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

Too Good to Be True
With over 300 clinical trials on vaccines for COVID19, it perhaps is not a surprise that at least two...
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December 1, 2020
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The Other Global Health Crisis
Wearing a face mask is the new front line of defense against the spread of the war on COVID-19,...
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November 17, 2020
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One More Sign of COVID?
I have written about Alzheimer’s disease…a lot, its warning signs and caregiving probably more than any other topic. Even...
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October 6, 2020
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None of the Above…
While everyone is awaiting the next vaccine to prevent COVID-19 or help in the treatment of the condition among...
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September 29, 2020
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COVID’s Other Deadly Toll
During this pandemic, over 13,000 more Alzheimer’s and other dementia patients have died than expected from these cognitive disorders,...
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September 22, 2020
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It’s Not a Sprint
I think it occurred to me Sunday afternoon last week, and I was anticipating Monday. But Monday was Labor...
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September 15, 2020
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That’s Not A Senior Moment
We all hear the phrase used as an excuse for a bit of memory lapse … that it’s just...
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September 1, 2020
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Heard or Herd?
I am really, truly, seriously, absolutely in need of good news – heard news and herd news. Today, I...
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August 18, 2020
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Hold Your Friends Close and Stangers Closer
Miss your friends, your older loved ones and those summer get togethers in the backyard? We can get together...
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August 11, 2020
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Pre- Instead of Post-?
When was the last time you studied after a test? Or prepared your dinner after you had dined? Or...
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July 21, 2020
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In the Caregiver's Words

Recent Client Praise

Barbara Bush, wife and mother to presidents, has taught us another lesson this past week, and it is about how she chose to die. She taught us that palliative care and hospice care are different concepts, but she also taught us about the importance of an end of life plan. Let me start with the first. Let me clarify that hospice care is reserved for patients who will face an end to treatment and wish to be comfortable. Palliative care is simply the “comfort care” we saw requested for Ms. Bush, but it can be for any patient about to embark on a difficult or painful treatment regimen. We deal with a lot of families of older loved ones who are faced with difficult diagnoses. If the diagnosis has a treatment option that may prove difficult or painful, doctors may suggest palliative care. And that is when some family members may freak out just a bit… not an exaggeration. Yes, they may freak out because there is an association between palliative care and end of life, or hospice care. So what we saw for the former first lady was a care plan that included anything she needed to simply die comfortably, hospice care, but they did refer to it as comfort care. Ms. Bush was able to make her own decision at the point when a choice needed to be made, but so many people will not get that chance. This is also why it is important for families to have a discussion about the “what if scenarios” that families may face. What if there is no hope for recovery? What if the patient will not regain consciousness to make a decision about how to cope with a potentially painful end of life? As an Aging Life Care professional, we talk about the importance of a care plan. A key element of a comprehensive care plan will be what to do if. ….If mom cannot make the choice for ending treatment…If dad’s dementia precludes dad’s own decision for comfort care. We were told in Ms. Bush’s eulogies that she ended life pretty much on her terms. I would encourage us all in this country to make plans with family members that will assure the same level of comfort…that we should all end life on our own terms. If you have not already, it may be time to speak with your older loved one about what “their terms” are. You and they will be very gratified that you were sufficiently bold to start the conversation. 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.
If you are a caregiver to someone with diabetes - Type 1 or Type 2 - then you know that one of the biggest challenges is the fact that food seems to have become the enemy to a diabetic. The difference between Type 1 and Type 2 diabetes is that the former requires insulin to manage blood sugar levels. Type 2 diabetes, the more common of the two, can be managed by diet and/or oral medications. Both require a rethinking of food, however. And if you are caregiver to a diabetic, you may find it most challenging to help your loved one with the food side of the equation, but here are three tips that can make this manageable medical condition also a bearable medical condition.

1.    Don't Manage Diet with No's. Too often it is easy to think of all the foods that a diabetic cannot eat, because they contain sugar. According to professionals who work with diet, they suggest making the whole household's diet healthier. Rethink how you prepare or coordinate meals for everyone so that you are incorporating more complex carbohydrates, more fruits and vegetables along with protein. You should limit, but you do not need to eliminate, foods like cake. Make them special occasion foods, instead of every meal foods.

2.    Portion and Convenience Control. A lot of the excessive intake we all are prone to is because we don't think about proper portions. We make a bag of microwave popcorn, pour it all in a bowl and head for the TV. Instead, we should take a serving dish of the stuff and stop when done. Snack food tends to be high in sugar and salt, so make your own convenience foods. Package in small containers some baby carrots or unsalted nuts or something else that can take the edge off your loved one's hunger until meal time.

3.    Get up and Move. To get a diabetic to exercise, appreciate that they will not respond to a drill sergeant approach. Don't nag. ask them to join you for a walk. Put an exercise bicycle in front of the TV - or a treadmill. Buy a pedometer to record how many steps each day a person logs, and work toward 5,000 steps and then 10,000. Set a time goal of a 30 minute minimum, and have alternatives to walking for the days the weather may be uncooperative like mall-walking. (Many stores open early just for "mall walkers.")

      The way to gauge success long term is by monitoring long term A1C. Blood glucose can swing rather widely based on how recently a person has eaten, but the long term blood sugar measured by A1C should stay as far below 6% as possible. And remember that this is a long term measure just as the changes in diet and physical activity should be long term changes for the better.

            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.
It’s not just about being lonely. Isolation may be a bigger senior health issue than even dementia – never mind that research has shown a clinical link between these two. I had a client a few years back who responded to a question from an attendee at her 100^th birthday about how it feels to be 100 by saying simply, “Not so much peer pressure…” Now, this individual was surrounded by friends and family, but what she highlighted was the attrition of social connection that accompanies aging in most individuals. As one ages, one loses friends and loved ones and one also loses the ability to physically get out and about. As one becomes increasingly isolated, there are mental, physical and emotional correlates of the loneliness:
- Research published in 2012 showed a clear relationship between social isolation and death among adults 52 years of age and older. One cannot say that isolation kills people, but one’s chances of dying from any cause are greater if living alone.
- Research from the University of Chicago has found a clear link between levels of loneliness and poor cognitive function and even dementia risk. In other research reported in 2016 older patients with the amyloid markers of Alzheimer’s were 7.5 times as likely as those without the markers to report feeling isolated or lonely.
- The National Center on Elder Abuse adds to the bad news by reporting that socially isolated seniors have higher rates of physical or financial abuse. Are they easier targets for predators or do predatory caregivers isolate them to take advantage?
- Isolated seniors also report more of just about every chronic medical condition from COPD to heart disease, poor mobility and, of course, depression. Loneliness is even linked to high blood pressure. This, after taking into account gender, ethnicity and other factors.
Most of these can give rise to the proverbial chicken and egg arguments about loneliness as a cause of the problems or the problems themselves giving rise to loneliness. So, let’s turn it around and look at what you can do if you are one of the circle of caregivers for an older loved one. Loss of a spouse leads to isolation. Be present in the weeks and months (not just days) following such a loss to help an older loved one re-integrate into a new social support system. Transportation challenges can lead to social isolation. If you have a loved one without transportation, look for alternatives like para-vans, carpooling and volunteers. Caregivers are at risk for social isolation. Find respite care resources, lay volunteers from religious organizations and home care options to give these caregivers a break. And don’t forget the isolation of that caregiver’s care receiver. Loneliness can be contagious. Volunteering can go the other direction also. Encourage your older loved one to engage in community activities, take a class or seminar, join a club, etc. And appreciate that with these added social activities you are helping to prevent a slide into unhealthy behaviors for your older loved one, such as smoking, drinking or just poor diet. Now is the best time of all to engage an older loved one in new activities. It is, after all, the New Year. And it is the season of long and cold nights. Encourage activities that can be part of the good habits of the new year. 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 came across some recent research that is - to say the least - counterintuitive. People drink diet carbonated drinks because they are being careful about their sugar intake and their health, right? Well, recent research reported in the Journal of the American Geriatrics Society says the opposite is true among older adults. A group of scientists at the University of Texas Health Science Center in San Antonio, Texas, studied the link between diet soda consumption and weight and waist size in 750 patients over age 65. What they found seems to be the opposite of what one would expect from people consuming "diet" beverages. The scientists measured the waist, height and weight of these 65+ year olds along with their diet soda intake over a ten year period. For their analysis they divided the patients into three groups: those who consumed at least one diet soda daily, those who drank less than one soda daily and those who drank no diet soda at all. The first group showed an average increase of 3.16 inches in their waistlines over the decade of the study. Those who consumed less than one diet soda a day increased an average of 1.83 inches during this ten years, but older adults who drank no diet soft drinks increased their waistlines by only about 0.8 inches. Ironically, the increase in waist size was not tied to an increase in overall weight. It was the belly fat associated with diet sodas that resulted in growing waistlines. As I have written in other posts, the weight we put on around our middles is the most unhealthy, and it has a direct and negative impact on cardiovascular health. And while the researchers cannot explain exactly why this increase in waistline was tied to drinking low calorie carbonated beverages, it is pretty clear that diet soda should be off the menu for older adults. I also have mentioned in other postings that carbonated drinks have a negative effect on a person's esophagus resulting in a higher likelihood of gastro-esophageal acid reflux, GERD, owing to the carbonic acid in sodas. Carbonated drink consumption also is associated with calcium depletion in the bones and ultimately osteoporosis. So, if you are a caregiver to an older loved one encourage them to find alternative beverages to their diet sodas. At the very least help them to cut their intake of these caustic libations as even getting most of the way to a zero soda goal will have its benefits. 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.
In the first of this two part series on caregiving to Alzheimer's or other dementias I spoke to what kinds of people will have logged the nearly 20 million hours of caregiving to patients with these dementias during the year. And if you are one of those caregivers to a loved one whose mental faculties are failing, there may be some comfort in knowing you are not alone. In this posting, however, I would like to share some advice from the perspective of a geriatric care manager who helps to care for both the dementia patient AND the caregiver to the patient. Take Care of You. It has become something of a mantra for me, and I cannot say it too much: Take care of the caregiver. If you as a caregiver to a loved one with some form of dementia do not take care of yourself, you will not be able to take care of your loved one. This is what allows everything else to happen; caring for the caregiver is job one! Learn All You Can. You may have known your loved one for decades, but the dementia is a stranger to you. Everyone's journey with Alzheimer's or other dementias will be different, based in part on the personality they had when the symptoms of the disease first appeared. But the condition will make things progressively different. Get educated. Be Realistic. This is about you and knowing your loved one would not want you to give up your life to care for theirs. And it is about accepting the changing capabilities of your loved one as the condition progresses. Don't Isolate Yourselves. It may seem challenging to do what you used to do as a family, but don't retrench so far that you fear even venturing out of the house. Do all that you can do and simply accept the limitations on some of the activities. Prepare the Paperwork. End of life discussions are always at least a bit awkward, but they will not get easier with the passing of time and further erosion of mental faculties. Most everyone will have a will, but you will also want a living will, powers of attorney and Do Not Resuscitate (DNR) orders in place. Be sure that the living will and the DNR are in all your loved one's medical records in the event of an unexpected hospitalization. Don't Go It Alone. This is an extension of number one above. Throughout this journey you will benefit from having others with whom you can relate what you are feeling. This could be support groups of other caregivers like you or you may feel more comfortable talking with a counselor who will let you know that it is simply okay to feel as you do. We may not have any cures for any of the dementias yet, but science is getting better at understanding how to postpone the progression of Alzheimer's and some other dementias. Professionals in this are also are getting a lot better about helping people to understanding the conditions and how both the patients and the caregivers can cope with them. Some of my "go to" resources include http://www.webmd.com and the Alzheimer's Association (http://www.alz.org/). This latter has state and local chapters who can offer personal help to both caregivers and their loved ones where they live. 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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