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

Too Good to Be True
With over 300 clinical trials on vaccines for COVID19, it perhaps is not a surprise that at least two...
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December 1, 2020
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The Other Global Health Crisis
Wearing a face mask is the new front line of defense against the spread of the war on COVID-19,...
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November 17, 2020
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One More Sign of COVID?
I have written about Alzheimer’s disease…a lot, its warning signs and caregiving probably more than any other topic. Even...
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October 6, 2020
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None of the Above…
While everyone is awaiting the next vaccine to prevent COVID-19 or help in the treatment of the condition among...
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September 29, 2020
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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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In the Caregiver's Words

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What is the most widely used drug by seniors? It’s the same one that is most widely used by all adults: caffeine. It’s estimated that about four in five adults world-wide consume at least one caffeine-containing beverage daily. I am going to share with you not one, but three quizzes on this go to “medication.”
1. Considering caffeine and some common medical conditions, which of these is true?
a. Patients with chronic kidney disease who drink caffeine have significantly lower mortality.

b. Caffeine improves motor function in Parkinsonian patients.

c. The risk for rosacea is dramatically increased with caffeine consumption.
Odd as this may sound, it is “a”. People with chronic kidney disease have a lower risk of dying if they consume caffeine. It was a study among 5,000 chronic kidney disease patients, and those who drank caffeine drinks had a 25% lower risk of dying. Drinking more caffeine did not get more benefit from the caffeine.
1. Which one of these is true about caffeine and heart health?
a. Consuming unfiltered coffee significantly increases the bad cholesterol and triglycerides in the blood stream.

b. Moderate caffeine consumption increases the likelihood of elevated blood pressure.

c. Regular caffeine consumption increases the deposits of calcium in the arteries.

Again, it is “a”. It is all about how the coffee is prepared, because unfiltered coffee can have some bad effects on blood cholesterol. The lesson here must be that filters good; no filters bad.
1. Although this may vary by individual, what is the “toxic level” of caffeine in the blood system of a healthy adult?
a. 400 mg per deciliter.

b. 600 mg per deciliter.

c. 800 mg per deciliter.
Okay, you may be on to me if you said “a”. There is variability across individuals, but 400 mgs is the limit, so more of a good thing can be a bad thing. And the very young have even lower threshold which is a bit scary with all the high caffeine canned beverages available to your people these days. By now, you have to be wanting to know how many milligrams in a cup of caffeine. The answer is about 95 milligrams, but of course, that may vary depending on who is making the coffee. Now, how did you do on the test? If you are satisfied with your score, figure out how much caffeine you have had so far today to see if you should reward yourself with a trip to the coffee maker. 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.
You’ve heard the statistic. Every day 10,000 more Americans turn 65 years old. We all know someone who has celebrated their 65th birthday…no crisis. The crisis will be the magnitude of need that’s represented 10, 15 or 20 years down the road as health issues add up. But even that is not the real crisis. The real crisis comes from too few younger caregivers to meet the needs for their aging care receivers who will outnumber them…we might call that the storm surge that follows the Silver Tsunami. Picture a hurricane that just parks in America and stays…for a generation! So if you know there is a storm called the Silver Tsunami in the forecast, do you stock up on bottled water, gasoline and dry goods? Let’s use the Florida panhandle residents as a case in point:
- The large percentage of them had a plan…they left the area for safety
- But most of those who stayed behind also had a plan…they stocked up
- A very small percentage just hunkered down…because they had no plan
Aging America is upside down on this. Seven out of eight of the potential caregivers to older loved ones in America have no plan. That is about 95 million Americans who will just hunker down. They have no water, no gas and no dry goods…and no plan. Well, here is the fall back to an actual plan, and it is a lot like just stocking up. Ask your older loved one to make copies of their important documents and to keep one copy with someone they would designate as a caregiver and keep another one in a safe. The documents to copy should include:
- A life insurance policy, if they have one, with contacts
- Their written will or trust and the lawyer to contact
- Contact people such as their primary physician, close friend, family, etc.
- A complete and current list of all their prescriptions
- Their written health records or the logon information for their records
Some of you may be saying there is little or no chance to get my loved one to have this conversation. It’s simpler than you think. It is actually all about starting a conversation that can more naturally lead to some concrete action steps like these. Use an occasion like a holiday gathering, perhaps a friend’s unexpected hospitalization or the diagnosis of a celebrity that has created a buzz to start the conversation. This conversation and the list could also be the beginning of a “what if” conversation that results in a plan. Make the Silver Tsunami just another “Tempest in a Teapot.” 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.
We have all heard that pride goes before a fall. It turns out that feeling down often precedes falling down as well…at least for older adults. For a number of years, there has been a well-founded suspicion among health care providers that some drugs are just bad for a person’s balance. It’s a noteworthy side effect. And, of course, add those medicinal imbalances to an older physical frame, and some unfortunate accidents can happen. Most notably, it is the fall that results in a hip fracture and the difficult recovery that represents to an older loved one. Researchers in Sweden have found that the chances of a hip fracture are about three times greater among 65+ year old patients on antidepressants versus those not on these medications. Closer examination over the period preceding diagnosis through actually receiving a prescription, however, revealed something that came as a bit of a surprise to doctors. The period before a patient actually begins taking a prescription for their depression actually has an even higher risk of a fall, so it evidently is not all about what just the medication can do to the patient. In the 16 to 30 day window while a patient is depressed, but before they are taking a medicine for it, they are nearly six times more likely to have a fall than non-depressed patients. The month preceding that was the second highest risk…about four times that of non-depressed patients. What encouraged this research in the first place was the noteworthy presence of depression in hip fracture patients in hospital and recovery. While getting through the hip fracture and rehab, physicians in Sweden had noticed the relatively high prevalence of depression. This was not entirely uncommon for an older, sometimes frail or isolated population, but as they dug deeper they found that depression may have actually been a contributing factor to the fall. Also important in predicting fall risks was age. The older the patient, the higher the risk. Men also were at greater risk for a fall than women. The researchers also note that there likely are multiple factors at work for any given person, but depression should be a red flag nonetheless. If you have an older loved one, you should be sensitive to changes in mood…as a healthy approach all by itself. Now, you know it is also a way to look out for their fall risk. Please pass on the attached diagram about safe walking…and also encourage anyone who has more than their share of seasonal blues to see a professional. That office visit may be the step that keeps them on their feet. 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.
Autoimmune diseases have gotten a lot of press in the past decade or so, because scientists have developed biologic agents that have been able to slow or halt the progression of many of these diseases. The list includes the usual suspects you have seen on television commercials like rheumatoid arthritis, plaque psoriasis or Crohn’s disease. But the category also includes conditions like type 1 diabetes, lupus, multiple sclerosis and nearly twenty other medical conditions. Well, these conditions may be poised to get some more attention. Researchers in the United Kingdom have found a link between patients who early in their lives have been diagnosed with an autoimmune condition and those same patients later developing dementia. This includes both Alzheimer’s disease and vascular dementia. It all comes down to big numbers. The researchers accumulated data on roughly 1.8 million patients who had been diagnosed and treated for autoimmune conditions between 1998 and 2012. They also had a control group of about 7 million patients – those who had not been diagnosed with an autoimmune condition. Of the 25 autoimmune conditions, 18 of them proved to be statistical predictors of later development of dementia. The disease with the most dementia diagnoses later was hypothyroidism. Over all the autoimmune conditions, the risk of developing dementia later was about twenty percent higher than for the control cohort. That said, we are talking very small risks for either group. Of the dementias, Alzheimer’s disease was a slightly lower risk outcome than vascular dementia. The researchers speculate that as patients with a disease like RA likely will be taking NSAIDS like naproxen or ibuprofen which may also have a neuroprotective effect against Alzheimer’s disease. Overall, the risk for developing any dementia was slightly higher for men over women, but there was substantial variability across specific autoimmune diseases. The research seems in general to be encouraging further study of anti-inflammatory drugs as preventive care against dementia…perhaps to see if the same anti-inflammatory drugs that address autoimmune conditions can have an effect on neuroinflammation. The Alzheimer’s Association is taking this seriously. Last year they announced a $7million investment in clinical trials looking at drugs addressing brain inflammation. The researchers suggest that the data are preliminary, but admit that the inflammatory route is worth more analysis. 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 left off last week with the first five (of ten) tips to healthy aging. Before I continue with the five that comprise the rest of the list, I want to point out that this is not meant to be an onerous list that no one can ever complete. It is about your loved ones doing their best on as much of the list as possible. And as with Rome, it will not be all done in one day. Picking up where we left off, here is 6 through 10:
1. Filling Out an Advanced Directive – In 1990 Congress passed the Patient Self Determination Act which allowed adults to have a say in how their life decisions would be managed if they were unable at a particular moment to have a say. Talk with your older loved one about “what they would want if.” Some states have the form on line, but an attorney can easily be consulted to help dot the “i’s” and cross the “t’s”.
2. Be active – Your older loved one does not have to join a gym, take a course in Pilates or run a marathon unless they wish to do so. But they do need to keep the parts moving so that they will work better. Regular exercise such as long walks or swimming also helps stave off high blood pressure, diabetes, arthritis and depression. Or if they say they would rather read a book, show them how to do that … on a stationary bike! It’s worth the sweat.
3. Input affects output – We all have heard that we are what we eat. It’s true. Steer your older loved ones to something new and delightful like fresh foods over processed foods or organic produce over the old alternatives. Encourage new recipes and portion control. Regarding portions, a rule of thumb is to target eating until we feel 80% full.
4. Active Applies to the Brain – Some cognitive decline is just part of the aging process, but encourage your older loved one to not just give up on their brains. And this is not limited to just doing the Sunday crossword puzzle. Anything that stimulates the brain is good for the brain. Think of the brain as a muscle that needs to work out to be its best.
5. Aging is Not a Solo Act – More than one in four older adults lives alone, but that does not mean that they need to consider their residential status to be some sort of “solitary confinement.” Getting out for coffee is not about the coffee, it is about the company they keep.
I said this last week, but please allow me to repeat myself when I say that all of these tips are great counsel for anyone at any age. 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 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.