Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • older parentChicago's Geriatric Care Manager Center of Excellence

Advice from the Perspective of 100
This marks the 100th posting on our blog since its inception October, 2010, and it gave me pause to stop and...
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April 16, 2012
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In the Caregiver's Words

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Associate Care Manager Gregory Peebles returns with a series on the Internet and aging. Gregory is both a Certified Senior Advisor (CSA) and Certified Dementia Practitioner (CDP) 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 part of CCM, Inc. for over a decade. – Charlotte We think of the Internet as a place that caters to young people. While this is mostly true, it remains so only because that’s the way our culture trends--not because virtual reality becomes suddenly indecipherable to those of us who have crossed the threshold of middle age (or older). As we mentioned in this topic’s introductory post, recent data tell us that at least two-thirds of Americans 65+ have a reason to be online. So what are they doing? Where are they? Let’s take a quick look.
1. Email. This is still top of the game for our older community. In fact, the older a person is, the more likely they are to view email as a way of sharing information. This is the way the Silent Generation prefers to use the Internet: by staying in touch, more casually even than by using the telephone.
2. Shopping. Silver is where the gold is. Online marketers have figured out that aging adults spend more money online than any of their generational counterparts, and that the same people are more than twice as likely to spend on products that report improved quality of life, and vendors are taking note. Amazon recently developed the 50+ Active and Healthy Living Store, and its initial success will doubtless inspire more, similar online shops from already successful providers.
3. Socializing. Seniors are on Facebook, too! (And at a growing rate … a little more than half of folks surveyed; other social platforms don’t register anything close to these numbers.) Facebook has become the virtual town square to many Americans. More and more folks get some version of news media from the social giant. Facebook, which integrates new, non-social features, seems to be positioning itself to become The Only Internet Anyone Needs.
4. Dating. Online dating has taken a swift upturn in the last few years, and adults 60+ are the most rapidly growing group in the pool. While services like SeniorMatch are geared specifically to those looking for love later in life, Match.com reports 4.5 million active users in the demographic!
Now that we know where they are and what they’re doing, we can start to address issues of safety. Next week we’ll be talking about the security dangers that our older loved ones can face on-line. 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 and Amazon Best Selling author of a new guide for caregivers to older adults with dementia: How Do I Know You: A Caregiver’s Lifesaver for Dealing with Dementia
Associate Care Manager 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 part of CCM, Inc. for over a decade. – Charlotte This is the first 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.” As a care manager, I know first-hand that there are lots of people with the wrong idea that Medicare is a cheap, single-payer, universal care package for US citizens who have retired from the work force. There is a fantasy at work in the minds of many Americans that once they have “paid their dues” and transition into retirement that their medical concerns will be easier to manage, and that all care is covered. Unfortunately, folks who have enrolled in a Medicare plan and those helping to coordinate their care already know that this is only partially true. While Medicare, our government-subsidized health insurance program for adults 65 or older, is somewhat simpler to manage because it is a single-payer service, it has changed significantly since its implementation. But the real shock to many is that coverage was never meant to be universal. Medical providers who agree to take Medicare “assignments” agree to maximum prices able to be charged for services. This does keep costs down, and Medicare pays 80% of those contracted prices; however, service receivers are expected to pay the remaining 20% of costs, not including prescription drugs. When the source of payments is a fixed income, that income gets spent very quickly on covering the “gap” that Medicare does not pay. So, while Medicare may be inexpensive in comparison, it is still rarely easily afforded by those who use it. What Medicare was designed to be is a program to help offset medical costs for aging adults. It was consequently split into two broad categories – Medicare Parts A and B – which correspond to two primary methods of treatment. Part D, added later, supplemented Original Medicare as the trend for prescriptions for aging adults increased.
- 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 PCP visits, or referrals)
- Part D – [Addenddum under the Medicare Modernization Act of 2003] Covers select prescription drugs.
These broad categories do cover the bulk of what we would call internal medicine, yet there are surprising omissions in coverage, which we’ll talk about next time. Another consideration for those about to transition to Medicare is that the program is not one-size-fits-all; rather, it can be individualized (within limits) to the patient’s needs. Much like traditional insurance, if the selected plan is not optimal for the patient, parts of the plan can be modified during open-enrollment periods. We’ll talk about this, too, when we fill in another “gap” and talk about Medicare Part C. 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.
How many times have we all seen the commercial with the plaintive actor on the floor crying, "Help, I've _____ and I can't get up." No one would ignore a plea for help from an older person who has fallen and cannot get up. But a lot of caregivers may be ignoring a similar plea with all of the health threat that a fall can represent. It is just that this fall is in slow motion. And it goes like this: "Help, I am so fatigued that I don't feel like getting up." Tired often does not get enough attention in medical circles, but it is a common symptom reported by people age 65 and older. We tend to discount fatigue, because we cannot accept that a person who has retired and now enjoys six Saturdays and a Sunday every week could not be well-rested. And if you are a caregiver to an older loved one, you may find it a bit challenging to muster the sympathy for your older loved one when you already are stretched across your responsibilities for your children, your partner, your job and... Yet, we should all pay attention to the subjective complaints of fatigue in our older loved ones, because tired can be a symptom of more serious medical conditions and because tired can lead to serious physical decompensation. Let's start with the other medical conditions for which fatigue can be a warning sign. Perhaps the most common clinical condition that presents with fatigue is depression, itself one of the most common comorbidities of aging. Depression often can arise from the hallmark aspects of getting older - loss, diminished physical capacity and social isolation to name a few. Chronic fatigue also can be a symptom of sleep apnea, restless leg syndrome, fibromyalgia, chronic obstructive pulmonary disease and any number of heart conditions. Poor quality sleep may also be indicative of musculoskeletal conditions or pain. If your older loved one is consistently tired, it may be time to accompany them on a visit to their physician for an assessment and a conversation. Sleepiness can also be just one more step along the slippery slope to frailty. Fatigue can be a strong disincentive for your older loved one to be as active physically as they once may have been. Fatigue also puts a damper on appetite which in turn reduces the quality of the fuel the body consumes to run the body's engine which leads to increased tiredness and low motivation for physical activity. And all of this translates into decreased mobility and frailty. Medical professionals refer to frailty as a "pre-disability." So, if the tiredness has gone on for an extended time, begin to look for signs of genuine frailty. No surprise, the signs include exhaustion ("hyper fatigue?"). Frailty also is predicted by weakness in grip and slower walking pace. And by weakness, we mean a quantum reduction in ability to grasp, and by slower we are talking a fraction of former strides. All of these point to diminished physical activity. Think of frailty as one step away from a permanent reliance upon a walker or wheelchair. The next time you are speaking with an older individual who reports being consistently tired, it may be time to wake up and take stock of their overall health. 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@cr eativecaremanagement.com.
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We see a lot of therapies advertised commercially these days, and all of them talk about possible side effects – usually toward the end of the ad. My favorite is when they tell us that if we are allergic to the medication, we should not take it…if you haven’t heard this before, just listen until the very end of any of the ads on your cable network. But nobody talks about the side effect that is the sixth leading cause of mortality in the United States – behind stroke and ahead of Alzheimer’s disease - and it leads to an estimated 125,000 deaths a year. Ready for this? It is NOT taking your medication…they sometimes call it nonadherence or noncompliance, but it’s responsible for 10% of hospitalizations and costs the healthcare system an estimated $289 billion dollars a year, and yes, it kills 125,000 a year. (I know there is a difference between nonadherence and noncompliance, but we won’t get into that here.) And it’s not a really new phenomenon. Hippocrates even warned about noncompliance when he cautioned his medical students to “keep watch also on the fault of patients which makes them lie about taking things prescribed.” Sadly, some of the noncompliance among older adults comes from the financial strain of being on multiple meds that are so expensive that it forces them to choose between food and medication. But some of it also is just not fully comprehending the importance of what they take and when to take it. There are lots of technologies or gadgets that have built-in reminders for pill-taking like plastic boxes labeled for day of week, day of month or time of day. Some have beeping noises as an added reminder, and some actually will tell a potentially-forgetful patient not only when they should take a pill, but also if they already have taken their pill(s). If you are the caregiver to an older loved one, you may consider a bit of a test with your care receiver. In this test you simply ask your loved one about the medication(s) in question. Does the patient know what it is for? …what they are taking the medication to avoid? …or what sort of ill effect is a consequence of their not taking it? Many patients know only that a pill makes them dizzy or urinate more often or feel bloated or lose sleep. But they may not appreciate that the medication reduces their risk of stroke or a heart attack or improves the quality of their lives. How does one get to that point where the patient is motivated and therefore is compliant? First, it's a team effort; I like to call this “Team Mom” or Team ____ (whatever your loved one’s name is). The players on the team are you, a partner or spouse, the prescribing physician and the most important player, the patient. Help the star player, the patient, to translate the medication into something that is really valuable to them…make it personal. Then, identify any obstacles to compliance…forgetfulness, having the medication where they are at that particular time of day or night, side effects that are unacceptable, and such. And don’t forget patient educators, making generic alternatives available and making compliance count for them, the patient. And physicians suggest starting with modest first steps. Don’t take on all six medications the patient may be taking, but start with the two that are most critical to their health or start with the medication that has the most conspicuous benefit. Establish a pattern of conspicuous success…I call it catching them in the act of doing things right. Then continue by asking how many doses the patient may have missed since the last conversation…don’t ask if they are “taking their medications.” Who wouldn't just say yes to the first question? And scaring them does not work either! And I had mentioned technology. Just Google “medication reminders,” and you will see a host of options. And don’t forget that you can enlist the support of Alexa as a relatively pleasant verbal reminder for your loved one. 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.
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 to navigate a new medical condition or other complication for which a little support or explanation would be greatly appreciated. They have another window on their site that offers at least a couple dozen resources that may be just what you need. Please check out: Silverado Web Resources. It has everything from links to Alzheimer’s support groups to veteran’s health benefits and more.

If you find resources like these, please do not hesitate to pass them on to me, and I will share them on the blog site. Also, do not hesitate to send me your questions, and I will do my best to answer them.

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 throughout metropolitan Chicago. Please email your questions to Charlotte Bishop.

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