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

What You Can and Cannot Change About Dementia
Let me start with the short answer to a question we raised in the email announcement of today’s post. ...
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June 21, 2022
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Age and “Long Covid”
There seems to be a cliché for everything, so we’ll start with this go-to for COVID: “We’re not out...
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June 7, 2022
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A Good Habit Missing for Most Older Adults
Even among those older adults who dodged COVID, “gymnesia” may be a lingering effect. Please let me explain… What...
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May 24, 2022
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When Being in Demand Isn’t Healthy
If you’re a musician, you want to be busy, because gigs represent a better living. If you’re an actor...
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May 17, 2022
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HDL Graduates from “Good” to Better
You may have had the conversation with your physician about your cholesterol levels during your annual physical; there are...
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April 26, 2022
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When That Doesn’t Stink…
There are a lot of tests and exams we all know that are important to catching a condition early...
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April 12, 2022
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Respect and Inclusion
I was very pleased this past weekend that my son and his wife invited my husband and me along...
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April 5, 2022
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Consult Your Lifestyle Physician
You, or your older loved one, have a consistent pain in your hip, and you finally get a referral...
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March 29, 2022
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When the IRS Calls…
How about a show of hands regarding the Internal Revue Service (IRS)… Have you ever filed a tax return...
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March 8, 2022
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Dementia from a Pet’s Point of View
Fetch! Come! Sit! Stay! Remember! So, I’ve given away that I’m a dog owner rather than a cat or...
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March 1, 2022
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In the Caregiver's Words

Recent Client Praise

With over 300 clinical trials on vaccines for COVID19, it perhaps is not a surprise that at least two are very close to emergency authorization by the Food and Drug Administration this month. Where are you in the line to get a vaccination? Well, if you have a loved one over age 65 still living independently, the answer is behind front line health care workers, other essential services workers, individuals with preexisting conditions that place them at particular risk. Yes, it will be a bit of a wait. Government agencies are coordinating the access to a COVID vaccine, and they are also watching out for scams. Do not fall prey to that call or email that promises you easy or early access to a vaccine. So, how do you tell the good guys from the bad guys? Homeland Security and FDA have some suggestions:
- Vaccines will not be available on the internet…and that goes for any alleged treatments for COVID as well;
- Only sign-up for a vaccine through a licensed medical provider…and even then, be sure that they have been certified to provide a vaccine;
- COVID vaccines may at some point be available through your CVS or Walgreen’s pharmacy, but do not trust online pharmacies, especially those whose names are not familiar to you;
- Avoid any texts, emails or calls about a vaccine you can purchase…there will be no Cyber Monday or offshore providers for vaccine distribution;
- And COVID19 vaccines will not be available through Facebook, Twitter, Instagram or other online feeds.
And be aware that the global rollout of a COVID19 vaccine will not be like in the movies where a convoy of camouflage vehicles arrives in town with uniformed soldiers spilling out to set up tents for administering a vaccine. Hollywood does not get to set the stage here. There may be lines of people – socially distanced – waiting at a pharmacy or clinic for their injections, and get this, there may be no charge. All the details are not available just yet, but appreciate that the federal government already has forked over billions of dollars to a host of pharmaceutical giants to develop vaccines. So, your tax dollars have covered this already. If you receive a vaccine offer that is too good to be true, it likely is too good to be true. If you see (or hear) something, say something. Homeland Security wants to hear from you, and you can go online to report any kind of suspicious activity. Go to: COVID 19 investigations. But please refrain from “dancing in the streets” until at least 70% of the population has been vaccinated. Yes, that would be “herd immunity,” just not the kind that comes from so many people being sickened in order for it to happen. In the meantime, call or ZOOM a friend or family member. We all need some continued support to make it to the goal. 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.
According to the Centers for Disease Control (CDC) adverse drug reactions or overmedication result in more than 700,000 hospitalizations a year. And many of these could be avoided by following advice offered by the American Geriatrics Society. The AGS’s Foundation for Health in Aging offers advice for all of us who care for older parents or adults in our orbits. Here is a summary of the six major recommendations.
1. Ask before taking OTC drugs: Never assume that just because you can buy a medication in a drug store without a prescription that it will be harmless. Most of these drugs started out as prescription meds. Ask the doctor or pharmacist if an OTC drug is a risk by itself or in combination with a prescription your elder may already be taking.
2. Make/update your List: A lot of medical offices are very good about asking patients on every visit what medications they are taking and keeping it in their records. With every visit the provider needs to add new medications so that everyone is aware of what your elder is taking.
3. Question your provider: When you or your elder receive a new prescription ask questions about when to take the drug, with or without food, what to do if a dose is missed, is it available in generic form and what are the common side effects?
4. Read the labels and follow them: There is a fine print insert of patient instructions that comes with every prescription. Don’t be intimidated by the scientific jargon; look for the indications and usage section as well as the adverse events sections. And then take them as directed – don’t add a dose for better effect or stop just because you feel better.
5. Report any ill effects: There is a saying in geriatric circles that every symptom in an older adult should be considered a side effect of a drug until proven otherwise. Especially if there is sudden difficulty breathing or swallowing, light-headedness or irregular heart beat. If you cannot reach your loved one’s provider call 911.
6. Review your medications with your provider: At least once a year you should talk with your elder’s provider about the medications, the doses and any changes you may have noticed. And do not leave out vitamins, supplements or herbals.
For more information go to the American Geriatrics Society web site as well as refer to a list of drugs that have known side effects or other issues. This is called the Beers List .

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 Charlotte Bishop
I have written a lot about dementia over the years as well as other issues that can mimic the losses in cognition that are the hallmarks of dementia. One potential cause of poor recall and attention that does not get a lot of attention is a vitamin deficiency. The vitamin in question is vitamin B12, and the deficiency can occur even among older adults who take multi-vitamin supplements. In fact, it is a common vitamin deficiency in older adults, and it is very common in vegetarians as much of dietary vitamin B12 comes from meat products. Vitamin B12 is important to the body’s function, because it has a hand in creating red blood cells, maintaining healthy nerves and generally regulating the body’s overall metabolism. B12 deficiency can happen to anyone, but older adults are even more at risk for pernicious anemia in general. Their digestive systems become less efficient with age, so even increased consumption of the vitamin will not always result in a proportional increase in effective absorption. Catching B12 deficiency early is important, because some of the effects cannot be reversed if they are allowed to progress too far. The early warning signs of vitamin B12 deficiency beyond include:
- Gradual onset of muscle weakness in the limbs
- Cold or lack of sensation in tips of toes or fingers
- Awkward gait or even stumbling
- Sore tongue or impaired taste and sense of smell
- Low grade fever
- Stomach or intestinal digestive difficulties
- General anemia as diagnosed by a provider.
If you see evidence of any of these issues with an older loved one, it will be important to speak with their provider who can issue orders for a blood test. If caught early enough, normal function can be returned. A question you may be asking is if taking extra vitamin B12 can improve normal memory, and the answer is no. Normal is, well, normal, and vitamin supplements can only move us back to where we have been. So, if you’re asking if this all means that being alert to vitamin B12 deficiency is important for our older loved ones, the answer is a definite “yes.” If you’re asking if it is important for us all to monitor our B12 levels, that’s a “yes” as well. 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.
It has been over a year since my first posting when I started this blog by talking about why a person should call a Geriatric Care Manager (GCM). Since I have answered this question with almost everyone of the calls I get from people looking for our help, it seemed like a good idea to revisit our “job description.” GCMs are:
1. Local professionals who know what resources are appropriate for your older loved one and which are most appropriate. What I often tell people is that we are “option-makers” for the decision-maker.”
2. Eyes and ears that can help long distance caregivers be aware of any changes that may affect an older parent’s independence or well-being. The long distance family caregiver may have bought mom the walker, but the local GCM can be there to see whether mom is using it.
3. Bridges to help an older family member make life transitions from fully independent living through home assistance and ultimately to assisted living at the appropriate times. Earlier involvement with a geriatric care manager also can help your elder family member develop a rapport with a professional who can facilitate the bigger changes later because they have been there earlier for the smaller changes.
4. Peace of mind by being the professional buffer to a long distance caregiver for some of the minor or major crises that may otherwise be very stressful for the entire family.
Finding a GCM is easy. The national association that certifies GCMs, the NAPGCM, has a comprehensive, searchable list of all the professionals in good standing. You can search geographically by simply entering a zip code or you can search by name. The search tool also asks you to check what kind of GCM you are seeking; check the “Certified GCM” box to see a complete list of professionals in good standing. Here is a link to another site that offers a range of resources, including care managers, Aging Care. Finally, Caring.com offers a listing of GCMs specifically in the state of Illinois.

As you make contact with a potential GCM for your elder, I encourage you to look for a good communicator, because this professional is going to be your loved one’s advocate. You also want to ask about their experience, and check professional references who can speak on their behalf. Finally, it is important to ask about fees since insurance does not cover a GCM. A recent article in Reuters suggested that fees nationally range from $60 to $300 an hour.

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 throughout metropolitan Chicago. Please email your questions to Charlotte Bishop.
You’re seated with your frail mother in a jet at about 28,000 feet, row 15. You had volunteered to fly out to meet her and fly her back to your home, and you just took off moments ago. Mom had been unable to use her right side to any good effect for some time, and you are bringing her to your home so you can better care for her. You haven’t made specific plans yet, but you’re certain it will be a good move for her and for your family at home. The plane suddenly lurches downward. The air masks drop from the ceiling. What do you do? If you had paid attention to the in-flight talk as you got settled before taking off you would know that you are to secure your own face mask first, and then help someone with you if they require any assistance. Anyone who has traveled with any regularity has probably heard this so many times that they could probably recite the pitch themselves. But who thinks to apply the same lesson to the rest of their lives? The New York Times carried an opinion piece this past weekend by an author named Lorene Cary. Her book has a title that pretty much tells it all: “Ladysitting: My Year with Nana at the End of Her Century.” She digs deep into the unsavory aspects of caregiving in the 21^st century. It’s often not just transporting a loved one to the doctor or picking up groceries and doing a load of laundry. Caregiving usually starts with no training and then quickly moves into bathing the family member, learning the nuances of adult diapers and all of the other assorted “Activities of Daily Living.” It’s hard, unpleasant and seemingly relentless. One person who came up to me after I had spoken to a gathering some time ago introduced himself as having “recently graduated from four hours of uninterrupted sleep to four hours of interrupted sleep a night caring for his mother.” And did I mention that most caregivers to family members do all of this without pay? Ms. Cary cites a figure that I still find staggering. According to AARP’s Public Policy Institute this cottage industry we call caregiving would total nearly half a trillion dollars in revenue if all the voluntary caregivers were paid just minimum wage. Ms. Cary also raises a point that can easily get missed if we just translate this “caregiver crisis” as some call it into dollars and cents and hours spent. She says, “Too many people have to reconfigure their lives around a loved one’s disability.” She goes on to talk about a different kind of national debt based on what she labels our “Gross National Happiness Index.” If you are a caregiver, try a little exercise. First, in one column list all the activities you have directed to your care receiver this past week….the trips to the store, the in home tasks…everything. Next, make a list of all the activities in which you have participated just for yourself? If that second column looks a bit wane, start today to rebalance your books and begin by caring for the caregiver. It will actually make you a better caregiver as it also makes you a healthier and happier person! 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.
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.