Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • elder resourceChicago's Geriatric Care Manager Center of Excellence

Elder Resources – Free Legal Advice
I have been hearing that the web resources I have been offering in my postings have been informative and...
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December 30, 2010
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Where There is a Will You Still Need an Advance Directive
About 50% to 70% of Americans will die without a will. So, you can imagine that the percentage without...
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November 22, 2010
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Becoming Educated about Elder Resources
Making decisions on behalf of a loved one is not always easy. Yet the challenge can be eased with...
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November 17, 2010
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Maximizing Well-Being for Everyone
Independence is as much about the caregiver as it is the older adult or special needs individual who receives...
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November 7, 2010
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In the Caregiver's Words

Recent Client Praise

We have all heard that we Americans are living longer, and that is a good thing generally speaking. It seems, however, that living longer also exposes those with greater longevity to medical conditions that don’t affect younger adults. One of them is within the category of dementia with a long name that they abbreviate to LATE (Limbic-predominant age-related TDP-43 encephalopathy). You can see why the abbreviation. You have heard of the telltale deposits of beta-amyloid that are the hallmark of Alzheimer’s disease. LATE has TDP-43 protein deposits on the brain that impair cognitive function, and among people 85 years of age and older the odds are one in four that they will develop this neurologic condition. Okay, you might say, it is just another of the nearly one hundred kinds of dementia. It is important, in no small part, because before physicians identified this unique dementia it was just one more chance for a misdiagnosis, and where there is a misdiagnosis, treatment is going to be wrong also. All the more reason to get a specialist to diagnose any cognition issue your older loved one may be manifesting. One of our team shared that his mom had been diagnosed with “organic dementia.” It was a diagnosis by her primary care physician who promptly prescribed Namenda. Follow this now. First, Namenda is approved by the FDA to treat Alzheimer’s disease. Second, it is meant to be used in combination with the first line medication, Aricept. Third, it turns out she did not have Alzheimer’s…she had vascular dementia. Never mind that this would have been medications that together would cost between $500 and $900 per month…and have absolutely no effect on his mother’s condition. So, misdiagnosis leads to more problems than just not addressing the medical condition properly. It is about not getting the right treatment and not helping caregivers to the patient understand what part of the brain is compromised so that they are attentive to the unique needs a patient will have based on their condition. When our team mate pointed out the discrepancy with the “organic dementia” and the Alzheimer’s meds, the doctor sneered, “So, it’s the cost of the medicine?” You can see where misdiagnosis can go. The need to reliably identify what type of dementia is clear. If it walks like a duck and quacks like a duck, it still is only walking like and quacking like a duck. Ask an ornithologist what type of fowl it is! Or, in this case a neurologist. 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.
Birthdays are a leading cause of falls that can result in an emergency room visit, and every year this takes a particular toll on those 65 years of age and older. The 65+ year olds represent 2.5 million visits to the ER according to the CDC, and that makes them the most susceptible of any age group. Sadly, one in three of this 2.5 million will be back again within a year of their first visit having fallen again, some within days of the first fall. So, keep your older loved one in the safe confines of home, right? No … researchers report that a substantial percentage of these falls are trips, slips and stumbles right at home, the bathroom and kitchen being particularly dangerous fall hazards. As any physical medicine doctor can tell you, walking is actually controlled falling. We learn this skill at a very early age when we are all thankfully closer to the ground. If this isn’t clear, just watch an infant struggling for that first milestone step…a lot of falls precede the successful step. As we age, we don’t forget how to walk safely, but older adults go through health and physical changes which challenge their agility and some medications are also culprits in this gravitational conspiracy. Here are some tips to help your older loved one to a safer gait:
1. Make a specific appointment and go with them to visit their doctor: be sure to cover their medications for any side effects, talk about any history of falls and explore whether any health conditions may be potential contributors.
2. Encourage a daily regimen that includes more than just walking - perhaps a physical therapy regimen or yoga or strength training, because strength and changing up the training – what some refer to as “muscle confusion” – is good for agility.
3. Outfit the feet: “sensible shoes” may be a dirty word in fashion circles, but help your older loved one to have properly fitted, effective footwear with soles that have traction – avoid high heels, floppy shoes, bunny slippers, etc.
4. Conduct a home safety inspection to declutter, eliminate trip hazards, upgrade poor lighting, and make home more accessible with everyday items within easy reach. Remember, baths and kitchens are particularly hazardous places.
5. Be sure your older loved one’s house is well-lit, and this goes for middle of the night trips to a rest room or early morning risings during this season of short daylight. Encourage a flashlight at bed side.
6. Upgrade home safety with hand rails on all stairs or even longer hallways, non-slip treads on stairs, adaptive toilet seats and grab bars in the bath.
7. There are professionals who can help – physical therapists can help with a “workout and flexibility regimen,” and your local senior ombudsman also can recommend area craftspeople who can make home accommodate your older loved one.
So, when you visit your older loved one during the holidays take along a pad of paper or your smartphone to make a list. This is not the naughty and nice list; it’s the safe and non-safe list! I have a home safety checklist I will be happy to send you if you just email me. 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.
Would you look for advice from an investment counselor who simply promised a lower rate of loss on your investments? Would you buy the car that promised mileage not as bad as some of the others? Well, we have been told until well into the 1990s that the number of brain cells we have is pretty well fixed post-adolescence, so it would have seemed that anything we can do in the way of brain help is the equivalent of less loss. The story starts with some information you may not have heard. We all have heard of the “gray matter” of the brain which is the neurons that create and hold our memories…our interactive scrap books. We don’t hear as much about the connective brain tissue called white matter, or axons, a fragile network that can be prone to thinning or atrophy over time. This latter part is the wiring of the brain, and it was considered to be a fixed asset of the brain…it was assumed it didn’t grow and probably was prone to some amount of wearing down over time, much like our cities’ infrastructure…the wires begin to wear out with age. Scientists have found within the past decades that not only can our brains produce more neurons over time, but also more axons to connect the neurons even as we age. A team of neuroscientists at Colorado State University has focused recently on the white matter among 60+ year old subjects finding that it can grow and remold itself…especially among physically-active people. In their study they divided these “older” volunteers into three groups assigned to supervised programs of stretching and balance (yoga), brisk walking or dancing. They were all tested at baseline for aerobic fitness and they received MRI scans of their brains. At the end of six months the dancers and walkers not surprisingly were more aerobically fit. As the scientists examined the brain scans, they found that one group stood out with renewed white matter, some parts of the brain even larger and any tissue lesions on the white matter that had earlier been detected were smaller now. Dancers and walkers showed the most benefit, but even within these two groups the walkers were clearly the leaders in their axon health. And at the other end of the exercise continuum, the yoga group, showed more thinning and more lesions in their white matter. These findings were supported by cognitive tests which were generally consistent with the aerobic fitness results showing better results with the walkers. More work still needs to be conducted among larger samples and more age diverse groups of people. At the very least, however, the science to date shows that we all will benefit by getting up and moving. Put on the miles and your brain and legs will repay you with better health…physical and mental. Your white matter…well…matters! 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.
Any discussion of hygiene - whether in an older adult or anyone else for that matter - is an admittedly subjective discussion. It is not just about taking a daily bath or shower. In fact, in many other parts of the world, a daily cleansing is considered a bit excessive, and some people of earlier generations did not necessarily grow up on the daily dousing we call personal hygiene. Everyone potentially has their own take on how frequently they wish to bathe, but hygiene also can be an indicator that something else is not quite right in an older adult.

When I get a call from a client who is concerned about their older loved one's hygiene, I start by simply asking if this is a recent change from old habits or if it simply the way they always have been. If it is just the way the habit has always been, then it will not be easily changed...if, in fact, it even should be changed. Old habits are deeply ingrained. But a change in personal habits can be the sign of something else at work.

In an earlier post, I had pointed out that loss in appetite can be a warning sign of depression. The same holds for an older adult who has lost interest in how they look or how they smell. Depression is a bigger issue than hygiene, and in fact, if the older adult addresses the depression with talk therapy or medication, if indicated, they may find a renewed interest in self-care and hygiene.

And as with appetite as I addressed in the last posting, a change in hygiene can simply be a product of the older adult's diminished ability to smell what you as a caregiver may find offensive. Conversely, you may find that your older loved one has dumped excessive amounts of cologne on themselves, because they cannot tell that they have given themselves an overdose of the good smelling stuff. Regardless, any discussion you may have with the older adult about something as personal as how they smell should be a very sensitive discussion.

Your older loved one also may also be finding it difficult to navigate the bath like they used to because of their diminished agility. And modesty may preclude them from asking for help. So if this is the case, consider enlisting the help of third parties like home care aids who will not be as threatening to their sense of propriety.

Forgetting to shower or bathe can also be a sign of a larger pattern of forgetfulness, so try to assess hygiene against the "big picture." Does your older loved one also miss appointments or forget to pick up their clothes from the cleaners? Maybe suggesting a calendar with dates filled-in with the "things to do" can be an assist, because we all can forget things. If the forgetfulness, however, is part of a greater disorientation, be alert to early onset dementia. Even if this forgetting is part of a dementia, don't immediately push the Alzheimer's panic button. Mild dementia can be exacerbated by poor sleep or even a medication that has a side effect of confusion. Diphenhydramine (branded Benadryl), an ingredient in a lot of over the counter medications, can precipitate some amount of forgetfulness in a person of any age.
Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.
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.
Miss your friends, your older loved ones and those summer get togethers in the backyard? We can get together at distance with friends and family in manageable numbers while maintaining distance, but there is no chatting around the water cooler or dropping by the grandparents or social hour at a local establishment like there once was. All of that is mostly lost, at least if you’ve been following the guidelines, and the isolation you and your older loved ones feel is not unique. Odd to talk about isolation and then offer that you are not alone, but… Research is showing that strangers may be every bit as important to your emotional well-being and your older loved ones’ well-being as the friends that you all may now be missing. If you’re like a lot of folks, you are walking more, perhaps with a dog in tow. Or you many be shopping for groceries in the less crowded grocery stores. Or you may be at home to have the mail delivered as your retired parents are and meet the letter carrier or the delivery person from those on-line purchases we all have been making in greater number. I am not exactly an extrovert, but I always make it a point to at least say hello to all of these people with whom I have casual contact. And my husband, the extrovert in the family, may spend minutes chatting up a neighbor we had not met until the recent months or the person from the pizza parlor who delivered tonight’s guilty pleasure or someone eight blocks from home on his long walks with our now physically fit dog. Well, those casual encounters may be helping his and my mental health in a way that we used to think only close friends or confidents could according to a book I came across. The book, titled “Consequential Strangers,” is co-authored by a psychologist and a science reporter who analyzed the importance of those “weak ties” that we all have on a daily basis. In fact, the authors contend, those strangers are as important as family in best friends in giving us a strong grounding in the world. And the authors further point out that the more ties we have with “consequential strangers” the less likely one is to become depressed. Some of the benefits also include better sleep patterns, more productive work effort and just about all of those parts of daily living we value. To truly be healthier during this extended break from normal, ask strangers how they are faring…and then how their family’s health is…and maybe what they have been bingeing lately. You will have primed the pump for your better health. Now, do the same for your older family members and friends and you are passing it forward. Remember, we all will get through this, and we will get through it in much better shape if we hold our strangers closer. 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.