Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • geriatric careChicago's Geriatric Care Manager Center of Excellence

Planning for the Holidays is More than a Menu
The latest news reports suggest only about 10 percent of American Adults have received their seasonal booster for COVID. ...
Read more
October 24, 2022
0
0
What’s COVID Going as for Halloween?
It’s been a year and a half since the COVID19 vaccines came on line to address the pandemic when...
Read more
October 11, 2022
0
0
The Will To Do the Right Thing
This whole idea to write up a legal document to give surviving loved ones clarity about how to take...
Read more
August 9, 2022
0
0
Why AND Is the Most Important Word
Do you recall the 1991 movie called City Slickers? It was another great role for Billy Crystal, but it...
Read more
July 19, 2022
0
0
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...
Read more
June 7, 2022
0
0
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...
Read more
May 24, 2022
0
0
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...
Read more
April 26, 2022
0
0
When That Doesn’t Stink…
There are a lot of tests and exams we all know that are important to catching a condition early...
Read more
April 12, 2022
0
0
Respect and Inclusion
I was very pleased this past weekend that my son and his wife invited my husband and me along...
Read more
April 5, 2022
0
0
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...
Read more
March 1, 2022
0
0

In the Caregiver's Words

Recent Client Praise

Elders have more health care issues and have more doctors’ office visits and more hospitalizations than their younger counterparts. Where about one in four 18-44 year olds report no visits to a health care professional in the past year, two out of three 75+ year old patients have seen a health care professional four or more times in that same time. More than a quarter of 75+ year olds report in excess of ten visits a year. What may not be as obvious is that seniors also require more and different recovery help from their medical episodes, especially those that have required hospitalization.

Hospitalization can be the “perfect storm” for older patients, because they have potentially more medical issues in the first place. Second, everyone is discharged as soon as possible from hospitals these days, because insurance typically pays for the condition, not the days. Some in the hospital business refer to this kind of logic as “discharging sicker quicker.” A third factor can also be added, and that is the mental processing ability of an older patient is more challenged by the assault of a hospitalization, especially the discharge process. In a study recently published in the Journal of General Internal Medicine, and reported by UPI, a researcher named Lee Linquist and colleagues followed a group of 200 patients 70 years and older. Although all these patients lived independently in their own communities and none had been diagnosed with dementia or other cognitive medical issues, fully one-third were diagnosed with low cognition post-discharge. The good news is that with special post-discharge care, nearly three-fifths of these same patients improved in the areas of orientation, registration, repetition, comprehension, naming, reading, writing and calculation.

There is further good news. The researchers suggested that screening all seniors while still in the hospital could have helped to flag those in need of transitional care once they were discharged. This would help bridge the time between not being sick enough to still be in the hospital and being fully able to take care of themselves at home. In the past (and present) there has been no insurance that would pay for any of this, but a new bill has been proposed in the U.S. Congress. It would make it easier for patients already receiving Medicare benefits to also receive an “observational transition” that would determine if they should have more skilled nursing care at home care once discharged. The bill was introduced by Senators John Kerry (D-Mass.) and Olympia Snowe (R-Maine) and Reps. Joe Courtney (D-Conn.) and Tom Latham (R-Iowa). The bill has the backing of AARP, and you can read a bit more about it in Modern Healthcare.

If you are a caregiver to an elder, be attentive to any changes you may notice in your loved one not just as they are recovering from the illness, but also as they are being prepared for the transition home. The general rule of thumb for physical recovery is that for every day a person is in a hospital bed they will need at least two days to get back to normal. As much as being able to stand on their own be mindful of how they are interacting with you and others around them.

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

Copyright ©2011 Charlotte Bishop
We often refer to Geriatric Care Managers as the eyes and ears for the family when they cannot be there for an older parent or loved one. But it is more than just being present for a distance caregiver, it is also about learning to hear what others may not be able to hear or not wish to hear. With Mother's Day around the corner, let me share the following as a test of your "caregiver hearing."
1. In your next visit with your older parent, listen carefully to their complaints. It may be that mom may always have sounded plaintive in your memory, but don't let that get in the way of hearing if anything in mom's health status may need attention. Find a way to filter out the "noise" from what is really being reported by mom.
2. Turn that one around and there are some parents who never seem to complain. You ask them, and everything is fine. You may have to change your question from the usual "how are you doing" to "how is it climbing the stairs" or "do you sleep through the night without waking" or "any changes lately?" Don't ask if they are eating well; check the refrigerator to see if it is well-stocked, if items are growing moldy, etc.
3. In that visit, take note of your older mother's disposition. Is she irritable or irritating? This is where history can be a bit complicating if mom always was at least a bit out of sorts, but note any changes that may actually be signs of depression. Depression is not just a bout with sadness; it can also be manifested in outright anger or belligerence.
4. Be aware of your own biases...and then step back. It can be easier for some of us to ignore the signs or symptoms that something is wrong with an older parent, because it would upset the status quo. It can seem easier to ignore the elephant in the room, but ignoring a problem will not make mom (or dad) better.
5. This may go for your older parent's health care provider as well. Even physicians do not necessarily like to be the bearer of bad tidings. You may have to ask pointed questions, so accompany your parents to their office visit and be prepared with questions that are germane to their health status. If they are on statins, ask about their cholesterol levels as well as their heart. If they have a diagnosis with a label like chronic obstructive pulmonary disease or congestive heart failure or other progressive condition, ask about their prognoses.
6. Be alert to changes in your older parents' functional ability, what we refer to as activities of daily living (ADLs). These are important, because declines in functional activities lead to declining medical status. The six general categories of ADLs are eating, bathing, dressing, toileting, transferring or continence.
7. Finally, benchmark the signs you should be monitoring. If you are a caregiver who has frequent, regular contact with your older parent, you may not notice the decline that a sibling who comes from out of town every few months may see. Take note of how your parent walks now versus last Mother's Day, for instance, or how tidy the house is now versus then, etc.
Charlotte Bishop is founder of Creative Case Management, a team of a geriatric care managers, advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.
Only about one in seven adults over age 65 do any kind of routine strength training, according to the experts. Those six in seven who are neglecting their exercise regimens are the people who are hastening nature's unfortunate digression to greater bone and muscle loss as well as decompensation owing to other common chronic diseases. And people with conditions like heart disease, diabetes or arthritis can help delay the worsening of these conditions by regular exercise. Exercise also is a great way to be sure that an older adult can "take care of themselves" longer and along the way, it reduces stress and improves their mood. Engaging in regular physical exercise is one of the healthiest things older adults can do to maintain their health and well-being. If you are a caregiver to an older loved one, encouraging them to be more physically active is good for their bodies as well as their mental outlooks. But some older adults may fear that it will be too hard to exercise or that it may even harm them. The first thing to do is talk to their provider to see if exercise is safe; be sure to note if the provider personally is in reasonable shape before asking their opionions. If you will receive a valid answer, then begin to ask about what kinds of exercise. And remember to encourage your older loved one not to try to get back into great shape the very first day at the gym. If it has taken a few decades to get out of shape, and it clearly will take more than a few sessions to get back into shape; only on the "Biggest Loser" television program will it all happen within one viewing hour. So how to start?
1. Balance - one-third of adults over age 65 and one half of those over 80 will fall each year. Exercises that help to restore the coordination of the muscles that help one walk, stand and stoop will go far in creating a safer self.
2. Stretching - flexibility is as important as balance, so gentle stretches help to make muscles more pliable and nimble. Stretching alone will not improve strength, but they will be a counterpoint to strengthening to avoid injury while the body gets stronger.
3. Strengthening - we see too many ads about low testosterone levels being responsible for men's bodies losing mass (beware of the cardiovascular risk of these hormone replacement therapies). Yet, working on building muscle mass also helps manage weight and blood glucose levels.
4. Endurance - your older loved one should not run a marathon the first day out. Endurance is probably the last of the four goals that one reaches as an older loved one increases their workout time or mileage over a period of months or even years. Taken together these four aspects to exercise will not only make everyone's body stronger, but it also will boost the immune system. Along the way, getting into better shape will also be the best preparation for any bout with any medical condition and recovery from that condition. There is no time like the present to get into shape for getting older, and that goes for your older loved ones as well as you, the caregivers. 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.
Miss your friends, your older loved ones and those summer get togethers in the backyard? We can get together at distance with friends and family in manageable numbers while maintaining distance, but there is no chatting around the water cooler or dropping by the grandparents or social hour at a local establishment like there once was. All of that is mostly lost, at least if you’ve been following the guidelines, and the isolation you and your older loved ones feel is not unique. Odd to talk about isolation and then offer that you are not alone, but… Research is showing that strangers may be every bit as important to your emotional well-being and your older loved ones’ well-being as the friends that you all may now be missing. If you’re like a lot of folks, you are walking more, perhaps with a dog in tow. Or you many be shopping for groceries in the less crowded grocery stores. Or you may be at home to have the mail delivered as your retired parents are and meet the letter carrier or the delivery person from those on-line purchases we all have been making in greater number. I am not exactly an extrovert, but I always make it a point to at least say hello to all of these people with whom I have casual contact. And my husband, the extrovert in the family, may spend minutes chatting up a neighbor we had not met until the recent months or the person from the pizza parlor who delivered tonight’s guilty pleasure or someone eight blocks from home on his long walks with our now physically fit dog. Well, those casual encounters may be helping his and my mental health in a way that we used to think only close friends or confidents could according to a book I came across. The book, titled “Consequential Strangers,” is co-authored by a psychologist and a science reporter who analyzed the importance of those “weak ties” that we all have on a daily basis. In fact, the authors contend, those strangers are as important as family in best friends in giving us a strong grounding in the world. And the authors further point out that the more ties we have with “consequential strangers” the less likely one is to become depressed. Some of the benefits also include better sleep patterns, more productive work effort and just about all of those parts of daily living we value. To truly be healthier during this extended break from normal, ask strangers how they are faring…and then how their family’s health is…and maybe what they have been bingeing lately. You will have primed the pump for your better health. Now, do the same for your older family members and friends and you are passing it forward. Remember, we all will get through this, and we will get through it in much better shape if we hold our strangers closer. 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.
June is National Alzheimer’s Disease and Dementia Awareness Month. I will be having a number of postings on related news this month, and the good news is there is, in fact, good news on a number of fronts. Most of us have heard of the importance of using imaging of brains to identify the telltale beta-amyloid deposits and plaque in the brain for earlier diagnosis of Alzheimer’s disease. Researchers at Washington University in St. Louis, Missouri, are suggesting that Alzheimer’s protein tau may be a better biomarker of the disease than even beta-amyloid. Everyone develops protein tau in their brains as a normal part of the aging process. But these researchers have shown that it is not whether one develops protein tau, but where one shows it. When the protein spreads to the lateral temporal areas or into the parietal region, that is the trigger for Alzheimer’s symptoms. It also is when only mild cognitive impairment has begun to surface, and that early warning may work hand in hand with one other piece of promising news…actual treatment to stave off the progression of the disease. You may recall an earlier posting in which I discussed the brain’s response to excessive carbohydrate consumption as being “type 3 diabetes.” Qian Shi, a doctoral candidate at Tulane University, is analyzing Veteran’s Affairs data in a retrospective longitudinal study of neurodegenerative disease. Ms. Shi is reporting preliminary findings that link metformin use with a substantial reduction in neurodegenerative disease. Metformin appears to be having a similar effect on type 3 diabetes as it has had historically on type 2 diabetes. It reduces the inflammation that negatively affects both the pancreas and the brain. Until very recently, most research has found little support for the benefits of nutritional supplements or nutraceuticals in either preventing or slowing the progression of neurodegenerative diseases. But Jennifer Lemon, a research associate in the Department of Medical Physics and Applied Radiation Sciences at McMaster University in Canada, has conducted controlled studies using laboratory mice that show real promise. (Note: Animal studies, such as those using mice, are almost always the first step toward research that will move to human subjects later, and virtually all mammal brain functions are similar metabolically.) Dr. Lemon gave a mix of vitamins and minerals, along with nutraceuticals, such as beta carotene, bioflavonoids, cod liver oil, flax seed, garlic, and green tea extract to one group of mice. Relative to other mice receiving no nutraceuticals, the treated mice maintained better brain cell numbers and mass and cognitive function over the duration of the study. The treated mice seemed also to preserve their sight and sense of smell, two capabilities associated with neurodegenerative decline. Much research remains to be done, but we ought not be too hasty in giving up on the supplements you can purchase at the corner health food store. Charlotte Bishop is an Aging Life Care Professional and 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.
It was an editorial in Time Magazine back in 2010 that brought up the concept of the "coping conundrum." They said: "There is guilt and mystery and anger and fear embedded in a process driven by love". They were talking about the notion we as a society seem to have it that as our parents grow older and more dependent that it is almost a reverse child-rearing syndrome that the sandwich generation experiences. We "raise our parents?" Not so, they warned. So, let's look at ourselves just a bit. With teens, we can (try to) tell them what they can and cannot wear, what they can and cannot do. We can dictate their hours, and when they do not get the keys to the car until they get the hours of driving logged. So how does that work when you talk to the parent who gave you the keys...maybe grudgingly... and you are proposing to take the keys away from their 60-70 years of driving experience. It is not access to a car; it is a habit, it is independence; it defines life in the suburbs; it is part of the "American dream." And there was Maria Shriver's report that came out in 2010 that essentially said that 10 million women would either care for an Alzheimer's parent or have the condition themselves. Caregiving is a big deal, because it is as much about our parents as it is about ourselves. This is the part where we all go look up conundrum in the dictionary. The number of Alzheimer's patients is going to triple over the next four decades. How would we want to be treated? So, it gets interesting. We all are living longer which means that those of us who are predisposed to conditions like Alzheimer's are more likely to manifest the symptoms. Back to the analogy of "raising" kids. We do not raise our parents, and we ourselves do not want to be viewed as children of our own children. Yet, the end game is about diminishing capacities of our older family members. Are we "lowering" our parents...hopefully very gently? ...versus raising children? So, now comes the coping advice. Rule number one for all of you who are caregivers is that you need to take care of the caregiver. Here is the subordinate rule. Find help in caring for the caregiver. And please know that what geriatric care managers (GCMs) do is support rule number two as well as rule number one. Yes, we assess, plan and execute to help the older loved one or other person with special needs. But every bit as important, GCMs help to care for caregivers. Remember that with every conundrum, there also is either an answer or perhaps even a cure. 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.