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

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November 30, 2015
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In the Caregiver's Words

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Do you have pain in your back, particularly your lower back - that area around your belt line or slightly lower? If not, please consider yourself lucky, but also just wait. According to some experts, about four in five Americans will at some point in their lives experience low back pain...chronic low back pain. What may be surprising is that most of these cases have no specific cause that can be diagnosed. As a geriatric care management professional, I hear about this a lot. And if you are a caregiver to an older adult, you may hear this from your loved one as well, or you may be experiencing the pain yourself. So, as a consequence, doctors are seeing more and more of these patients, and without having a specific cause to address they may be tempted to treat the pain. While surgery may be an option for serious spinal conditions, most of this low back pain does not reach such a level of acuity to justify surgery. A lot of doctors have started giving injections into the site with anti-inflammatories, opioids, or in some cases vitamin B-12. Injections would be great if they worked, but there is not much evidence to suggest that the injections are any more than a short term fix for the pain. A research commentary, reported earlier this summer in the Journal of the American Medical Association, says that there is almost no evidence in the larger literature that injections have any positive effect over the long term. Other reports suggest that they likewise do not substantially reduce the likelihood of surgery later. There was one research study published in February that actually showed the opposite; patients with pinched nerves in their lower back receiving injections showed less pain relief than a control group who received no injections. The JAMA authors are now recommending against injections. What are the alternatives? Here are :
1. For those with above average weight, especially belly fat, weight loss can be very beneficial.
2. Strengthen the back muscles with more exercise. It could be as easy as taking longer walks, swimming or riding a bicycle.
3. In a journal called The Clinical Journal of Pain, doctors recommend yoga or Pilates as a somewhat more aggressive approach that has showed good results.
It does not have to be confusing. According to some physicians, we seem to have made a symptom into a diagnosis. That is to say that pain is the result of something being wrong, and we ought to treat the source of a problem. Yet, most doctors do not like to prescribe long walks or losing weight, because patients ask for a "quick fix" to their problems. We have come to view pills as a solution to our problems instead of changing our lifestyles. I have talked in other postings about helping older adults to have more active lifestyles, because it will be helpful for their sense of well-being. Being more active, it seems, also will be good for addressing low back pain. Do it in small measures at first, but be persistent and grow the number of minutes, laps, blocks or other measure of investment in an active life. If you as a caregiver are walking with your older loved one, you also may find that the social activity of conversation is a health boost. Make sure their shoes give them solid support. The pain may not totally go away, but chances are that there will be relief at least during the exercise. And the relief can continue to grow. Charlotte Bishop is a Geriatric Care Management professional 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 don’t know how many of us would like to live full-time in Disney World, but most of us have some very fond memories of maybe the early days with the Mickey Mouse Club or a trip to one of their theme parks. But there is something new from the Imagineers of Disney, and it’s a senior residence designed for those 55 and older. The first of these “Storyliving Communities” is being built in California where they are preparing a community that in their terms “is a little more magical.” This is not a pitch for this megacorporation’s next big way to engage the market with a bit of fantasy. It’s my way of saying that as your older loved ones approach retirement and move into it, encourage them to “reimagine” the next phase of their lives. If you go to your search engine and type in “how to retire,” you will get a ton of advice on how to save, what are the financial vehicles and how much is considered enough to last…and of course, some tips on planning for long term care, etc. But what about how to get to retirement and then find a life that can be fulfilling? Allow me to offer some suggestions for those nearing retirement to anticipate as well as for those already retired to perhaps do some rethinking and tweaking of their plans. Consider:
1. Mind your diet so that you preserve your health and your quality of life.
2. Plan and then refine a daily plan that keeps you busy – at your pace.
3. It’s not a light switch…you can ease into retirement gradually.
4. Exercise your mind as well as your body.
  1. Mind: take on a language, join a book club, embrace puzzles.
  2. Body: your personal record may be behind you, but set goals.
5. Make new friends, join a club, volunteer for a good cause.
6. Get to know your health care provider better…before an emergency.
7. There are two ways to stop working – screaming or smiling.
  1. Don’t obsess…get professional help to let go, if need be.
  2. Keep your work friends…they’re still friends with whom you can share.
8. Don’t make a bucket list…make a pamper yourself list.
9. As we all look at relaxing travel restrictions…relax your own restrictions and get away.
10. Invest in your community – lots of needs can reward your effort with lots of thanks.
It’s really easy to get caught up in what we can’t do as we once did, but don’t fall into that trap. If you need an excuse to do more walking, get a dog who will take you farther and show their appreciation in return. Try some new recipes, plant some new flora, see a new part of the world…and learn just enough of their language to immerse. 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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It seems that you cannot watch the evening news without getting a pitch on why older men should be paying attention to their potential for “Low T”, or low testosterone hormone levels. And a pharmaceutical company just happens to have a supplement to take care of it! This is why I have asked our Vice President, Steve Steiber, Ph.D. to talk to us about what we may not know - but should know - about “Low T” and the new treatment. Steve has over twenty years of experience as a consultant to the pharmaceutical and biologic industry prior to joining us at Creative Care Management: First, of all, it is important to understand what normal testosterone levels in men are before we can really talk about what has been described as “Low T.” Low ranges have been associated with decreased bone and muscle strength as well as lower fertility in men. But it gets a bit complicated, because the testosterone level itself is affected by obesity and by age and it ranges rather widely among men. Researchers from Harvard Medical School have recently compiled data on blood assays of testosterone levels in panels of thousands of men in eight European countries and the United States. Without getting into the specific metrics, they calculated the overall range from the normal low to the normal high end for men 19 to 39 years old. It was 264 to 916 on their scale. Adding the obese subjects lowered both of these numbers. Men ages 40 to 49 had a range of 208 to 902. What I find remarkable is that as they tracked all the way of up to ages 80 to 89, the range was 119 to 902. The upper bound was unchanged, but more men slipped lower. So that is “normal.” How to “naturally” improve testosterone:
1. Exercise regularly and add weight training
2. Eat a balance of protein, fats and carbohydrates
3. Supplement with vitamin D and some sun to activate it
4. Add a balance of other vitamins and minerals
5. Reduce stress which releases cortisol
6. Sleep well.
If that older man you may know wants to consider adding the hormone, there also are some cautions. In clinical trials against placebo, older men taking the hormone had twenty percent greater build-up of non-calcium plaque in their arteries than men who did not take the hormone. In other words, the improved testosterone levels came with increased risk of a cardiovascular event. Another study looking to see if there is improved cognitive ability in men taking testosterone supplements found no improvement in men who had started with Low T and moderately impaired cognitive function. There also is a demonstrable increase (63%) in risk of venous clots in men taking a testosterone supplement. It appears that this effect is transient, only lasting for the six months following the start of treatment. The lesson appears to be simply that anyone considering testosterone hormone supplements needs to talk with his physician…and perhaps consider the “natural aids” versus the hormonal supplement. 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.
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For caregivers to older loved ones in northern climates, winter is more than just a warning about dressing for the cold. Especially with the recent round of record cold temperatures across two-thirds of the nation, here are some recommendations for assuring that your older loved one will be safe throughout the rest of this season. It is the Ice. It is not just the cold that can be a threat to your older loved one's safety, it is the slippery surfaces that accompany p[lunging temperatures. With about 1.6 million Americans visiting the ER because of a fall each year, it is important to prepare your loved one for treacherous walkways. Encourage your loved one to think of going outdoors as an athletic event; wear shoes that are appropriate for the conditions and do some stretching before heading out. Skin Protection. Older skin is both thinner and drier which means that an older person will bruise or cut more easily. They also may be more prone to nosebleeds. All of this encourages keeping indoor humidity a bit higher in order to have skin as prepared as possible for the assault of the cold, dry outdoor air. And boost your older loved one's inner humidity by encouraging more aggressive hydration with fluids. Prepare for Outages. Encourage your older loved one to stock up on staples should outdoor conditions get in the way of the weekly run to the store. And should the power go out or the pipes freeze, have them stockpile a few gallons of extra water - just in case. Flashlights with extra batteries along with candles and blankets are also essential back-up, and have a system in place for regular wellness calls by phone as well as from willing neighbors throughout the season. Keep Warm. This may seem obvious, but remember than an older adult's sense of feeling is diminished with age or because of chronic conditions like arthritis, diabetes or just poor circulation. Keeping the thermostat at or above 68 degrees F is a good marker, but still be listening in your wellness calls for any sign of cognitive difficulties like slurred speech which could be signs of hypothermia. Seasonal Affective Disorder (SAD). The long nights and short days of winter can take their toll on anyone, but age has its own way of exacerbating depression. Encourage your older loved one to get out and socialize and be alert to the glum noises of SAD in your regular wellness checks. All of these general warning signs also should be a reason to reach out to neighbors or programs that can call on an older loved one. Meals on Wheels, for instance, is only partly about food; it also is a way to keep isolated people from becoming even more disengaged. And this may not be just about your older loved one if you are a distance caregiver; check around your own community to see where you can be that neighbor who checks on someone whose day will be just a bit warmer for your reaching out. Take heart - Spring is only a bit more than two months away! 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.

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