Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • geriatric careChicago's Geriatric Care Manager Center of Excellence

To B or Not to B12?
I have written a lot about dementia over the years as well as other issues that can mimic the...
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May 11, 2021
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Three Milion More Victims…
We see the numbers on a daily basis. How many have died from COVID, to date, we all probably...
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April 27, 2021
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Everything to Lose
Not a day goes by that the sun does not linger a bit longer, that the landscape gets a...
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April 20, 2021
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Not Just Spring…
We’ve heard of Spring Training for those who follow baseball teams like the CUBS or the SOX, and we...
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April 13, 2021
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Three Steps to the Now Normal
Yes, it has been a long year, maybe in part because it has been more than a year of...
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April 6, 2021
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As If COVID Were Not Enough
We’ve all heard about COVID’s symptoms…the GI upset, the shortness of breath, the fever, the added symptoms of the...
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March 30, 2021
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Diseases that Mimic Dementia…But Are Treatable-part 3
As you can tell from now a third installment about other medical conditions that can mimic dementia, it’s not...
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March 22, 2021
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Diseases that Mimic Dementia…But Are Treatable – part 1
Dementia is the condition that adult Americans fear the most, and tragically there are conditions that can give a...
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March 9, 2021
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Can I Have A Hug?
I doubt there is anyone who does not have something that they have not been able to do during...
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March 4, 2021
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A Game Where Everyone Wins
Pick your metaphor. If you want your knife to slice easier, you sharpen it. If you want to improve...
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March 2, 2021
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In the Caregiver's Words

Recent Client Praise

We have all heard someone this season say, “It’s just a cold,” or “I have a touch of the flu,” or similar expressions that pretty much write off a lot of what is going around. And nobody gets pneumonia, right? Wrong! It may sound like a small number, but about 6 of every 1000 people in American will have a bout with what is termed “community-acquired” pneumonia this year. Still sounds small, but the rate triples for 65 to 69 year old people…18.2 per 1000. And for 85+ year olds, the number skyrockets to 52.3 cases per 1000 people. So, if you have an older loved one in your orbit, be vigilant to signs and symptoms that can tell you they have graduated to pneumonia. There are six signs that should alert you to something that deserves a visit to the doctor or emergency facility:
1. Productive cough – the kind that almost rattles with the mucous as a person coughs to clear their lungs.
2. Fever or not – Fever with a pneumonia infection is common among younger individuals, but pneumonia actually can suppress body temp in older cases.
3. Chest aches – While we are most often concerned about heart issues with chest pain, breathing with pneumonia can give similar symptoms.
4. Tired – While the immune system fights pneumonia, it takes energy away from the rest of the body resulting in fatigue.
5. Fuzzy head – The lungs are not the only congested organ; the brain gets a bit muddled with pneumonia also.
6. Breathless – With congested lungs, it should be no surprise that a patient with pneumonia may also be short of breath with even modest activities.
The rules of engagement with pneumonia are simple.
1. Doctors’ orders - especially with completing the full course of antibiotics…be sure your loved one takes all the pills prescribed.
2. Sleep – give the body a chance to devote its undivided attention to fighting the bug by resting and getting help around the house.
3. Fluids – think of it as “flushing” out the system, and it also helps get rid of the congestion in the lungs.
And remember that the risk may be lower for younger people, but the operating rules are pretty much the same. Give all the support you can to help your body fight the invaders too! 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.
You have heard from me before about how there is a new Alzheimer’s Disease diagnosis in America every 67 seconds…about one a minute every day and every night! According to medical professionals it is becoming even more prevalent worldwide. By the year 2050, this rate is expected to double to one new case every 33 seconds. It is ranked as number one in prevalence of all neurodegenerative conditions affecting 5-6 million Americans and as many as 47 million people across the globe. Translated, that means about one in eight individuals over age 65 will be affected by Alzheimer’s and that climbs to almost half of those 85 years and older. It has been studied for more than 100 years with little headway on what causes Alzheimer’s Disease, let alone how to treat it. I am going to talk more about treatment, and there are some avenues that show promise, in a second installment to this two part series on Alzheimer’s. In this part, let’s go over how Alzheimer’s is diagnosed accurately today than ever before. Not that long ago, Alzheimer’s could only be diagnosed after a patient had died when they could actually investigate how much beta amyloid plaque had accumulated in their brain. That is so yesterday. There are now three ways to arrive at an Alzheimer’s diagnosis in a patient. The first starts with a genetic marker that predisposes an individual to developing Alzheimer’s. It’s called the APOE4 gene, and about one in seven to one in ten people carry this gene. Those who have one copy of this gene are about two to three times as likely to develop the dementia as those who do not have the gene. And if a person has two copies of this gene the likelihood shoots up to 12 times that of a person with no copies of the gene. Should everyone get the genetic test? Well, talk to your doctor, but as medical professionals have consistently shown early diagnosis can be the first step toward more effective treatment of any condition. A second step toward diagnosis will be what is termed a neuropsychological test which assesses a person’s cognitive function. It should be conducted by a neurologist, not just a primary care physician. Combined with the genetic test, it can help to pinpoint Alzheimer’s Disease, but not without the third test. Brain-imaging can not only help to look for the signature of Alzheimer’s activity the brain, but also rule out other issues like hemorrhage or tumors that may be causing mental difficulties. It will also more concretely assess the extent of any Alzheimer’s spread in the brain. This latter testing can be done by a number of technologies like CT or PET scanning, but the most common test is MRI. Look for Part 2 next week when I review the existing as well as new, promising treatments for this condition. You all may recall that I have a book that I have co-written on what a caregiver should know about Alzheimer’s…it is noted in the closing paragraph here. If you want to save 20 percent off the Amazon price, please just send me an email and we will send you a copy for $19.97 which includes shipping and handling. 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.
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.
Most of us have grown up with the faith that when we have a medical issue, there is likely to be a drug to take to alleviate the problem. Yet, we as geriatric care managers have found that more than 700,000 hospitalizations each year result from adverse events or side effects of drugs or because patients are over-medicated. Most of these patients are older adults, despite the fact that those over age 65 years of age represent only about 13.5 percent of the population. If you are a caregiver to an older adult or other person with special needs, you should pay particular attention to the following to keep your loved one out of the hospital:
- It is not just prescription drugs that should concern you. Most of the medicines that we all purchase over the counter (OTC) were once prescription medicines. They can represent potentially harmful side effects like Tylenol with its potential for liver toxicity. And don't forget that even aspirin is an acid; but it was on the drug store shelf before there was an FDA to protect us from its stomach slide effects.
- Keep track of all the medicines your elder may be taking (and include the OTC meds). Most doctors' offices are getting very good about asking what medicines are being taken with each visit, but be prepared with your loved one's lists at each visit. And ask if any can be dropped; you may be surprised at how many prescriptions handle the side effect of another medication.
- Be careful about how a medication is to be taken. Make sure your older loved one and you both understand the time of day a drug is to be taken, with or without food or how it might interact with another medication or even certain foods.
- Read the fine print. Every prescription has something pharmacists call the package insert or PI. Read the indications and usage section of this long page and call your provider with any questions. Also read the adverse events to make note of anything that has a greater than 5% incidence - and what steps to take should that event happen.
- Make sure you watch for anything out of the ordinary and ask your loved one how they feel. It may be just a dry mouth, or it may be hard stools or other side effects they may not volunteer. Everything is important to monitor. And if your loved one suddenly has any difficulty breathing or feels anxious, call your provider.
Underlying all of these caveats, appreciate that your older loved one has less fluid per pound than a younger adult. Their metabolisms also function more slowly. And most drug trials are conducted only with younger and healthier adults, so side effects may be minimal and less consequential. Birthdays and drugs may have bigger side effects than the pharmaceutical companies may have found in their trials. Charlotte Bishop is founder of Creative Care Management, a team of geriatric care managers, certified professionals, advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecasemanagement.com.
You may have heard about music therapy, and you certainly have heard the often misquoted: “Music doth have charms to soothe the savage breast.” But does it work? Music therapy, that is. There actually has been a fair amount of research into how music can address some of the issues that trouble people, and some scientists in the Netherlands have scoured the scientific literature to see if music can be of help with patients who have Alzheimer’s. Specifically, they looked to see if a case could be made that music can help relieve the agitation, aggression or depression of dementia patients. In what is termed a “meta-analysis,” they examined a large body of literature to see what others have reported. While they could not control for variables like the size of groups being tested or the therapeutic elements of the settings, they did offer some tentative conclusions:
1. Music does not seem to have a measureable impact on a patient’s agitation. But the researchers suggest that there may be an effect, but since the therapy sessions may have been too long in duration, the effect may have been clouded by patients’ in ability to be stationary for the duration of the tests. The “calm” that was expected also could have been clouded by social interactions among patients in a group setting.
2. The findings were pretty much the same with aggressive behavior. There is no evidence. They could not sort out all the other background noise – not the music – to say with certainty that music reduced aggressive behavior.
3. What did seem more clear is that patients who had been predisposed to depression seemed to have a lifting of their moods with music. While this was a more consistent pattern, it might also have been confounded by the fact that the music therapy took place in a social setting. And isolation is one of the big causes behind depression.
When it comes down to it, we really cannot conclude that one kind of music will always have the same effect on all people. The fact that there were some positive changes across most studies, however, suggests that it is more than a bunch of notes. Music can make a positive difference for people who have cognitive issues…it simply may not be enough. But at the end of the day, we may come back to the traditional rule about not doing harm. If music is not a problem for people, then let the band play on. 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.
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