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

Advice from the Perspective of 100
This marks the 100th posting on our blog since its inception October, 2010, and it gave me pause to stop and...
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April 16, 2012
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In the Caregiver's Words

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How about a free genetic test to learn more about your ancestors? Free… And finding out about the people who no longer are alive to tell their stories? And your older mom or dad figure why not... Well, identity theft is why not. How many of you have taken the test to find out more about your ancestors? You know, the one where you offer a sample of your saliva in a tube, mail it off and they return a “report” to you that details what they know about where other people with similar genetic profiles call “home.” Most people find they have ancestral roots that go back to a lot of places, not just the family homeland they heard about as children. So, of course, scammers would be finding a way to use this test which is supposed to put us all on the map in order to defraud unsuspecting elders. The U.S. Department of Health and Human Services Office of Inspector General has sent out an alert. Scammers are offering people qualified for Medicare to get the same test that you or I may have paid for on-line. You may have thought your older parents were pretty insulated from this kind of scam, but here is how it works. We’ve all been to the public health or “aging well” events where a roomful of professionals are giving away books on senior residential options, refrigerator magnets, sticky note pads and a cool bag for carrying home the haul of freebies. There are other ways like telemarketing and door to door calls, but scammers are offering the unsuspecting older individuals a free cheek swab by simply providing their Medicare identity, and the target who does not recall that they no longer need to provide their social security number don’t hesitate to offer that in exchange for an ancestral map. Well, it becomes an access point to a different kind of map, your loved one’s financial map. And with the address and social information, scammers can begin the kind of work they do all too well. So, prepare your older loved one to be vigilant about:
- If a testing kit arrives at your loved one’s home, tell them to not do a thing if their physician did not request a test. Better yet, take note of the address of return and report it to the authorities.
- If a stranger offers a genetic test and…by the way…asks for a Social Security or Medicare number, stop. In fact, anyone other than a physician’s office or lab should not be given any of these pieces of identification.
- If anyone asks for Medicare information, and they are not a medical provider to your loved one, beware. So, this is more than saliva in a test tube. If you suspect Medicare fraud, depart the Office of the Inspector General of the Department of Health and Human Services.
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.
Our vice president for geriatric care management services, Steve Steiber, Ph.D., brought some startling information to my attention recently, and it concerns the risk we don't often think of when we hear that an older loved one has been hospitalized. He has nearly two decades experience in pharmaceutical medical device consulting prior to joining CCM.
For older adults, who are admitted to a hospital intensive care unit, it would seem that discharge from the hospital means they are out of the proverbial woods. Not so, according to researchers affiliated with Vanderbilt University Hospital. They studied older adults who were discharged from the hospital after a stay in the ICU. What were they were looking for? Complications from what they termed Potentially Inappropriate Medications (PIMs) and Actually Inappropriate Medications (AIMs). Very simply, AIMS are medications whose side effects or likelihood of adverse events outweighed the potential benefits the medications were supposed to confer. PIMs were seen as medications where the jury might still be out. In short, they were looking to see what negative outcomes were associated with the patients' prescriptions separate from their medical conditions. This is a big deal if you are a caregiver to an older adult, very simply because drug-related admissions for 65 to 84 year olds have increased by 96 percent between 1997 and 2008. And approximately half of all drug-related hospital admissions are among adults 80 years of age and older. As we all know the over 65 age group is growing more rapidly than the population at large, so we can only expect this risk to grow. Getting back to PIMs and AIMs, about half of all older adults are discharged with at least one PIM, and four out of five of these older adults are discharged with an AIM. This is all the more exaggerated among patients who have been in the ICU, since 85% are discharged with at least one PIM and more than half are prescribed at least one AIM. The lessons the researchers learned is that some of the AIMs that patients were discharged with were appropriate and useful in the ICU, but should have been discontinued upon discharge. As a caregiver, be aware of the new medications that your older loved one was started on in the hospital ICU, and ask your attending physician if they should be continued at home. The most common AIMs that patients carried home with them on discharge were:
- anticholinergics (37%) - These drugs are used to treat asthma, COPD, incontinence, stomach cramps, and muscular spasms. They can be used to help patients sleep when they are hospitalized.
- nonbenzodiazapene hypnotics (14%) - These are almost always used as a strong sleep aid, but if a patient takes them home beware of their effect with alcohol.
- opioids (12%) - These are indicated for significant pain, most often associated with trauma or in post-surgical recovery. There is significant addictive potential, and these should not be maintained long term.
So, if your older loved one carries home any of these prescriptions, ask the provider why they are appropriate for use at home. If they are appropriate, also then inquire for how long the patient will be taking them safely or for what kind of side effects you should be looking. Please let Steve know if you have any questions about drugs or their side effects or the unique medical challenges faced by older adults or others with special needs. Please email to: ssteiber@creativecaremanagement.com.
Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends who deliver geriatric care management services to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecaremanagement.com.
I promise that I am not going to get up on my soap box about diet and exercise and all the health benefits owing to not sitting around so much. I have a different soap box today. Doctors often refer to this problem as nonadherence, but we also more commonly talk about noncompliance. You often see this on the label of a medication: “Take as directed.” That means two things, and the first is don’t take more or less of it and don’t take it more or less frequently. It also means just plain take it. Only in baseball is it considered really outstanding to have small percentages of success like a batting average that is .250 to .330. (That translates into getting on base 25% to 33% of the times a player is at bat.) But when it comes to taking statins, the numbers are really low. In a study of 5500 patients presented recently at an American College of Cardiology conference recently, researchers followed the adherence of patients who recently had had a heart attack and who had been prescribed a statin to reduce their low (bad) cholesterol. These were “typical” heart attack patients with an average age of 57 years, and 80% of them were male. As the researchers followed these patients they discovered that 25% did not fill the prescription the doctor gave them. And another 25% did not refill their prescription the next time it was due … but it gets worse. Only a bit over 6 percent of the patients took the medication as it was prescribed 80 percent of the time. The small group who took their statins “as directed” had a 48% lower incidence of another heart attack. This matters even more for your older loved one. As a matter of practice, a fair number of doctors take their patients off a statin when they get to their mid-seventies. Doctor must know best, right? But a European study of over 120,000 people over age 75 has shown that stopping statin therapy is a bad idea. As researchers followed these people the group who went off statins had a 46% greater likelihood of a coronary event like a heart attack and a 26% increased chance of a stroke. And this is why I am raising this issue today, because we are Aging Life Care Advisors. I am not setting aside diet and exercise, but I want to underscore that if your older loved one’s doctor prescribes a statin, pester them about taking it. It does make a difference. 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.
September is Alzheimer’s Awareness Month, so we’re going to be sharing four posts that will help everyone with what we have seen to be the most important information about dementia in general and Alzheimer’s specifically. Our title here offers the “Four D’s” which provide a great starting point for understanding the medical condition that a majority of Americans fear more than death.
Dementia. It’s a category that includes about 100 specific cognitive conditions. Generally speaking, most dementias are diagnoses of exclusion. That’s medical talk for the fact that one narrows down what a person is manifesting by successive steps of eliminating other possible explanations for a behavior. Forgetting someone’s name is retrieval and it is not a warning sign of Alzheimer’s. Forgetting that you know the person at all, however, is a storage problem, and it can be a sign of a more serious brain issue. Misplacing the keys, according to the experts, can happen to just about anyone, but forgetting how to start the car and put it in gear should be cause for concern. If your loved one gets confused on the way back to your table from the restroom while dining out, that may be cause for concern. You should also look for smaller signs as basic as their stride. If their steps begin to more resemble a shuffle this may be a sign of a more fundamental uncertainty. Distraction. Who isn’t distracted? We live in an age of “multi-tasking” and where all manner of digital interruptions happen all day and into the night. Some of them we invite like podcasts, news segments, and streaming. Others are a bit more insidious like the “phone” that we all carry with us so that we won’t miss a text, breaking news or a call from a friend…or spam. And then there are those who take their constant companion to bed to catch up on last items, posts or other “essential information.” Oh, and this last one has been proven to be disruptive of normal sleep by your device’s light itself…never mind the content. Many of us have become a digital juggling act and yet wonder why we forgot the reason we walked into the kitchen from the living room. Delirium. Against all of the potential warning signs for possible dementia, be careful about a hasty judgment. A change in mental acuity that is rapid in its onset is better classified as a delirium – not dementia. These episodes can arise from urinary tract or other infections, dehydration or even some hormonal imbalances. Certain medications like steroids or combinations of medications can precipitate short term cognitive imbalances. And what your loved one’s neurologist prescribed for one condition may not mix well with what a cardiologist has prescribed. Be sure that there is a quarterback on your loved one’s medical team who knows what all the players are prescribing. Depression. Older individuals run a constant risk of isolation and all the effects associated with insufficient stimulation and socialization as well as loss. Their social network has diminished leading to less cognitive stimulation and the loss of friends, loss of status and loss of opportunities to feel validation simply lead to a smaller and smaller world which can result in sedentary solitude. Loneliness can look a lot like dementia, but it’s depression and can be addressed. Consider when your loved one last had a complete physical. By complete, we mean one in which all the medications they may have been taking are reconsidered. This is especially true if your loved one sees multiple providers each prescribing against the conditions in which they specialize; what the cardiologist prescribes may not “mix” well with what the neurologist or pulmonologist are prescribing. There may also be subtle cues that some have missed without a thorough exam that could include a neuropsychiatric evaluation or even something as basic as a hearing test. To read more on this subject, please check out our book…chapter 6. 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.
As a geriatric care manager, I am always alert to changes in people's eating habits and proper diet. As people age they naturally experience a decline in their appetite in part because their taste buds are not as responsive as they were when they were younger. Loss of appetite is also a potential sign of depression, and depression is one of the most common conditions older adults experience owing to the losses associated with their stage in life and aging. But if the diminished appetite leads to anemia owing to low iron intake, then there may also be a risk for dementia according to scientists. These scientists started with a group of over 2,500 mentally healthy women and men whose average age was 76. They then followed these people for 11 years testing them regularly for their blood counts and other mental function tests. At the outset of this study 392 people were clinically testing as anemic. By the eleventh year of this study 455 people had developed clinical dementia. These researchers also measured all study participants' age, gender, education, blood sugar levels (and diabetes diagnoses) and more than a dozen other biologic metrics. In statistical analysis they controlled for all these other variables and found that anemia still was a strong predictor of dementia beyond these other possible causes. In fact, of the people who started the study with anemia, they had a 49 percent greater risk of developing dementia during the 11 years of the study. What makes this study very compelling is that it is a prospective design. It is not one of the many studies we often see where scientists can ask questions about a person's background in an effort to explain a current condition. It also is a large panel of people for a study, so the chances a statistical error are reduced. What the study cannot tell us is what kind of treatment for anemia could "prevent" dementia. If you are a caregiver to an older loved one, what is the lesson to be learned from this research. At the very least it seems that caregivers should be watchful of their older loved ones' diet as a relatively easy way to rule out at least one potential cause of dementia. I have written about other steps that can be taken in other postings. Exercise and keeping mentally active are among those other steps that people of all ages can engage in to stave off mental deficits like dementia. 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.
Dementia is the condition that adult Americans fear the most, and tragically there are conditions that can give a false alarm to trigger that fear. What walks like dementia and quacks like dementia may not necessarily be dementia! There are a number of medical conditions that mimic dementia – quite convincingly – until the condition is examined more closely and treatment is administered. So, in a real sense, dementia is a diagnosis by exclusion…diagnosis by eliminating the “look alikes”. Did you know that…
1. Thyroid disease can mimic dementia– Physicians can readily diagnose when the thyroid gland is producing too much or too little hormone by calibrating the levels of Thyroid Stimulating Hormone in the blood. But it often takes a specialist, an endocrinologist to make the definitive call. They talk about “subclinical characteristics” such as fuzzy memory along with others like dry skin or fatigue or hair loss. Hypothyroidism is one that can be readily treated by a thyroid supplement and symptoms simply fade away.
2. Diabetes can mimic dementia – As if it is not difficult for a diabetic to manage sugar and carbohydrate intake to avoid “running high or low,” the condition can actually affect memory as well. In older adults who have not yet been diagnosed with type 2 diabetes, they may appear irritable and confused or may have difficulty with recall. These mental states are caused by changes in the body’s blood vessels which may not give enough flow to the brain resulting in dementia-like symptoms. If diagnosed early the problems can be reversed and normal cognition restored.
3. Alcohol abuse can mimic dementia – We all have seen someone who has been “over-served,” and that person is not only an impaired driver, but their brains generally are not sharp. Well, the next day that same person recovered motor and cognitive functions, and life is normal again. Repeat offenders, however, will create more lasting effects on the brain and memory shortcomings. The memory issues may not be dementia, but they can only be reversed if a person stops the abusive behavior early enough, and for some the cure is to abstain entirely.
So these are three conditions in which dementia can be the wrong diagnosis, and they are also issues that can be remedied. There are more conditions that can pose as dementia, but they are not. They may not just go away on their own, but unlike dementia, they can, in fact, “go away.” More to come next week. 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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