Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • elder abuseChicago's Geriatric Care Manager Center of Excellence

I Miss the Scams That Used to Be Easier to Spot
It was probably ten years ago that my husband’s mother was caught up in a telephone scam on her...
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September 26, 2023
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How (NOT) to Worry, Stress or Be Anxious
It’s not so much whether you’ll have worries, be stressed or feel anxious…it’s how you’ll manage your worries, your...
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March 21, 2023
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Another Side to the Story
It was just a year ago that Bruce Willis’ family disclosed that the actor would be retiring from acting...
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February 27, 2023
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Treatments for Alzheimer’s Disease
September is Alzheimer’s Awareness Month, and this is the third of four posts we’ll offer on the subject. I...
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September 20, 2022
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When the IRS Calls…
How about a show of hands regarding the Internal Revue Service (IRS)… Have you ever filed a tax return...
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March 8, 2022
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The “Other” Health Concerns for Older Adults
It was just two weeks ago that I underscored the fact that “older adults have a greater fear of...
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February 1, 2022
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Password Protected?
I often offer advice on how to help your older loved one with challenging tasks or how to protect...
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October 26, 2021
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Your Older Loved One’s Greatest Health Risk?
As our loved ones grow older, we probably are more acutely protective of their health and well-being, especially if...
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September 14, 2021
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Your Flight to Nowhere is Boarding
You have probably put off a vacation or most any travel for more than a year with the threat...
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August 10, 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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In the Caregiver's Words

Recent Client Praise

If you are a caregiver to an older loved one, you may find it a bit overwhelming to keep up with all the medications they take each day, and the times of day they take them. But have you thought about the potential side effects as well? The average older adult living independently is taking more than five prescription medications daily, and those in nursing homes may be taking at least seven prescription medications. We call this “polypharmacy.” We all have at least some sense of the side effects that many of these medications may carry, but what you may not know is that some of these medications have some unhealthy interactions with the other medications.
Recent research in the United States among older adults living independently found interactions between drugs in about 15% of the cases. In another study in Europe that tracked older patients being discharged from hospitals, as many as 70% were on medications with some interactions, and 24% were at risk for serious interactions among the drugs they were taking when they were discharged. What should you look for? Review the medications your older loved one takes looking specifically for these medications: • Statins – the drugs used to lower cholesterol • Proton Pump Inhibitors - the drugs that work against GERD or acid reflux • Antibiotics - the real offenders tend to be sulfa drugs or fluoroquinolones • NSAIDs - these are the pain relievers like Naprosyn, Motrin, etc. • SSRIs - these include the anti-depressants like Prozac, Celexa, Paxil • Calcium-Channel Blockers - like Norvasc • Warfarin – the blood thinner also known as Coumadin. This seems like a short list...no problem. The fact is that statins are the most commonly prescribed drug for older adults. More than half of those over age 55 are prescribed statins to lower their LDL. About one in five older adults in America take PPIs. And you can see with the number of medications your older loved one may take the likelihood of an interaction escalates. And some of these drugs also do not play nice with certain food groups or vitamins. If you see signs of muscle weakness, cramping or difficulty standing or walking, as well as fatigue or confusion, check in with your loved one’s doctor. But if you really want to be proactive take the list of the medications your loved one consumes regularly to your local pharmacist…and don’t forget to add the over the counter medications which can include PPIs or NSAIDs as well as an accurate assessment of alcohol intake. And next time you accompany your loved one to a physician’s office visit and the doctor recommends a new prescription, ask what can be taken from the list! 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.
November is National Alzheimer’s Disease Awareness Month, so I am going to give a lot of attention throughout this month to what we know as well as what we don’t know about dementia generally and Alzheimer’s disease specifically. More Americans fear an Alzheimer’s disease diagnosis than fear dying, and that should be no surprise, given that a new Alzheimer’s diagnosis is given every 67 seconds in the United States. But we should all be cautious in accepting any Alzheimer’s diagnosis for a loved one at face value. Research has shown that 24 percent of diagnoses actually are misdiagnoses. Given that there are about 100 different manifestations of dementia, perhaps we should be surprised that the rate of misdiagnosis is so low? And it is important also to bear in mind that the health care provider making the diagnosis may or may not be well-qualified to make the call either for lack of experience or for lack of proper tools with which to diagnose. Our team became involved with the mother of one of our people, because she was showing signs of cognitive decline. He recalls that on one of his visits her common introductions to friends of hers had become “You don’t have a name…this is my son.” He and his sister started making calls to her primary care physician’s office to get a sense of what was going on. In his mother’s file the diagnosis was “organic dementia.” The doctor had further prescribed an FDA-approved medication called Namenda for his mother for that “organic dementia.” First, Namenda is indicated for Alzheimer’s disease (not “organic dementia”) and is to be used in combination with another drug for Alzheimer’s called Aricept. Now with his mother’s doctor on the line, our staff member questioned why the prescription for a condition for which his mother had not be diagnosed and that was to be used only with a medication she had not yet been prescribed? And at $350 out of pocket per month? The doctor mumbled something about whether the son wanted his mother to have an autopsy to diagnose the condition…or was it the money. Stunned at how behind the times the doctor was, the son simply said it was the cost and the doctor withdrew the prescription. Let me get back to the autopsy. A decade and a half ago scientists could not definitively diagnose Alzheimer’s until after the individual had died and an autopsy of the brain could be performed. Now, we have neurologists who can confidently diagnose the condition with MRIs, PET scans and blood tests along with cognitive tests in real time and an historical look at a patient’s records. In these neuro-psych exams, the specialist is able to not only identify the condition, but more importantly what can be done. As it turns out with our team member’s mom, she had vascular dementia, the end result of numerous “mini-strokes” over time that deprived more and more parts of her brain of blood flow. As his mother’s condition deteriorated she was required to move from independent living to assisted care and finally to a memory unit. I have noted before in other posts that there are no cures for Alzheimer’s; well, there was no cure for vascular dementia that had progressed as far as it had for our team member’s mom either. But she lived to be more than ninety years of age and had a quality life. In the end, her quality of life was greatly assisted by those around her who knew the source of her dementia and how best to care for her. And that is as happy an ending as one can hope. For the rest of this month I am going to be talking a bit more about how dementia often gets confused with delirium or depression, as well as Alzheimer’s disease and also address your questions. Please just email me your questions or concerns at info@creativecaremanagement.com . 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.
In the first of my present series of postings on recent Food and Drug Administration (FDA) warnings, I had talked about new evidence of long term health risks from some pain medications that are available both in prescription and over the counter (OTC). In this posting, I am going to share with you another FDA warning, this one for prescription medications that lower cholesterol. The “family” of medications is commonly called statins and includes some very well known brands that many of you have seen advertised on television and in magazines. Others of you or the people you care for may also be taking these medications.

All Americans have been alerted to the risks posed by increasingly high levels of cholesterol many of us have in our bloodstreams owing to eating foods high in fats or just plain eating too much. One way to address the elevated “bad cholesterol” or low density lipids (LDLs) is through diet and exercise. But for people with persistently high LDL, a physician may also prescribe one of the many statins available. These go by names like Crestor, Lipitor, Zocor, Levacor and Pravachol, and when taken as directed, they do help to reduce LDL levels. Research published in the June 22-29, 2011, issue of the Journal of the American Medical Association looked at a number of individual studies which had showed a link between high-dose statin use and diabetes as well as a risk for cardiovascular events.

The researchers pooled the findings of five different and large clinical studies of moderate- and high-dose statin use among patients. These studies followed patients for a number of years and the results over time were pretty compelling.

When the researchers compared the moderate and high-dose groups at the end of the nearly five years of the research, the high-dose group had 12 percent greater chance of developing type 2 diabetes than the moderate-dose statin users. But the high-dose users of one of the statins, Lipitor, experienced a 16 percent lower likelihood of having some sort of cardiovascular event like a heart attack, stroke or even death. The other statin studied did not offer any cardiovascular benefit. It is not clear how other statins fared in terms of heart health. The diabetes link was the most consistent across medications.

As with a lot of modern medicine, the devil is in the details. It seems that high-dose statins pretty uniformly put patients more at risk than moderate-dose statins for diabetes. It is important to appreciate that these are significant differences, but even then, the numbers of patients who may expect an issue to develop will be quite small. As always, consult with your primary care physician or cardiologist about your medications of those of the elder for whom you provide care.

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.
You may have heard the noise about a new drug for treating Alzheimer’s disease and other dementias. It would make sense that there would be some noise, because we’re talking about a new treatment with a new target and new data on how well it works (or doesn’t). A lot of the noise, however, was not fanfare about a new drug as much as the red flags that Medicare (CMS) was raising about covering the new therapy's use. That, and it’s been since my book was released in 2017 that any new way to address the devastating effects of Alzheimer’s has come on line…and that's just about six years! I won’t go into the details of those “older drugs,” except to say they didn’t have anything close to the dramatic results that consumers or physicians wanted:
- Cholinesterase Inhibitors (Donepezil, Galantamine and Rivastigmine); and
- NMDA antagonists (Memantine, Memantine and Donepezil combination).
You can read more in Chapter Seven of the book if you want to understand their mechanisms of action as well as other healthy lifestyle habits that can make a difference in addressing both the progression of Alzheimer’s and how the medications work. I had mentioned the “noise” about a more recent addition to the inventory of FDA-approved treatments for Alzheimer’s. The new drug, Leqembi, was approved for treating AD, but there were a number of caveats imposed by the Food and Drug Administration from the get-go. When FDA gave its initial approval of Leqembi as “safe and effective,” the Centers for Medicare and Medicaid Services (CMS) placed some rather onerous restrictions on the use of this therapy. What restrictions? Patients can of course be prescribed Leqembi, but it will be “covered” by CMS only if their prescribing provider is part of a registry to monitor the use of the drug. This position has been a bit relaxed from their earlier restriction that patients could be prescribed this therapy only if they were involved in an extended clinical trial. And this is a first for CMS to require this sort of data-collection after FDA approval. FDA’s approval was based, it seems, on the therapy’s ability to reduce amyloid beta plaque in patients’ brains in a 79 week trial among 856 patients. The manufacturers of Leqembi had completed the trial with up to 93 percent reduction in plaque at Leqemi’s highest dose. CMS has made restrictions for drugs yet to complete an approved clinical trial, but Leqembi was already done with that. What’s missing in this picture? Since this is going to take a bit more space to unpack, I’ll leave with you a question to be answered in “part 2:” What about maybe judging a therapy based on measures of Cognitive Decline? Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of, 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.
Everybody eventually learns to accommodate the “empty nest” that inevitably follows the busy days of child-rearing and child-launching. And then – maybe after a rather substantial wait – there is, once again, the prospect of more little ones in the house. This time, however, they are grandchildren, and as much as everyone who raises kids knows how not to drop a baby, the world has changed. It translates into a new kind of child-proofing different from a generation ago. This is advice for seniors who may be hosts to little ones for the first time in a lot of years.

1.    First, it is important to start with an open mind. It is too easy to slip into a mindset of “what was good enough for my kids,” but times have changed and so has safety. So, some of the old toys may still be considered safe, but the old car seat, play pen or infant swing may not be just outdated; they may be dangerous. Defer to the new mom and dad for advice on what will still work and what needs to be replaced by the next new thing. This approach is also politically helpful in empowering the new mom and dad.

2.    Remember also that when you raised your own children, you may not have had any of the chronic conditions you now have. And you also would not have the medications associated with those conditions, so develop a plan to store medications safely and out of reach of kids. While you may not want the nuisance of those safety bottles, you really need to be certain that medications that will be attractive nuisances to little ones on the prowl are locked up. This is especially true if one of the older grandparents uses the “day of the week” pill reminders that often are stored in the kitchen as a reminder for prescription schedules.

3.    For an add layer of safety, go to the source. The Consumer Product Safety Commission has a twelve-step approach to fully kid-proofing your home, and a number of their recommendations like smoke alarms and carbon monoxide detectors which are great safety measures for everyone. They have a downloadable two page brochure to walk you through the steps (click here for brochure).

4.    This last one is making the grandparents house safe from what the toddlers or young children will bring with them. Falls among seniors are often caused by the unexpected, and there is nothing so unexpected as the little dolls, cars or a myriad of other items that you will buy for the kids or that they will bring with them. Make it a habit of picking up after play time, because you may not see the little hazard on the floor…especially after sunset.

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. Read more about Our Story and Charlotte's mission.
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