Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • caregiver coachChicago's Geriatric Care Manager Center of Excellence

Spring Tips for the Holiday Caregiver
We all know that that Spring in the Midwest isn’t on a straight line from Winter toward Summer, but...
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March 28, 2023
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How (NOT) to Worry, Stress or Be Anxious
It’s not so much whether you’ll have worries, be stressed or feel anxious…it’s how you’ll manage your worries, your...
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March 21, 2023
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Scammer v. 23.1
Call it Ocean’s 65+…instead of Ocean’s 8 or Ocean’s 11…but it doesn’t have a caste of Hollywood stars, and...
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March 7, 2023
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Ain’t No Sunshine…
…When She’s Gone.” Or how about, “You are My Sunshine, My Only Sunshine?” or “Here Comes the Sun?” or...
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February 21, 2023
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To Sleep, Perchance to Dream
No, this isn’t a refresher course on Shakespeare and the famous Hamlet soliloquy. (Spoiler Alert – Hamlet was ranting...
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January 2, 2023
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A Viral Trifecta?
To get to the question in the email first, the Spanish flu of 1918 did not get its start...
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December 13, 2022
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Would You Want to Know?
National Geographic has a new documentary series, Limitless with Chris Hemsworth, starring, of course, Chris Hemsworth of Disney’s Marvel...
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November 29, 2022
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Saying “No” May be the Right Answer
Saying “yes” when someone asks you to do something can be like eating candy. It feels right or good...
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November 15, 2022
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Doing Your Homework on Medicare Coverage
If you or an older loved one are at that age in the magical transition – otherwise known as...
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November 8, 2022
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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. ...
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October 24, 2022
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In the Caregiver's Words

Recent Client Praise

Independence is as much about the caregiver as it is the older adult or special needs individual who receives the care.

The principal goal of a Geriatric Care Manager is to optimize independence for seniors or others with special needs as safely as possible, for as long as possible and with the maximum quality of life for the whole family. In an earlier blog on making home a secure and safe place, I briefly discussed some ways to make home safer. And there is a host of other services available to help keep the house in order, food on the table and mom or dad living well. You can look to both light and heavy housekeeping, sidewalk and grounds services or meals delivered. If more personal care is needed, home health or companion care are available.

Yet there is another important need to consider - your own needs as a caregiver. Being a caregiver to an older adult or someone with special needs can be a significant drain physically, financially and emotionally. Keep in mind what you need to relieve these stressors on you as a caregiver as well as take care of mom’s or dad’s needs.

In my experience, I find it is important to make a connection with someone with whom you can talk about the work and stress of caregiving. Then, you need to find help to relieve some of the work duties. The “right” independent or private workers can be hard to find, because you want to make sure they aren’t a scam or that they are indeed certified and bonded.

You want to know that your loved one will actually feel secure and comfortable with the caregiver. In my experience over the past twenty-plus years, agencies offer a number of inherent advantages over freelance individuals. Home-care agencies – versus the independent individual you may find on your own - have the responsibility of bonding the aide, paying the aide’s wages and taxes as well as insurance if they become hurt on the job. They also know what kinds of people are well-suited to this kind of work, so that you have an optimal chance of getting someone who is capable and has staying power. The agency also then is the manager, so you simply have to be attentive to your older parent without the added burden of being a manager as well.

As you look to the agency you should ask a lot of questions, not the least, “Will this added help allow you the time to care of yourself, physically, emotionally?” Additionally, do your own research at your local library, which contains a lot of resources for free. One of the best elder resources in northern Illinois is the Senior Citizens Guide to Chicago, for instance, and other similar publications that you may get from your city hall or even drug stores or grocery stores. In the end, just getting a sense of what is available will help you in identifying what your older/special needs loved one may need … AND what you need.

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.
Any discussion of hygiene - whether in an older adult or anyone else for that matter - is an admittedly subjective discussion. It is not just about taking a daily bath or shower. In fact, in many other parts of the world, a daily cleansing is considered a bit excessive, and some people of earlier generations did not necessarily grow up on the daily dousing we call personal hygiene. Everyone potentially has their own take on how frequently they wish to bathe, but hygiene also can be an indicator that something else is not quite right in an older adult.

When I get a call from a client who is concerned about their older loved one's hygiene, I start by simply asking if this is a recent change from old habits or if it simply the way they always have been. If it is just the way the habit has always been, then it will not be easily changed...if, in fact, it even should be changed. Old habits are deeply ingrained. But a change in personal habits can be the sign of something else at work.

In an earlier post, I had pointed out that loss in appetite can be a warning sign of depression. The same holds for an older adult who has lost interest in how they look or how they smell. Depression is a bigger issue than hygiene, and in fact, if the older adult addresses the depression with talk therapy or medication, if indicated, they may find a renewed interest in self-care and hygiene.

And as with appetite as I addressed in the last posting, a change in hygiene can simply be a product of the older adult's diminished ability to smell what you as a caregiver may find offensive. Conversely, you may find that your older loved one has dumped excessive amounts of cologne on themselves, because they cannot tell that they have given themselves an overdose of the good smelling stuff. Regardless, any discussion you may have with the older adult about something as personal as how they smell should be a very sensitive discussion.

Your older loved one also may also be finding it difficult to navigate the bath like they used to because of their diminished agility. And modesty may preclude them from asking for help. So if this is the case, consider enlisting the help of third parties like home care aids who will not be as threatening to their sense of propriety.

Forgetting to shower or bathe can also be a sign of a larger pattern of forgetfulness, so try to assess hygiene against the "big picture." Does your older loved one also miss appointments or forget to pick up their clothes from the cleaners? Maybe suggesting a calendar with dates filled-in with the "things to do" can be an assist, because we all can forget things. If the forgetfulness, however, is part of a greater disorientation, be alert to early onset dementia. Even if this forgetting is part of a dementia, don't immediately push the Alzheimer's panic button. Mild dementia can be exacerbated by poor sleep or even a medication that has a side effect of confusion. Diphenhydramine (branded Benadryl), an ingredient in a lot of over the counter medications, can precipitate some amount of forgetfulness in a person of any age.
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.
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.
That depends on what you mean by “slow” motion. It was just a couple years ago that I noted in my book on dementia that a new case of Alzheimer’s disease is diagnosed in the United States every 67 seconds. I received a solicitation from my state chapter of the Alzheimer’s Association yesterday, and an opening sentence informed me that “every 65 seconds someone in the United States developed Alzheimer’s disease.” I paused for a moment, and then it really struck me. The train wreck is gathering speed. Two seconds less is no big deal, but that is three percent faster; three percent is higher than the current inflation rate. Would you invest in a financial instrument that guaranteed you three percent less each year? I think the takeaway is that we all need to be vigilant with our friends and loved ones when it comes to “forgetfulness.” The Alzheimer’s Association offers some very basic tips on the most common early warning signs of Alzheimer’s disease:
1. “Memory loss that disrupts daily life,” like recently learned dates or events
2. “Challenges in planning or solving problems,” such as recipes, paying bills, etc.
3. “Difficulty completing familiar tasks,” because familiar no longer is familiar
4. “Confusion with time or place,” is like having no clock, no map
5. “Understanding visual images and spatial relationships,” such as a clock’s hands
6. “New problems with words,” but it is not just “word-finding”…it’s sentence-making
7. “Losing the ability to retrace steps,” and then blaming someone for the problem
8. “Decreased or poor judgment,” like giving up on self-care or donating in excess
9. “Withdrawal from work or social activities,” because they just can’t keep up
10. “Changes in mood or personality,” like confusion, paranoia or depression.
The challenging part when we may take stock of a loved one is that all of these in some minor ways are simple products of just having more and more birthdays. I strongly encourage you to visit this page to see not just the warning signs, but also the “normal signs.” But I also add that the first steps one should take when the signs begin to seem real include getting specialized assistance in a proper diagnosis from a neuro-psychiatrist…and then, don’t go it alone. There are numerous resources in almost every community and on-line that help all of us with a loved one with “that diagnosis” … and to find the support that you as the caregiver need. You will do a much better job of caring for a loved one if you first take care of you! 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.
Being a caregiver to an older adult or someone else with special needs requires a lot of care and attention to details. It also requires a lot of courage, because some of the conversations a caregiver has with their loved one delves into topics that we all may find difficult. Such a conversation confronts some of the casualties of aging like the loss of certain privileges and some subjects would be awkward to address with just about anybody. Let me start with the easiest of three: giving up the car keys.

       Driving. Talking with an older adult about whether they should still be driving can be most challenging if addressed head on. It becomes easier, however, if you try to take the role of the older adult and simply ask yourself how you would want to be approached. If you already accompany them to their physicians' office visits, you may discreetly ask the provider if there are any physical issues that detract from their capacity to drive. When you do address the issue directly, bear the physician's feedback in mind and ask about how traffic is on the days when mom or dad is out. Chances are that they may initially see it as all those other crazy drivers. Work into it by asking about how safe they feel on the road and be prepared with other transportation options that might be more comfortable and "safer" alternatives to driving themselves. This may take some time. Check out some of my other tips in one of my earlier postings.

       Funerals. What are your loved one’s plans for their funeral? This conversation may surprise you. Your loved one may have gone so far as to have prepaid for their funeral already and all those decisions might now be a thing of the past. But as with the car keys, it can be helpful to think about how you would wish to be approached on this subject before talking it over with your loved one. You may even introduce the subject about how you have recently given it some thought owing to someone whom you both know from the community who has died. And remember, it is not about you. It is about respecting the wishes of your loved one that you are asking, and if they do not wish to speak about it, that may just have to do.

       Intimacy. Finally, if this is your mother or father for whom you are a caregiver, you may remember how awkward that first conversation about the birds and the bees was when they broached the subject with teenage you. Now, if your older loved one is still living independently at home or in a senior residential community, you should not even broach the subject. If one of both require some level of assisted living, then you may ask the facility about their policies and be prepared to advocate on your loved one's behalf. No matter what age, individuals who are capable of making their own independent decisions ought be encouraged to decide about intimacy as well. It may even surprise you to learn that their desire for intimacy may be as basic as holding hands and sharing a quiet moment. All that said, the odds of an older adult being diagnosed with stress, anxiety or depression are lower if they are sexually active. This is one of those behind the scenes conversations where there may be a need for more education and a bit of advocacy.

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 would like to share a bit of insight into what our more mature male friends should be aware of regarding prostate cancer, and it is not about the cancer itself. If you ask most men of an age what health issues they fear, chances are that prostate cancer will be high on the list. One in seven men will be diagnosed with prostate cancer in their lifetimes, but only one in 39 actually will die of this disease. Even so about 80% of men who reach age 80 will have cancer cells within their prostate. For men who may have a family history of prostate cancer or who are getting on in years, it is important to be vigilant. A patient may have signs of possible prostate cancer from other screenings such as MRIs, and this usually results in a referral to a urologist. If you or an older loved one comes to this fork in the road, listen carefully to what test is proposed to see if there is cause to truly be addressing the potential for cancer…or is it just a suspicion or a possibility. If the urologist talks of a random transrectal biopsy, that means they are planning to take a number of samples from the prostate. The random means that they don’t have a specific locale to investigate, so they will check around to see if there is anything to cause concern. They may take a dozen or so samples and test for cancerous cells. The tansrectal part is pretty clear as their point of access to the prostate, but this also is where other more immediate problems can arise. In about one in twenty of these procedures, an infection results. Since this infection will now be inside the patient, there are no signs before the fever spikes, and since it is inside, it can quickly turn into a full-blown sepsis. As many as one in three patients will die from a “severe sepsis,” so this is not a sequence of steps to be taken lightly. And there are alternatives. Ask your physician about the utility of a color Dopplar ultrasound or an MRI to check for signs of prostate cancer. These procedures can be repeated over time to be on top of things. There also are alternative biopsy procedures such as a transperineal approach which has an infection rate of only 0.5 percent. There are also MRI-guided biopsy systems which can be directed specifically at any suspicious tissue first identified by non-invasive imaging. And by the way, random biopsies do not have a stellar diagnostic track record either; they miss up to 30% of actual tumors. So, it is important to be watchful in all cases, but it also is important to listen carefully to what is recommended by your physician or the specialist to whom you have been referred. And never hesitate to ask for a second opinion. 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.