Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • geriatric care managementChicago's Geriatric Care Manager Center of Excellence

AARP’s Annual Report on Family Caregiving
In many of my postings on family caregivers I have talked about the really hard job of caring for...
Read more
July 18, 2011
0
0

In the Caregiver's Words

Recent Client Praise

That was on November 19^th this year…the pace of COVID-19 deaths in the United States…one every 44 seconds, or 1,971 in a 24 hour period. They have tallied “only 956 deaths for yesterday so far, but that figure will rise, and the high water mark was back on May 7 with 2,770 recorded deaths from COVID. We were supposed to flatten the curve, but that didn’t really happen, so now we are facing a precipitous rise to perhaps new highs. What can we do? There is no doubt that the two vaccines with 95% efficacy now seeking FDA approval will be a tremendous help in shutting down the pandemic, and there is another from Astra Zeneca with partial results that also are reasonably promising. But for any vaccine, we will be waiting three to six months for the shot. The wait is that short only for front line workers and later the older or at risk populations. They have gotten so much better at treating people with COVID, you may say, and it is true that remdesivir and dexamethasone are tremendous assets as are the ventilator units. What we may not fully appreciate, however, is that the health care workers on the front lines also have become much more informed about when and how to administer these aggressive techniques for them to be so effective. Even more hidden is the simple fact that far more young people have been getting infected, and they simply are more resilient in fighting the infection. And we do not have any real shortage of supplies (nationally speaking, because some more rural areas are a bit short on personal protective equipment, therapies and ventilator equipment), but we are beginning to stretch the capabilities of medical staff in a lot of major medical centers. In fact, in a number of areas there now are more ventilators than there are staff to manage them. So, how do you move toward that light at the end of the tunnel? If you want to have a place in line for the vaccination, you have to survive through the wait. You need to go back to the basics that were offered by the CDC early this year. Wash your hands frequently, keep social distance (I prefer to call it “physical distance” because I like being connected to people) and wear a mask whenever you cannot maintain distance. It’s simple…boring, frustrating and really tiresome…but simple. It’s also a bit ironic if you look at some of the archived pictures of people in urban centers back in 1918. You’ll see that they wore masks…they did not have a vaccine to which they could look forward, but they followed the guidelines. (They didn’t even have Netflix!) Let’s walk the number back from once every 44 seconds to once in a blue moon and then to never. We can do it right now. It’s simple. 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.
There were 39 million injury-related visits to the emergency room last year according to the Centers for Disease Control and Prevention (CDC). And 300,000 of those were hip fractures in 65+ year old adults that resulted in a hospital stay, and a good share of these were because the dog’s bark may have been worse than its bite! The older adults who have been walking their “best friends” are prime victims for fractures – mostly hip fractures – owing to an overly-exuberant four-legged friend. Researchers from the University of Pennsylvania looking at the causes of the injuries. While still only a bit more than one percent of all fractures nation-wide, the number of hip injuries caused by Fido pulling too hard on the leash have nearly tripled between 2004 and 2017. And this is just the first step, if you will, toward diminished health and quality of life for older adults who make the fateful fall to the sidewalk. Picture the recovery trajectory of a “normal hip hospitalization.” By normal I mean that a patient has the relatively common wearing of the bursa of the hip which leads to pain that can only be relieved by surgically replacing the head of the hip. It takes anywhere from one to six months and physical rehab to fully recover from hip replacement surgery. But other research shows that at least one in four who have a fractured hip will die within one year of the event. It is not the fracture so much as the incapacity and loss of one’s ability to do an array of normal activities of daily living like walking, sitting and rising, reaching to high places and more. But you can help your older loved one, especially if mom or dad has a dog:
1. Encourage your older loved one to talk with their physician at the next appointment to evaluate their risk for imbalance problems and perhaps encourage a vitamin D supplement to strengthen bones.
2. Get your loved one screened for bone density and risk for osteoporosis. Even before adding the canine, brittle bones are a risk factor.
3. Sign your older loved one up with a balance and strengthening class like Thai Chi. No way mom will do that, you say; so sign up with them.
4. Have your loved one’s vision checked to be sure they are not an accident waiting to happen, because they cannot clearly navigate their surroundings.
5. I add this “non-medical” suggestion. Pets can be extremely good therapy, so by no means should you discourage an older loved one from adopting a furry friend. Take the next step, however, and have a professional help train that loyal companion to work with mom or dad.
Please also do a keyword search of my blog to find more suggestions on how to help your older loved one get and stay fit. This one is an example of how to help with a better walking gait as a basic approach to better health. Then, just add the dog! And yes, the one in the picture belongs to our household. 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.
Some have called it an epidemic. And it’s particularly virulent within the senior population. The epidemic leads to even more serious conditions. But the cure is simple, and it distills down to three words: “Never Cry Alone!” I’ve written many times about the isolation that so many older adults in America face as they age. And then comes the COVID pandemic and all the rest of us who are not yet of an age got the chance to experience isolation first hand, and social media assaults, and out political climate, and out climate climate…the list goes on. It’s a feeling of loss that sets in and in many cases becomes full blown depression so much so that mental health tops the list of the health care issues threatening our society. It’s Simon Sinek that offered the simple message based on years as an inspirational author and speaker: Never Cry Alone! Ironically, Sinek doesn’t talk about loneliness or depression as something to deny or from which to create as much distance as possible. It’s part of being normal, he says. Resilience is the goal, not just happiness. Surround yourself with friends … or at least a friend … whom you can call when you just need to say, “This is not just a bad day; can we talk?” What does that good friend do, because remember friendship is a two way street? A truly good friend is not there to “fix things” for you, and a truly good friend is not there to “cheer you up.” A truly good friend is there to listen. That may sound simple enough, but extremely few of us are “good listeners” without some training. In fact, a psychologist named Kenneth Haugk, Ph.D., started an entire movement called Stephen Ministry in 1975, based on this simple premise of “active listening” to others with a problem, a tough situation or just in need of a sensitive ear. So, it’s just listening? Well, it’s all about active listening. I have a go-to phrase with my family when they come to me with problems: “Do you want me to problem solve or just listen?” With listening in motion, the active piece comes into play with additional questions that may sound like:
- I’m sorry to hear that; how are you feeling now?
- How is that working for you?
- You mentioned ____; talk to me about that.
- You’ve given this some thought; what do you think?
And maybe based on Mr. Sinek’s advice, you learn to allow your friend to cry and simply provide the tissue. And keep listening. 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.
While speaking with Matt Margolis (Elder Law attorney with Heartland Law Firm) recently, he mentioned a common question he receives often: “Why do I need a Health Care or Power of Attorney?” The short answer, he offered, is because only YOU can make a health care decision on your behalf or sign your own name. And he offered to expand on this in our blog with this post:

It is important to differentiate between a Power of Attorney for Health Care (HCPOA) and a Power of Attorney for Property (PPOA). If a doctor or other medical professional cannot communicate with you about your health care needs, whether it is because you are mentally incompetent or physically incapacitated (i.e. in a coma), a HCPOA allows someone else that you appoint to talk to the doctor and make a decision on your behalf. This authorized person is called your “agent.” A key component of the HCPOA is that the agent is making YOUR decision for you. It is not the agent’s decision or based on how the agent feels about a certain situation; rather, it is based on what you noted in your HCPOA and what you discussed with your agent (hopefully) prior to your incompetency or incapacitation.

A perfect example of what can go wrong when not having a HCPOA in place is the Terry Schiavo case from Florida. In 1990, Schiavo suffered major cardiac arrest, and a few months later was declared to be in a permanent, vegetative state. In 1998, Schiavo’s husband petitioned the court to remove her feeding tube, which was opposed by Schiavo’s parents. After many court filings and appeals to the Florida and US Supreme Court, the court’s decision to remove the feeding tube was upheld in 2005, and she died shortly thereafter. The problem was that Schiavo did not have a HCPOA in place. Therefore, no one had the legal authority to instruct the doctors on what to do without court supervision.

A PPOA allows your legally appointed agent to sign your name on your behalf and to handle your financial affairs. If you were to become mentally incompetent or physically incapacitated, who would continue to pay your monthly bills on time so your mortgage is current and your gas and electricity aren’t shut off? If you do not have a PPOA in place, there is NO ONE else that has the legal right to access the proper accounts and take care of your financial matters for you.

If you do not have a HCPOA or PPOA, a legal guardian will need to be appointed by a court to allow someone to make health care decisions for you or to be able to legally sign your name. A guardianship is a costly and time-consuming process. An attorney must appear in court a minimum of three times before the permanent guardian is appointed. Once appointed, the guardian must file an annual accounting with the court every year showing what money has come in to the estate and what money has been paid out from the estate. This can be a very arduous process when the person whom the guardianship is being sought for is not agreeable (typically due to their mental incompetency). This is called a “contested guardianship.”

To avoid the potential of any costly and unnecessary court proceedings, you should consult with an attorney to ensure that you have valid Powers of Attorney for Health Care and Property in place. This will not only protect you, but will save your loved ones a lot of aggravation and expense in the future.

Heartland Law Firm is a holistic elder law and estate planning firm. Heartland Law Firm concentrates in assisting seniors and those in transition with understanding the landscape they are in and what protections and benefits are available to them and their loved ones. Visit their web site at: Heartland Law Firm.

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.
October 29th is World Stroke Awareness Day. We may not be hearing as much about strokes as we once did, because in the United States the incidence of strokes is on the decline. Just under 800,000 people will have a stroke this year, and three-quarters of them will be over the age of 65. The reason the incidence in the United States is on the decline is because Americans are doing a better job of managing their blood pressure and because fewer of us smoke. Because so many of the stroke victims are older adults, it is important for caregivers to help their loved ones to further prevent stroke. With the proper preventive measures fully 80% of strokes could be prevented. Here are some suggestions for preventing strokes:
- Know your loved one's blood pressure; this is a routine part of anyone's annual physical, but you also can get a screening at health fairs or even your retail pharmacy using a machine;
- Know the signs of atrial fibrillation, a condition in which the heart rate goes so high that it fails to pump blood effectively which can lead to pooling and clot formation;
- Stop smoking - this is just one more very good reason to kick the habit if your loved one has not already done so as smoking doubles a person's stroke risk;
- Monitor your loved one's cholesterol intake and blood levels - any total cholesterol count above 200 is cause for concern;
- Manage blood glucose levels in your loved one if they are a diabetic - one of the complications of diabetes is poor circulation which can lead to stroke;
- Diet and exercise are part of almost every approach to better health - boost your loved one's intake of fruits and vegetables (five portions a day) and reduce intake of trans-fats and salt;
- Manage alcohol intake - most doctors recommend limiting alcohol consumption to two or fewer drinks a day.
The good news about managing these risk factors is that not only will you as a caregiver be reducing your loved one's risk of stroke, but you will be adding to their quality of life as well. In addition, you may find that these healthy habits also are contagious which can results in a healthier caregiver. Stroke prevention can become a win-win! For more information, I recommend checking out the web site for the National Stroke Association (http://www.stroke.org/site/PageNavigator/HOME). 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.
Steve Steiber, Ph.D., our vice president for senior services, completes his two part posting about how time of day of dosing can impact the effectiveness of a care receiver's medications. Steve has more than two decades experience in pharmaceutical consulting prior to joining CCM about 8 years ago. He reports: In the first installment on this subject, I had written about some of the general rules regarding when to take medications that are dosed once a day. In general, once a day doses should be taken at night. Let me get down to the differences across certain classes of drugs and the conditions they treat.
- Cholesterol - If your older loved one is taking any of the statins (e.g., Zocor, Lipitor, Crestor, etc.) to lower their cholesterol, they should be taken before retiring at night. Oddly, while much of the body is shutting down a bit, the liver produces more cholesterol after midnight than any other time of the day.
- Asthma - This condition is an early riser with a real spike in attacks between 4 a.m. and 6 a.m. Given how long it takes the inhalers to max out, it is recommended that the inhaled dose be taken in the afternoon in order to cover the early morning risk interval.
- Allergies - Allergic reactions will climb through the night and peak in the morning, so help your older loved one to take the single dose (for once a day) or one of the doses if the medication is a twice daily dose before retiring for the night for best coverage.
- Osteoarthritis - Dosing for this one should be dictated by when your older loved one is most active and will therefore be most pained. Read the label to see at what intervals the NSAIDs may be taken and back off from the high pain point by two to four hours.
- Reflux - There are two kinds of medications: proton pump inhibitors (PPIs) and H2 antagonists. PPIs are longer acting but slower to build up; once your loved one has reached an effective level, be sure that they dose before dinner so as to keep up the dose during the last meal of the day and through the night. With H2 blockers, have them dose as much as an hour ahead of dinner in order to cover the meal and night time. Why night time? Two to three times as much acid is produced in the stomach between 10 p.m. and 2 a.m. than at any other time.
- Hypertension - This gets more complicated with age. Have your older loved one take at least one of their medications before bedtime to cover their sleep time and the early morning spike. Younger individuals will have a natural lowering of BP at night, but older individuals with high BP may not have this dip, thereby exposing themselves to a greater risk of a cardiac event overnight.
As I emphasized in the first part of this series, be sure that you or your older loved one consults with their doctor before making any changes in their medication dosing. Be prepared also that older physicians simply may not be aware of some of this more current research on medicine and the body's clock. 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.

See all Testimonials »

Posts tagged with ‘geriatric care management’

AARP’s Annual Report on Family Caregiving

Contact

Newsletter Sign Up

Areas We Serve

Accreditations

Connect

Careers