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Trusted Voices on COVID-19
The news cycle calls the COVID-19 crisis a rapidly developing story. It unfortunately also has been one with a...
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March 17, 2020
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In the Caregiver's Words

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How many times have we all seen the commercial with the plaintive actor on the floor crying, "Help, I've _____ and I can't get up." No one would ignore a plea for help from an older person who has fallen and cannot get up. But a lot of caregivers may be ignoring a similar plea with all of the health threat that a fall can represent. It is just that this fall is in slow motion. And it goes like this: "Help, I am so fatigued that I don't feel like getting up." Tired often does not get enough attention in medical circles, but it is a common symptom reported by people age 65 and older. We tend to discount fatigue, because we cannot accept that a person who has retired and now enjoys six Saturdays and a Sunday every week could not be well-rested. And if you are a caregiver to an older loved one, you may find it a bit challenging to muster the sympathy for your older loved one when you already are stretched across your responsibilities for your children, your partner, your job and... Yet, we should all pay attention to the subjective complaints of fatigue in our older loved ones, because tired can be a symptom of more serious medical conditions and because tired can lead to serious physical decompensation. Let's start with the other medical conditions for which fatigue can be a warning sign. Perhaps the most common clinical condition that presents with fatigue is depression, itself one of the most common comorbidities of aging. Depression often can arise from the hallmark aspects of getting older - loss, diminished physical capacity and social isolation to name a few. Chronic fatigue also can be a symptom of sleep apnea, restless leg syndrome, fibromyalgia, chronic obstructive pulmonary disease and any number of heart conditions. Poor quality sleep may also be indicative of musculoskeletal conditions or pain. If your older loved one is consistently tired, it may be time to accompany them on a visit to their physician for an assessment and a conversation. Sleepiness can also be just one more step along the slippery slope to frailty. Fatigue can be a strong disincentive for your older loved one to be as active physically as they once may have been. Fatigue also puts a damper on appetite which in turn reduces the quality of the fuel the body consumes to run the body's engine which leads to increased tiredness and low motivation for physical activity. And all of this translates into decreased mobility and frailty. Medical professionals refer to frailty as a "pre-disability." So, if the tiredness has gone on for an extended time, begin to look for signs of genuine frailty. No surprise, the signs include exhaustion ("hyper fatigue?"). Frailty also is predicted by weakness in grip and slower walking pace. And by weakness, we mean a quantum reduction in ability to grasp, and by slower we are talking a fraction of former strides. All of these point to diminished physical activity. Think of frailty as one step away from a permanent reliance upon a walker or wheelchair. The next time you are speaking with an older individual who reports being consistently tired, it may be time to wake up and take stock of their overall health. 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@cr eativecaremanagement.com.
As if dementia sufferers don’t have enough quality of life challenges, we can add to the list dehydration. In addition to the other short term memory issues older adults with dementia may not recognize that they are dehydrated … or they simply forget to drink enough water. We have long known that older adults in general often do not drink enough water, in part because they just don’t feel thirst as acutely as younger people do. Some also worry about incontinence, so they cut back on that risk by taking in less water. Older adults also often are on medications that can deplete their water, and this is especially the case for older adults on some blood pressure medications or antidepressants. Add to this the simple fact that older adults need as much as fifty percent more water daily than their younger counterparts to function optimally, and you get the potential for a thirst epidemic. Forgetting to hydrate can have real health consequences. As an adult grows older and begins to take in less water, they effectively can amplify the effects of some of the medications they take, increasing their dose without changing their intake. Dehydrated adults are also prone to some infections, particularly urinary tract infections. They also are prone to dizziness, headaches, confusion and difficulty walking. Enter a British college student named Lewis Hornsby. Hornsby was a design student who noticed that his grandmother who suffered from dementia seemed simply to have little interest in drinking water, and this led to a perpetual dehydration for her. Hornsby came up with a concept he calls “Jelly Drops” that are brightly colored balls contained a bit more than an ounce of flavored water…a hydrating finger food. As a design student, we was very conscious of not making it look like a medicine, hence the bright colors in packaging that could have been suited to a box for chocolates or gummies. Jelly Drops may not be available where you or your older loved one resides, but that doesn’t mean you can’t engage your loved one with more appealing hydration. Try popsicles or smoothies. Some folk make prefer milkshakes, Ensure or sports drinks or any of the burgeoning number of bottled waters. Maybe add bubbles…just try to avoid carbonated drinks that also add sodium. 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.
I came across an informative piece in the Washington Post about a week ago, and it brought to light a useful perspective on falls and injuries and recoveries. I’ve talked a bit in earlier posts about preventing falls, especially with your older loved ones. Preventing a fall is arguably the best place to be, but as the more recent article highlights, how we recovery from a fall is also critical. What do you think?
Before the fall. If you have an older loved one, don’t wait for the phone call; here are some simple steps you can take to assess your care receiver’s risk as well as help bolster their safety:
- Assess your loved one’s risk for falling using the CDC’s questionnaire.
- Make certain your loved one gets an annual eye exam, and keep their glasses (if needed) current with their vision.
- If you accompany them to their doctor visit, ask about their feet, posture, leg strength and agility.
- Help assess and address any clutter or other safety issues in your loved one’s “space,” and remember that a lot of this revolves around lighting and ease of access.
This last one has a lot to it. If you would like, we have a home safety checklist that you can use to identify potential trouble spots in your loved one’s house. Just email me at info@creativecaremanagement.com , and I will send you a copy. You may have noticed that I have nearly 600 postings in this blog. Please just type in “home safety” or “fitness” in the search box on the Blog…or any other keywords that are top of mind for you about your loved one’s safety. After the fall. The author of the recent piece, Elizabeth Heath, quotes a “mental recovery expert” on what to acknowledge post-fall: “Decreased confidence and fear of reinjury are two common side effects of any injury.”
- Appreciate that the mind has to recover from a fall just as the body does…and it may take longer; consider counseling to help with constructive self-talk and “baby steps.”
- Set realistic goals…you don’t need to get back on the proverbial horse right after being thrown; the same is true for falls while walking…start with an easier path.
- Age is an important consideration, so engage a personal trainer for your older loved one so that they can be re-trained in “getting their nimble back;” that’s “trainer talk” for using multiple ways to work the muscles to keep them responsive to surprises on their path.
- Don’t battle through the pain; your older loved one’s body will show remarkable resilience in recovery if they are allowed to give the body the time it takes…which may be a bit more time than it would have decades ago.
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.
You may have heard the noise about a new drug for treating Alzheimer’s disease and other dementias. It would make sense that there would be some noise, because we’re talking about a new treatment with a new target and new data on how well it works (or doesn’t). A lot of the noise, however, was not fanfare about a new drug as much as the red flags that Medicare (CMS) was raising about covering the new therapy's use. That, and it’s been since my book was released in 2017 that any new way to address the devastating effects of Alzheimer’s has come on line…and that's just about six years! I won’t go into the details of those “older drugs,” except to say they didn’t have anything close to the dramatic results that consumers or physicians wanted:
- Cholinesterase Inhibitors (Donepezil, Galantamine and Rivastigmine); and
- NMDA antagonists (Memantine, Memantine and Donepezil combination).
You can read more in Chapter Seven of the book if you want to understand their mechanisms of action as well as other healthy lifestyle habits that can make a difference in addressing both the progression of Alzheimer’s and how the medications work. I had mentioned the “noise” about a more recent addition to the inventory of FDA-approved treatments for Alzheimer’s. The new drug, Leqembi, was approved for treating AD, but there were a number of caveats imposed by the Food and Drug Administration from the get-go. When FDA gave its initial approval of Leqembi as “safe and effective,” the Centers for Medicare and Medicaid Services (CMS) placed some rather onerous restrictions on the use of this therapy. What restrictions? Patients can of course be prescribed Leqembi, but it will be “covered” by CMS only if their prescribing provider is part of a registry to monitor the use of the drug. This position has been a bit relaxed from their earlier restriction that patients could be prescribed this therapy only if they were involved in an extended clinical trial. And this is a first for CMS to require this sort of data-collection after FDA approval. FDA’s approval was based, it seems, on the therapy’s ability to reduce amyloid beta plaque in patients’ brains in a 79 week trial among 856 patients. The manufacturers of Leqembi had completed the trial with up to 93 percent reduction in plaque at Leqemi’s highest dose. CMS has made restrictions for drugs yet to complete an approved clinical trial, but Leqembi was already done with that. What’s missing in this picture? Since this is going to take a bit more space to unpack, I’ll leave with you a question to be answered in “part 2:” What about maybe judging a therapy based on measures of Cognitive Decline? 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.
Please consider what I am sharing with you here to be the raw material side of recommending some recipes for your upcoming Thanksgiving feast. By raw materials, I mean that these recommendations are not recipes, strictly speaking, but I am recommending your feast this week have ample quantities of vitamins D and E. In fact, you might carry these doses over into your regular diet after this week. If you are like most folks who have been following advice on healthy eating, you already appreciate that vitamin D is very important for bone health and vitamin E is central to heart health. But what you may not have seen is that both of these also are important to brain health. Separate studies have shown that vitamin E can help to keep Alzheimer's at bay and vitamin D can lower the risk of cognitive decline. Starting with the case for vitamin E, researchers at New York State University have studied the effect of regular quantities of walnuts (rich in vitamin E) on what they termed "Alzheimer's-susceptible mice." Granted, these are animal studies, but the nutrition needs of mammals can be generalized to some extent. And their results published just this month were quite striking. The group of mice in their experiment who consumed regular doses of walnuts showed statistically significant improvement in learning, memory, motor skills and even anxiety levels over the mice who received no walnuts. (How do they measure anxiety in mice?) No surprise that walnuts contain Omega-3 fatty acids as well as other antioxidants which have been proven in other studies to ward off cognitive decline. And then there is vitamin D. This was a study among older Italian adults rather than mice. The researchers tracked vitamin D levels of nearly 2,000 adults whose average age was 73.9 years for over four years. They found that those individuals with vitamin D deficiency or insufficiency (measured by their serum 25OHD) were more likely to have declining cognitive skills as measured by a standard test called the "Mini-Mental State Examination." This was compared to their baseline test at the outset of the study which showed all participants to begin at comparable and robust levels of mental ability. It is important to note that this second study simply noted the differences among individuals based on their blood serum levels and did not control what they ate. More testing will be needed to see if vitamin supplements can make a positive difference versus in mental capacity. And, of course, the first study was on mice, so it would be helpful to move this up to humans. And by the way, the amount humans would consume to give the equivalent dose for what the mice ate would be only about 1-1.5 ounces of walnuts daily. So, if you are a caregiver to an older loved one this holiday, these two studies may not include any recipes, per se, but they do suggest what you may wish to add to your Thanksgiving spread as well as the dinners that will follow. And you don't have to choose between these two vitamins; cover your bets by adding a bit of D and a bit of E. 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.
I’ve talked about this often in past posts: older adults have a greater fear of Alzheimer’s than of any other medical condition. In a recent survey, 39% of adults over age 55 feared Alzheimer’s while cancer trailed with 30% of these respondents reporting that as their fear. What we don’t hear as much about is the fear that the future caregivers of Alzheimer’s patient have…and with what they will have to cope. They don’t seem to have done any surveys, about future caregiving to an Alzheimer’s patient, but it’s likely the fear is mutual. When first confronted with a loved one’s diagnosis, caregivers naturally ask what they may now expect from their loved one…but the answer is a moving target. The symptoms of Alzheimer's disease devolve over time which dictates their capabilities and the appropriate interactions from the caregiver. Stage 1: It’s called mild or preclinical, because before the diagnosis is even made a patient’s brain is losing some of its original capabilities. During this first stage, loved ones may begin to see some changes in word-finding ability, name recall or what we can often write off as just “forgetfulness.” My husband’s mother had vascular dementia, but her early experiences were very parallel to Alzheimer’s. One of her go to questions came to be, “How do I know you,” which we used as a title for my book on dementia. Planning became more difficult, so she found it increasingly easier to simply let others organize her days and her life. Loving caregivers responded by simply picking up the slack in order to preserve her quality of life and her dignity. Stage 2: In some ways the progression to this stage is an amplification of the early stage symptoms, but diminished nerve cells take an understandable toll. As a caregiver, one learns to not simply remind the Alzheimer’s love one, but perhaps to also pick up the slack. The forgetfulness also extends to more fundamental activities of daily living. A caregiver will not merely help with finding the right word, but also the appropriate clothing for the season and other choices that earlier were almost done without a thought. Caregivers should also look for psychological withdrawl or moodiness and offer comfort. The patient will still continue with normal activities of daily living, but require more assistance. Stage 3: The final stage is marked by a graduation from anything that could be called mild impairment to more obvious shortcomings. A client once described life with his Alzheimer’s mother as having graduated from getting only four hours of uninterrupted sleep a night to now having only four hours of interrupted sleep each night. In this stage it becomes increasingly important for a caregiver to seek added help for what has become constant demands from their loved one. The patient’s overall health also is affected. It also takes a special kind of love as personality changes also begin to surface to the point that the loved one no longer is herself, but soothing music or loving touches can help. Alzheimer’s ultimately does “take a village” with professional support as well as the loving help of friends and extended family. It also is a significant help to have had a family health care provider engaged from the early stages forward so that they also have monitored as the caregiver sees the changes that need to be addressed. And everyone sees the patient who was and is. Let me also add that it is very important to seek out caregivers and care managers who are certified and accredited in supporting the family as well as the patient. 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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