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

Listen to an Astronaut about COVID-19
A small percentage of us may be coping with symptoms of COVID-19 or we know someone who is, but...
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March 24, 2020
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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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One is Number One Threat to Seniors
We’ve all had times when we desperately need our own space…time to ourselves, just ourselves. And it’s good to...
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March 10, 2020
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Helping Your Older Loved One – AND You – Avoid COVID19
All of us here know how to prepare for a blizzard, people in the South know how to prepare...
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March 3, 2020
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Part 2: Five Important Tips for Caregiving and Self-Care
In my last post, I gave you some tips on distance caregiving that arguably could be called the 30,000...
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February 18, 2020
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Tips for Distance Caregiving: Up Close and Personal at a Distance
If you think being a caregiver to an older loved one is hard–with all the trips to help them...
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February 4, 2020
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Five Things You Need to Know about Coronavirus
Okay, there may be more than five things you want to know about the coronavirus, but these five basics...
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January 28, 2020
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Alzheimer’s: A Cure at Hand?
I have posted before that the currently approved therapies for treating patients with Alzheimer’s disease are not really very...
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January 21, 2020
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GOOD NEWS FOR CHRONIC CARE
Associate Care Manager Gregory is a Certified Senior Advisor (CSA), Certified Dementia Practitioner (CDP), and Medicare Counselor, whose work...
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August 6, 2018
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Long-Term Doesn’t Mean Put It Off Until Later
Gregory Peebles is a Certified Senior Advisor (CSA), Certified Dementia Practitioner (CDP), and trained Medicare Counselor, whose work focuses...
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June 24, 2018
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In the Caregiver's Words

Recent Client Praise

As many as seven million Americans, in fact, probably had a pretty “blue” Christmas this past season according to estimates from the Centers from Disease Control and Prevention. I have written before about how many chronic conditions disproportionately affect the over 65 crowd, and depression is high on the list. In fact, 65+ year olds comprise about 16% of all suicides in America, so to label their Christmas blue is a bit of an understatement. Depression, often associated with loss, finds older adults to be something of a perfect storm as an age segment. As one ages, there are the inevitable losses in terms of just not being able to do what one used to do easily. And the job that used to define a person’s success and image is now history. And any number of physical illnesses can rob a person of their vitality. Cognitive decline also warps the lens through which older adults may view the world around them …a far cry from the proverbial “rose-colored lenses” of an optimist. Older adults are more likely to have suffered the loss of a loved one such as a spouse, friend or even son or daughter. That, combined with the other physical losses both shrink their social circles and reduce their desire to even get out of their homes. They become isolated which only reinforces any depression they may already have from their losses. And the losses accumulate. But it is crucial to remember that depression is not just an inevitable part of growing older. It is not a “normal” part of the aging process. When you gathered with your older loved ones over the holidays or spoke or Skyped with them did you notice any signs of:
- Crankiness or nervousness
- Fatigue
- Lack of focus or concentration
- Too much or too little sleep time
- Too much or too little appetite
- Vague digestive issues or pains
- Suicidal thoughts or comments?
Act now on any of these signs and symptoms of depression. Most depressed people don’t speak up…they simply accept the way they are feeling and slip another notch into their malaise. There is, in fact, a stigma that many associate with “mental illness” of any sort that may fuel their resistance to help. Insist that they see a professional, perhaps their clergy if not a professional trained in mental illness. Giving them a happier new year would be a wonderful belated gift for the holiday just past. And since this is the 21^st century, there is a text hotline. Just text 741741 for help. 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.
Let me first say that Medicare is absolutely a boon to older adults who will face many medical issues associated with aging at the same time they also are on more modest fixed incomes than they had enjoyed in their earlier years. Now, shift gears from Medicare to Medicare Advantage, or Medigap as it is often called. These are also called Part C plans, and they can pick up what otherwise would be out of pocket costs like copays or deductibles not covered by Medicare. Medicare Advantage plans have more than 22 million enrollees, and no one would term these supplemental plans (whose open enrollment just closed) a scam. But there are some not so obvious costs embedded within many Medicare Advantage plans that everyone should know. You don’t always hear about what happens if you switch carriers for Part C. Especially if you have had a medical event like a surgery or diagnosis or accident that may lead to ongoing issues…or not…issues such as if you’ve had a medical event…which will then become a “pre-existing condition. Try to change plans and suddenly some care coverage will be denied or some of your specialists are not “in network” or coverage may even be denied. All of this is not something that we can fully address in a single blog post, but every 65+ year old deserves an advocate who can help sort through a very complex minefield of coverages. So, if you are a caregiver to an older loved one, you have almost a year to do some research in anticipation of the next enrollment period, and here are some resources to help. Specifically, check out this: Medicare.gov Medicare also has a resource titled: "When can I buy Medigap?" And there is another Medicare publication that explains the rules for getting in or out of a Medigap plan. As I have said, you have nearly a year before the next open enrollment period. Please do your homework…and maybe even consider it advance planning for your own future. I had used the plural –scams. Continue to help protect your older loved one from:
- Winning a Sweepstakes – if they get the call that they have “won,” and all they have to do is give some personal information or pay a “fee for the transfer,” hang up!
- Tech Support – may call to help your loved one defend themselves against a “virus” or “malware,” don’t let them go to a site, log on to anything…just hang up!
- Old Crushes – may reach out with a text or email harkening back to a school crush from back in high school – log off or hang up!
- Social Security – if someone calls about benefits or technical issues, don’t give them any information – first hang up and then call the Social Security Administration directly – 800.722.1213.
Now, you will have made someone’s world safer. Please enjoy the run-up to your holidays, and embrace your families. 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 have had the good fortune to connect with Julian Hills, a content writer and blogger for a great website and resource, Drugwatch.com. When I asked about the latest on diabetes and treatment, she offered these things to consider when it comes to elder care at home.

Diabetes is the seventh leading cause of death in the United States. Controlling the disease can save lives, but it’s also important for caregivers to know that controlling it can also come with its own set of consequences. Diabetes occurs in people who have high blood sugar because their body cannot move sugar into fat, liver and muscle to be stored for energy. The pancreas either does not make enough insulin or cells do not respond to insulin.

There are two common forms of the disease. The first, called type 1 diabetes, can be diagnosed in people of any age. The cause is unknown. These people need daily injections of insulin. The second, type 2 diabetes, is becoming more prevalent in the United States due to high obesity rates. Teens and young adults are now among many of the people developing type 2 diabetes. The Centers for Disease Control estimates that more than 8 percent of Americans have diabetes. Controlling diabetes is important because if untreated the disease can cause heart disease, stroke, hypertension, blindness and kidney disease. With nearly 26 million estimated cases in this country alone, an entire drug industry has blossomed, and caregivers need to be aware of the complications that have arisen from this group of drugs. While many of the medications on the market have helped patients control their condition, there are also a number of complications being reported.

As more and more people depend on these drugs, more and more lawsuits associated with their usage are arising. Here are some examples of conditions associated with these drugs:
- • Actos helps patients with type 2 diabetes by making their cells more sensitive to Insulin. But studies show extended use of the drug has been linked to an increased risk of bladder cancer. Patients taking Actos need to watch for painful or bloody urination, and unusually severe back pain.
- • Byetta is an injectable drug for type 2 patients. The drug controls blood sugar, but has been linked to damage of the pancreas, kidneys and thyroid. These complications can be fatal.
- • Januvia works in tandem with other type 2 diabetes medications to increase their effectiveness. It’s not for type 1 patients. Pancreatic cancer and pancreatitis are closely associated with the drug. In 2011, the Food and Drug Administration received nearly 200 reports of acute and chronic pancreatitis linked to the drug.
- • Victoza is another drug aimed at fighting type 2 diabetes. It has been linked to thyroid tumors, as well as pancreatitis and kidney failure.
Not all patients will suffer from these complications, but drugs may not be the only option. Adopting a healthier lifestyle may help people depend less on medication and avoid the potentially dangerous effects of these medications. Caregivers need to remember that helping people with the condition develop better diet and exercise habits is a great way to control the effects of type 2 diabetes.

SOURCES: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002194/
http://www.cdc.gov/diabetes/pubs/factsheet11.htm
http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf

Julian Hills is a content writer and blogger for Drugwatch. His journalism career has taken him from newspapers to local television news stations and even a 24-hour cable network in the Southeast. Julian is a graduate of Florida State University.

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 who need help with elder care at home in metropolitan Chicago. Please email your questions to info@creativecaremanagement.com.
We have heard forever that carbohydrates are a major source of added (and unwanted) body fat, but dementia? So, when I came across this research, I thought to myself that well, there always is a New Year's resolution about dropping weight by decreasing sweets and grains, but if a person also can reduce the long term risk of dementia, why not get on board? Well, it turns out that a doctor named Perlmutter has been documenting a wide range of medical literature that shows a link between blood glucose levels and risk for dementia. It seems that as early as 2005, researchers were finding a link between blood glucose levels and brain atrophy and cognitive decline. I won't get into all the technicalities, but it seems to follow a path back to increased body inflammation and free radicals and "oxidative stress." Okay, I said I would not get into technicalities. But you see a lot of the familiar language on real problems on the loose in one's bloodstream. And this is not in the radical fringe of medical journals. As recently as last summer, researchers reporting in the New England Journal of Medicine showed that continuous elevated blood sugar levels as measured by HbA1C were associated with higher risks for dementia. Reading between the lines, diabetics whose long term sugar levels are not in good control are not just at risk for diabetic retinopathy and other vascular compromise, but their brain function also may suffer. All of that said, researchers do not show a direct causal relationship between elevated blood sugar levels and dementia. So, let's retrace some of the steps. Increased carb consumption does lead to elevated blood glucose levels. People with elevated blood sugar levels also have been shown to have elevated heart event risk as well as immune issues. And we encourage people to lower their carb intake to improve heart health and immune system health. The author of the most recent research also points out that there are no experimental trials that show using seat belts reduces casualties, yet we accept that we ought to buckle up. So, at the end of the day, you need to draw your own conclusions. And maybe unlike the seat belt analogy, we can say that we all should practice moderation in our carbohydrate consumption. And that is not something you would see driving safety advocates offering. "Use seat belts in moderation?" So here are some medical citations for those who want to see the research. For your brain's sake, read what you will and draw your own conclusions:
1. Enzinger C, Fazekas F, Matthews PM, et al. Risk factors for progression of brain atrophy in aging. Neurology. 2005;64:1704-1711.
2. Crane PK, Walker R, Hubbard RA, et al. Glucose levels and risk of dementia. N Engl J Med. 2013;369:540-548.
3. Erickson KI, Voss MW, Prakash RS, et al. Exercise training increases size of hippocampus and improves memory. Proc Natl Acad Sci U S A. 2011;108:3017-3022.
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.
Although Alzheimer’s disease is the most common type of dementia, there are over 100 different causes of reduced brain function and cognition…dementia. Although we are all hopeful for a cure...or should I say cures. So, it is huge when we begin to learn what factors predispose someone to reduced cognition and how we can modify behavior or the environment to reduce the risk and that cognitive outcome. Let’s take them one at a time:
1.Dementia has been statistically tied to high mid-life blood pressure
Longitudinal research recently reported in the British journal Lancet Neurology statistically linked higher and rising blood pressure in early to middle age with a higher incidence of dementia in later life. In this research “middle age” was defined as 36 to 53 years of age, and “later life” was defined as 69 and older.1.Dementia is linked to decreased brain size This is where it is all linked. The higher blood pressure or rising blood pressure in early life is also linked to a smaller brain volume. In the British study they followed people from birth to older age with 20 measurement points along the way. The link between brain size adjusted for early life cognition is not necessarily a direct one. We talk about “adjusted for early life cognition,” because people who have cognitive issues early in life tend to have more as they get older. But those with smaller cranial size have an even great incidence of cognitive impairment. The researchers speculate that it is the clear link between reduced brain mass and the development of white matter brain lesions that gives rise to the dementia, not just a matter of brain size.
2.White matter brain lesions are linked to the later onset of dementia
Here is where the link becomes really concrete. The researchers showed that a given increase in blood pressure yielded quantifiably more white matter lesions. Back to brain size, the same sort of trade off was demonstrated with brain size…more pressure yields smaller brain mass. The bigger the increases in blood pressure the greater the incidence of white matter and the smaller the brains.
3. 30% of dementia cases are modifiable
Yet, blood pressure alone was not directly associated with cognitive function at any given point in time. It was the early rise and sustained high blood pressure that created the brain size and white matter problems later. These were tied to diminished cognitive abilities. And this now gets back to modifying risk factors for dementia, and it is pretty clear. Everyone gets their blood pressure check early and regularly…and gets it under control if it is elevated!
4. All of the above
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 was at an event this past week and had a conversation with an attendee about her parent and driving, but it was more than just aging and driving. It was about her parent and their cognitive decline and the ability to competently get behind the wheel. It’s complicated. I have talked before about the different types of dementia and how they all have an effect on an individual’s ability to cognitively process what they experience into memories and even react to situations in real time. Each of the major types of dementia – Alzheimer’s, vascular, frontotemporal, Lewy body and Parkinsonian – also has a different kind of impact on one’s ability to drive. But it also has to do with the degree to which a dementia has progressed. As soon as the doctors use words like “moderate” or “severe” the ability to drive safely is pretty much out of the question no matter what kind of dementia it is that affects your loved one. One of the more telling statistics on the effect of dementia on driving capabilities is that accidents are almost twice as likely in dementia patients versus healthy individuals in the three years prior to diagnosis. Starting with the most hazardous diagnosis, it gets a bit more complicated with Parkinsonian patients with dementia because the motor as well as cognitive functions of these patients are affected. While the data are relatively sparse, it appears that more than 80% of these very mild to mild dementia patients cannot pass a driving test. In vascular dementia (owing to strokes) 70% patients with very mild to mild diagnoses fail a driving competency test compared with 11% of same age, but healthy adults. The risk increases with more strokes even moving from just the first stroke to a second event. Even “mini-strokes”, often referred to as transient ischemic attacks (TIAs) can cause this driving impairment. Frontotemporal dementia patients are only slightly less driving-impaired than vascular patient. About 50 – 60% of these patients who are categorized as very mild to mild will fail an on-road test. Alzheimer’s disease drivers particularly have difficulty remembering directions, routes or landmarks, but they also misjudge distances and are slower to react to conditions. It’s about their inability to orient themselves in real time that makes them a risk to themselves and to other drivers. About 55% do not pass a driving test. Dementia with Lewy bodies shows a typical fail rate among very mild to mild patients of 35 – 40%. In simulator tests, however, Lewy body patients show a higher rate of collisions in testing. So, you can see that it is a matter of degree when it comes to driving, and when an older loved one progresses to moderate or severe dementia, no one should drive. The real takeaway here is that if you have an older loved one with even early stage dementia of any sort, they should be tested for their ability to drive…or maybe just for whatever constraints should be in place to assure a safe driving experience. And as a loved one sees these limitations on “their freedom,” be sensitive to all the other limitations they may be facing in their day to day lives. With the potential for depression looming always, be sensitive to how you communicate and do all that you can to support their sense of self-worth and independence. To get ahead of the curve with your loved one, AARP offers driver safety course at locations throughout the region; please check it out. 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.