important also because there is a big connection between the thyroid gland in your older loved one's neck and their brain and heart. For anyone whose TSH levels are out of range, the impact on the heart would be through the potential for significantly elevated cholesterol levels. It is estimated that this could be as many as 10 million Americans. So, for people whose thyroid condition has not been diagnosed, but they have been put on lipid-lowering agents like the statins, their cure may be even easier. By taking a thyroid supplement, suddenly cholesterol levels may become better managed. Yet, fewer than half the adults with diagnosed elevated cholesterol levels in a recent survey were aware if they had ever been tested for elevated TSH levels. I had mentioned the brain connection, and there are two significant brain manifestations of hypothyroidism. Patients who are out of range on their TSH levels may be depressed or they may display signs of delirium. The former may have led to treatment with antidepressants, treatments that may now prove unnecessary, and the latter may be confused with dementia if the delirium goes unchecked over time. And there are other symptoms of hypothyroidism that you should be looking for if you are a caregiver to an older loved one: • thin, brittle, dry hair or skin • increased sensitivity to cold • fatigue • muscle or joint pains • constipation. You don't need to remember all the signs and symptoms of hypothyroidism, but you should remember to ask your loved one's physicians at the next annual physical what your loved one's TSH level is. If the number is too high or too low, begin advocating for help to avoid the other conditions. Yes, your loved one may take home one new prescription, but they also may get rid of one or more existing prescriptions...and feel a lot better. Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care 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 info@creativecaremanagement.com.

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