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

Who Owns the Decision?
I have talked in some of the recent blogs about when decision-making may transfer to another person from an...
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December 15, 2010
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With over 300 clinical trials on vaccines for COVID19, it perhaps is not a surprise that at least two are very close to emergency authorization by the Food and Drug Administration this month. Where are you in the line to get a vaccination? Well, if you have a loved one over age 65 still living independently, the answer is behind front line health care workers, other essential services workers, individuals with preexisting conditions that place them at particular risk. Yes, it will be a bit of a wait. Government agencies are coordinating the access to a COVID vaccine, and they are also watching out for scams. Do not fall prey to that call or email that promises you easy or early access to a vaccine. So, how do you tell the good guys from the bad guys? Homeland Security and FDA have some suggestions:
- Vaccines will not be available on the internet…and that goes for any alleged treatments for COVID as well;
- Only sign-up for a vaccine through a licensed medical provider…and even then, be sure that they have been certified to provide a vaccine;
- COVID vaccines may at some point be available through your CVS or Walgreen’s pharmacy, but do not trust online pharmacies, especially those whose names are not familiar to you;
- Avoid any texts, emails or calls about a vaccine you can purchase…there will be no Cyber Monday or offshore providers for vaccine distribution;
- And COVID19 vaccines will not be available through Facebook, Twitter, Instagram or other online feeds.
And be aware that the global rollout of a COVID19 vaccine will not be like in the movies where a convoy of camouflage vehicles arrives in town with uniformed soldiers spilling out to set up tents for administering a vaccine. Hollywood does not get to set the stage here. There may be lines of people – socially distanced – waiting at a pharmacy or clinic for their injections, and get this, there may be no charge. All the details are not available just yet, but appreciate that the federal government already has forked over billions of dollars to a host of pharmaceutical giants to develop vaccines. So, your tax dollars have covered this already. If you receive a vaccine offer that is too good to be true, it likely is too good to be true. If you see (or hear) something, say something. Homeland Security wants to hear from you, and you can go online to report any kind of suspicious activity. Go to: COVID 19 investigations. But please refrain from “dancing in the streets” until at least 70% of the population has been vaccinated. Yes, that would be “herd immunity,” just not the kind that comes from so many people being sickened in order for it to happen. In the meantime, call or ZOOM a friend or family member. We all need some continued support to make it to the goal. 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.
While everyone is awaiting the next vaccine to prevent COVID-19 or help in the treatment of the condition among those who have contracted the virus, too many Americans already suffer from medicinal proliferation. Too much of a good thing happens to too many seniors who are over-prescribed. 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? Ask one or more of these questions when you accompany your older loved one to their next medical appointment:
- Is the symptom the physician is about to treat a side effect of a medication they already are taking?
- Is there a safer drug to replace any of the medications your loved one is already taking?
- Can a lower dose of a prescribed medication be tried with any on the list?
- Does my loved one need to take any of these drugs at all?
And if you feel really bold ask how diet and exercise may be used to replace taking a drug. For instance, a balanced diet with enough vegetables and fruits can address diarrhea. Reducing consumption of sweets or other carbohydrates can alleviate pre-diabetic or diabetic symptoms. And getting up and walking can lower one’s high blood pressure and reduce weight as well. And all of the above can improve those feelings of melancholy that are far too common during this COVID quarantine. 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.
COVID 19 was not in my calendar for 2020, and I strongly suspect it was not in yours either. I often have said that family life crises don’t make appointments; they just show up. And I am usually talking about how to be prepared for the inevitable call from or about an older loved one in your orbit…AND how to be prepared for your and their next steps. Well, this time, preparing for a crisis could be closer to home, because all of us need to be prepared so that the people who may get the call that we have taken ill can be prepared. What do you need to do to make a Plan? When I have spoken in the past, some people back off from talking about a loved one in a crisis. This list is about you, so please forgive me for getting “personal.” Here is my “short list” of the documents you need to have and make them available to your partner, your kids or other close friend … sometimes with no notice:
- Medical Release – the document you need so your medical providers to speak with your loved one’s about your health status, medications and prognosis.
- Power of Attorney (POA) for Finance - a legally binding document that gives a person (referred to as the “agent” or “attorney in fact” permission or power to act on your behalf in matters of property or finance.
- Power of Attorney (POA) for Healthcare - a legally binding document that gives a person power to act on your behalf in matters of medical treatment. The “power” typically is in force when it is deemed the person in question can no longer act for themselves or if they are not conscious.
- Practitioner Orders for Life-Sustaining Treatment (POLST) – a document (varies state by state) that specifies in advance what measures you wish to have in the event you cannot expressly grant permission yourself. These orders typically revolve around life-saving measures; they are sometimes referred to as advanced directives and are placed in your medical files. The forms are downloadable at your state’s web site.
- Health and Life Insurance Policies – the health policy will help everyone involved understand what is covered and which physicians and other providers are available to you. The Life insurance policy should be in a safe place so that it can be readily accessed should that become necessary.
- Estate Plan – is (potentially) a wide-ranging document that let’s everyone know how any real estate or other holdings are titled and what the “plan” is for when your will is executed.
- Trust documents – help to identify how your estate is to be transmitted to beneficiaries. Trust names need to be consistent with life insurance, will and holdings in order to be in effect.
- Last Will and Testament – the legal document by which you express your wishes of how property is to be distributed at death, and names one or more persons, the executor, to manage your estate until its final distribution.
- The Grab and Go – This is a list that typically is sealed in a plastic bag. It includes your medical insurance documentation, a list of allergies, a list of medications, primary care physician contact details and in case of emergency (ICE) contact information.
Please email (info@creativecaremanagement.com) me with any questions on any of these…as well as how to take the next steps which is your plan. Do yourself a favor…don’t wait. 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.
The big splash on the medical news this past week gratifyingly was not COVID-19, but instead an approval of a new Alzheimer’s treatment by the FDA. If you have been following any of the news on this new drug we have difficulty pronouncing, aducanumab, you may be scratching your head a bit. I’ve asked one of our senior people, Steve Steiber, Ph.D., to explain this new drug and what is going on in the “Alzheimer’s space” generally, because Dr. Steiber has over 30 years doing market research in the biopharma arena. He’s been published in JAMA, American Journal of Public Health, Public Opinion Quarterly and more and he has a book, Measuring and Managing Patient Satisfaction, in its second edition. He also is my co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia. … I am happy to share with you my take on aducanumab, the Alzheimer’s treatments that preceded it, the controversy that surrounds aducanumab and also how much research into an effective Alzheimer’s treatment is still going on right now. Medical practitioners have been using biologic agents to treat conditions for a very long time if you count insulin, human growth hormone, thyroxine and other “naturally-occurring” body hormones. Aducanumab is a novel biologic, however, that works to interrupt the formation of beta amyloid plaque in the brain. You may recall reading about one of the ways that Alzheimer’s disease is diagnosed is by assessing the accumulation of plaque in the brain through PET imaging. But let me start with what we have had available to treat Alzheimer’s prior to the approval of aducanumab. Prior to aducanumab, FDA had approved five drugs to slow the progression – but not cure - Alzheimer’s:
- 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.
None of these treatments could reverse or halt the progression of Alzheimer’s disease, and they really only modestly slowed its progression. The last of these was approved by the Food and Drug Administration in 2003. It had been a very long time since anything new has broken on the scene to address the ravages of Alzheimer’s disease when aducancumab and Biogen presented their case to the FDA committees seeking approval. It would be charitable to say that this new treatment offered mixed results at best in two Phase 3 clinical trials on patients with the disease. Phase 3 is the trial that builds on early research in animals and later humans to test against placebo whether a therapy can show a statistically significant improvement over placebo on specific predetermined clinical outcomes called clinical endpoints. Biogen halted both its phase 3 studies, called Engage and Emerge, early when they assessed that aducanumab was not likely to meet its clinical endpoints ("clinical endpoints" are the pre-established goals that a study proposes to meet in order to be deemed successful). In subsequent analysis, Biogen found that the Engage study, in fact, did not meet its endpoints, but Emerge showed some positive outcomes. Generally, this kind of analysis after the fact is not accepted by FDA, and FDA also takes a pretty dim view of one study’s success offset by another study’s failure. Nonetheless, FDA gave its conditional approval to Biogen. The condition was to be a phase 4 clinical trial to settle some of the questions on efficacy. You can go to your financial news feed to see that Biogen’s stock shot up 39%, so this is a big deal…but the deal is not over. In my next post to Charlotte’s Blog I’ll be sharing with you more of what FDA has demanded of aducanumab going forward, some of the organizational fallout at FDA, and also why we might still be hopeful. I’ll share with you some details on more than a dozen other companies who are moving forward with their clinical trials on therapies that show tangible promise in the fight against Alzheimer’s disease. I’ll also share the sites you can visit to gather more information on all clinical trials currently underway as well as where you can go to see how you can help your loved one apply to be part of some of these clinical trials that show promise if you are a caregiver to someone with Alzheimer's. It gets interesting. I encourage you to also send any questions you have to info@creativecaremanagement.com . I'll do my best to provide answers in my next post...part two. 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.
One of the other casualties of this extended quarantine is the cognitive consequences of less social interaction and less intellectual stimulation…what we call the “Activities of Daily Living.” If you have an older loved one with whom you still maintain at least some contact by phone or ZOOM, are you keeping track of their mental acuity? Allow me to put one more tool in you tool kit for monitoring you older loved ones. If you sense a disorientation or confusion that was not there before or maybe it seems to have elevated in frequency or intensity, it’s important that you get a professional to weigh in. First, be prepared to help the provider who may intervene on your loved one’s behalf by giving your best understanding of the timeline for the onset of this new cognitive issue. It used to be that we would look to perhaps a urinary tract infection for relatively sedentary older adult who has become more conspicuously confused within a short time – days or weeks versus months. A cognitive decline of such short duration can simply be delirium, and it can be cleared up as easily as the underlying infection can be cleared. That is, if it is a urinary tract infection, but let the professionals make that diagnosis. If the decline has been over months, what seems to be most conspicuous about the change? Is it confusion about:
- Dates and times?
- Location?
- Short term recall of names or objects?
- Simple math?
- Name retrieval of objects or people?
If so, the health care provider or a referral to a neurologist may result in a Mini-Mental Exam. It’s a straightforward 30-question test. And there is a relatively newer test called the Montreal Cognitive Assessment that is as long, but it also has the ability to test for cognitive abilities like:
- Language and communication skills
- Short term memory
- Attention and concentration
- Spatial and temporal orientation.
This last one literally does call for a visual exercise in connecting dots in a systematic way. And this is the important part - if your loved one’s provider is assessing that individual’s cognitive ability, the Montreal test is better at catching a problem early, and it is more sensitive to cognitive impairment owing to a variety of conditions such as Parkinson’s, vascular dementia, Huntington’s, brain tumors, trauma or multiple sclerosis. But neither of these tests will actually diagnose the specific underlying cause among all of these potential conditions to which we can also add Alzheimer’s. That would take a full-blown neuro-psych evaluation. The key takeaway is that the “new test on the block,” the Montreal Cognitive Assessment, can detect real cognitive issues earlier and across a wider range of underlying conditions. So, if you do communicate any cognitive concerns to your loved one’s provider, be aware that all tests are not equally capable, and early diagnosis is better than too late if you want to have an optimal outcome. During this time of quarantine, it is important to be as vigilant as we can – albeit at distance. 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.
May is National Geriatric Care Manager Month, but I am thinking that most of you probably did not get the memo. You may have been following my blog – especially those with an older parent or loved one – and you know what it means to be a caregiver, but not as many may know what a geriatric care manager (GCM) is. Geriatric care managers are the people who work with caregivers to older parents who want time for their own families and confidence that their mom or dad will be well cared for. We also work with older adults who do not want to be a burden to their families as they navigate health care issues and make decisions about where and how they can live as independently as possible.

And a person does not have to really be a caregiver to seek the services of a geriatric care manager. We also work with professionals who want to get help for their aging clients when they have had a life-changing incident and wish to remain as independent as possible. These are professionals who want to help their clients maintain quality of life when life changes and coordinate the medical and other resources that make that happen.

I sum up what it is to be a geriatric care manager by describing the four activities where I am most involved in helping elders or others with special needs:
1. Resource: GCMs make the home of a loved one who is aging in place more secure. We help show families what services can be brought to an elder’s home and at some point identify what are the best alternatives to home. And quite often with sandwich generation adult children of older adults, we can be there at a doctor’s appointment when they cannot be there.
2. Counselor: GCMs help families to reach consensus about how to best care for mom or dad when there are so many options or in cases where it may seem that there are no good choices. We help caregivers to older adults or even spouses to sort out whether it is just tiredness or if it is depression or old age.
3. Advocate: GCMs help to coordinate the care from multiple medical specialists who may be attending to an older adult and make sure they are all communicating with one another and with the caregiver. We also work to document a clear care plan the helps to preserve the life an older adult really wants, and we are the eyes and ears to look out for what is best for an elder if they are living in a senior community, assisted living or nursing home. We are particularly alert to any signs of abuse or exploitation.
4. Friend: GCMs are also good listeners, because it can be really important that a caregiver have someone with whom they care share how hard it really is to reverse roles with the parent who had raised them from childhood. It helps for me to have been a caregiver, so I can personally and professionally empathize with what it is like.
For more information on geriatric care management visit Care Manager.

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 Charlotte Bishop.

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