Not to be out done by the Navigator development team, the SCANS team is continuing their "rolling release" of V1.3.  SCANS is the Senior Care Navigation System that provides geriatric care managers with expert advice, best practices, and practical tools to help families with the well-being or their parents.

The June edition of V1.3 includes 26 new resources, process, or tools.  The list includes items like these:
  • Death in the Home – Information for Caregivers
  • Tips for Alzheimer Caregivers
  • Delirium vs. Dementia
  • Transitioning an Individual with Dementia into a Facility
  • Member Portal Instructions
  • Continence Education – Constipation
  • Urinary Incontinence – When to Seek Immediate Medical Attention
  • Crime Prevention Education for Older Adults
  • IADL (Independent Activities of Daily Living) Education
  • Physical Therapy and Occupational Therapy
  • My Medicare Matters
  • Advance Directives for Mental Health Treatment
  • Drug Review and Side Effects
  • Geriatric Friendly Pharmacy
  • Medicine Reconciliation:  Brown Bag Consultation
  • Feeding Tube Education
  • Special Diet Needs Education
  • Defibrillator Education
  • Diabetes Education
  • Fibromyalgia Education
  • Pacemaker Education
  • Physician Planner Case Note
  • Alternative Living Options Education
  • Speech Therapy Education
  • Social Participation Barriers
  • Social Support Plan
These tools are available to the clients of My Health Care Manager and our affiliates.  Some of the content is also discussed in our blogs and can be accessed for free.  Check out Natalie Langley's blog titled "Healthy Aging".  Natalie is one of the principle researchers and authors of the tools in SCANS.  Her blog covers a holistic look at healthy aging and senior well-being.

The SCANS content team headed by Jean Bandos along with the development team announced today that the SCANS Version 1.3 - May release is now available.  SCANS Version 1.3 is a major content release to the SCANS Knowledge Base.

In order to make more real-world tools for eldercare available more quickly, Jean and the team have devised a "rolling release".  For 3 months beginning in May another group of resources, processes, and tools will be made available to geriatric care managers at My Health Care Manager and our affiliates.

The May release contains 57 new and/or revised resources, processes and tools.  Some sample items include: 
 

  • Behaviors and Alzheimer's Disease
  • Grief Education
  • Activities of Daily Living Education
  • Depression and Alzheimer's disease
  • Early Stages and Impact on Health
  • Memory & Cognition Questions
  • Memory Care Unit Checklist
  • Memory Care Unit Education
  • Mild Cognitive Impairment
  • Sobriety Programs Resource
  • Handyman Resource
  • Private Handyman Contractor Checklist
  • Smoke & Carbon Monoxide Detectors
  • Daily  Money Management Education
  • Financial Planning Education
  • Trust Education
  • Verifying Funeral Arrangements
  • Veterans Benefit Information
  • Elder Law Resource & Checklist
  • Medication Management Procedure
  • Medication Reconciliation
  • Polypharmacy
  • How to Find a Pain Specialist
  • Pain Education
  • Pain Resources
  • Pain Visual Analog Scale
  • Arthritis
  • Heart Failure
  • Hypertension Education
  • Family History - Cancer Education
  • Family History - Dementia
  • Family History - Diabetes Education
  • Family History - Heart Education
  • Seat Belt Education
  • Cataracts Education
  • Glaucoma Education
  • Hearing Aid Education
  • Sensory Changes
  • Assistive Devices
  • Hospice Education
  • Spiritual Connections
Stay tuned; the June release will include resources on incontinence, cognition, supporting services, and more processes.

Be sure to visit Jean's blog, click here.

Alzheimer's AssociationAccording to the latest report from the Alzheimer’s Association, the total health care costs are more than three times higher for people with Alzheimer’s and other dementias than for other people age 65 and older. It is reported that there are 5.3 million Americans living with the disease and every 70 seconds someone in America develops Alzheimer’s disease. By 2010, it is estimated that there will be nearly a half million new cases of Alzheimer’s each year. Currently we know that Alzheimer’s is the sixth leading cause of death in the country, surpassing diabetes; it is the fifth leading cause of death among individuals 65 and older.

My next blog will cover the newest focus for Alzheimer’s: early detection and intervention.

Over the last year, I have written several blogs on aging in place for older adults and their caregivers.  Today, in honor of Stroke Awareness month (April), I wanted to raise your awareness about this concern, which is a preventable health issue. I recently attended an educational session on stroke prevention and would like to share the National Stroke Association’s efforts to educate the public on recognizing stroke symptoms.  Most of us think of stroke as a disease of old age – one that is debilitating and causes lasting disabilities. But it can strike at any age. 

Did you know that 80% of strokes are preventable and that by acting in time, the long term of effects of strokes could be minimized?

Here are some simple tips to follow to prevent a stroke: 

  • Know your blood pressure.      
  • If it’s high, work with your doctor to lower it.
  • Find out from your doctor if you have atrial fibrillation
  • If you drink alcohol, do so in moderation.
  • Find out if you have high cholesterol. If so, work with your doctor to control it.
  • If you are diabetic, follow your health care provider's recommendations carefully to control your diabetes.
  • Include exercise in the activities you enjoy in your daily routine.
  • Enjoy a lower sodium (salt), lower fat diet.


Look for my next blog entry, where I’ll share with you an easy-to-remember way to recognize the symptoms of a stroke.  This is important for caregivers, aging adults, grandchildren – everyone should be able to recognize stroke symptoms so that quick action can be taken.
 



**The following post is from my guest blogger, Natalie Langley, MSW.  She is a Geriatric Care Research Analyst for SCANS (for more on SCANS, please see Eric Tinsley's blog by clicking here).**

Where can I go to find the right doctor for me?

Finding the right physician is one of the most important health decisions you will make.  Whether you do not currently have a doctor or you are unhappy with your current doctor, there are several resources available that can help you find the right health care provider for you.  To start, you want to make sure the physician you choose is in your insurance network.  If not, you may call the insurer and ask if they would consider adding this physician to their list. Whether you are a senior looking for yourself or a caregiver looking for your aging loved one, the following is a list of helpful websites for locating a physician. 

American Medical Association 
www.ama-assn.org   

National Institute on Aging – Age Page on Finding a Physician
http://www.nia.nih.gov/NR/rdonlyres/67530CA6-7AC1-4C45-BB8D-27D0E3C54A65/7441/Choosing_A_Doctor.pdf

American Board of Medical Specialties
www.abms.org 

American College of Surgeons
http://www.facs.org/public_info/yourhealth/findadoc.html

Diabetes and Heart/Stroke Physician Recognition Program
http://recognition.ncqa.org/

Healthfinder
www.healthfinder.gov 

Medline Plus
www.medlineplus.gov

American Geriatrics Society Foundation for Health in Aging
http://www.healthinaging.org/public_education/physician_referral.php
 


The following article is from Agingcare.com:  The Community for Caregivers and is in addition to the previous blog, Caregivers and Stress.

"Don't Let Caregiving Ruin Your Other Relationships
by Carol Bradley Bursack
In the 1970s, there were ongoing debates about whether a woman could balance a family with a career. The discussions centered on being a good wife, mother and employee.  The question seldom posed, in those days, was how, besides being a wife, mother and career woman, could a woman also be a good daughter?

Today, we hear about the toll elder care takes on families as routinely as we heard the former arguments in the ‘70s. Adult children are being faced with choices (or seemingly, assignments) they never thought about before. They are raising children or teenagers and holding down a job, when suddenly they find that their aging parents need an ever-increasing amount of attention.


Why is elder care more of an issue now than in the past?  For one thing, people are living longer than they used to and, often, they are not living with good health. Yes, we all love to point to the 93-year-old guy out there playing golf everyday, and these people exist. I know a couple of elders like that and they are a joy to behold.

However, many elders today are stroke survivors, or are suffering from diabetes, lung problems or dementia. Sometimes they have a combination of these ailments, and others, which likely would have caused death even a decade ago. Now, medical advances provide lifesaving options. Many of these people live – some even living fairly good quality lives – but they need assistance from family or paid attendants.


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We have partnered with ElderCarelink.com to provide a free referral service that helps you find everything from Home Care and Assisted Living to Financial Planning and Personal Emergency Responses. Let us assist you.
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 Another piece of the puzzle is that many people have chosen to have children at a later age, thus putting them in a position where they have young children and older parents at the same time. This can be a delightful combination, as long as the elders are reasonably healthy, but when they are not, the adult children of the elders, also parents of young children, can be faced with very difficult choices. These are the people now famously known as the Sandwich Generation.

Whatever the circumstances are that propel people into elder care, the problems that can come from it are myriad. All you have to do is click on the Agingcare.com community forum and you’ll quickly see that many caregivers, both men and women, find themselves feeling pulled in so many directions that they can no longer find their soul.

They fear for their own health – mental and physical – as they try to take care of the needs of three generations, the most demanding often being the elders. Caregiving for a sick elder, especially one with dementia, can become so all-consuming that the caregiver’s other relationships suffer.

First to go is the time, or even the energy and desire, to maintain friendships. Even maintaining friendships that go back years can seem like just one more thing to do when a caregiver is so swamped with demands.

So, caregivers stop seeing friends, hence friends stop asking them to do anything fun. Friends get tired of being turned down. And caregivers forget that life was once fun. They are too busy giving care to everyone else to even notice the loss.

Then there are the children at home. I had two young sons when I started going through my two decades of elder care, seven elders total. One of my sons has multiple health issues. I believe I gave my sons as much attention and care as any mother could, but I was always torn. It seemed someone always needed me. A child was sick and an elder’s personal alarm was set off. What should I do? How should I handle it?

Or I’d just be having fun with my sons, and I’d get called away on an emergency. My sons got used to me telling them that we had to stop what we were doing, be it playing music, reading or a craft, because I had to run to Grandma’s and see what’s wrong, since her personal alarm was set off. Or I had to meet the ambulance at the emergency room, because Grandpa fell at the nursing home and broke his arm. Or I needed to reschedule my uncle’s doctor appointment, because he was had gotten the flu.

Certainly, it doesn’t hurt children to know that elders need care, and children need to share their parents with the older generation. Likely, my kids had a little too much of that, but they survived. However, some children have much tougher issues than mine had to face. Some have grandparents with dementia living in their home, verbally or even physically abusing them. Or a single mom and her kids find it more economical to live with the grandparents, but the grandparents end up sucking up all of Mom's time. The parent – the caregiver to generations – can’t see a way out, so the family stays. But the relationships with the children are damaged.

And then there are the marriages. I hear from many caregivers who have supportive spouses, but I also hear from many who do not. The spouse feels neglected. The spouse never liked the elder, and now that the elder needs a lot of care, the spouse becomes even more resentful. The stress in the marriage can be intolerable for both sides. Marriages can and do break, under the stress of caregiving.

How much do caregivers owe their aging parents? Do they owe their health, their financial future, their family relationships? Where does “honoring your parents” begin and end?

I don’t believe anyone owes their own health, their marriage or their children’s emotional well-being to the elder that raised them. In most cases, the elders, if they could think straight, wouldn’t want that kind of sacrifice made for their benefit. However, often they’ve gotten to a point where they don’t recognize what they are demanding of the caregiver, so they resent not getting every need met and make that resentment well known.

This is where caregivers must take a stand. They must look for outside resources such as their state aging services for some direction. They must learn to balance their love and their time, giving as much care as possible to the elder, yet making sure that they have time, patience and energy for their children, their spouse and even their friends. If they don’t do this early on, breaking the pattern will become harder, though not impossible, as time passes.

Certainly, if the elder’s life is coming to a close, the whole family should gather around in support. But if elder caregiving is a long-term situation, the caregiver should look for balance. She needs to set boundaries as far as the elder care goes.  If she does not, all relationships that matter will be damaged, even the relationship with the elder. The caregiver who feels she has given up everything for everyone else will find that no one got what they needed. If the elder care situation sucks the life out of all other relationships, everyone loses.

For over twenty years author, columnist and speaker Carol Bradley Bursack cared for a neighbor and six elderly family members. Because of this experience, Carol created a portable support group – the book “Minding Our Elders: Caregivers Share Their Personal Stories.” Her sites, www.mindingourelders.com and www.mindingoureldersblogs.com  include helpful links and agencies. Her newspaper column, “Minding Our Elders,” runs weekly, she speaks at many caregiver workshops and conferences and has been interviewed by national radio, newspapers and magazines. She is the moderator of the AgingCare.com forum."
 


In past blogs, I’ve talked about how the holidays are bittersweet for many caregivers, with the increased stress levels and happy memories of the past contrasting with the difficulties of the present.  These extra demands on time and energy can seem overwhelming both to you and your aging parent.

Try to create a balance between rest and activity. In order to keep up with family traditions, take time to assess how important these traditions are and how they affect your responsibilities of caring for your aging parent - especially when your parent has Alzheimer’s or other chronic illnesses such as diabetes, CHF, or arthritis. 

Start early and write down activities that are important to you. As you are making your calendar remember to:
  • Keep or adapt family traditions that are important to you
  • Include your aging parent as much as possible
  • Recognize that things will be different
  • Encourage friends and family to visit you this year to limit the number of trips you have to arrange for your aging parent
  • If your parent has Alzheimer’s, avoid crowds, changes in routine, and strange surroundings that may cause confusion or agitation 
  • Do your best to enjoy yourself
  • Try to find time for the holiday things you like to do, even if it means asking a friend or family member to spend time with your aging parent while you are out
  • If there are occasions that are large events, try to have a space available where your parent can rest, be alone for awhile, or spend some time with a smaller number of people, if needed.

Most importantly:

  • Have realistic expectations about what you can do
  • Take care of your needs and keep it as simple as possible!

For more information on caregiving, you may want to visit the National Institute on Aging and explore their available publications.


We are constantly hearing certain buzz words in eldercare: aging in place, healthy aging, senior healthcare, wellness, and senior well-being.  How do we truly age in place and take care of our senior health needs in our current healthcare system?  One should become aware of the truths about aging versus the myths that are out there.  One should also help health care providers to promote wellness and independent function by asking them questions and having periodic overall health assessments. 

Do you know – Is this TRUE or a MYTH?

Most older adults are sick. 

MYTH!
  Most older adults (78% of 65+) are healthy and engaged in normal activities.


If you are old, you are sick. 

MYTH!
  Only 23% of older adults claim to have a disability.  85% of the debilitating diseases are from cancer, coronary artery disease, stroke, diabetes, kidney failure, obstructive lung disease, pneumonia, and flu. Remember  -- Chronic illness does not translate into functional inability.


Older adults have more chronic diseases than younger persons, but fewer acute illnesses.  

TRUE!
  Older adults have more chronic diseases than younger persons, but fewer acute illnesses.  There are 102 acute illnesses reported per 100 people over 65 and 230 acute illness per 100 people under the age of 65.   85% of the debilitating diseases are from cancer, coronary artery disease, stroke, diabetes, kidney failure, obstructive lung disease, pneumonia, and flu.


Your body systems are affected by age.

MYTH!  Body systems such as your heart and lungs are minimally affected by age but PROFOUNDLY influenced by lifestyle behaviors such as cigarette smoking, physical activity,  what you eat, and sometimes if you have enough resources to access the care you need.


What should the older adult expect?  The older adult can expect to lose 2 inches of height by age 80, which can lead to changes in posture and our feet - which could affect our balance and create a potential fall risk.  Another fact is that the body cannot regulate its temperature as it did when one was younger, so an older adult needs to be aware of exposure both cold and heat.  If the temperature outside is high, the older adult is at risk for heat stroke.  

The most important item for an older adult to remember?  A health assessment promoting wellness and independent function is a must.  Remember that health care needs to be individualized… and that the body can remain healthy as one ages. Although our organs may gradually lose some function, a senior may not even notice these changes except during periods of great exertion or stress.
Today, there are more than 4 million Americans 85 and older. That number is expected to grow almost 5 times by the year 2050.  By the year 2030, it is estimated that the “oldest-old” (85 years and older), will grow to 10 million people. 

Views on aging are changing  

TRUE!  Aging is no longer synonymous with physical decline and illness. 


Future Blogs will continue to address the issues of senior health care and healthy aging.

Resources:
• Luggen, A.,S Meiner,S. E. (Eds.). (2001) National gerontological nursing association: Core curriculum for gerontological nursing. St. Lois:  Mosby.
• Mezey, M, Fulmer,T, Mariano, C, (Eds.). (2005) Best nursing practices in care of older adult. Curriculum Guide. ( 3rd ed.) New York:  The John A. Hartford Foundation: Institute for Geriatric Nursing.


**The following post is from my guest blogger, Natalie Langley, MSW.  She is a Geriatric Care Research Analyst for SCANS (for more on SCANS, please see Eric Tinsley's blog by clicking here).**

Nutrition and eating right are important components to keeping us all healthy.  But what happens when a chronic illness such as diabetes, congestive heart failure, or cancer is brought into the picture?  Having a chronic illness may mean taking a few more steps to ensure the older adult is getting the appropriate nutrients daily.  Making sure that all the key nutrients are a part of your diet can actually help you stay healthy, fight off infections, and feel stronger.  Even making simple changes such as removing the salt shaker from the dining room table can help reduce the amount of salt you put on food, therefore, reducing the sodium level for someone who has Chronic Obstructive Pulmonary Disease (COPD).  Other nutrition tips can be found on the web resources below for individuals who have chronic illnesses.  If you notice you are losing weight (10 pounds or more) involuntarily over a 6 month period, please check with your primary care provider.  In addition, before making any changes in your diet, always consult with your primary care provider. 

American Heart Association
http://www.americanheart.org/presenter.jhtml?identifier=1444

American
Cancer Society – Recipes high in calories and easy to eat
http://www.cancer.org/docroot/MBC/content/MBC_6_1_Recipes.asp

American
Lung Association – Eating well with COPD
http://www.lungusa.org/site/c.dvLUK9O0E/b.3529631/#eating 

American Diabetes Association
http://www.diabetes.org 

National Institute of Diabetes and Digestive and Kidney Diseases
http://www2.niddk.nih.gov/ 

National Institute of Arthritis and Musculoskeletal and Skin Diseases
http://www.niams.nih.gov/


In several of my past blogs, I discussed safety concerns and the older adult.  One the main concern is medication safety. Not just the management of medications but how many are actually taken.

It is often reported in the news about a medical error made and the impact it has on individual lives.  Those articles are frequently about hospitals errors.  But have you ever thought about the older adult and how they manage at home...?  The impact our current health system has on managing medications...?  How chronic illnesses such as congestive heart failure, diabetes, and arthritis impact the older adult and his/her caregivers...?  Different providers – prescribing different medication – generic versus brand names.  multiple medications with multiple doses all affect the medication management and the safety of the older adult.

Let’s look at the key safety issue: polypharmacy (multiple medications).  
A caregiver may ask what defines polypharmcypolypharmacy or how many pills or too many?  The answer would have to be that different entities in the current health care system define Polypharmacy differently.  I have seen it defined as low as two or more medications, but in general it deals with using more than three to five medications or herbal supplements for longer than 90 days in a given year.  In my career I have witnessed shoe boxes filled with medications that have numbered over 20 different medications- especially when dealing with multiple chronic diseases, over the counter medications, herbs, and vitamins.

Where should the caregiver and/or older adult start in trying to deal with their medications?
First, realize that the main problem with polypharmacy is that it increases the clients’ risk for drug interactions.  Drug interactions occur when one medication or herbal supplement reacts negatively with another medication when they are taken together. It is important to report any side effects to your physician.
 
The following are some steps you can take to prevent drug interactions:

  • Provide a complete list of your medications and herbal supplements to your physician and/or pharmacist
  • Discuss how each medication/herbal supplement works inside the body.
  • Verify with your physician that you are receiving the recommended dose of each medication/herbal supplement.
  • Verify with your physician that you are receiving the recommended form of each medication/herbal supplement you are taking (pill, liquid, tea, extract).
  • Determine how many times a day your medications/herbal supplements should be taken.
  • Discuss any side effects that might be experienced.
  • Discuss the common prescription medication interactions.
  • Discuss the common herbal supplement interactions.

If you can not complete a list of medications, take them all into your physician or pharmacist and have a list made for you. 

The National Institute on Aging is a great resource for learning more about medication managements, herbs, vitamins and safety concerns - learn more by clicking here.


The My Health Care Manager's Client Portal serves as a communication platform for families caring for aging parents. It provides easy access to information like:
  • Schedule of care events (e.g. medical appointments, therapy, geriatric care visits)
  • Medical issues (e.g. Alzheimer's, arthritis, incontinence, congestive heart failure, diabetes, COPD)
  • Health provider contact information and specialties
  • Medication list including dosage, frequency, prescribing physician, and other specifics
  • Recent Hospitalizations
  • Client contact information
  • Updates on key issues of aging such as Caregiving, Advanced Directives, Living Independently, Family Communications, Depression, and more
  • Resources
  • and more

It also supports secure, private interactivity with the Health Care Manager providing geriatric care for the family using tools like a discussion board, contact logs documenting visits and phone conversations, and posting of care goals like improving home safety, reducing isolation, improving depression, improving mobility, supporting treatment plans, and so on.


Last week, I traveled from Indianapolis, IN to Litchfield, CT with my Mother to attend my sister’s wedding.  It was a long trip as we got to the airport early to deal with security, took a 2 hour flight to Newark and then rented a car and drove 3 hours to a Bed and Breakfast in Connecticut.  Along the way, we had to take our shoes off, give up our purses for a security inspection, and take escalators, elevators and a train in pursuit of a National rental car.  Everyone knows that traveling today is an exercise in both patience and logistics…b ut when you are accompanying a senior who is not steady on her feet and tends to be confused….. the patience/logistics requirements increase ten-fold.

Planning and advance preparation can help ease the journey.  In our case, I found it helpful to:

  • Keep my Mother’s ticket and ID with mine, rather than risk her misplacing the paperwork.
  • Consolidate all carry-on items in one bag (meds, jewelry, reading material), so there was less to keep track of during the trip.
  • Dress for the security line….slip on shoes, no heavy jewelry, easy to remove jacket.
  • Bring an extra sweater, as most airports are freezing.
  • Pack snacks in case of airline delays, missed meals and long wait times.  The food court can be a long way from the assigned gate – a walk a senior is not up to.  If a senior has diabetes or a loss of mobility, packing snacks is essential to avoiding missed meals or long walks to the food court.
  • Request a wheelchair or flag down a motorized cart to assist with transportation from gate to gate, if necessary.
  • Stop when the senior gets tired and sit for a few minutes.  The airport pace is very difficult for a senior to keep up with.  This is especially true if your loved one has a loss of mobility.
  • Limit information and do not provide it all at once – just focus on the next step and explain to the senior.  Discussing the entire itinerary i.e. we are catching a plane, then renting a car, then driving to Connecticut... is too overwhelming.
  • Remember that the crowds, noise and fast pace of the airport can contribute to a senior’s confusion and anxiety.  Try to buffer them as much as possible by walking so that they are close to the wall and you are on the outside to take the bumps as people push past you.
  • Be sensitive to their fears – dementia may cause even seasoned flyers to feel nervous about flying.
  • Enlist help – ask someone else to accompany you to help with luggage, logistics and provide moral support.
  • Enjoy the senior’s sense of wonder along the way – for them, a plane trip is a rare and exciting event. 

In summary, traveling with a senior should not be taken lightly.  Advance planning is key to ensuring a safe and stress-free trip for both caregivers and seniors alike. Be prepared, be patient and always remember that seniors will need extra special care and attention during the trip.


To make effective use of any set of tools you need to combine them with process.  In the case of caring for aging parents, the process is something you have to repeat over and over.  The situation changes, health conditions like diabetes or cognitive concerns change, needs and desires change, and all of these play in to the decisions about the next course of action.

At My Health Care Manager we have defined, detailed and implemented processes at all levels of service delivery - over 100 in all.  These include detailed flows, processing narratives, measures, entry Evaluation Cycleand exit criteria, responsibility identification, and more.  At the core, however, these processes all revolve around this simple cycle.

If you are caring for a senior, consider adopting a process like this one and implementing changes in the top 3 (or fewer) areas of concern in each iteration.  Clearly, trying to change too many things at once can actually be counterproductive.  Any of us, especially if we're sick, depressed, or struggling with cognitive decline, can only impact a small number or areas at one time.

Understanding that this is a cycle with re-evaluation can help manage the sometimes overwhelmingly long list of things needing attention.

As we entered into spring, the presidential candidates continue the health care debate.  The real issue is that the US has an aging population.  By 2030, the number of adults age 65 and older will nearly double to 70 million. With twenty percent of the Medicare population having at least five chronic conditions (e.g. hypertension, diabetes, arthritis), the question remains: How do we care for these elders? 

Geriatrics is a growing specialty where physicians, nurses, social workers and other health care providers receive special training dedicated to improving the health, independence and quality of life of all older adults.  Geriatricians are physicians who are experts in caring for older persons; they are initially trained in family practice or internal medicine and then complete at least one additional year of fellowship training in geriatrics. They have the expertise to coordinate services among multiple specialty care providers.  For more information on the profession, visit the American Geriatrics Society website at http://www.americangeriatrics.org.

A geriatrician will coordinate a health assessment for older adults with the primary goal of encouraging and promoting wellness and independent function. The health assessment will include an interdisciplinary team approach to the physical, emotional, cognitive, functional, and medication status of the older adult.  If you would like to locate a physician in your area who is sensitive to the special needs of older adults, you can submit your request by completing a form on line located at http://www.healthinaging.org/public_education/physician_referral.php  or contact a geriatric care manager in your area.  To locate a local geriatric care manager, visit http://www.caremanager.org/.  In addition, telephonic geriatric care management services are now offered by My Health Care Manager.  To learn more, visit our website by clicking here.

Even though Mother was safe and secure in Independent Living (IL) in a Continuing Care Retirement Community (CCRC), we quickly realized that managing her prescription and over-the-counter (OTC) medicines was a challenge of its own.  With 10 prescription medicines and 4 OTCs, the variables of continuing supply with many expirations and prescription renewals combined with generic vs. brand names, dosages and time-of-day preferences were an overwhelming task for her … and her caregivers!  Fortunately, we devised a Weekly Schedule and medicine reconciliation program that allowed her to manage her own meds (with our assistance) that has now become a My Health Care Manager computer-based decision aid.  However, loading her pill tray every week and managing the time for her diabetes blood sugar tests and consumption of the pills became (and remains) an ongoing challenge.  Until becoming exposed to the issues of polypharmacy and older adults, I didn’t understand that normally-prescribed medicines and dosages affect many seniors differently – sometimes even causing symptoms such as confusion and loss of balance.  Even multiple medication regimes that were tolerated in the past can at any moment cause problems or unwanted symptoms.

When trying to get my hands around the multiple medications challenge, it became clear that no single health care provider had information on everything that was being taken by Mother.  Each knew what he or she had prescribed, but the rest of their knowledge was based on answers given to the common question, “What medicines are your taking?” at office visits.  Often confused over generic vs. brand names, dosages, and omitting OTC products, older adults often can’t be counted on to correctly answer this important question.  In developing My Health Care Manager’s suite of decision aids, we added a letter that the senior can choose to send to all of their health care providers (or only to the ones they designate). The letter lists the providers, their prescribed medicines, and any other OTC products being taken by the senior.  Several doctors have remarked that this simple summary of information is not available from any single source in our health care system.  You might try this important task on your own if you are immersed in eldercare.  We’ll have more on managing medicines in my next blog.


For the New Year I would like to share some resources and various sites that are useful whether you are looking for assistance in locating elder care services or trying to find specifics regarding geriatric health care.

Where you aware that the National Institute on Aging provides publications and other materials such as “Age Pages that address healthy aging, caregiving and specific topics such as dementia, diabetes and tips on medications.  Call 1-800-222-2225. or visit web www.nih.gov/nia.  Majority of their information is provided free of charge.  Other government sites are the Administration on Aging www.hhs.gov  or for the official governmental site for those who have Medicare http://www.medicare.gov

Some of the associations that share geriatric information are the American Association of Retired Persons  www.aarp.com   American Geriatrics Society , www.americangeriatrics.org and caregiver alliance www.caregiver.org

For end of life issues – Aging with Dignity is an excellent site to assist you in addressing those hard to discuss topics ( http://www.agingwithdignity.org). Aging with Dignity is a non-profit organization that was established to provide practical information, advice and legal tools you need to assist you in identifying and documenting your wishes and those of your loved ones.  The document called the “Five Wishes” is legally valid in 40 states  you can obtain a copy at http://www.agingwithdignity.org/5wishes.html

As we meet the challenges that 2008 will bring – I will continue to provide tips and resources to assist you in navigating the health care system and meeting the needs of your aging parents.   

Happy New Year!  


This week marks the 10th anniversary of the "Web Log" ... the genesis of the "Blog".  Of course, sharing ideas over the internet goes back to the dawn of the net itself.  The original idea of the then government sponsored network was to connect academic institutions and government agencies for the purpose of research and collaboration.

The Blog came along originally as a way to share information about where the "blogger" had been on the internet that day and what they had experience.  It quickly became an on-line diary of sorts.  This created the "stickiness" of the concept which since evolved in that dimension and many more.  

ConversationFor My Health Care Manager the concept has been extended to caregivers helping aging parents and even seniors looking to improve the health and well-being.  Take a look at the blogs listed here - you'll find information on all of the most common heath challenges facing seniors and their families.  Some examples include falls, home safety, dementia, congestive heart failure, diabetes, and many more.

Having access to key thoughts on these challenges is valuable, but even more valuable is the key blogging concept of providing direct feedback to the author.  If you have a question of a comment on an article you've read, don't hesitate to use the "Comments" link right below the posting.  You can read comments and responses from others and best of all ask your question directly. 

If you don't see an article on the subject you're most interested in, post your question as a comment to the top entry in the Blog.  We'll answer the question in a future blog, comment, or email.


A recent study published in the Journal of the American Medical Association by John Robbins, M.D. et al identifies an algorithm for identifying the five year risk of a hip fracture in postmenopausal women.  While the study is limited to one gender and further studies are needed to assess the implications and use of the algorithm, it underscores the importance for seniors to remain vigilant in maintaining their mobility and maximizing their safety.

The factors affecting the 5 year risk are as follows: “age, self-reported health, weight, height, race/ethnicity, self-reported physical activity, history of fracture after age 54 years, parental hip fracture, current smoking, current corticosteroid use, and treated diabetes.” 

What can you do? 

  • Be aware of the factors, and do your best to engage in health activities like remaining active, exercising, and refraining from smoking. 
  • Do a home safety check.  Remove items like throw rugs that are easily tripped over, resulting in a fall, and possibly a fracture. 
  • Check with your doctor to assess your risk for a hip fracture and work with him/her to decrease your risk.

For a home safety checklist from the CDC, please click here.
To read more about the study published in the JAMA, please click here.


If you live in a part of the country where season is changing to ice and snow, I am sure your are worried about that icy accident where you could fracture your hip. Just remember to be careful and do not take chances on icy and/or wet surfaces.  A simple fall can have a dramatic impact on your life.

But remember that falls happen everyday, even on beautiful days.  As you age, your sight, hearing, muscle strength, coordination and reflexes begin to change. You may notice that your balance may be off or that you lose mobility.  If you have diabetes or heart disease, your balance can be affected and some of the medications that you are taking can cause dizziness. Then there is Osteoporosis, where your bones become thin and break easily.  All of these things can contribute to your first fall- creating that change in your life that affects your overall well-being.  So how do you take care of yourself to remain active and maintain your quality of life?  Here are a few simple tips:  

Ø      Contact your doctor and ask him about Osteoporosis and a bone density test that will tell you how strong your bones really are or if you need medications to help strengthen your bones.  

Ø      Plan an exercise program that is right for you. Always talk with your doctor before beginning your exercise program  

Ø      Review your medications with your pharmacist and/or physician for any side effects. 

 Ø      Stand up slowly – this will prevent you from feeling faint if your blood pressure drops too quickly  

Ø      Wear shoes and socks (low-heeled shoes that fully support your feet).  

Ø      If you have handrails in your home, make sure they are safe and use them.  

Ø      Pick up your throw rugs.  

Ø      Don’t take chances.  

Ø      Make your home safe by making sure you have good lighting and keeping areas tidy.  

Ø      In your bedroom, put your telephone next to your bed.  

Ø      Keep night lights on.   

Some additional fall prevention resources are:  

Ø      The Older Consumers Safety Checklist is free by contacting the U.S. Consumer Product Safety commission at www.cpsc.gov  

Ø      National Institute on Aging provides Age Pages on osteoporosis, home safety and fall  prevention tips at www.nia.nih.gov    


World Diabetes Day logoToday, November 14, is World Diabetes Day- the first ever!  A resolution passed in December of 2006 by the United Nations created an annual United Nations Day for World Diabetes starting in 2007.  For more information on the day of recognition, please visit the World Diabetes Day homepage.

It just so happens that two recent studies have highlighted some of the issues affecting diabetics...

A diabetes study in the Journal of General Internal Medicine (set for the December issue) found that of diabetic seniors, 92% have at least one other chronic condition.  Even more worrisome: almost 50% have three or more other chronic medical conditions in addition to diabetes.  Seniors often make managing their other chronic conditions a priority and fail to properly manage their diabetes.  Many of the other conditions in seniors were triggered (or aggravated) at least in part by their diabetes.  The study stresses the importance of holistic care and taking a 'whole-person approach' to disease management. To read more about the study, click here.

For families, diabetes can affect multiple generations.  It's important to take preventative measures like eating a healthy diet and being active.  Once diagnosed with diabetes, it's important to take care of yourself!  A recent study in Australia suggested that more than 60% of those diagnosed with diabetes are wearing the wrong size shoe.  The wrong size of shoe could increase the chance of having foot problems, which (especially for diabetics) can even lead to amputation.  Please encourage those with diabetes in your family to have their feet properly measured to ensure they are wearing shoes the correct length AND width for their feet.  For more on this study, please click here.

It's important for seniors to work with their health care provider or geriatrician to manage their diabetes.  As the first study finds, many seniors have other chronic conditions in addition to diabetes.  For these seniors and their caregivers, a geriatric care manager or eldercare manager can partner with them and their other health care providers to approach their disease management in a more holistic fashion.