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

Password Protected?
I often offer advice on how to help your older loved one with challenging tasks or how to protect...
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October 26, 2021
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Can You Hear Me Now?
From 2002 to 2011, actor Paul Marcarelli was the voice for Verizon pitching their cellular communications with the simple...
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September 28, 2021
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What Does It Mean to Age Gracefully?
I think I can say with high confidence that your parents taught you how to walk…or what the kinesiologists...
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September 21, 2021
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Your Older Loved One’s Greatest Health Risk?
As our loved ones grow older, we probably are more acutely protective of their health and well-being, especially if...
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September 14, 2021
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Nursing Homes Still a Risk for COVID-19?
It has been a tough pandemic for everyone, but it has been especially difficult for residents of nursing homes...
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August 31, 2021
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Your Flight to Nowhere is Boarding
You have probably put off a vacation or most any travel for more than a year with the threat...
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August 10, 2021
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The Side Effects Physicians Don’t Talk About
You all have heard about the side effects of FDA-approved medications that make their sales pitches on your television. ...
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June 29, 2021
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Breaking News for Alzheimer’s … part 1
The big splash on the medical news this past week gratifyingly was not COVID-19, but instead an approval of...
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June 15, 2021
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If You’reOnly as Old as You Feel?
We’ve all been asked a question like “How are you feeling?” And we probably didn’t take but a moment...
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May 25, 2021
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To B or Not to B12?
I have written a lot about dementia over the years as well as other issues that can mimic the...
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May 11, 2021
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In the Caregiver's Words

Recent Client Praise

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.
COVID 19 was not in my calendar for 2020, and I strongly suspect it was not in yours either. I often have said that family life crises don’t make appointments; they just show up. And I am usually talking about how to be prepared for the inevitable call from or about an older loved one in your orbit…AND how to be prepared for your and their next steps. Well, this time, preparing for a crisis could be closer to home, because all of us need to be prepared so that the people who may get the call that we have taken ill can be prepared. What do you need to do to make a Plan? When I have spoken in the past, some people back off from talking about a loved one in a crisis. This list is about you, so please forgive me for getting “personal.” Here is my “short list” of the documents you need to have and make them available to your partner, your kids or other close friend … sometimes with no notice:
- Medical Release – the document you need so your medical providers to speak with your loved one’s about your health status, medications and prognosis.
- Power of Attorney (POA) for Finance - a legally binding document that gives a person (referred to as the “agent” or “attorney in fact” permission or power to act on your behalf in matters of property or finance.
- Power of Attorney (POA) for Healthcare - a legally binding document that gives a person power to act on your behalf in matters of medical treatment. The “power” typically is in force when it is deemed the person in question can no longer act for themselves or if they are not conscious.
- Practitioner Orders for Life-Sustaining Treatment (POLST) – a document (varies state by state) that specifies in advance what measures you wish to have in the event you cannot expressly grant permission yourself. These orders typically revolve around life-saving measures; they are sometimes referred to as advanced directives and are placed in your medical files. The forms are downloadable at your state’s web site.
- Health and Life Insurance Policies – the health policy will help everyone involved understand what is covered and which physicians and other providers are available to you. The Life insurance policy should be in a safe place so that it can be readily accessed should that become necessary.
- Estate Plan – is (potentially) a wide-ranging document that let’s everyone know how any real estate or other holdings are titled and what the “plan” is for when your will is executed.
- Trust documents – help to identify how your estate is to be transmitted to beneficiaries. Trust names need to be consistent with life insurance, will and holdings in order to be in effect.
- Last Will and Testament – the legal document by which you express your wishes of how property is to be distributed at death, and names one or more persons, the executor, to manage your estate until its final distribution.
- The Grab and Go – This is a list that typically is sealed in a plastic bag. It includes your medical insurance documentation, a list of allergies, a list of medications, primary care physician contact details and in case of emergency (ICE) contact information.
Please email (info@creativecaremanagement.com) me with any questions on any of these…as well as how to take the next steps which is your plan. Do yourself a favor…don’t wait. 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.
Excess weight is not healthy and obesity definitely is not healthy, right? When it comes to your older parent or loved one, the answer is a bit more ambiguous. Picture you have been going to the physician with your older mother for a number of years, and mom has been “robust,” BMI 29, but not what would strictly be termed obese. (BMI, or body mass index, is calculated from a person’s height and their weight, and technically 30 or higher is considered obese.) This year, however, mom’s BMI is up to 30, yet she has not gained a pound. So, by the book she is “obese?” Not necessarily…this is part of what is termed the “obesity paradox.” As a person grows older, there is a tendency to lose muscle mass, and it can get replaced by body fat. There is also a tendency to lose height while maintaining a stable weight as in the case with “mom” above. As people age, they may accumulate more “protective weight,” weight that can be a reserve against unintentional weight loss. Among the young obesity is associated with adverse health impact in the form of risk of hypertension, diabetes, heart disease, certain cancers and a negative effect on most organs of the body…and reduced life expectancy. Yet, some older people who are patently obese have dodged these ill effects. These are also part of the “obesity paradox.” The fact is that a lot of their younger cohorts may already have succumbed to disease before they got so old, not unlike the octogenarian who has smoked a pack of cigarettes a day and continues to smoke without any seeming impact on their health. So, should mom lose weight? If it is all weight around the mid-section, weight loss is called for. Appreciate that any weight loss regimen is likely to result in loss of muscle as well as fat and therefore deconditioning. The rule is that weight loss in the 5 to 10 percent of body weight range tends to have positive effects. Also, weight loss that owes to real life style changes such as diet and exercise are positive. This kind of program should also include sufficient intake of protein to be safe. The American College of Sports Medicine also recommends exercise at least twice a week. This exercise should include strengthening exercise and resistance training. They identify what some call “muscle confusion” training which simply means changing up the regimen frequently to encourage a more nimble and flexible gait, balance and core strength. It is also helpful to involve your older loved one’s primary care physician to assure that their medications do not introduce issues of balance or body hydration. But beware of the physician who cautions against exercise for a “person of this age.” Don’t let them discount mom because of birthdays. Get a second opinion. And remember that it ultimately is about quality of life…and a healthy weight. 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.
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.
If you see something, say something. We have all heard this about everything from neighborhood watch programs to announcements in airports…that is, back when people actually took flights to somewhere. But what if you can’t see “something”… something like elder abuse. Another casualty of this COVID quarantine is the blinders it places on all of us who have looked out for or looked after an older loved one. We cannot really get anywhere close to those in senior living communities, and for seniors living less independently, it is even worse. You don’t have to be a caregiver to an older loved one to be “looking out” for their well-being. Let me offer you a number of tips for preventing elder abuse as well as intervening when elder abuse is suspected: Prevention:
1. Power of Attorney – have the difficult discussions with your older friend or loved one about selecting someone(s) to be POA for health care and for finance. Sure it’s awkward and personal, but not having protection in place is what causes financial or health crises.
2. Stay Connected – call or email your loved one regularly. And if they have a laptop or access to one, make sure they learn how ZOOM can make a personal contact just a few clicks away.
3. Know their Caregiver – make sure you know your loved one’s caregivers…by name and more. If a caregiver knows that someone is watching, they will be on their best behavior.
There are more steps that can be taken if you are family so that you have help to prevent breeches of security or fraud. Intervention:
1. Neglect – We find that self-neglect actually is far more common than caregiver neglect, so be as informed as you can about your loved one’s food and water intake as well as their medical care and living conditions.
2. Mandatory Reporters – front-line workers like doctors or nurses are mandatory reporters, that is they have to report suspicious behavior or abuse to authorities. Be sure to ask them what they are seeing so that it does get reported.
3. More Connected – I mentioned calls, messages and ZOOM, but there’s more. Inquire about fall detectors or medication reminders if you have reason to believe your loved one may be at risk.
4. Follow-Through – Don’t be satisfied with just paying attention. Make it a point to take any concerns to people in charge. If your loved one is not in a facility, find out who you community ombudsperson is in order to get action. When in doubt, call 911.
5. Take it Higher – If you are unsure who can help locally, there is a federal agency who can help you find help: the Eldercare Locator(800-677-1116), a public service of the U.S. Administration on Aging. There’s also Adult Protective Services.
And it’s better to be wrong in sounding an alarm than in not speaking up when something is really wrong. If you suspect something, say something! 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.
Eating healthy should be a priority no matter what your age or health condition. Of course, during Thanksgiving, we are all tempted to indulge a little more than we would on a normal basis. Imagine if we were to reverse that thinking and made a more conscious effort to eat better during the holidays? If you’re preparing this year’s big feast, think about serving a mix of foods that align with a more healthy diet. For instance, if you’re caring for an elder adult, or an Alzheimer’s patient, you might want to consider a Mediterranean diet.

Studies have shown, as reported by ABC news, that a Mediterranean diet is great for preventing stroke and dementia. In general, the diet has exceptional nutritional value, with benefits that keep the body healthy and improve mental cognition at the same time. The American Academy of Neurology studied brain scans of those who exhibited various degrees of commitment to the Mediterranean diet. Those who stayed with the diet were 36% less likely to have infarcts – strokes in the brain that usually don’t produce any symptoms.

Another study by the American Academy of Neurology shows that the Mediterranean diet can improve the long-term health of Alzheimer’s patients. A focus on high fruit and vegetable consumption as well as low meat consumption seems to create benefits for mental and overall health.

So how do you infuse a bit of Mediterranean in your thanksgiving meal? First, if you’re a caregiver for a loved one, give them a few options and ask them what they prefer. It could be as simple as adding a salad to the meal, or trying a new and healthier way to prepare the stuffing. A quick search online will offer new ideas for side dishes and entrees. You may find that your efforts will encourage healthier eating habits for everyone at the Thanksgiving table, including yourself!

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. Visit our For The Caregiver page for more information and resources.