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

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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Every 44 Seconds
That was on November 19th this year…the pace of COVID-19 deaths in the United States…one every 44 seconds, or...
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November 24, 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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You’re Bringing What for Thanksgiving?
Remember Thanksgiving just a year ago? It was that family gathering when you prepared the turkey and someone brought...
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November 10, 2020
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Connecting the Dots Means Early Detection in Dementia
One of the other casualties of this extended quarantine is the cognitive consequences of less social interaction and less...
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October 27, 2020
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Online Shoppers Beware
We all think that we could never get scammed, right? We all think that only other people can be...
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October 20, 2020
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If You Can’t See Something…
If you see something, say something. We have all heard this about everything from neighborhood watch programs to announcements...
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October 13, 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

I have again asked our vice president for senior services, Steve Steiber, Ph.D. to share a guest posting about a concept that is gaining more attention these days, especially among health care providers caring for older adults. It is all about what time of day is best for your care receiver's medicines. Steve has more than two decades experience in pharmaceutical and medical device consulting prior to joining CCM about 8 years ago. He reports: If you are a caregiver to an older loved one, you probably have seen all the medications in their cabinets, and part of the label of each of those is a clear statement of how often to take them. Prescription medicines used to have abbreviations like B.I.D., T.I.D., Q.I.D., Q.D. of less commonly Q.O.D. which translate into twice a day, three times a day, four times a day, once a day or once every other day, respectively. Thankfully, prescriptions now say things in plain English so caregivers or the care receivers do not need to know medical shorthand to understand when to take their medications. One element that has been conspicuously absent from the labels, however, has been any mention of when to take the medications, and that is getting a lot of attention in some circles. Very simply put, your body does have a clock that works pretty much on a 24 hour cycle which is why most people have a typical time to go to bed, a time to rise and fairly regular times for their meals throughout their daily cycle. The new focus, of course, has a name, and this research into when is the best time to take a given medication is called "chronotherapy." The focus of chronotherapy is on optimizing the timing of medications to give the best clinical effect with the fewest side effects. In very general terms, the best time of day to take a once a day medication most often is at night time. Treatment for certain types of colon cancer, for instance, work better at night because the body's normal cells are resting and less sensitive to the agents while the cancer cells are more vulnerable. And for medications with a drowsiness side effect, why not take them at night to actually benefit from the side effect instead of fighting it. For certain blood pressure medications, it is important to take them at night time so that they are at their best in the morning. That is because when the heart is just starting to "wake-up," there is a spike in body hormones that can stress an unhealthy heart. Cardiac events are much more common early in the day versus any other time of day. Drugs that are part of a category called "narrow therapeutic index" (NTI) drugs are most effective when taken at the same time every day because their doses typically are measured in micrograms instead of milligrams. Small changes in dosing can make a big difference in effectiveness. For any medications, make sure you also are paying attention to whether it should be taken with or without food. And, of course talk with your physician before you may any changes in your medication schedule. In the second part of this two-part series, I am going to get into some specifics of certain classes of medications and how to use your clock to maximize their benefits. And just so I say it again, please do not make any changes in your care receiver's medication regimen without first talking to their physicians. 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: Steve Steiber. And check next Tuesday for part 2.
Perhaps you have now had the chance to once again be together with family and older loved ones for the holidays or maybe the visit is still on your calendar? If so, you may have noticed or soon will notice that some things are not quite the same, and the changes may be subtle. You may notice that your older loved one's reaction time behind the wheel is more than a bit slow or tentative. You may see evidence that your loved one is more than just "behind on housekeeping;" there may be signs that taking care of home is just more than they are up to. Or you may notice that they have some difficulty standing after sitting for a time or that there is a shuffle to their walk. What can you do? Driving. Talking about giving up the car keys may be premature, but the per mile rates of auto accidents escalates rapidly after about age 70. So, you have to ask yourself if you would prefer to have this hard talk before or after a collision. Then, you need to ask how you would want to be approached if you were the questionable driver. Ask them about how safe they feel on the road with "drivers these days." And do not hesitate to reach out to your loved one's primary care provider as someone who may be able to speak with more authority. Housekeeping 101. This one is more than keeping tidy in the kitchen. If you have done a surreptitious check on the quality and quantity of food your older loved one has in the pantry or refrigerator, you may have found limited quantities as well as staples beyond their expiration dates or making their way to a science experiment. This may be as simple as getting a shopper for your mom or dad, and you can offer to help them find someone to help with the "heavy lifting." Another "heavy" may be in the housecleaning category. No one really relishes pulling out the refrigerator to vacuum or to get under the bed to chase out the dust bunnies. Getting your loved one to agree to help with the heavy lifting on this front may be a nice step toward getting more help as needs change. Fall Risks. Housekeeping may help in beginning to eliminate some of the fall risks your older loved one may face at home. Every year about one in three adults over age 65 have a fall, fortunately not all of them serious. But look for worn carpeting whose frayed edges are a trip risk, particularly on stairs. Scatter rugs also are a big risk as are cords for electrical devices that may be blocking walkways. These may be easy suggestions to make, but you may also wish to bring in a professional like a geriatric care manager who can walk through a veritable checklist on what to look for along with many of the easy fixes. With all of these facets of "home improvement," it is important to remember that you do not have to go it alone in the conversations with mom or dad. You may enlist the support of your siblings so that the whole family is trying to lend a hand, particularly if you collectively have a history of working together around the house. Barring that, you also can raise these subjects in a less threatening way, such as in the kitchen while helping with serving or preparing the next family meal...just one on one. Or if it is the older father, a walk around the yard or block may be an easier venue for a conversation. People tend to talk easier if the talking accompanies a task. There is always that family friend of your older loved one who has been like the extra aunt or uncle who can help facilitate a conversation. And here again, talk with a geriatric care manager about your concerns and how best to bring them up to an older loved one. It does take a village. 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.
We all have been in desperate need for a ray of sunshine during this COVID-19 quarantine. Well, this week, we are told that a vaccine for COVID-19 has gone to phase 3 clinical trials. These are the trials in any FDA approval process where the company with the therapy specifies what they expect as the outcome of the treatment – in this case a vaccine – and increases the number of test subjects to the thousands so that they can be more statistically sure of the outcome and also vigilant about any negatives that may occur in very small percentages of people. A ray of sunshine? Good news, right? There is a bonus with this vaccine. Those who ultimately will become vaccinated not only will be virtually eliminating the chance of coming down with COVID-19, but they also likely will be reducing their chance of developing Alzheimer’s disease as well. Yes, those who receive this and some other vaccines will have a measurably reduced chance of developing Alzheimer’s if retrospective science just out holds up. Public health scientists have long worked to show that the anti-vaxxers shouting about an increased risk for autism and even Alzheimer’s are wrong associated with vaccines are just plain wrong. They did what honest scientists have always done, and that is … follow the data. What they found quite amazed them and continue to impress scientists. Just this week, two pieces of research presented at the Alzheimer’s Association International Conference that not only do vaccines prevent the diseases they are designed to prevent, but they also serve to protect memory and cognition. These are not just small scale studies. The first of the two from the University of Texas compiled data from millions of records in a national data base. The scientists were generally looking for any factors that would influence people succumbing to Alzheimer’s among other conditions. One of the factors with a measurable and positive effect was flu shots. The scientists found that a bit unexpected, so they looked more closely at medical records of about 9,000 60+ year old people. They compared those who had received flu shots with those who had not controlling for other factors like smoking habits, diabetes, obesity and more. People who had received at least one flu shot reduced their Alzheimer’s risk by 17%, and those who had regular immunization dropped their risks another 13%. More vaccines results in less Alzheimer’s! This was a bit surprising, because the conventional wisdom had been that vaccines do introduce some inflammation, and this had also been associated with Alzheimer’s disease. I had mentioned a second study. That one had looked at pneumonia vaccines. In that study, they looked at 5,000 65+ year olds who had been vaccinated for pneumonia before they were 75 years old. Those receiving the vaccine were 25% less likely to develop Alzheimer’s, although having a flu vaccine also did not add to this benefit. The jury is out on exactly why vaccines and Alzheimer’s have this relationship, and the scientists are look at what may actually cause what. They also are looking at other vaccines. I would have been on board for an anti-COVID vaccine already, but this added benefit just seems to be icing on a cake that is too long in coming. It is also gratifying to see that anti-vaxxers are on the wrong side of the longstanding debate about vaccines. 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.
When I talk to people about advocacy and geriatric care management, they get that part of what we do in our professional role is look out for older adults and guard against abuse of a variety of sorts. One of those kinds of abuse is financial abuse in the form of scams that target older adults. Scammers target older adults in part because, as a group, older adults can be more vulnerable, but older adults also are the ones who will have accumulated some amount of money over their lives - their nest eggs. But did you know that more than 90% of reported financial scams targeting seniors are perpetrated by their own family members? If you are a caregiver to an older adult or just a concerned person in the orbit of a senior, here are some of the common scams going around.
1. Meet you at the Funeral - Believe it or not, some scammers will go to a complete stranger's funeral claiming to the family or widow that money is owed for some prior contract or other obligation. But that is not all. Beware of the "add-ons" that some funeral homes may try to railroad at this vulnerable time in a family's loss. It is a really good reason that we all should make our own funeral arrangements before the time comes.
2. Boomers don't Age - With the boomers starting to fill the ranks of the over 65 cohort, there is a host of anti-aging products to assist those who feel 70 is the new 50. Help your senior to see through the false claims as well as the fake products posing as the brand names like Botox. And remember that if it is not fake in the case of Botox, that it Botox made from a deadly toxin; be certain of the recipe.
3. Fake Drugs - With pharmaceutical prices still a large part of any senior's budget, the lure of non-U.S. pharmacies is still there. Be sure that the distributors actually offer the real deal. FDA has been reporting an average of 20 major investigations of fake manufacturers every year.
4. Just Bill Medicare - Anyone over age 65 will qualify for Medicare to pay part of their medical costs. Some providers working the system, however, can purport to offer services and then bill Medicare. Since they can use your elder's personal information for a direct billing, the older patient will never be the wiser.
The list, of course, goes on. The reason why some of these frauds may happen is that they take advantage of a senior who is not as tech savvy on the web as younger web surfers may be. And at any age, we all can be victims of the deal that sounds too good to pass up. So, if you are a caregiver, lend an eye and an ear to that older adult in your orbit. Your vigilance will benefit them, and it also will give you the benefit of advance learning for when you are there one day. 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.
It was an editorial in Time Magazine back in 2010 that brought up the concept of the "coping conundrum." They said: "There is guilt and mystery and anger and fear embedded in a process driven by love". They were talking about the notion we as a society seem to have it that as our parents grow older and more dependent that it is almost a reverse child-rearing syndrome that the sandwich generation experiences. We "raise our parents?" Not so, they warned. So, let's look at ourselves just a bit. With teens, we can (try to) tell them what they can and cannot wear, what they can and cannot do. We can dictate their hours, and when they do not get the keys to the car until they get the hours of driving logged. So how does that work when you talk to the parent who gave you the keys...maybe grudgingly... and you are proposing to take the keys away from their 60-70 years of driving experience. It is not access to a car; it is a habit, it is independence; it defines life in the suburbs; it is part of the "American dream." And there was Maria Shriver's report that came out in 2010 that essentially said that 10 million women would either care for an Alzheimer's parent or have the condition themselves. Caregiving is a big deal, because it is as much about our parents as it is about ourselves. This is the part where we all go look up conundrum in the dictionary. The number of Alzheimer's patients is going to triple over the next four decades. How would we want to be treated? So, it gets interesting. We all are living longer which means that those of us who are predisposed to conditions like Alzheimer's are more likely to manifest the symptoms. Back to the analogy of "raising" kids. We do not raise our parents, and we ourselves do not want to be viewed as children of our own children. Yet, the end game is about diminishing capacities of our older family members. Are we "lowering" our parents...hopefully very gently? ...versus raising children? So, now comes the coping advice. Rule number one for all of you who are caregivers is that you need to take care of the caregiver. Here is the subordinate rule. Find help in caring for the caregiver. And please know that what geriatric care managers (GCMs) do is support rule number two as well as rule number one. Yes, we assess, plan and execute to help the older loved one or other person with special needs. But every bit as important, GCMs help to care for caregivers. Remember that with every conundrum, there also is either an answer or perhaps even a cure. 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.
Perhaps you have heard stories about people who are checked into a hospital and develop an infection while there. Or perhaps you have heard of the person with a minor infection that develops quickly into a systemic infection. All too often in these kinds of cases, the infection can move quickly to sepsis and ultimately even to death. Each year more than a million people develop sepsis, a multiple organ or systemic infection that causes the body to start shutting down altogether. In as many as half the cases of sepsis that develop, the patient actually dies because this runaway infection simply is not detected early enough. It is most common among adults over age 65, people with compromised immune systems and hospitalized patients.

            If you are a caregiver to an older person or someone with a compromised immune system, you may be the best person to see the warning signs. That is because the warning signs can be so subtle that a health care provider not familiar with how a patient is normally may not detect the small changes that can be the hallmark of sepsis. If your loved one develops an infection, be on the lookout for two of more of the following symptoms which may be the warning signs of sepsis:

·          Infection accompanied by a high fever or a very low fever, often accompanied by a chill or trembling.

·          Hypotension or very low blood pressure in a patient who has no history of low blood pressure.

·          Elevated heart rate - typically anything above 90 beats per minute.

·          General disorientation which may appear almost like a mild dementia or confusion about their surroundings or why they may be in the hospital.

·          Shortness of breath, rapid breathing or even hyperventilation which may be caused by fluid building up on the lungs.

·          Skin that is warm to the touch or what may appear as a heat rash.

·          A white blood count reported by the provider, but one that is unusually high or low.

       Most of these warning signs are what you as a caregiver can observe, but some may require you asking the nurse or physician charged with your loved one's care. And as in any case, you as a caregiver should be actively asking questions about anything you do not understand. Rarely will a patient identify their condition as sepsis, especially if the condition causes confusion.

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.