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

What Caregivers Should Know About Diabetes Drugs
I have had the good fortune to connect with Julian Hills, a content writer and blogger for a great...
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September 18, 2013
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It Is Never “Just” Diabetes
I have again asked our vice president for geriatric care manager services, Steve Steiber, Ph.D. to share his insights,...
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August 21, 2013
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Naturally Sweet Seniors are Better
We hear a lot of news these days about the obesity epidemic, and it is important to appreciate the...
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March 11, 2013
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Three Tips for the Diabetes Caregiver
If you are a caregiver to someone with diabetes – Type 1 or Type 2 – then you know...
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March 4, 2013
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In the Caregiver's Words

Recent Client Praise

You may have heard about some of the changes in how hospitals are reimbursed under the Affordable Care Act (ACA). For instance, hospitals actually are financially penalized if too many of their recently discharged Medicare patients return to the hospital too soon. Most of these repeat visits come by way of the emergency room. I am not going to tell you about what hospitals are doing to keep people from being readmitted inappropriately, but I will share with you when it really can be better for an older adult to avoid the ER for their own health reasons. First, using an emergency room when it is not an emergency is expensive. The New England Healthcare Institute estimates that $38 billion dollars a year are spent on emergency room services that could have been received elsewhere. For instance, a person who goes to the ER with an upper respiratory tract infection – flu or flu-like – symptoms will spend about twice as much of their own copays or deductibles than if they had gone to a primary care physician’s office. With millions more now covered by insurance under ACA, the ER simply should not be viewed as a first line response. Second, a non-emergent visit to the emergency room gets queued up along with all the other real emergencies which then gets in the way of providing needed care to the “real cases.” It also unnecessarily exposes the non-emergency patient and whomever brought them to the ER to all the infectious illnesses of the other contagious patients in the waiting area. The old line about the way to get sick is to go to the hospital is not really a myth. Third, consider your options. Even your older loved one’s primary care physician may have an after-hours option. Or you may consider the urgent care centers that are popping up everywhere these days…or simply get on the appointment list with the primary for the very next day. And if you are a caregiver to an older loved one, check in on them between Monday and Thursday so that you can get to the doctor’s or other office on a weekday. Most hospital readmissions I mentioned occur between Friday and Sunday! Fourth, the American College of Emergency Physicians offers guidelines for recognizing a real emergency. If you are a caregiver to an older loved one, look for these signs that it may be time to call 911 or take your loved one to the ER: • unusual abdominal pain or upper or lower abdominal pain, pressure • difficulty breathing, shortness of breath, faintness, dizziness • significant vision issues • confusion, changes in mental state, suicidal ideation • coughing or vomiting blood or any uncontrolled bleeding • severe or persistent vomiting or diarrhea. When in doubt, call your loved one’s primary care provider or make that trip to an urgent care center. And, of course, there can be real emergencies; that is what the ER is for.. 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’ve all heard about COVID’s symptoms…the GI upset, the shortness of breath, the fever, the added symptoms of the long-haulers, the after effects among those who survive COVID and more. We don’t hear much about the other big side effect among even those who don’t actually come down with the disease – depression. In the years leading up to the pandemic and quarantine more than 18% of people 65 years of age and older showed signs of depression. Dr. Kathleen Rogers of the Cleveland Clinic warns that depression or anxiety may be something akin to their own pandemic as a consequence of the isolation of 2020 and beyond. If you have an older loved one with whom you are only just now beginning to restore contact, be watchful:
- Those who have lost friends or loved ones to the pandemic are highly likely to be depressed.
- If your loved one talks with you about loneliness, isolation, lack of socialization...be attentive for a “down countenance” or even suicidal ideation.
- Signs of disorientation or memory lapses also can be indicators for depression owing to disengagement.
- Don’t be misled by the mom who always took care of things; women are almost twice as likely to have depression.
Signs of depression ought not be taken lightly, because depression is linked to other conditions like cardio-vascular health, dementia and more. People do not just “snap out of” a clinical depression. If you see or hear any signs of depression with your older loved one – and this is harder to discern over the phone or on ZOOM -reach out to:
- Your loved one’s primary care provider who is able to schedule an appointment for an initial assessment.
- The social worker or community case manager of the setting in which your older loved one may live.
- Your local city or community health department; they are likely to have a social worker or an advocate who can go to bat.
- The hotline - The National Substance Abuse and Mental Health Services Administration or dial 800.622.HELP.
We’ve talked before about “if you see something, say something.” Well, we are working with blinders still on as we all move back toward a new normal, so we may not visually see things as we once did. Follow your instincts and emerging from the pandemic and quarantine may actually be a return to “normal.” Charlotte Bishop is a Caregiver Coach, an Aging Life Care Advisor, 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. She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.
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New research recently reported sheds some light on what we need to know about Alzheimer's as well as what we may not want to know. Please allow me to explain. You likely have heard of some of the genetic advances that now allow labs to identify certain individuals who are more likely to develop Alzheimer's disease (AD) based on the apolipoprotein E ( APOE) ε4 allele risk factor for AD. Very simply, those who have this gene are at a higher risk of developing late-onset Alzheimer's, but how this happens is not yet fully understood. Scientists conducted a study among people with this genetic expression by dividing the individuals into two groups based simply upon whether they knew they had the gene or not. All individuals had the gene expression, so if they were randomly divided into groups one would expect that any person would have the same chance of having cognitive problems as any other individual. What the scientists found was quite remarkable. These study subjects were asked to rate their own memory performance and mental processing on a number of tests. Their actual performance was also quantified by the scientists. At the end of the testing, those people who knew they had the gene performed the same as those who did not know on the objective tests. When they scored themselves, however, those who knew they had the gene did worse than those who were unaware they had the gene. So, a person has to ask whether they will be better off knowing that they have a predisposition to AD or not? In a more upbeat bit of clinical research among Alzheimer's patients scientists offer a glimmer of hope for even those who may be predisposed to AD. It is a federally funded study and the largest and longest duration study of this type. Over a period of five to six weeks the experimental subjects were exposed to a number of hour long sessions in either reasoning, memory or processing speed, cognitive abilities that often decline as individuals age. All individuals were tested for cognitive ability at intervals up to five years from their initial training, and those who had been trained did better than those without the training. Even ten years out, there was a positive difference between the two groups, but the trained group did tend to decline somewhat from where they had been. So, if you are a caregiver to an older loved one, you may have one question along with one certainty. First, do you want them to have the test if knowing can be its own down side? Second, you should know that you want to encourage them to be socially active and intellectually challenged. 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.
I have really lost track of how many conversations and/or blog postings I have had about Caregiver Stress. As a certified geriatric care manager, we work with families, and a substantial part of my focus is upon the stress of a caregiver trying to both deal with a loved one's eroding health, but also the demands on them from the others who depend on them. I would like to devote a bit of space here to addressing the stress of the aging loved one and how a caregiver can help them to cope with what life throws their way. Retirement is a break from the stressors of a workaday world, to be sure. But as one lives to do what one wishes as a reward from a long career, there comes a time when new stressors emerge. There can be increasing physical challenges from a medical condition that is not going to get better. Many of these conditions like arthritis, cardiovascular or pulmonary issues just get worse with time. As a person becomes less and less able to do the things they used to do to take care of themselves, the stress mounts. Other very common stressors are those that come with needing an elder caregiver, a spouse or partner to help with every day tasks; it takes an increasing toll. With general changes in health status can come a profoundly diminished sense of well-being and just plain depression. So much for the Golden Years. As a caregiver, look for these warning signs of excessive stress in one or both of your older loved ones:
- signs of anxiety, undue worry or outright panic attacks
- irritability or angry outbursts
- sadness, melancholy or lethargy
- indecisiveness or difficulty focusing
- difficulty getting to sleep or staying asleep
- an array of aches, pains or other issues of nonspecific origin
- rashes, breathing problems or other "new" allergies
- drinking or eating too much or too little; or
- an increasing number of prescription or OTC medications on hand.
As a caregiver, you can help by helping your loved one to find a remedy for the stress. There is no absolute way to rid ourselves of all stress at any age, but the key is finding help to cope more effectively with the stress in our lives. For your older loved one, consider:
1. Gently and persistently encouraging your loved one to be more socially engaged with friends, clubs or outings in order to get a break from the stress cycle;
2. Help your loved one to find seek out talk therapy; it is not about getting another prescription nearly as much as "unloading" to a trained therapist;
3. Seeking a physical aid in the form of gentle massage therapy, exercise classes like yoga, relaxation therapy or just getting out for longer walks.
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@creativecasemanagement.com.
September is Alzheimer’s Awareness Month, and this is the third of four posts we’ll offer on the subject. I have been hoping to post with a subject line like “First Cure for Alzheimer’s Disease.” I would settle for “First Effective Treatment for Alzheimer’s Disease.” Sadly, neither of these seem even close to what we can expect anytime soon. But as I noted in an earlier post, there are nearly 3,000 clinical trials in progress on various tests, predictors or treatments of Alzheimer’s Disease. And 172 of these trials represent 143 therapies under investigation. Tests and biomarkers are almost as important as treatments. These studies will help to identify the condition earlier in patients as well as help scientists to better understand the disease progression. They can then more effectively investigate a cure or a way to at least slow the progression of this diagnosis that most people fear more than death itself.
Thus far, the only FDA-approved therapies have been very limited in slowing the progression of Alzheimer’s disease, and the most recent approved therapy has been so ineffective that Medicare will not even approve reimbursement for its use. Here is a brief overview of what have been the approved medical treatments for Alzheimer’s:
- Aduhelm (aducanumab) claims to reduce beta-amyloid plaques in the brains of Alzheimer's patients, but the final conclusions from the clinical trials have been contested.
- Aricept (donepezil) is able to claim that it can slow the cognitive progression of Alzheimer’s and modestly improve confusion, memory and awareness.
- Exelon (rivastigmine) claims to address the memory loss of both Parkinson’s and Alzheimer’s.
- Namenda (memantine) claims to treat the moderate to severe confusion of Alzheimer’s disease, but it is to be used in combination with one of the other agents.
- Namzaric (donepezil and memantine) combines an extended release form of Namenda as well as Aricept in one pill to address the symptoms each addresses individually.
- Razadyne (galantamine) claims to improve the ability to think and even remember by increasing brain levels of acetylcholine, a beneficial enzyme.
So far, these treatments have not been very effective or effective for very long. Most of them tend to focus on beta amyloid and tau tangles, and this whole concept has come under fire, of late. The contention is that early research setting this premise for treatment may have been based on doctored evidence. More to follow on that controversy at some point, but other controversies have created their own firestorms. With approximately 6 million people already diagnosed in America, you can imagine how much is being invested in finding an effective treatment. When there is good news, we will get it to you as soon as practicable. 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.

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Posts tagged with ‘Diabetes’

What Caregivers Should Know About Diabetes Drugs

It Is Never “Just” Diabetes

Naturally Sweet Seniors are Better

Three Tips for the Diabetes Caregiver

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