Whether you’re new to caregiving or a veteran, there are still things to learn about the US healthcare system. This series of videos from Alz Live provides a roadmap. This is part four of an eight part series.
Throughout your caregiving experience, you will interact with many members of your loved one’s care team.
They might be clinicians, such as neurologists, geriatric psychologists or nurse-practitioners. Or, they might serve a support role, as social workers or geriatric care managers. Confused about who does what and why? Read on.
Geriatrician: Geriatricians are medical doctors certified in either family or internal medicine who have additional training in treating, diagnosing and preventing disease among those over age 65. You may want to seek one out if your loved one’s primary practitioner does not specialize in the health of older adults.
Why: Nine out of 10 adults age 75 and older have at least one chronic illness, and about 1 in 5 have five or more chronic conditions, according to AARP. In addition to Alzheimer’s, your loved one may be battling heart disease, Parkinson’s disease, diabetes, or other conditions which require ongoing care and monitoring. The geriatrician is the “point person” who manages your loved one’s overall health and coordinates care provided by other care team members. Geriatricians help you and your loved one evaluate goals of care and develop a care plan that encompasses the things that matter most to the individual.
It’s important for the family caregiver to help the geriatrician stay on top of health issues — but communication may not always be optimal, said Mara Botonis, of Ft. Myers, FL, a family caregiver and author of When Caring Takes Courage. Use a checklist or keep a log to monitor medical and behavior issues; review it regularly with the provider to identify areas of concern.
Neurologist: A neurologist is a medical doctor trained to diagnose and treat disorders of the central nervous system, including the brain. He or she may help the primary physician diagnose Alzheimer’s or other dementias through an examination of the nervous system and brain functioning. Neurologists may perform diagnostic tests such as CAT scans, MRIs, or spinal taps.
Why: A referral by the primary care provider is common if Alzheimer’s or other dementia is suspected. The neurologist will take complete medical and psychological history and perform a variety of physical, cognitive and lab tests to pinpoint probable Alzheimer’s – such as testing motor skills and cranial nerves, and conducting a standardized a mental status evaluation. Neurologists can diagnose the likelihood of Alzheimer’s with about 90 percent accuracy by eliminating other conditions, say experts at the University of Miami. However, the only way to actually confirm that diagnosis is through autopsy.
Geriatric Psychiatrist: Geriatric psychiatrists are trained to treat patients with AD and to counsel caregivers. They perform clinical assessments, provide comprehensive behavioral treatment and management, advise and educate individuals about mental health issues of older adults. Geriatric psychiatrists also help family members cope with the psychological toll of caregiving.
Why: Behavioral problems become more common as the disease progresses, according to the Geriatric Mental Health Foundation. These symptoms may be the result of a treatable problem such as pain, infection, or discomfort and managed through non-pharmacological and pharmacological approaches. The primary goals of treatment are to improve the quality of life of the patient and caregiver and to maximize function by enhancing cognition, mood and behavior.
Nurse Practitioner and Geriatric Nurse: A nurse practitioner (NP) is a registered nurse with advanced education and training in the diagnosis and management of common medical conditions, including chronic illnesses. Nurse practitioners provide a wide range of health care services — including some of the same care provided by MDs — and maintain close working relationships with physicians. An NP may serve as someone’s regular health care provider, although regulations and “scope of practice” vary by state. The Family Caregiver Alliance calls the role of nurse practitioners “pivotal” in early diagnosis of Alzheimer’s and in managing disease progression.
Geriatric nurses care for the elderly, focusing on creating and carrying out treatment plans for chronic illnesses, including diabetes, hypertension and respiratory disorders. They also educate and counsel families of elderly patients who suffer from acute and chronic conditions.
Why: Nurse practitioners are part of many medical practices, hospitals, and clinics and may treat your loved one for routine care. “Many people believe nurse practitioners are better listeners and often have more time to spend answering questions and offering support.” said Susan Reinhard, Ph.D., R.N., Director of AARP’s Public Policy Institute. Nurses can talk about the day-to-day topics that they weren’t always comfortable talking to the physician about, like “how do I get him to the bathroom? How do I prevent those falls at night?” explained Liz Capuzeti, Ph.D., R.N., Hearst Foundation Chair in Gerontology at Hunter-Bellevue School of Nursing, City University of New York.
Therapist: Physical therapists apply research and proven techniques to help people get back in motion. Occupational therapists evaluate a person’s ability to carry out daily tasks and can individuals to function more independently.
Why: Regular exercise is important for both for overall health and to address issues specific to Alzheimer’s, says The Fisher Center for Alzheimer’s Research at The Rockefeller University in New York. Studies show that light exercise and walking appear to reduce wandering, aggression and agitation in people with Alzheimer’s. Incorporating exercise into daily routines and scheduled activities can also help alleviate problem behaviors.
Physical therapists will assess your loved one’s ability to walk safely, the risk of falls, and other functional tasks. The therapist will develop a treatment program, including exercise, to help maintain your loved one’s current abilities, which also helps reduce caregiver burden.
Occupational therapy for people with Alzheimer’s and other dementias combine environmental modification, adaptive aids, problem-solving strategies, skill training and caregiver education and training. They help your loved one achieve maximum independence and enhance daily living activities.
Geriatric Social Worker: These experts are trained to work with older adults and provide supports for family caregivers. Geriatric social workers “address the specific challenges of the aging process by promoting independence, autonomy, and dignity in later life,” according to the National Association of Social Workers.
Why: You may work with social workers in hospitals, rehab facilities, at home or through an insurance company. They are your liaison between the care team and family – providing medical case management, tackling barriers to service, fostering collaboration and coordination among professionals, and addressing gaps in care.
Care Manager: Care managers act as family guides and advocates. They often have backgrounds in nursing, social work or psychology. They assist with many facets of care, including medical services, provider-caregiver communication, bill paying or navigating programs like Medicare and Medicaid.
Why: If you’re a long-distance caregiver, or just simply overwhelmed with what you need to do, a care manager can ease some of the stress and burden by taking over some of these time-consuming, complex responsibilities.
Resources
Area Agencies on Aging Finder
Area Agencies on Aging (AAA) are offices established through the Older Americans Act that serve to facilitate and support the development of programs to address the needs of older adults in a defined geographic region and support investment in their talents and interests.
Geriatric Mental Health Foundation
Caring for the Alzheimer’s Disease Patient: How You Can Provide the Best Care and Maintain Your Own Well-being (downloadable pdf also available in Spanish)
American Physical Therapy Association (APTA) Patient Resources
American Occupational Therapy Association
National Association of Professional Geriatric Care Managers – Find a Care Manager
Eldercare Locator: Find services in your community by zip code
Geriatric and Extended care services for Veterans
So Far Away: Twenty Questions and Answers About Long-Distance Caregiving from the National Institute on Aging
Liz Seegert is an independent health journalist who covers aging and related issues. Follow Liz on Twitter and see more of her work at lizseegert.com.
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