Chicago's Geriatric Care Manager Center of Excellence – Since 1991 | Chicago's Geriatric Care Manager Center of Excellence

Singing is a Breath of Fresh Air for Caregivers
Associate Care Manager Gregory is a Certified Senior Advisor (CSA) and Certified Dementia Practitioner (CDP) whose work focuses on...
Read more
February 12, 2018
0
0
A House is Not a Home (Part 3)
At CCM, home and safety are as important to us as to you, so it’s no surprise that it’s...
Read more
June 18, 2017
0
0
A House is not a Home (Unless You’re There)
At CCM, home and safety are as important to us as to you, so it’s no surprise that it’s...
Read more
June 5, 2017
0
0

In the Caregiver's Words

Recent Client Praise

I have asked our vice president for senior services, Steve Steiber, Ph.D. to share a guest posting about the recent news on prescribing combination medications including acetaminophen. Dr. Steiber has two decades experience in pharmaceutical and medical device consulting prior to joining CCM about 8 years ago. He reports: Let me start by saying very unequivocally that when taken as directed, Tylenol (acetaminophen) is a safe and effective analgesic. That said, the US Food and Drug Administration (FDA) has recently asked healthcare professionals to stop prescribing prescription pain relievers that contain more than 325 mg of acetaminophen per dose. The reason is very simply the potential for liver toxicity. This is not news. Medical providers have known for some time that acetaminophen in excess of 3,000 mgs a day can shut down the liver; some even place the bar lower at closer to 2,000 mgs. This latter threshold may be most appropriate for older adults as their systems do not process chemicals out of their bodies as readily as younger bodies do. The most recent attention from the FDA is for the number of what are called combination medications - those that contain two or more active ingredients. Acetaminophen is one of the more common additives to other pain medications, cold and flu medications or allergy medicine. In fact, - which contain Tylenol in addition to something else. It is estimated that there are in excess of 70 medications that contain some amount of Tylenol in combination with something else. FDA has set the dose limit of acetaminophen very simply because there seems to be no evidence that doses in excess of 325 mgs does any more good than the lesser dose. Although acetaminophen is classified along with drugs like naproxen or ibuprofen as non-steroidal anti-inflammatory drugs (NSAIDs), unlike these other two, it is a very weak anti-inflammatory. In short, more is not necessarily more effective. FDA's action will have the most direct impact on some of the heavy hitters among pain medications, those also containing an opioid like codeine, hydrocodone or oxycodone. In some of these mixtures, there is as much as a 750 mg dose of acetaminophen. According to the FDA: "There are no available data to show that taking more than 325 mg of acetaminophen per dosage unit provides additional benefit that outweighs the added risks for liver injury. Further, limiting the amount of acetaminophen per dosage unit will reduce the risk of severe liver injury from inadvertent acetaminophen overdose, which can lead to liver failure, liver transplant, and death." FDA had asked that drug manufacturers comply with this request by January 14 of this year, but it would still be advisable if you are a caregiver to an older loved one on one of the affected medications that you read the label and the doctor's recommended dose. This will be particularly true of over the counter (OTC) medicines that contain acetaminophen as they are not covered by this action. Please let Steve know if you have any questions about drugs, their side effects or the unique medical challenges faced by older adults or others with special needs. Please email to: ssteiber@creativecaremanagement.com
We have probably all used some expression about being "only as old as you feel" or know someone who is "young at heart" or my favorite that "you do have to grow older, but you do not have to grow up." Well you get where I am going. It is a medical fact that chronological age is not a truly accurate assessment of how well a person really is. If you are a caregiver for an older loved one, you may at times would like to know how well they really are, not just how well they may be cared for by their provider. Some researchers in Norway have come up with a way to calculate a person's fitness age, and this may be one that caregivers and older adults may both want to know. Fitness experts for a long time have known that one of the best ways to measure fitness is to measure an athlete's peak oxygen intake. To do that they run that athlete to their maximum exertion and then measure their VO2 max, or how effectively the body is delivering oxygen to the cells. In many big clinical studies, this has proved to be a pretty good predictor of how long a person may be expected to live. Well, not too many of us have access to the apparatus to measure our peak oxygen intake, so these Norwegian researchers found a reasonable alternative for estimating how old a person's health is using some measures that we all can record. First, the researchers measured the real peak oxygen intake of nearly 5,000 people whose ages ranged from 20 years old to 90. They also took a lot of other measurements and ultimately found that five really basic measurements do a very reliable job of predicting the fitness that peak oxygen intake measured. The five include:
- gender
- calendar age
- waist measurement
- resting pulse; and
- frequency and intensity of regular exercise.
For that last item, they have a brief check list for you to approximate the rigor of your weekly fitness routine, and for resting pulse, just find a quiet place and count your pulse for 30 seconds and then multiply times two. To let their algorithm tell you what your or your older loved one's fitness age is, just go to http://www.ntnu.edu/cerg/vo2max and plug in the numbers. No one can control their gender or their birthdays, but the exercise part and the waistline part are controllable. So, this is a way not only to find your "real age," but also to take years off that number. Good luck on that and Happy Birthdays.
Recently, I had the good fortune to speak with the chief executive of a national specialty, Monarch Specialty Pharmacy, who has advice for caregivers who may be trying to help manage the prescription drug costs of an older parent or other loved one who has Alzheimer's Disease. Stephen Cichy's advice distills down to four tips, one of which is to take advantage of a new discount prescription offering from his company. He talks about Alzheimer's Disease specifically, but you can see that this can apply to a lot of the chronic medical conditions older adults face. Please give it a read.

"I was recently browsing the internet and came across a published report regarding the problem of medication compliance with persons living with AD. Turns out that when persons living with AD get their prescriptions filled, they take their pills as prescribed only about half the time*. (*Curr Med Res Opin. 2010 Aug;26(8):1957-65).

In addition to the challenge of dealing with multiple daily pills and the persistent problem of memory loss, an important factor contributing to the problem of medication use for persons with AD is the high cost of drugs themselves.   Let’s face it, the price of prescriptions continues to soar. In fact, drug prices are the fastest growing chunk of consumers' healthcare expenses, according to the non-profit Families USA.

If you have health insurance, your plan may or may not pay for prescription medicine. It depends on what kind of insurance you have. For example, if you have private health insurance through your employer, some or all of the cost of your medicine may be covered. If you have the traditional Medicare plan (sometimes called fee-for-service), you'll need Medicare Part D to make sure your medicine is covered. If you have Medicaid, the Medicaid plan in your state may cover the cost of prescription medicines with certain restrictions.

As someone who cares for a loved one living with AD, you may know first-hand the complexities of dealing with the high cost of medication. What might not be so evident is the risk of not taking medication as prescribed. When a person’s AD goes untreated, they run the risk of their medical symptoms becoming exacerbated and may end up in the hospital emergency room, or worse, get admitted for conditions that could have been avoided had medications been more readily available earlier.

This problem is vexing, although I’ve learned several tactics that are helping persons living with AD pay for their medications, and that may be useful for you:

1.             Look Beyond Brand Names

Generic drugs can cost as much as 70% less than brand name prescription. Always ask your doctor or pharmacist if there is a generic equivalent for your prescribed medication!

2.            Leverage State and Community Programs

Some state governments offer affordable medicine programs for seniors, people who are disabled and people who have low incomes. Community health centers, Area Agencies on Aging, free health clinics and other community programs may also offer help. Some social agencies, such as the Salvation Army and some private hospitals, offer financial help for people who cannot afford prescription medicines. To use these services, you may need to show that you don't qualify for private health insurance or that you don't make enough money to pay for your own medicine.

3.             Maximize Prescription Assistance Programs

Patient-assistance programs (also called PAPs) are sponsored by companies that make prescription medicine. Each company has its own rules about who qualifies for its PAP. In many cases, you will need to show that you don't qualify for private or public health insurance (such as Medicare or Medicaid). You may also need to prove that your income is below a certain level.

Each PAP has its own application process. In many cases, your doctor, nurse or social worker will need to apply for you. For some programs, your doctor or nurse can submit an application online. For others, the application must be mailed in. It's important to keep in mind that applying for a PAP does not guarantee that you will get your medicine for free or at a lower price.

4.             Tap the GoRx Prescription Savings Program

Prescription savings programs are an innovative new approach to access to free savings on prescription drugs for persons without prescription coverage or for persons with prescription coverage who may require significant out-of-pocket expenses for their medications.

One such program is GoRx™ (www.GetGoRx.com). The GoRx prescription savings program is free and available to every person and family living with AD, with no age, income or health restriction. All commonly prescribed prescription medications are eligible for a discount. The discounts are available to consumers who do not have prescription drug insurance or the particular drug they need is not covered by their insurance. The average savings is 32 percent off the regular retail price the consumer would otherwise pay at the pharmacy. A majority of participating retail pharmacies will honor the GoRx Prescription Discount Card.

Simply put, GoRx™ is a simple and easy way to reduce your cost of prescription medication. The program covers practically any drug, including vitamins and supplements, so you don’t have to worry about checking if their prescription medication is part of the program. "

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 ccbishop@creativecasemanagement.com.
Yes, you are supposed to ask why being male and over 65 is a medical condition; so what do I mean by cure? The best "cure" at any age is appropriate prevention, and I would like to offer some prevention guidelines for any of you who have a loved one over age 65. I offer 65 because as we all age, what we should be screening tends to change along with the frequency of screening. I am starting with men in this posting, but I will offer a parallel "cure" for women in my next post. Blood Pressure - everyone should have their blood pressure documented annually, and hopefully by the same provider so that they can track any trends. If your older man already has diabetes or heart disease, this monitoring should be at much shorter intervals. Oral Hygiene - a cleaning and an exam once a year is the minimum, and most dentists recommend a cleaning twice a year. Appreciate that oral health is correlated with heart health, so consider your trip to the dentist to have more benefit that just a great smile. Cholesterol Levels - if your cholesterol have been within normal ranges in the past, you may need to check them only about every five years. As with blood pressure, however, if your older male has heart disease or diabetes, this should be more frequent. Colon Health - guidelines suggest annual stool sample screenings, but a flexible sigmoidoscopy is suggested only every five years and a colonoscopy every ten years. The U.S. Preventive Services Task Force has recommended talking with a provider after age 75 and no invasive testing after 85. All of this is much more aggressive for anyone with colon issues or cancer or who has a family history of any of that. Eye Health - a vision exam is generally recommended every other year as a screen for glaucoma or visual acuity, unless the older patient has diabetes. More frequent testing for a diabetic is recommended to watch for diabetic retinopathy. Immunizations - keeping current is the important part of immunizations. For pneumonia vaccines, every five years is recommended. Flu shots are an annual regimen given the variation in strains that are considered the biggest risks. A shingles vaccination may be a one shot matter, but ask your doctor, and a tetanus booster every ten years is recommended. For other immunizations or other infectious diseases consult a physician. Prostate Health - most doctors will test the size of the prostate during an annual exam, and the doctor also is the best one to advise on how often a patient should take a PSA test. Bone Density - although women are more at risk for osteoporosis than men, the risk increases appreciably after age 50. Taking in calcium and some vitamin D along with aerobic exercise will go far in maintaining bone health, but a physician may recommend how frequently to measure bone density. Everything else - annual exams are a great time to assess weight, height and hearing. It also can be a good time to check your 65 year old for signs of depression as well as go over all medications and any possible interactions or contraindications. 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.
Alzheimer’s Disease affects nearly 6 million Americans and despite having some clinical therapies that modestly impact the disease onset or progression, there is not yet a cure. Yet, there is accumulating evidence that the best “cure” for Alzheimer’s may be a lot like the cure for other chronic, degenerative diseases. That is, the best cure is in prevention, according to research reported in JAMA, Psychiatry. What I have to share today is not truly new, but the findings reported by some researchers in China suggest that certain “intellectual activities” can protect aging adults from the onset of Alzheimer’s. Other studies have shown that engaging in games and social contact is associated with lower rates of Alzheimer’s. This study, however, is noteworthy because it follows a very large number of subjects – more than 15,000 – and the researchers followed them for nearly seven years. The scientists further controlled for other factors that have muddied the research waters in the past, factors such as physical activities, other psychiatric issues and some social and demographic traits. The intellectual activities that had the effect of reducing the number of people who succumbed to Alzheimer’s disease were as simple as reading or playing card or board games….even betting on horse races. Active participation in intellectual activities, such as reading and playing board games or card games, may delay or prevent dementia in older adults, even if these activities take place in late life, this new research suggests. All subjects in the study were at least 65 years old, and the researchers found that by year three they could identify individuals who had some measurable cognitive decline. This decline continued with those who measured lower on the equivalent of the mini-mental health scale. Those who declined were involved in about half as many of the intellectual activities. They also tended to more often be women than men, they were less educated and they had poorer diets and physical activity than those who scored higher on cognition. An interesting side note is that there were comparable rates of smoking and other psychological diagnoses across the dementia and non-dementia groups. As with most research into dementia’s onset, there are still questions. For instance, how much did a better diet affect the outcomes. Or did people who engaged in more intellectually healthy activities also more often engage in other healthy activities. Clearly, there is more to come. I would conclude that engagement in more intellectual activities is good for your brain, but I would add that you may not wish to bet too much on the horses! 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.
I talked about 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.

The report tells us that women are disproportionately more often a caregiver to an older spouse who may have some form of dementia. But women also represent almost two-thirds of those who will have Alzheimer’s disease. It is not genetically-linked. But it is a function of women’s greater likelihood to live to be much older than their male counterparts. With the expected epidemic of Alzheimer's we will see globally in the next three decades, advocates are pushing for more funding of Alzheimer’s research. Currently a new case of dementia is diagnosed globally every seven seconds, and it is expected that there will be about 80 million people with the condition by 2040. As a Geriatric Care Manager, you can imagine that dementia generally and Alzheimer’s specifically are becoming an ever larger part of my work. Our association, the National Association of Professional Geriatric Care Managers has a lot of elder resources and other useful information on how to be aware of the signs and symptoms of Alzheimer's.

I also would be very happy to address your concerns or questions in future postings, so please e-mail me at Charlotte Bishop.

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.

See all Testimonials »

care manager

Singing is a Breath of Fresh Air for Caregivers

A House is Not a Home (Part 3)

A House is not a Home (Unless You’re There)

Contact

Newsletter Sign Up

Areas We Serve

Accreditations

Connect

Careers