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

What Tony Bennett Can Teach Us
Tony Bennet has arguably been one of those “one in a million” kind of musical talents, but sadly he...
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February 9, 2021
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Scamming as a Superspreader
We have all seen the advertisements for the on-line services that will help you find your ancestry by taking...
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February 2, 2021
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Until the Vaccine?
We have all been following the news on vaccine rollouts, and frankly you may have been as disappointed as...
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January 26, 2021
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Better than a Resolution
After nearly a year of a pandemic and its quarantine, we are all ready to get back to normal. ...
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January 12, 2021
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How the COVID Vaccines Work
If you’re like me, you have been following too much news on the pandemic, but hopefully you also have...
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December 15, 2020
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Too Good to Be True
With over 300 clinical trials on vaccines for COVID19, it perhaps is not a surprise that at least two...
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December 1, 2020
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The Other Global Health Crisis
Wearing a face mask is the new front line of defense against the spread of the war on COVID-19,...
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November 17, 2020
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One More Sign of COVID?
I have written about Alzheimer’s disease…a lot, its warning signs and caregiving probably more than any other topic. Even...
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October 6, 2020
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None of the Above…
While everyone is awaiting the next vaccine to prevent COVID-19 or help in the treatment of the condition among...
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September 29, 2020
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COVID’s Other Deadly Toll
During this pandemic, over 13,000 more Alzheimer’s and other dementia patients have died than expected from these cognitive disorders,...
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September 22, 2020
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In the Caregiver's Words

Recent Client Praise

For the Caregiver
Make Care Giving Work
Peak Over the Wall
The Caregiver Blues

For the Family Caregiver

For the one leading the charge, the drains are not always visible.
Care giving can be just as demanding as a full time job. Days are long and it is hard to take a break. This is why it is so important to watch for your own symptoms as a caregiver. You want to be as good for yourself as you are for your loved one who depends on you.

Are you…

missing a lot of work?

not exercising and instead eating a lot of unhealthy foods?

having nightmares or disturbing dreams?

feeling lethargic or maybe even depressed?

angered by minor issues, or are you impatient with your loved one?

MAKING CARE GIVING WORK

While keeping yourself and your family strong
Family care giving is the single biggest contribution to an older adult being able to stay in their own home and age in place. Caregivers do everything from transporting the older adult to and from medical appointments to coordinating the services of other medical providers, managing multiple medications and advocating on behalf of their family member. It takes time and weighs heavily on the caregiver who still must balance everything against a full-time job, parental responsibilities and a marital partner. Caregivers often don’t get much explicit attention as part of the tremendous contributions. The most recent report on family care giving published by AARP is required reading for caregivers and their families. It provides a sense of the huge and important work that caregivers are providing for their families in America today.

Creative Care Management recommends three points that cannot be repeated often enough.

One, caregivers’ contributions need to be appreciated by the entire family who benefits.

Two, the whole family also needs to help in caring for the caregiver.

Three, it takes a village for all of the above.

PEEKING OVER THE WALL

After surviving the climb

5 Steps Towards becoming a Better Caregiver:

Become educated about your loved one's condition in order to be as effective as you can be.

Recognize that you are not superman or superwoman; set some limits on what you and others can expect from you.

Do not beat yourself up about feeling angry, afraid or even resentful; instead find ways to vent

Talk is important as a principal way to vent – especially to a therapist, counselor, clergy member, and even trusted friends.

Lift smart. As a caregiver, be smart about not hurting your back when lifting, pushing and pulling; keep yourself in shape and use an assistive waistband if your physician recommends it.

For more tips for the caregiver, Chicago IL care resources and more, don't forget to visit Charlotte's Blog and please make sure to learn more about what we do at elder care services page.

THE CAREGIVER BLUES

Building a Prevention Strategy
With the amount of stress and pressure caregiving can produce, many choose to ignore signs of caregiver depression. The sad irony is that the caregiver feels guilty about even talking about the dark cloud that seems to be hanging over them, guilty that they do not feel the fulfillment of taking care of the parent who once took care of them. This, despite the fact that the caregiver of an older adult more often than not has other family responsibilities already. More than 20 million Americans suffer from depression, and family caregivers are more likely than the average person to get something that is not just the "blues." We all recognize the time and work that a caregiver puts in to help an older adult, but they also may be giving up the time they would have been spending with their spouse or significant other –or the nights out with friends and acquaintances, the moments during any given week that would give a break from the routine, make them laugh or fulfill them.

Love, Live, Laugh

Tips for Caregiver Blues

Include you; make time each day to do something that delights, relieves or distracts you.

Make lists; prioritize your caregiving duties, make lists and you will see you are making progress even when there remains more to do.

Request help; appreciate that it is gratifying to the others whom you may ask for help to be of help to you and your elder.

Leverage your abilities; the others who can give you respite are actually better equipped for what you may delegate than you are.

Make yourself laugh; hard work like caregiving can seem devoid of fun, so you have to take time to have some fun.
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.

Let me tell you about a list you should know about. If some drugs have added baggage beyond the healthy effect sought by a prescriber and a patient, a doctor named Mark Beers, MD, and his associates have been the “baggage handlers” since 1991. That is when they first came out with the “Beers List.” Beers and his associates were concerned that certain commonly prescribed as well as OTC drugs were causing what are referred to as adverse drug events (ADEs, sometimes shortened to just AEs). Beers, a doctor specializing in geriatric care, found that the elderly were particularly susceptible to many of the undesirable effects of these drugs because their older bodies tend to have less water content and more fat content than younger individuals. This, coupled with their bodies’ diminished efficiency in metabolizing or processing chemicals through their systems helped to account for the disproportionately high rate of AEs and associated hospitalizations and deaths among the old.

Beers' most recent list of 48 drugs and drug classes has been published in the Archives of Internal Medicine and has been embraced by the Centers for Medicare and Medicaid Services (CMS). Beers and his associates have established a set of criteria for determining if a drug poses a risk, that is, is it a potentially inappropriate medication (PIM) for the elderly. Using an expert panel of internationally-recognized experts, Beers and associates were able to find consensus on the drugs that are part of their list of potentially-hazardous medications. It is an important elder resource you should know.

The Beers list has a number of “old friends” as well as exotic medications of which most of us have never heard. You will find the likes of over the counter Naprosyn or Aleve (generically known as naproxen sodium) as well as Benadryl (diphenhydramine) and Chlor-Trimeton (chlorpheiramene). There are also household names like Valium (diazepam), Tagamet (cimetidine) and Prozac (fluoxetine). It is important not to take the Beers list as a blanket generalization that these are simply drugs to avoid. It is not quite that black and white. Some agents are on the list because they can cause complications among specific groups such as diabetics, asthmatics, or insomniacs. Others are contra-indicated for individuals with balance or gait problems because they become prone to falls, some for individuals who have bladder outflow compromise or still others who suffer from chronic obstructive pulmonary disease, emphysema.

The list goes on, and in some cases it is simply a dosage or extended release formulation warning that justifies being included on the list. Check it out: Beers List

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.
“I think I could speak clearer and did not wait as long in answering questions,” she said. “Sometimes, in the past, things would leave my mind and I couldn’t remember things.” Let me just start by saying that this could be a quote from the first Alzheimer’s disease patient to undergo a successful treatment to reverse the condition. Not a cure, and no one yet knows how durable the change, but a rather significant clinical step in the right direction. Our medical science staffer, Dr. Steve Steiber, and I have written before about how there are a number of FDA-approved therapies for Alzheimer’s Disease and hundreds I clinical trials, but so far there is nothing that does more than slow the progression of Alzheimer’s cognitive decline. Scientists at West Virginia’s Rockefeller Neuroscience Institute have initiated a “proof of concept” trial on just six 50 to 85 year old mild to moderate Alzheimer’s patients using ultrasound to penetrate the blood brain barrier, a layer that protects the brain itself from all that can invade our blood stream. They used a thousand tiny probes with oscillating ultrasound that used microscopic bubbles that could move into the area of the brain most affected by Alzheimer’s amyloid plaque. The ultrasound seems able to break up some of this debilitating plaque. This first test seems to demonstrate the safety of the technique as well as likely efficacy, but all of this is with a couple caveats. First, it is with a very small number of patients. The real test will come later when a large enough number of subjects can be tried in order to demonstrate cognitive differences that are statistically significant. Second, it is “just” the ultrasound that has cross the blood brain barrier to break up the plaque. Medical professionals see this method as really kind of a transportation test. If they can safely cross the blood brain barrier to the part of the brain where they can address the disease head on, the hippocampus, then they can use the waves and their tiny bubbles to carry actual chemicals that fight the plaque to where they can do the most good. It’s a bit like showing that we can launch a special rocket that succeeds in getting where we want to go; and now we can potentially attach an important payload to this rocket. (Yes, it is brain surgery and rocket science…) The doctors and researchers in this project admit that it may take a few years to begin to realize the full potential of this technique, but it is the patient’s husband who takes our rocket science and brain surgery metaphor a “small step” further. “This is man on the moon stuff,” Mark Polak said of his wife’s success in the first trial. “Maybe we’re on to something?” If you want to read more on the science, please click here; if you want to read more of the personal story of one patient’s experience with the science, please click here. 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. And yes, we may be revising this book a bit sooner than we had anticipated...
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.
Happy Valentine’s Day…a couple days late. February is American Heart month, so why would I start by talking about your older loved one’s pancreas? Let’s start with the fact that one in four adults over age 65 develops diabetes. And although it is over-simplifying things a bit to say that type 2 diabetes is all about having too many sweets, there is a strong connection between consuming too many carbohydrates over one’s lifetime and developing type 2 diabetes. Unfortunately, there also is a strong connection between diabetes and cardiovascular disease. But wait, it gets even scarier. The combined prevalence of prediabetes and diabetes – both undiagnosed and diagnosed, respectively – is estimated to be between 50% and 80% among older Americans. So, why does this affect the heart? Well, diabetes has a way of making a person’s blood a bit sticky. Well not literally sticky like gum on a sidewalk, but uncontrolled diabetes leaves more sugar floating in the bloodstream, and the sticky cells that have been tangled up with the blood sugar tend to block the smallest vessels in the cardiovascular system. The heart may pump blood through some very big arteries, but the muscle itself is made up of a lot of microvascular pathways that keep it fed and oxygenated. Once we add free sugar to the mix, some of those tiny vessels become clogged. The less well-controlled the diabetes is, the more sugar is roaming the cardiovascular highway, and the more blockage there is. No surprise then, that in excess of 70% of both men and women over age 60 have some level of cardiovascular disease. Now, we could go on about the damage to other microvascular regions of the human body like the kidneys or even the eyes and the feet and the hands, but the lesson is already clear. As we reflect on our past valentine’s day, go a bit lighter on the candy that may still remain in the box and a bit heavier on the love. Because in addition to hurting the little vessels of the heart, the excess chocolates that we cannot burn as energy for our bodies get stored. And you probably already see where this is going; the unused sugar gets converted to fat, and each pound of that unwanted baggage creates another mile of blood vessels. It is a bit crazy to think that we have to feed the fat, but every cell of the human anatomy is no more than one cell away from a supply of blood. So Valentine’s Day has to share the calendar with American Heart Month. And if we all do that, then maybe we can even consider renaming February as American All Around Healthy month? Charlotte Bishop is an Aging Life Care Professional and 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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