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

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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Just the Facts – About COVID Today
For a pandemic and quarantine that has lasted about 18 weeks, it is safe to say that most of...
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July 14, 2020
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Negative Thinking Causes What?
What could be worse than a COVID pandemic? How about the uptick in depression and anxiety that mental health...
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July 7, 2020
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Dementia: We’re Not Post-COVID Yet
If you have a family member or loved one with dementia, this pandemic and its restrictions have been exponentially...
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May 26, 2020
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Distance Caregiving Through a Wall
I’ve written numerous times about distance caregiving, and one of the observations I have offered is that distance is...
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May 19, 2020
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In the Caregiver's Words

Recent Client Praise

As November (National Alzheimer’s Awareness month) is winding down and we continue to see efforts to educate people about this disease, it is easy to lose sight of why it is so important to build awareness year round. For some, it may seem like people are generally aware of the damage Alzheimer’s can cause, the fight for a cure, and the advancements for treatment that could be made. However, there are many things people may not know about the disease and assumptions that could be debunked by those who experience Alzheimer’s in their daily lives.
1. Most cases of Alzheimer’s aren’t detected until its late stages – meaning people usually either don’t spot the symptoms or they ignore them to be a sign of old age. In some cases, people feel like Alzheimer’s cannot be treated so they bypass medical assistance all together.
2. There are treatments for Alzheimer’s – in that you can delay its progression significantly. Medical advancements have helped patients live longer when they maintain healthy habits and keep careful track of their condition.
3. Certain practices earlier in life can increase a person’s risk for Alzheimer’s disease, such as not eating right or not getting enough exercise.
4. In some cases, people who have experienced Alzheimer’s – sufferers, their families and friends - are afraid to talk about the disease. Sufferers may feel they might be treated differently.
Of course, there are more reasons to educate people about Alzheimer’s and participate National Alzheimer’s Awareness month. There are also even more reasons to continue after November is over - as often and as much as possible – for families, sufferers, and caregivers.

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.
“We are what we eat” is an old adage that takes on new meaning with some research recently published by a nutritionist at Rush University Medical Center. According to findings reported by Martha Claire Morris, a Ph.D. nutritional epidemiologist at Rush University, a diet high in the right fruits and vegetables among other foods is a significant deterrent to late onset Alzheimer’s Disease. The researchers in Rush’s Memory and Aging Project followed a group of 954 patients whose average age at the study outset was 81 years, tracking their diets and also monitoring their mental abilities for five years. It is important to point out that with this older age group – unlike younger adults - genetic issues play a very small role in developing AD, but the researchers found that diet did. Participants who followed a “brain healthy” diet reduced their risk of developing AD by as much as 35% to 53%. A brain healthy diet includes vegetables, especially green, leafy vegetables like kale and spinach. It also includes beans, nuts, berries and whole grains. The berries that packed the biggest preventative punch were blueberries. Fish and poultry were the primary meats in the diet, and the diet also included olive oil and wine (sorry…only one glass a day). As important as consuming the good foods is avoiding the “bad diet.” On the list of foods to avoid in order to maintain brain health are red meats and fried or fast foods. And if you have a sweet tooth, you may need to retrain it as sweets and pastries are also taboo. Finally, cheese and butter are unhealthy for cognitive health…at least in amounts that exceed about a tablespoon of butter a day. As the researchers reported, it is not a surprise that the “brain healthy” foods are high in vitamin K, but they cannot say it is vitamin K alone or whether something else in combination with this vitamin that helps brain health. They also caution that this is not a predictive study, but given that the results square with other research on “brain healthy” foods their findings suggest that we can use these foods to good benefit. To learn more about the research and how nutrition is part of your brain health, visit the Rush University Medical Center web site (click here). And then head out to the grocer and grab a bunch of kale. 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 was just reminded of a very important aspect of senior residential options that can get overlooked in conversations between caregivers and the elders with whom they discuss their residential options. As a geriatric care manager, I often am asked to facilitate the discussion that a family will have with mom or dad or other loved one as they consider moving out of what can be their lifelong home.

Let’s start with the stuff we always address. Surveys among older adults usually tell us there are three important touchstones for seniors making these decisions:
- Safety – Older adults can become a bit fearful about going out at night or live in fear of break-ins and more. Senior residential options offer a very safe alternative, often with security personnel and gated grounds.
- Helping Hands – Seniors have had a lifetime of cleaning up the house, mowing the lawn, and more. Senior residential communities can give them the independence to do for themselves what they want to do and the freedom from the “heavy lifting.”
- Medical Security – We have all seen the ads for “help, I’ve fallen…” Senior residential communities have behind the scenes staff to respond to emergent needs as well as support independence with help for activities of daily living.
But there is another facet of senior residential living that can be overlooked - a sense of community. I have a client who is now 85 who had tried a senior residential community when she was in her seventies. She and her husband moved back out within a year, because they did not feel “that old.” A few years later, the now-widowed wife moved back in to the same place, because she wanted all those items above. But also because she wanted a sense of community. The residence, it seemed, acted like her more manageable size version of a neighborhood. For her, it was a group of people she could play bridge with in the afternoon after lunch dishes were cleared away in the common dining area. It was a place where just down the hall (what used to be just down the block) were people she could just drop in and visit with when she felt like it. In fact, a lot of her neighbors keep their doors open all day so that people who walk by can feel welcome to do just that.

There are weekly events and daily activities at most senior residential communities ranging from book club meetings to – yes, bingo - and sing-alongs and craft clubs. If you listen to any of these people, they like “being active.” And for them, active is all of the above. They even have gatherings to get really active in yoga or stretching classes adapted to their older bodies and more limited range of motion.

So, if you are a caregiver having a residential discussion with your older family member or friend, listen for the cues. Do they talk about feeling lonely, isolated or just not being close to friends? And if they have been active in clubs and groups, but lately are not as active? This may be where it may be time to talk about a neighborhood where everything is within a short walk.

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.,geriatric care manager Chicago, geriatric care Chicago

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When I get a call about our geriatric care management services, most people are not asking for a geriatric care manager, per se. They are asking a question about something they have noticed or been told about their older parent or loved one. The question most often is about a change in the older parent that sets off the caregiver alarm that something is just not quite right. In this posting I am going to go through some of the questions I hear and then explore some of them in more detail in later blogs. Please also let me know any questions you may have or any telltale signs you may have seen in an older loved one that give you concern.

Change in eating habits: Have you noticed that your loved one's clothes are fitting more loosely, that they miss meals or that they just don't have the appetite they used to? Losing interest in food or eating significantly less are not normal or inevitable parts of aging. But older stomachs do empty more slowly than a younger adult's, and food may be less appealing because the sense of smell and taste are diminished. Yet, the fact remains that malnutrition is a serious health threat to an older adult. “There’s a fair amount of evidence that suggests if you lose appetite as an older person, in the next six months, you’ll have a higher chance of dying.” This is according to Dr. John Morley, professor at the medical school and Director of Geriatrics at Saint Louis University Hospital.

The cause may not be directly tied to food losing its appeal, per se. It may be that your older loved one simply has poor fitting dentures that just take the joy out of eating; it is actually painful. Loss of appetite is also potentially a sign of depression among older adults.

Older adults also have had a lifetime of losses, such as retirement, debilitating chronic disease, death of a close family member or simply not being as socially engaged as they once were. And these losses can become a huge emotional burden that detracts from appetite.

Any of these causes that lead to a diminished appetite can also ultimately lead to malnutrition which is a slippery slope. Malnourishment can lead to a reduced immune system and the ability of the body to resist diseases or other assaults. Small cuts or bruises will be slower to heal or even be more prone to infection in a malnourished older adult. As the malnourished body looks for nutrition it will feed upon itself, particular muscle. Once an older adult's muscle mass is diminished they will, in turn, be more susceptible to falls or even degradation of bone mass and fractures. And it is hard to put the healthy weight back on.

So, when next you visit the older adult in your life or have a meal with them, take note of the food they consume and what gets left on the plate or not served. Also, check their refrigerator if they are living independently. Look for how well-stocked it is, signs of food well beyond expiration dates or spoiling. It is not just about eating a full meal as much as fueling a healthy, older body.
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.
I like Simple. If you do also, then you will like the American Heart Association’s and American Stroke Association’s “Life’s Simple Seven.” In short, what they find is: what works well for cardiovascular health also shows the promise of working really well to stave off dementia caused by strokes, vascular dementia, and even Alzheimer’s disease. If you have an older loved one whom you would like to see have a healthier heart, you will get the added benefit of a healthier brain by encouraging the Simple Seven. And there is a bonus...it also will work for you! The seven steps that have been recommended to improve heath health now also are considered as important to improving your brain’s health. "Life's Simple 7" are considered to help prevent dementia caused by strokes, vascular dementia, and Alzheimer's disease. They have been chosen by AHA and ASA as metrics to help confer brain health. "…the same risk factors that cause atherosclerosis are also major contributors to late-life cognitive impairment and Alzheimer's disease," commented Philip Gorelick, MD, Mercy Health Hauenstein Neurosciences in Grand Rapids, Michigan, chair of the advisory writing group. The seven steps are a combination of individual characteristics and behaviors that help to foster better brain as well as heart health: 1. Don’t smoke 2. Be physically active 3. Maintain or reduce body mass index to less than a 25 on the scale 4. Have a healthy diet – there are guidelines for this 5. With a combination of exercise/reduced weight have a blood pressure of <120/80 mm Hg 6. Without meds (but with diet and exercise), have a total cholesterol <200 mg/dL 7. Maintain an A1C (fasting blood glucose) < 100 mg/dL Before this most recent analysis, researchers tended to look at brain health and heart health as pretty much different conditions caused by different lifestyle or health behaviors. But "over time we have learned that the same risk factors for stroke that are referred to in Life's Simple 7 are also risk factors for Alzheimer's disease and possibly for some of the other neurodegenerative disorders," Dr Gorelick noted. All of this is a step toward better brain health while at the same time promoting better heart health. This is one of those fortunate opportunities where a person can get two for the price of one. Take better care of your heart and you get better brain health as a bonus. Take better care of your brain, and your heart also gets a benefit. Not a bad bargain for anyone who is a bargain shopper…no coupons required. Be healthy. 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.
Acetaminophen (Tylenol) is everywhere within mainstream medicine these days. It is used by itself for fever or pain as well as in combination with other medicines for flu, moderate to severe pain, cold symptoms or insomnia.

But acetaminophen and a lot of other medications don’t simply go from the mouth to where they are needed in the body; they must be absorbed through the digestive tract and into the blood stream. Acetaminophen along with many other meds are then metabolized through the liver. If too many medications are being processed through the same site in the liver, liver function can be compromised. It does not have to be multiple agents that create this liver logjam; it may simply be the amount of a single agent like acetaminophen that can cause problems. Older patients will be able to process even less through their “slower livers.”

Historically, patients have been cautioned not to exceed 4,000 mg of acetaminophen a day as the potential for liver failure can follow from that daily dosage even in otherwise reasonably healthy individuals. I hear from some doctors that the number should be closer to 3,000 mgs, especially for older patients.

Pain killers start with as much as 500mg or more per dose taken every six to eight hours. And then there is Tylenol “extra strength” which can bump an individual dose even higher. Some individuals may be tempted by the “if one is great, then more is better” syndrome. And then a person may take an OTC sleep aid that also contains acetaminophen or use a cold formula containing acetaminophen.

Remember also that older patients can become confused, because they have multiple pills to track. They can accidentally take another dose beyond what their regimen would dictate. As a geriatric care manager, I have a client whom I tell to set her acetaminophen tablets out in a medication tray like her other meds so that she knows how much is left of the total amount she can safely take each day.

The FDA has recently convened to determine just how much acetaminophen should be allowed as a daily limit to avoid problems of liver toxicity, but the jury is still out. So, if you are watching your older parents’ meds, don’t focus just on their prescriptions (which can contain acetaminophen); look in their medicine chest for the rest of the drugs they buy at the store without a prescription. Then do the math.

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.