Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • In Home CaregiverChicago's Geriatric Care Manager Center of Excellence

Dementia: We’re Not Post-COVID Yet
If you have a family member or loved one with dementia, this pandemic and its restrictions have been exponentially...
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May 26, 2020
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Distance Caregiving Through a Wall
I’ve written numerous times about distance caregiving, and one of the observations I have offered is that distance is...
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May 19, 2020
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Caregiving During COVID: Four Tips for Reengagement
You may recall that I have recommended limiting your news consumption, because it really does add to our stressed...
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May 12, 2020
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Tips for Distance Caregiving: Up Close and Personal at a Distance
If you think being a caregiver to an older loved one is hard–with all the trips to help them...
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February 4, 2020
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Caregivers and their Medicare?
Yes, you read it right. I am posting this one about what caregivers should know about their Medicare. But...
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September 12, 2013
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In the Caregiver's Words

Recent Client Praise

They call it Trendelenburg gait. You may have noticed it in the way your older loved one walks. It is a side to side upper torso sway for men and a side to side sway of the hips for women. It results in about a four degree shift in the opposite hip from the leg that is stepping forward, and that doesn’t sound like a lot, but it really impacts the knee on the side that is shifting…a 23 degree shift. Over time, the knees get a lot of exaggerated grinding which will wear down the cartilage. Parkinson’s or even dementia can encourage this exaggerated gait, and hip replacement and the gait pattern that can follow surgical recovery also can set it in motion. But Trendelenburg gait is not inevitable. We all have to grow old…versus the alternative, but we do not have to “walk old.” Physical therapists recommend a few exercises that help to strengthen core muscles that can prevent that side to side gait:
1. The Walk-Over – Stand in front of a mirror so that you can monitor your exercise. Standing upright with feet shoulder-width apart and a towel rolled up in front of one of your feet, simply lift your leg up and then step over the towel. Tap your foot to the ground in front of the towel while keeping your hips horizontal, and then lift your foot again and tap behind the towel. Do this back and forth for 30 seconds and then switch to the other leg. Do the exercise twenty times. This can be twenty times in one exercise or over multiple “exercise breaks” in a day. It’s a strengthening exercise, so picture yourself getting stronger the more repetitions you do. Do this as many days of the week as you can with three to four days as your target.
2. The Plank – You may wish to “Google” this so that you can see it. We are talking side planks which mean that you lie on your side, preferable on a soft carpet or exercise mat. With your elbow lifting your upper body, you form a straight line from your feet to your head and hold for 30 to 60 seconds. Alternate this pose and holding with the other side. Go back and forth between sides about three times and do this as many days a week as you are able.
3. Chair Sits – Begin by standing in front of a wooden chair with your arms folded across your chest and your fit about shoulder width apart. Lift one leg forward to form about a 20 degree angle with the other leg that is vertical. Slowly sit down with that leg extended. Once you have made contact with the seat of the chair keep the pose while standing back up again. Change to the other leg and repeat. Do this as many repetitions as the plank and as many sets.
I have been talking about helping your older loved one, but this may be perfect for us all so that we all can grow old…without walking old! 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.
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.
Most of us have become familiar with generic drugs. We now have a new category in your medicine cabinet called “biosimilars,” so I have again asked our Vice President, Steve Steiber, Ph.D., to talk to us about what we may not know - but should know if you are a caregiver to an older loved one - about the evolving federal rules and science around biologic medicines and the new medicines who are enough like them to get FDA approval. Steve has over twenty years of experience as a consultant to the pharmaceutical and biologic industry prior to joining us at Creative Care Management: We all have heard of some of the (mostly) injectable medicines that have changed the lives of people with rheumatoid arthritis, Crohn’s disease, psoriatic arthritis and some other conditions that are part of a larger category called autoimmune diseases. They have been around for about twenty years and have become names many of us know from television and magazine ads. We also mostly know what a generic medicine is. It is the same chemical molecule as one that a drug company brought to market with a “brand name,” but it is manufactured by another company after that brand drug’s period of patent exclusivity expired. All drugs discovered by a company can be patented for 20 years so that no one can make and sell the same drug until that patent expires. Companies apply for patent protection well before they go to FDA for approval, so they do not have a full 20 years alone in the market following FDA approval. For instance, once Aleve’s patent expired, you had other companies flooding the market with naproxen sodium (the generic name of Aleve). And once Motrin’s patient expired you got ibuprofen, and Tylenol gave way to acetaminophen, and so on. Well, one of the provisions of the Affordable Care Act (ACA) was to change the rules for biologics to be like that process. Before ACA changed those rules, any medicine patterned after one of those approved biologics like Humira, Remicade, Cimzia and others had to go through a process just like a new medicine. Now, like the generics, a medicine can apply to be a biosimilar to a brand medicine simply by proving it is as good as that medicine. Hence, the name biosimilar. Don’t ask me why they couldn’t call it “generic,” but it amounts to pretty much the same thing. So, if you are a caregiver to an older loved one on a biologic, you may soon have a cheaper alternative available. Generics and biosimilars inevitably will be cheaper than the brands they are like. It also means that in most states the pharmacist can substitute the biosimilar for the brand medicine if you agree … even if your physician writes the branded name on the prescription slip. Do your research so that you know the clinical evidence on the new biosimilars as you make that decision at the pharmacy or in a conversation with your care receiver’s doctor. Think of it as getting a BMW-performing car without the logo…and without the price tag. But ask your physician for their thoughts. 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.
Caregiving is not like a switch that we turn on or off, that we are either caregiving for an older loved one or we are not. What I have found in my work as a geriatric care manager working with family caregivers is that there is a line that is crossed at some point. That line distinguishes what I would term the occasional caregiver from the immersed caregiver; a line that distinguishes the younger daughter or son who routinely looks in on mom or dad from one that suddenly is thrust into a role of scheduling and coordinating care for their loved one. Any caregiver can be caught by surprise when they get the call that mother has fallen and fractured a hip, that dad has had a stroke or that their loved one is hospitalized for any of a number of acute conditions than are suddenly life changing events. But for most caregivers, there are not-so-subtle signs that it is time to become more involved. Note that I said more involved with, not more in control of your loved one's life. One of the reasons that even a loving caregiver may not see the signs that they should be stepping up is that their parent wants to still be in control. The fact is that they can always be in control, but they may need more help with some of life's day to day tasks that are becoming a challenge.
1. Look into the Details. I have talked in other postings about activities of daily living as a number of facets of what we all may take for granted until we begin to lose some our abilities to take care of ourselves. For instance, are there bills that have not been paid on time, are there signs that mom or dad has not been preparing regular meals, do you notice that your older loved one is not keeping up their personal hygiene? Is there slippage? Gently ask to help with some errands or to bring in groceries or cook a meal - perhaps their favorite dish? Remember that you are not taking over; you are just helping out.
2. Become Part of the Conversation. Mom or dad might appreciate a ride to their next doctor's visit, and ask if they have any questions the doctor has not addressed. They may or may not have raised the questions, but they did not track with the answers. And you may have some questions about how well they are managing a chronic condition like diabetes, congestive heart failure or chronic obstructive pulmonary disease. Again, you are not usurping control; you are simply participating because you also care.
3. Everybody Has a Role. As you are seeing what else can be done to help your older loved one, remember to listen for what they want to control and what they are happy to relinquish. Find out from the provider what the larger goals are, and then work with your loved one to devise a game plan in which they actively participate. If they are not an active participant, they will not own the goal. You already have made it possible for them to understand the changes in their health; now make it possible for them to participate in their success.
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.
Over the years I have devoted a lot of space to talking about what a Geriatric Care Manager (GCM) does. And that is because we as a profession have a long way to go before people know what we do as clearly as they know what a doctor, lawyer or accountant do. In this post, I am going to give two examples of when to call a Geriatric Care Manager, because unfortunately we often get the call later than we could. The call comes after a family crisis instead of before a crisis when we could have been the professionals who help avoid the crisis. Here are two examples of when... The Big Fall. After age 65 approximately one in three older adults will take a fall, not just a stumble or a trip, but a fall where they hit the ground hard. Beyond the age of 80 the chances increase to fifty percent. As geriatric care managers, we certainly can be part of the team who helps your older loved one recover, rehabilitate and get safely back on their feet. Much of that process will be in the hand the medical providers who may repair the broken hip, arm or other bone. And the physical therapists will do a wonderful job of helping to rehabilitate your loved one back to full or nearly full recovery. What a GCM can help with is putting together the lifestyle recovery plan with the family. We assess not just the individual, but also the home in which they live. We help the family to get everything for the recovering loved one that they perhaps used to do for themselves. We also help to make home a safer place for getting about, eliminating further fall hazards and helping everyone to navigate the path to recovery. But, what if the family had called when they first noticed that their loved one's gait had eroded from a stride to a shuffle, and what if the GCM had received the call to come by your loved one's home and help make it safer for getting about and avoid the fall? Dementia. Older adults fear losing their mental capacity more than they fear dying itself. As geriatric care managers we can certainly be called upon to counsel the family in how to manage a crisis once your older loved one has actually wandered away from home and given everyone the big scare. We can give family members by coaching in how to deflect instead of confront a confused older loved one during conversation. And much more. But we can be more effective if we get the call before your loved one has walked aimlessly into the night. We can help the family to make your loved one's home safer against "breaking out" just as you would want security from burglars breaking in. There are also ways to sharpen mental acuity at the first signs of confusion through social engagement and other intellectually challenging therapies. Working toward social engagement in meaningful ways is a high priority. The list is longer than just these two crises to which GCMs respond. How is your older loved one's driving? How safe is home from fires? How safe is your older loved one from scam artists? Is your older loved one getting the best medical care and support for a chronic medical condition? and much more. I would be remiss if I did not also add where you can find a professional Geriatric Care Manager. There are a lot of people who offer services to "help older people," but many lack training or certification. The best place to find a GCM is at the professional association's web site. Click on the button that says: "Find a Care Manager" to locate a professional near you. 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.
The discussion about whether home is still the right or safe place for an aging parent should start with whether an older adult wishes to stay in their lifelong home or not. Some older adults are ready for a move, whether it is just to downsize the responsibilities of home ownership or to move to a warmer climate. But if they really want to stay where they are, the next conversation can then focus on what can be done to allow that to happen, but only if the choice is to stay and age in place. This is going to be the first in a two-part series about helping an older parent maintain independent living within their own homes. I have talked about some of the hardware-related issues in earlier posts, but this is more about lifestyle changes.
Emergencies Just Happen. There are a lot of options to make an elder’s home safer from falls. But, a fall or some other medical emergency can occur no matter how hard we try to prevent one. Make sure you have copies of all the important phone numbers in case of a medical emergency, especially if you live in another town away from your parents’ home. And be sure that this includes the local hospital, the primary care physician, any medical specialists and even the phone number of a neighbor or two who can step up if called upon. Also, keep current with any diagnoses or medications that your older parent currently takes.

Unheard of Problems. Hearing loss is typically a slow process of degradation. It may not be noticeable to those whom your parent sees everyday. But you take care of a Chicago senior living some distance away, note any change you may notice since your last visit. It is not just that you want your parent to benefit from optimal hearing – when one loses hearing, it is harder to even talk on the phone. Add up the difficulties in social situations and the inability to reach out with phone calls, and an older adult is at risk for becoming isolated which ultimately fuels melancholy and depression.

Vision Too. Older adults who have progressively lost visual acuity also are at risk for the same isolation that deafness can produce. If it is hard to see the buttons on a telephone it becomes just as hard to reach out to others as when one loses hearing. But if your older parent does have a decline in seeing or hearing, it does not mean that they cannot be socially active, but you may have to get help in the way of transportation, organization social venues and the like.

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. Visit our For The Caregiver page for more information and resources.