Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • care managerChicago's Geriatric Care Manager Center of Excellence - Since 1991 | Page 8

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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Caregiving During COVID: Four Tips for Reengagement
You may recall that I have recommended limiting your news consumption, because it really does add to our stressed...
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May 12, 2020
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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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In the Caregiver's Words

Recent Client Praise

April showers are supposed to bring May flowers, but what does May bring? It brings Mental Health Awareness Month…among other things. If you are a caregiver to an older loved one, this is particularly important. Mental illness – particularly depression – is a high risk for individuals as they age. One out of every four older adults has some form of diagnosable mental illness in any given year. About six percent of older adults manifest some form of clinical depression, but older adults can also respond to talk therapy and medication for their mental health issues at rates comparable to younger adults. Yet, older adults more often go undiagnosed and therefore untreated. Some people have a lifelong battle with a mental illness like depression, but for many more it may be precipitated by a condition like stroke, Parkinson’s disease, diabetes, cancer or arthritis. But older adults also have a life that has accumulated losses, most specifically they have lost friends, family, loved ones. We all probably know that the average life expectancy in the U.S. is just under 79 years…that means that the typical 79 year old has lost half of their friends and family by that time. The rate of suicide for 75+ year olds in the U.S. also is higher than any other younger cohort, in part because those over 65 have a “success rate” in their suicide attempts that is five times more lethal than those who are younger. This is not to depress you; it is a wake-up call. It will be up to those of you who are caregivers to older loved ones to look for the signs, because only half of depressed patients are diagnosed by their primary care physicians and only half of patients who discuss any depressive symptoms with their physicians will get any treatment. So, what should you look for?
- Any signs of a sad or “blue” phase that lasts more than a couple weeks
- Difficulty remembering things or confusion in even familiar settings
- Self-medicating with pain medications or alcohol
- Perpetual worries around money or health or loved ones
- Sustained challenges sleeping or concentrating
- Intense caregiving for a loved one that is not allowing them to “get a break”
If you see any of these signs, bring them to your loved one’s physician’s attention…and be persistent if the signs and symptoms persist. Sadness or depression are not “just part of getting older.” Eighty percent of older adults who are diagnosed and get treatment recover from their depression. Your “mental health awareness” can be their mental health cure! 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.
Dementia is one of the topics to which those of us who are geriatric care managers (GCMs) devote a fair bit of attention. In our day to day work and in my blog I have often talked about how caregivers can best communicate with, and care for, older loved ones who may be experiencing the cognitive deficits of Alzheimer's Disease or other forms of dementia. In this posting, however, I am going to share with you a bit of good news for caregivers and other individuals in their middle years who wish to take positive action to avoid dementia themselves. Yes, there are steps that a middle aged individual can take that will quantifiably reduce their risks of dementia, at least according to long term research recently released from the University of Eastern Finland. Very simply, what the Finnish researchers set out to do was study what kind of influence healthy diet could have among individuals from midlife as they aged. The researchers developed an index which helped them to quantify what constituted a "healthy diet" versus what they considered to be an "unhealthy diet." Healthy foods included unsaturated fats from milk products as well as fish, fruits, berries and vegetables. Unhealthy foods, on the other hand, included saturated fats, salty fish, sweetened drinks, other sweets, eggs and sausages. At the end of fourteen years, those who had eaten the healthiest foods had a 90% lower risk of developing dementia than those whose diets were the least healthy. These individuals started the program at about fifty years of age and the final assessment was in their mid-sixties. Those participants who had the highest consumption of saturated fats at the outset of the study were at higher risk of being diagnosed with "mild cognitive impairment" at the 21 year point in the study as well. This link between saturated fat consumption and incidence of cognitive impairment was consistent among the panel of participants. But there was another finding about coffee that may come as something of a surprise. They found that the "sweet spot" was three to five cups of coffee a day. That is to say the researchers found that those who consumed fewer than three as well as those who consumed more than five cups of coffee a day had higher risks for developing dementia over the courses of their lives. Something of a "happy medium." What should people in their middle years make of this study? The researchers had used this measure of a healthy diet based on the sum total of what a person consumes because they argued that there are a lot of interactions across foods and nutrients. That said, it also makes it difficult to point to a single food that is the miracle "dementia stopper." In reality, maybe it is just that...that there is no one food that is going to make us healthier or one that will make us inherently less healthy. If you want to make it to your later years without as great a fear of cognitive decline, should you eat less saturated fats and consumer more fruits, berries and vegetables along with an average dose of coffee. These researchers would probably say that it couldn't hurt. 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@cr eativecaremanagement.com.
If you are a caregiver to an older loved one, I'll bet that one thing you probably watch closely is their behavior or demeanor. Do they remember important facts from yesterday or are they tracking what is said in a conversation? In an age when most people worry about dementia more than mortality itself, everyone is rightfully vigilant for signs of an slip in cognitive function. But what about when the caregiver cannot be there to watch? Our caregiver clients often refer to our geriatric care managers as their eyes and ears. Let me share with you two real life examples of memory issues, but when things were really not what they may have appeared to be after all. And a geriatric care manager's eyes and ears could make the difference.
1. The Dementia that was an Infection. It started like this. The distance caregiver gets the phone call that the mother was found on the floor of her apartment in an independent living facility. She seems confused and has difficulty with word formation, all signs of classic post-stroke confusion or even dementia. The patient is rushed to the nearest hospital and initial tests rule out stroke. So, perhaps it is dementia? What would you do? A care manager on the scene likely would start with dementia as a consideration, but dementia typically is not a sudden onset predicament. It progresses over time...often a long time. A care manager would ask the medical providers if they have run blood and urine tests? Have the providers done a full body check. Why? to rule out any toxic exposure or an elevated white cell count. In this case, the tests found the woman had an infection that went systemic and dramatically and quickly affected the woman' mental abilities. So, this turns out to be delirium. The principal difference between dementia and delirium is that the latter is more sudden and often transient. Antibiotics within a matter of days brought her back to normal..
2. The Renal Failure that Wasn't. This one starts with the caregivers in an independent living center noticing that the man seems very tired and does not track what is going on very well. Delirium? A care manager suggests a trip to the physician's office for a blood test. The test shows renal function that is at virtually zero. No urine is being produced. None. The physician pronounces renal failure and ships the gentleman to the hospital for dialysis, but what does the nephrologist do? The patient is put on an IV drip and quickly given a large quantity of normal saline solution, and kidney function begins to return. Within three days of the start of this rehydration kidney function is returned to near normal. In this case, the patient was a sparse water drinker, and when the condition worsened, the body's response was to turn off the thirst sensation resulting in real dehydration and renal failure. With the renal issue resolved, the care manager enlists a caregiver who will help the gentleman keep to his medication schedule AND drink four cups of water in the presence of the caregiver each day. Both of these examples came from distance caregivers, siblings whose older parent lived in another state. Both of these cases also represent one reason that a care manager can be engaged before a crisis. In both cases, had there been a trained professional routinely just "dropping by" to be the eyes and ears for the adult children of the older parent, the infection might have been caught earlier and the renal issues may have been avoided. Geriatric care managers often get the call in an emergency, and they can make a difference in how well the older adult recovers from the emergency. But if you are a distance caregiver to an older adult, you should also consider having a GCM be the eyes and ears present when you cannot be. You might just find that having a sister in Chicago is a great addition to the family. 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@cr eativecaremanagement.com.
Once in a while “yesterday’s news” is also tomorrow’s news. Earlier this year you probably heard or read that Medicare is now authorized to negotiate prices directly with drug manufacturers. It’s not a blanket permission to negotiate; it’s focused on single source, patented drugs that may be prescribed for older adults. When drugs go generic, there is competition which generally brings prices down for the consumer, but “single source” is simply code for the company that won the race to be patented gets to pretty much set the price of the “new” drug. I put the “new” in quotes, because it’s not always a truly novel medicine; it may be a combination of two or more existing drugs that can work well together to manage a medical condition like hypertension or HIV or others. This is a welcome relief to older Americans, many of whom are on fixed incomes. A study released just this past week by AARP looked at the top brand name 25 medicines with the highest spending among Part D drugs. They’ve more than tripled since their entries into the market, and they did not start out cheap. We all hear monthly reports on the consumer price index (CPI) and howl a bit when gasoline goes up 32 cents (8 percent) a gallon. Many of these new drugs didn’t start at four dollars per unit as gas may have. Their market entry price has often been in the hundreds of thousands of dollars a year. But all of this restraint by way of CMS’s negotiations will be resulting in howls of “unfair” from drug manufacturers, some calling this move “extortion” to their industry. And we’ll probably be hearing the howls for a while as the negotiations are slated to occur this year into 2024. The negotiated prices will not take effect until 2026, but we are off to the races. If you have an older adult in your family or you, yourself, qualify for Medicare, you have a home work assignment. Look to your loved one’s or your own medication list to see what the list price is for any of your branded meds. Be prepared to perhaps even drop a letter or a call to your federal representative to see where they stand on the new authorization. If they backed it when it moved through congress to become law, thank them. If they hedge on the issue or just admit they did not support the bill, ask them why. Being an active citizen just might turn out to be really good for your health! Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of, 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’s been a year and a half since the COVID19 vaccines came on line to address the pandemic when it first swept across the globe, and COVID’s been changing ever since. It’s what viruses do. My oldest son has tested positive for COVID three times since the outset of this 21^st century plague, and he has been fully vaccinated and boosted. The last two instances didn’t even keep him home from work. He is an emergency room doctor, so he was needed at work. One of the metrics he reports as positive is the virtual absence of intubated patients. So, I asked him what we can expect this year. First, COVID 19 has not just gone away, but it has changed to the even more virulent omicron variants for which our bodies do not yet have good enough protection. So, it seems that we will on a go forward basis need to get booster vaccines like most of us have for whatever current flu strain is taking root each year. The real difference, of course, is how deadly and more easily spread COVID is. But this season we have more understanding of how to treat the disease and an even better understanding of what the vaccine needs to have in order to combat the current strain. The current vaccine addresses two variants of the Omicron variant…yup, variants of the variant. They’re the BA.4 and BA.5 which public health experts say will pretty much cover the COVID that they expect to continue circulating through the cold weather months. But, the few who have not yet received the first round of vaccines will still need to get those before being eligible for the new Omicron variants vaccines. Their immune systems have some catch up to do. And all of this is the optimistic scenario with the virus staying relatively stable in these newer, dominant strains. If that changes, we all will need to change to be optimally protected against whatever COVID is cooking up for public consumption. When? Good question and there is some variability in the answers, but most medical providers encourage some time between now and Halloween, because cases already are showing up in the emergency rooms. My son, however, points to a small positive in that virtually no one is sick enough to require intubation because they had been vaccinated for COVID before. But for your older loved ones, contact their PCP as soon as possible, because age and comorbidities factor into the overall calculus. And while you’re having that conversation with your loved one and their provider, ask about shingles and any other issues for which your loved should seek protection. …because you want the scariest part of this season to be the costumes the little trick-or-treaters will wear around your neighborhood when Halloween arrives not the infections circulating. Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of, 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.
In my last posting, I gave a checklist of the preventive health touchstones for men over age 65, and you will see some fairly predictable parallels to women's health as they hit 65 as well. But take note of the differences if you are a caregiver to an older woman. I am going to start Bone Health - all women need to have their bone density tested even before age 65, and it is largely because of the hormonal changes that are associated with aging. the bone density test is called a DEXA scan, and if you are a caregiver to an older woman, you should approach her doctor about having it done as well as ask about what amount of calcium supplement will be a helpful part of her daily intake. Again, exercise will be important as well. Breast Health - there are risk factors that every woman ought to know, but on average, a mammogram every year or other year depending on their risk factors. All women of any age should learn self-exams as part of their monthly ritual as well. Pelvic Health - once a woman stops ovulating, and 65 is well beyond that, PAP smears are no longer part of the annual routine unless they have had a positive test result at some point along the way. The rule is that three negative tests within the past decade makes for a safe future but check with the physician. Blood Pressure - women should have their blood pressure documented annually as with men. With diabetes or heart disease, this maybe more frequent. If blood pressure is above 135/80 blood sugar levels should be tested regularly. Oral Hygiene - as with men an annual cleaning and exam is a must. Again, oral health tracks with heart health, so twice a year has more benefit that just a great smile. Cholesterol Levels - if cholesterol has been within normal ranges, a check about every three to five years is adequate. With heart disease or diabetes, this should be more frequent. Colon Health - up to age 75 a "virtual colonoscopy" every five years. A stool test every year, a sigmoidoscopy every five years and a colonoscopy every 10 years without a history of family colon issues or cancer. Eye Health - again, a vision exam is recommended every two years as a screen for glaucoma and visual acuity. If the older patient has diabetes, more frequent testing. Immunizations - as with older men, keeping current with all immunizations is important. For pneumococcal vaccines, every five years; flu shots annually. And the shingles vaccine if she has had chicken pox when younger. A tetanus booster every ten years is recommended, and talk to the primary care provider about anything else. Everything else - as with men annual exams are a time to weigh in, record height and test hearing. And women as much as men are prone to depression as they age. A physician can offer an assessment as well as a consult on all medications and any possible interactions . 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.