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

There is an ‘I’ in Caregiver: 5 Tips to Avoid Burnout
We all have heard of coaches exhorting their players to work together by saying “there is no ‘I’ in...
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September 25, 2018
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Singing is a Breath of Fresh Air for Caregivers
Associate Care Manager Gregory is a Certified Senior Advisor (CSA) and Certified Dementia Practitioner (CDP) whose work focuses on...
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February 12, 2018
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Insta-Gram: It’s a Date!
Associate Care Manager Gregory Peebles returns with a series on the Internet and aging. Gregory is both a Certified...
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September 23, 2017
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In the Caregiver's Words

Recent Client Praise

This month I have been posting exclusively about Alzheimer’s because November is National Alzheimer’s Disease Awareness month. Most of us probably know someone who has been diagnosed with the condition, a condition that sees a new diagnosis in America once every 67 seconds. If you know anyone who is a caregiver to a loved one with Alzheimer’s disease you also know that the caregivers are losing sleep with the stress that Alzheimer’s can represent. But who would have thought that losing sleep itself can be a cause of Alzheimer’s? Researchers in New York have recently published their findings that show a distinct correlation between obstructive sleep apnea (OSA) and the accumulation of plaque amyloid in the brain. At first, the researchers had to seriously question whether the Alzheimer’s promoted the sleep issue or if the sleep disturbance could exacerbate the progression of Alzheimer’s. They divided a group of 55 to 90 year old adults into groups with no sleep apnea, those with mild sleep disturbance and those with pronounce obstructive sleep apnea. They followed these individuals for two years taking regular measures of the amyloid deposits in their brains through PET scanning as well as their OSA intensity through monitoring. They found that those with the more advanced sleep issues developed statistically more deposits of amyloid on their brains over time. The modest good news here is that not everyone who develops amyloid deposits is doomed to cognitive decline…it is not quite so linear. But people with more advanced Alzheimer’s symptoms also tend to have more amyloid plaque deposits. These scientists continue to work on this association, because while Alzheimer’s has no proven treatment to alter the decline in cognitive function, sleep apnea can be treated. And slowing the progression of a disease with no present cure by addressing OSA is a win. It is also important to take sleep apnea seriously, because it is not just the rattling of the rafters for the poor bed partner; it is a medical issue with implications for brain health. Please check my interview with Eric Horng of Chicago's ABC7 Sunday morning, November 12. We discussed what caregivers in the midst of a crisis can do ... for themselves! Please check it out on this link. 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. It is available through Amazon. But if you would like $10.00 off the Amazon price, I invite you to follow this link: and apply the discount code: ZH3VK3U6.
In past postings I have talked a good deal about the importance of exercise for seniors who need care and their caregivers. And it is a proven medical fact that exercise is good for us in so many ways - physical and mental. As a geriatric care manager, however, I find that a lot of the older adults with whom we work do not exercise their voices enough - at least not with their doctors. A lot of folks think that they don't know what to ask about their medical conditions or they don't want to appear to be questioning the doctor who has all those degrees and certifications. Well, caregivers and older adults need to exercise their voices as their own advocates:
1. For every appointment with a provider, bring a list of questions about the medications, anything that may be different or just about what to know to be as healthy as possible.
2. Ask even it may feel embarrassing. Doctors and other providers are used to talking about urinary incontinence, sexual dysfunction, prostate problems and everything else.
3. Write down the answers to your questions. There may be a lot of information shared, and you want to make sure you can really process that information later when everyone is back at home.
4. If your loved one is not sure about how to "follow doctor's orders," ask. That way, your older loved one will be able to make changes that improve their health once they are back home.
What kinds of questions can be addressed with your older loved one's provider? Well, just about everything is part of the whole health picture, like:
- Psychological well-being - has your loved one talked about being really sad or blue lately - ask what can be done.
- Stress - have the worries of the day begun to intrude on a good night's sleep, gotten in the way of their usual appetite? - talk about it.
- Falls and balance - has your loved one seemed unsteady or have you noticed bruises? - ask them to bring it up to their provider.
- Medication side effects - or maybe your loved one just does not feel quite right with nausea, light-headedness, dizziness, and such - ask about it.
- Exercise - Your loved one does not have to be in training for a marathon, but exercise for seniors feels better and allows one to do better – so ask the doctor.
- Sleep in general - it may not be stress that is taking away a good night's sleep, but the doctor may have suggestions - ask about it.
And at the end of the day, everything begins to feel better once it is out in the open, so just the mere act of talking about a worrisome health issue may make it a lot easier to deal with everything.

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.
Today’s posting is from one of our long-time staff members, Gregory Peebles. In addition to his Master’s degree, Gregory is a CSA (Certified Senior Advisor). He has been an integral part of our team for nine years. You remember it don’t you? When mom was at home, cleaning the house, you and your smiling siblings were at school, dad had a balanced work/home life that allowed him enough energy and leisure to be little league coach, and grandma lived in the converted garage, basically independent, but so loved that everyone agreed she should just move in? Surely you remember that. EVERYONE DOES, RIGHT?! Wrong. If you don’t remember life that way, don’t feel badly, because I don’t either, and we’d be hard pressed to find anyone else who could relate to that fantasy even ten years ago, let alone today. If, however, you felt some sort of connection with that icon, it’s because that’s the way the family was until only recently idealized in advertising—upper middle class, happy, and homogenous (which is to say, mostly white)—and we have a tendency to compare those images to our own experience while feeling a sense of let-down when our lives don’t match. We can all breathe a sigh of relief and let go of those comparison benchmarks, because the American family never was and never will be only the sanitized version; it’s just the version we see most in the media. It’s changing, slowly of course, to reflect a more diverse, if still primarily heteronormative representation; however, family is so much more than the genetic bonds we share with people who look and act like us. Family is forged in the fire of love and sacrifice, and those of us giving care to members of non-traditional or unrecognized families certainly have hammered out meaningful relationships that previously would have been shackles of burden instead of weapons against loneliness. As the strict definition of family changes to include diverse relationships once cause for social shame (divorce, now legal same-sex relationships, blended families, children born in love, but out of wedlock), it is important to remember that the complicated family is not new. What is new is the larger concession, even reticent, to allow compassionate discussion. Family dynamics are hard enough to navigate when traveling the well-worn roads of traditional narrative; complex feelings of ownership regarding the care receiver can invade and upend even the most conventional dynamics. What happens when mom isn’t independent anymore, but the kids hate mom’s new wife? What do we do when Dad, non-responsive, has children from two marriages, and both groups are sure they know best? How do we protect each other when we don’t have enough history of what works to move forward with assurance and conviction? How do we get out of this? The same way we got in: by being open to something new, by being as full of love as we are capable, and by communicating with the people who are important to us early and often. It’s important to talk to your loved ones about their wishes in the event of incapacitation before it happens, so it is especially important for families bound by non-traditional roles to make plans. Below are some suggestions for helping your complicated family communicate more simply. If you expect to be the recipient of care: Make it public
- As many family members as can/are willing to be present
- Neutral, sober space
- Everyone gets a voice, even if everyone doesn’t get to make decisions
- Allow for the possible necessity of multiple meetings
Make it Clear
- Documents for estate planning
  - DNR - “Do Not Resuscitate” (DNR)
  - POLST – “Physicians Orders for Life-Sustaining Treatment”
  - Five Wishes
  - There are many helpful tools for this online and at our website, creativecaremanagement.com)
Make it legal
- Print, sign, and have an attorney review the documents so that they “stand up” in court if need be
If you expect to be giving care:
- Listen listen listen – This is not about you.
- Be honest with yourself/your loved about what you feel comfortable/uncomfortable honoring
- Respect the sovereignty of the Individual - If you cannot in good conscience provide the care and services your loved one request, do not impede the process.
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.
Although most of us think of a Valentine's heart when February comes up on the calendar, it also is National Heart Month. If you are a caregiver to an older adult - or an individual of almost any age - February may be a good time to take a refresher on the warnings signs of a heart attack (or myocardial infarction) and of a stroke. For either of these cardiovascular events, catching them earlier and getting help quickly are essential.

Heart Attack. The most common warning sign of a heart attack is described by people who have had an attack as a tightness or discomfort in their chest. It commonly will last for a few minutes and it may even come and go, and the victim will describe it as a squeezing or a weight on the center of their chest. The warning may not be confined to the chest; some report a pain in the arm, the back, stomach, jaw or neck. And women tend to have more varied symptoms than men, and it can be confused with indigestion, the flu or other more common problem. It also can be accompanied by a shortness of breath, because remember that the heart's pumping is being hindered. Finally, because the heart is being attacked, some of the same symptoms that accompany other sever injuries may occur. The Heart attack victim may feel suddenly nauseous, break out in a cold sweat or feel light-headed.

Stroke. The American Heart Association gives us an easy way to remember what to look for when someone is having a stroke, and they spell the word F.A.S.T. :
- Face Droop - Does the person report numbness on one side of their face; strokes usually are one side or another. Or does the person's facial expression noticeably droop or sag on one side?
- Arm Weak - If asked to raise their arms, does the individual have difficulty with one of their arms or is one arm seemingly heavier than the other?
- Speech Slurred - Does your loved one suddenly have difficulty speaking clearly? As them to repeat a simple statement; can you understand what they say?
- Time to Act - If a loved one you care for experiences any of these symptoms, call 911 even if the symptoms go away.
The call to 911 is important for both heart attack and stroke, because first responders will be able to intervene on the spot and so that you do not have the added wait of transporting the patient to the hospital ER. Time is of the essence, because in the case of a heart attack a part of the heart muscle is being starved of oxygen. And with stroke, the longer the wait the greater the chance that the deficit may become permanent. For more information on both of these conditions, check out the website of the American Heart Association.

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.
…which is to say that there is new research that shows exercise can help keep the brain healthy and able to produce and retain memory function! I have had a number of posts over the years on the importance of diet and exercise and their beneficial effect in helping to avoid medical issues or just in being healthy. This one is back to the healthy effects of physical activity in actually reducing the progression of Alzheimer’s disease. Recent research presented at the last meeting of the Alzheimer’s Association showed a direct link between regular exercise and an improvement in blood flow as well as reduction in the amyloid and tau levels in the brain that are the hallmarks of Alzheimer’s erosion of cognitive function. All of this works to not only stave off the debilitating cognitive impact of Alzheimer’s disease, but other forms of vascular dementia as well. Every 67 seconds in America, another person is diagnosed with Alzheimer’s disease, so how can exercise help in warding off this condition? Research reported by scientists in Perth, Australia, followed individuals and their “brain amyloid load,” a measure which increases with the progression of Alzheimer’s disease. They grouped these patients into two types based upon level of exercise. The exercise group was comprised of those who exercised 150 minutes or more a week, and the low exercise group was those individuals who reported fewer minutes of exercise weekly. Overall, there no differences in amyloid between the two groups, but when researchers looked specifically to those who had the genetic potential for Alzheimer’s, they found that those with this genetic marker in the low exercise group were significantly higher in their levels of brain amyloid. As they more closely examined both exercise groups across those with and those without the markers, it appeared that those who exercised more were able to slow the accumulation of amyloid despite having the genetic predisposition. All of this is preliminary information, and it is yet to be seen if exercise can really delay the ultimate onset of Alzheimer’s among people who have the genes that predispose them to the condition…or for how long and by how much. It also is yet to be determined what kind of exercise may be most beneficial, but it appears that cardiovascular exercise may show the most promise. One physician at the conference also adds that so far there are no side effects from exercise which is a lot more than can be said of most FDA-approved medications for cognitive impairment. That this kind of rigorous exercise also manages blood sugar levels is an additional benefit, but the lower blood sugar levels may also be reducing another risk factor for reduced cognitive ability – reducing risk for type 2 diabetes. There is more “lifestyle” research in motion, so please stay tuned…more to come. These early results show real promise. 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.

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There is an ‘I’ in Caregiver: 5 Tips to Avoid Burnout

Singing is a Breath of Fresh Air for Caregivers

Insta-Gram: It’s a Date!

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