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

Your Older Loved One’s Greatest Health Risk?
As our loved ones grow older, we probably are more acutely protective of their health and well-being, especially if...
Read more
September 14, 2021
0
0
Nursing Homes Still a Risk for COVID-19?
It has been a tough pandemic for everyone, but it has been especially difficult for residents of nursing homes...
Read more
August 31, 2021
0
0
Your Flight to Nowhere is Boarding
You have probably put off a vacation or most any travel for more than a year with the threat...
Read more
August 10, 2021
0
0
The Side Effects Physicians Don’t Talk About
You all have heard about the side effects of FDA-approved medications that make their sales pitches on your television. ...
Read more
June 29, 2021
0
0
Breaking News for Alzheimer’s … part 1
The big splash on the medical news this past week gratifyingly was not COVID-19, but instead an approval of...
Read more
June 15, 2021
0
0
Three Milion More Victims…
We see the numbers on a daily basis. How many have died from COVID, to date, we all probably...
Read more
April 27, 2021
0
8
Everything to Lose
Not a day goes by that the sun does not linger a bit longer, that the landscape gets a...
Read more
April 20, 2021
0
0
Not Just Spring…
We’ve heard of Spring Training for those who follow baseball teams like the CUBS or the SOX, and we...
Read more
April 13, 2021
0
0
As If COVID Were Not Enough
We’ve all heard about COVID’s symptoms…the GI upset, the shortness of breath, the fever, the added symptoms of the...
Read more
March 30, 2021
0
0
Diseases that Mimic Dementia…But Are Treatable-part 3
As you can tell from now a third installment about other medical conditions that can mimic dementia, it’s not...
Read more
March 22, 2021
0
0

In the Caregiver's Words

Recent Client Praise

The older people with whom I speak often talk about the things they don’t do so well anymore, and the one that tends to top the list is sleep. While it is not just older adults who have trouble either getting to sleep or staying asleep, it can be a chronic issue. And one for which some of the medicinal therapies available may just not be good options. Why not a prescription sleep aid or perhaps one of the over the counter options like Benadryl – also known as diphenhydramine? Well, older adults tend to already have a number of prescription medications they take for any number of issues like elevated blood pressure or COPD or even neurologic conditions that just may not interact well with sedative drugs. The older metabolism does not process an added medication as easily as a younger metabolism, and a medication may simply be more potent to an older adult than a younger one because their bodies just have less fluid by volume for processing another medication. The American College of Physicians has a number of recommendations for getting their targeted seven to eight hours of sleep a night, and these can be guidelines for us all. They suggest: • The first seems to be a no-brainer, but they recommend you keep light and noise to a minimum and have a comfortable bed and pillow; • Keep the bedroom quiet and relaxing; watch television in another room, and in fact do your reading or have your conversations in another room as well; • Avoid having a clock where you can easily see the time, because it will just distract you from letting drift off; • If you do not fall asleep in about 25 minutes, just get up and go to another room; if you wake in the middle of the night, reflect back on relaxing thoughts like long walks; • Be active during the day, especially outdoor activity, but do not schedule your activity within two to three hours of bed time; • Limit caffeine to earlier in the day, and do not consume alcohol close to bedtime (it may make you drowsy, but it also will wake you when its effect wears off); • If you smoke, quit…the nicotine is a sleep inhibitor – never mind that the smoking itself is just plain unhealthy; and • Eat balanced meals, but again, not too close to bedtime. The ACP has a complete booklet you can download from their site, and it includes a personal diary for any of you or your older loved ones who do have trouble sleeping. They recommend maintaining the diary for the recommended week and bringing it along to the next visit with the physician. 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.
COVID 19 was not in my calendar for 2020, and I strongly suspect it was not in yours either. I often have said that family life crises don’t make appointments; they just show up. And I am usually talking about how to be prepared for the inevitable call from or about an older loved one in your orbit…AND how to be prepared for your and their next steps. Well, this time, preparing for a crisis could be closer to home, because all of us need to be prepared so that the people who may get the call that we have taken ill can be prepared. What do you need to do to make a Plan? When I have spoken in the past, some people back off from talking about a loved one in a crisis. This list is about you, so please forgive me for getting “personal.” Here is my “short list” of the documents you need to have and make them available to your partner, your kids or other close friend … sometimes with no notice:
- Medical Release – the document you need so your medical providers to speak with your loved one’s about your health status, medications and prognosis.
- Power of Attorney (POA) for Finance - a legally binding document that gives a person (referred to as the “agent” or “attorney in fact” permission or power to act on your behalf in matters of property or finance.
- Power of Attorney (POA) for Healthcare - a legally binding document that gives a person power to act on your behalf in matters of medical treatment. The “power” typically is in force when it is deemed the person in question can no longer act for themselves or if they are not conscious.
- Practitioner Orders for Life-Sustaining Treatment (POLST) – a document (varies state by state) that specifies in advance what measures you wish to have in the event you cannot expressly grant permission yourself. These orders typically revolve around life-saving measures; they are sometimes referred to as advanced directives and are placed in your medical files. The forms are downloadable at your state’s web site.
- Health and Life Insurance Policies – the health policy will help everyone involved understand what is covered and which physicians and other providers are available to you. The Life insurance policy should be in a safe place so that it can be readily accessed should that become necessary.
- Estate Plan – is (potentially) a wide-ranging document that let’s everyone know how any real estate or other holdings are titled and what the “plan” is for when your will is executed.
- Trust documents – help to identify how your estate is to be transmitted to beneficiaries. Trust names need to be consistent with life insurance, will and holdings in order to be in effect.
- Last Will and Testament – the legal document by which you express your wishes of how property is to be distributed at death, and names one or more persons, the executor, to manage your estate until its final distribution.
- The Grab and Go – This is a list that typically is sealed in a plastic bag. It includes your medical insurance documentation, a list of allergies, a list of medications, primary care physician contact details and in case of emergency (ICE) contact information.
Please email (info@creativecaremanagement.com) me with any questions on any of these…as well as how to take the next steps which is your plan. Do yourself a favor…don’t wait. 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.
The Boomers are aging, and that means the percentage of adults 65 years of age an older has now surpassed 13% of the population and growing. It also means that the number of older adults who suffer from physical, financial or mental abuse along with neglect is rising with this tide. But there is a second level of elder abuse that will also be rising, and it provides the added insult to the injury of abuse of those older adults less able to care for themselves. The second level is comprised of those who see abuse and don't report it as well as those who receive the reports of abuse but fail to act. In research conducted by the National Center on Elder Abuse, 45% of patients in nursing homes report being abused in some fashion and 95% report being neglected or seeing another resident suffer from neglect. Yet, we do not see this prevalence in any of the other "official" statistics, because it is either not reported or not acted upon. If you are a caregiver to an older loved one, you can do something about it. 1. If you see something, say something. I am borrowing this one from the TSA, but it works here also. Regardless of the age of the older adult whom you know, if you suspect active abuse or passive neglect, report it to a health care provider, social worker or law enforcement professional. These are what are termed "mandatory reporters" who must file, but sometimes they do not. Medical providers may not wish to be seen as violating the confidence of a patient, but that is patently wrong. Keeping silent only allows the perpetuation of this predatory behavior. 2. You do not have to see it to ask about it. Especially neglect may be incredibly subtle, and the abused victim may be hesitant to report a caregiver or even a spouse who is abusive for fear of reprisals. But inquiries have become part of the standard procedure for a lot of health care providers these days. I recall being a bit taken aback when on a doctor's office visit my older parent was taken out of my earshot by the provider and queried about whether she felt safe at home. That provider was doing her job. 3. Make sure there is action. Reporting abuse or neglect is the first step, but the professional to whom the report is made needs to act on the information. This is where it can get a bit murky, especially if this report is about a nursing home facility or chain that carries weight in political circles. The state of California has passed what has come to be known as the Elder Abuse Act which is intended to counter the potential obstacles to protection that political clout can create. Closer to home, the state of Illinois last year passed a law prohibiting anyone with a history of violence against older adults from holding a job in a position of care for an elder. Legislative changes are certainly important steps, but it also comes back to my rule about the village. It takes a village to support a senior just as it takes a village to raise a child. It is part of everyone's job description. 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.
It’s a disease that affects about 26 million Americans. If untreated it will kill these people. And more than a third of patients who have been diagnosed with it and counseled about it do not even know they have chronic kidney disease; it's a disease that nobody sees. That is not a typo; I did say they do not know they have the disease, at least according to research recently conducted at Vanderbilt University and reports from the specialists who treat kidney disease. Kidney disease is a concern to me as a geriatric care manager, because it affects disproportionately more older adults and because it can be an outcome of poorly controlled of diabetes or high blood pressure and just more birthdays.

A research team headed by Dr. Kerri Cavanaugh of Vanderbilt surveyed 401 patients with various stages of chronic kidney disease. The patients were being treated at the university’s nephrology clinic, and the majority had actually seen a nephrologist within the past year, and many had even attended “education courses.” Yet, when they were asked if they had chronic kidney disease, more than one in three said “no.” This speaks to my top two rules about visits to a health care provider:
- Always take along a prepared list of questions and get answers from your provider;
- Always take a caregiver, friend or family member along to ask questions,
  
  listen and take notes along with you.
I mentioned in my title to this posting that this is “the disease nobody sees.” Now, the five things you should know if you or someone for whom you care may have chronic kidney disease, because the end stage of chronic kidney disease is renal failure which leads to dialysis as your kidneys simply stop doing their clean-up job on your blood:
1. If you have diabetes, hypertension, a family history of the disease or are over
  
  60 years old, get a kidney function test every year.
2. Maintain good control of your blood sugar and cholesterol levels and keep your weight down.
3. If you have even stage 1 kidney disease, stay away from acetaminophen, ibuprofen and aspirin as well as laxatives, antacids, ulcer medications, certain decongestants and even enemas.
4. Stay away from foods that are high in salt as well as anything that may contain magnesium or aluminum.
5. Be alert to changes in urination, swelling of the extremities and face, fatigue, a metallic taste, dizziness, shortness of breath, nausea, leg or back pain or feeling cold even when it is warm.
For more information on what to be alert to as well as how to preserve kidney function, I recommend the website of the National Kidney Foundation.

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.
You have heard from me before about how there is a new Alzheimer’s Disease diagnosis in America every 67 seconds…about one a minute every day and every night! According to medical professionals it is becoming even more prevalent worldwide. By the year 2050, this rate is expected to double to one new case every 33 seconds. It is ranked as number one in prevalence of all neurodegenerative conditions affecting 5-6 million Americans and as many as 47 million people across the globe. Translated, that means about one in eight individuals over age 65 will be affected by Alzheimer’s and that climbs to almost half of those 85 years and older. It has been studied for more than 100 years with little headway on what causes Alzheimer’s Disease, let alone how to treat it. I am going to talk more about treatment, and there are some avenues that show promise, in a second installment to this two part series on Alzheimer’s. In this part, let’s go over how Alzheimer’s is diagnosed accurately today than ever before. Not that long ago, Alzheimer’s could only be diagnosed after a patient had died when they could actually investigate how much beta amyloid plaque had accumulated in their brain. That is so yesterday. There are now three ways to arrive at an Alzheimer’s diagnosis in a patient. The first starts with a genetic marker that predisposes an individual to developing Alzheimer’s. It’s called the APOE4 gene, and about one in seven to one in ten people carry this gene. Those who have one copy of this gene are about two to three times as likely to develop the dementia as those who do not have the gene. And if a person has two copies of this gene the likelihood shoots up to 12 times that of a person with no copies of the gene. Should everyone get the genetic test? Well, talk to your doctor, but as medical professionals have consistently shown early diagnosis can be the first step toward more effective treatment of any condition. A second step toward diagnosis will be what is termed a neuropsychological test which assesses a person’s cognitive function. It should be conducted by a neurologist, not just a primary care physician. Combined with the genetic test, it can help to pinpoint Alzheimer’s Disease, but not without the third test. Brain-imaging can not only help to look for the signature of Alzheimer’s activity the brain, but also rule out other issues like hemorrhage or tumors that may be causing mental difficulties. It will also more concretely assess the extent of any Alzheimer’s spread in the brain. This latter testing can be done by a number of technologies like CT or PET scanning, but the most common test is MRI. Look for Part 2 next week when I review the existing as well as new, promising treatments for this condition. You all may recall that I have a book that I have co-written on what a caregiver should know about Alzheimer’s…it is noted in the closing paragraph here. If you want to save 20 percent off the Amazon price, please just send me an email and we will send you a copy for $19.97 which includes shipping and handling. 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.
Barbara Bush, wife and mother to presidents, has taught us another lesson this past week, and it is about how she chose to die. She taught us that palliative care and hospice care are different concepts, but she also taught us about the importance of an end of life plan. Let me start with the first. Let me clarify that hospice care is reserved for patients who will face an end to treatment and wish to be comfortable. Palliative care is simply the “comfort care” we saw requested for Ms. Bush, but it can be for any patient about to embark on a difficult or painful treatment regimen. We deal with a lot of families of older loved ones who are faced with difficult diagnoses. If the diagnosis has a treatment option that may prove difficult or painful, doctors may suggest palliative care. And that is when some family members may freak out just a bit… not an exaggeration. Yes, they may freak out because there is an association between palliative care and end of life, or hospice care. So what we saw for the former first lady was a care plan that included anything she needed to simply die comfortably, hospice care, but they did refer to it as comfort care. Ms. Bush was able to make her own decision at the point when a choice needed to be made, but so many people will not get that chance. This is also why it is important for families to have a discussion about the “what if scenarios” that families may face. What if there is no hope for recovery? What if the patient will not regain consciousness to make a decision about how to cope with a potentially painful end of life? As an Aging Life Care professional, we talk about the importance of a care plan. A key element of a comprehensive care plan will be what to do if. ….If mom cannot make the choice for ending treatment…If dad’s dementia precludes dad’s own decision for comfort care. We were told in Ms. Bush’s eulogies that she ended life pretty much on her terms. I would encourage us all in this country to make plans with family members that will assure the same level of comfort…that we should all end life on our own terms. If you have not already, it may be time to speak with your older loved one about what “their terms” are. You and they will be very gratified that you were sufficiently bold to start the conversation. 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.