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

Another Side to the Story
It was just a year ago that Bruce Willis’ family disclosed that the actor would be retiring from acting...
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February 27, 2023
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How to Say ‘NO’ to Dementia
It was about two and a half months ago that we posted about the diagnostics telling Chris Hemsworth he...
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February 14, 2023
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A Defensive Game Plan for Dementia Outbursts
It’s not just about forgetting or being confused. If you have a loved one with dementia, it is also...
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January 31, 2023
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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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Stranger Things: Step up Your Diet with New Options
If I were to ask you what you or an older loved one had for dinner yesterday, the chances...
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October 4, 2022
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Treatments for Alzheimer’s Disease
September is Alzheimer’s Awareness Month, and this is the third of four posts we’ll offer on the subject. I...
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September 20, 2022
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Diagnosing Alzheimer’s Disease
September is Alzheimer’s Awareness Month, and this is the second of four posts we’ll offer on the subject. A...
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September 13, 2022
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Dementia, Distraction, Delirium and Depression
September is Alzheimer’s Awareness Month, so we’re going to be sharing four posts that will help everyone with what...
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September 7, 2022
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In the Caregiver's Words

Recent Client Praise

Acetaminophen (Tylenol) is everywhere within mainstream medicine these days. It is used by itself for fever or pain as well as in combination with other medicines for flu, moderate to severe pain, cold symptoms or insomnia.

But acetaminophen and a lot of other medications don’t simply go from the mouth to where they are needed in the body; they must be absorbed through the digestive tract and into the blood stream. Acetaminophen along with many other meds are then metabolized through the liver. If too many medications are being processed through the same site in the liver, liver function can be compromised. It does not have to be multiple agents that create this liver logjam; it may simply be the amount of a single agent like acetaminophen that can cause problems. Older patients will be able to process even less through their “slower livers.”

Historically, patients have been cautioned not to exceed 4,000 mg of acetaminophen a day as the potential for liver failure can follow from that daily dosage even in otherwise reasonably healthy individuals. I hear from some doctors that the number should be closer to 3,000 mgs, especially for older patients.

Pain killers start with as much as 500mg or more per dose taken every six to eight hours. And then there is Tylenol “extra strength” which can bump an individual dose even higher. Some individuals may be tempted by the “if one is great, then more is better” syndrome. And then a person may take an OTC sleep aid that also contains acetaminophen or use a cold formula containing acetaminophen.

Remember also that older patients can become confused, because they have multiple pills to track. They can accidentally take another dose beyond what their regimen would dictate. As a geriatric care manager, I have a client whom I tell to set her acetaminophen tablets out in a medication tray like her other meds so that she knows how much is left of the total amount she can safely take each day.

The FDA has recently convened to determine just how much acetaminophen should be allowed as a daily limit to avoid problems of liver toxicity, but the jury is still out. So, if you are watching your older parents’ meds, don’t focus just on their prescriptions (which can contain acetaminophen); look in their medicine chest for the rest of the drugs they buy at the store without a prescription. Then do the math.

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.
If you are a caregiver to an older adult, you may have noticed some of the changes in their bodies, like the wasting of their muscle mass. They may have lost some upper body strength, some of their former endurance in their legs and some of the spring in their step. Muscle cells simply begin to break down over time, but older adults who work out can preserve a much greater percentage of their strength and muscle performance than those who do not exercise. Well, your brain and nervous system run pretty much the same path as the muscle systems as a person ages. The neurons which comprise the nervous system also tend to atrophy, and some nervous pathways just don't work like they did in a younger body. But a person may maintain their mental agility by mentally working out just as physical ability can be preserved and enhanced by hitting the gym. Research shows that older adults who remain socially engaged do better mentally over time than more isolated individuals. Those who read or work crossword puzzles also do better than people who simply watch television or other less-engaging mental activities. There are, of course, factors that cannot be controlled by just more aggressively working out one's mind. Alzheimer's disease and some other forms of dementia will simply intervene and wreck havoc with one's faculties. Other hormonal shifts or chronic diseases also can be the culprits which rob a person of their intellectual capabilities. A person develops hypothyroidism during their career, for instance, is at risk for a whole host of unfortunate side effects if they do not maintain their balance with thyroid supplements. One of those side effects is dementia-like symptoms. Unchecked infections, particularly those of the urinary tract also can cause sudden onset of delirium, so it is important to track the big picture and to also look for other sides of such an infection such as frequent or painful urination. Also, the ability to intellectually process or aberrant behavior can be caused by out of control diabetes. Circulatory or lung issues may starve the brain of much-needed oxygen, manifesting itself in odd behavior or confusion. Mini-strokes - sometimes referred to as transient ischemic attacks or TIAs - also can manifest themselves as confused mental processing or language difficulties. And poor nutrition may impede the healthy function of an older person's brain and nervous system. So, if you are a caregiver, here are some useful steps that I as a geriatric care manager recommend you take to monitor your older loved one's mental health:
- be aware of how much real exercise your older loved one gets routinely;
- be alert to signs of isolation, social disengagement or depression;
- note regularly how well your loved one eats at family meals and how well stocked their pantry and refrigerator are; and
- notice how quickly any given change develops - chances are that the more quickly symptoms show themselves, the less likely the condition is to be dementia.
Remember, getting older is inevitable, but deteriorating is not. Keep a sharp eye for how sharp your older loved one is. 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.
Anyone who has raised children in the 21^st century can probably remember helping their young ones learn how to stay safe while out of the house, and later while driving the car and in between while surfing the internet. If you also have an older loved one, you may now have to work with mom or dad to be alert to the new scams targeting the unsuspecting who have internet access. It is not just a matter of helping your older loved one install current anti-viral and anti-malware software. The new scammers are taking advantage of the perfect storm of technology, trust and assets.
Today more than three in five adults over age 65 have access to the internet, and nearly four of every five have a cell phone. According to Microsoft there is a new consumer scam taking advantage of these technologies and the trust of their owners to dupe an estimated 3.3 million individuals – many of them 65 years and older – of an estimated $1.5 billion. It starts with their phone when an alleged representative of Microsoft or Windows calls advising of a virus detected on their equipment. The consultant directs them to log on and go to a support web site that will double-check their computers for the trouble. Once logged on to the site, malware is installed that can hijack any personal or financial information your trusting loved one may have on their computer. But be aware that Microsoft does not make outbound calls. Or it may be just the phone alone that gives the bad guys access to your older loved one. Ask your loved one if they have received any calls where no one was on the line when they picked up. If so, they may be part of an automated system that is accumulating a data base of people who can be targeted for later scams. If your older loved one does not yet have caller ID, have it installed. Or the number one fraud presently taking advantage of people’s phone access poses as a representative of the IRS. This may be the one phone call everyone dreads, but the simple fact is that the IRS does not make outbound phone calls. That said, when an unknown caller invokes the name of the IRS and then proceeds to make demands, most people – elders included – can become very intimidated. Let your older loved one know about this, and if they ever receive a call like this or from any of a number of agencies or federal offices, simply look up the number of the nearest office by that name and call them yourself. Again, the IRS – or any other predator - does not call you; you need to call them. 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.
I am sometimes asked why we have that phrase on our brochure and web site that says "Your Sister in Chicago." The Chicago part is not where the question arises, but some ask why we talk about the "sister." Well, we have discussed that among our own staff, but it really comes down to how roles sort out when it comes to caregiving. Aside from the fact that research shows that it is spouses who are more often the caregivers to one another than anyone else, it most often is the daughter than the son who is the caregiver to an older parent who needs the help. The University of Michigan collects data from Americans every two years in what they call their Health and Retirement Study. It's a survey of more than 26,000 adults over age 50 in America, and some of the recent findings shed some light on how caregiving sorts itself out by gender among adult siblings. The averages begin to tell the story. Daughters, the survey shows, perform 12.3 hours of caregiving to an older adult in an average month compared with fewer than 6 hours for the average son in a family. And when there are both a son and a daughter in the sibling mix, this sibling gender mix reduces the sons' average hours while it increases the hours the daughters will spend in caregiving. According to this survey, the pattern has remained essentially unchanged for more than two decades. There has been a consistent gender gap, and it is more pervasive that just elder caregiving. If you look to see who the stay at home parent is when families sort out responsibilities, women still outnumber men as the stay at home caregivers to children. The authors of the research suggested that it is not up to the daughters of America to more actively recruit their brothers to be involved in caregiving to mom or dad. They argue that the brothers ought to assert themselves into the mix as a remedy for the stress that daughters will experience as the disproportionate caregivers. Women may provide more care to the parents, but they also take on a larger share of the caregiver stress. Yet, this gender gap is not always because men do not step up. We see cases in our own sphere where it seems that the sons' voices do not get heard as much as the daughters, so maybe adult siblings of all genders need to do a better job of sharing the family caregiving responsibilities. But until we can proudly say that we are your "sibling" in Chicago, we will continue to be a sister to both the daughters and sons who are looking for a care navigator to help them with their care receivers. 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@cr eativecaremanagement.com.
Okay, so it has been five days since you received that box of chocolates from your sweetheart on Valentine’s Day. And if you did not consume truly massive quantities of chocolate all at once, how do you feel? The answer is you should feel the calm that comes from lower blood pressure. This, according to a group of physicians headed up by Dr. Dirk Taubert who did a clinical study on generally healthy people who had elevated blood pressure to find out what happens to their blood pressure if they eat dark chocolate over a period of time. Very simply, they found that it statistically significantly lowered the people’s blood pressure. I bring this up because as a geriatric care manager, a lot of the clients I see have blood pressure that is above what it should be. And I can tell them that the doctors say they should have a diet that regularly includes some amount of dark chocolate. People with dietary restrictions, however, need to check with their physicians.

This dietary recommendation does not take the place of the other recommendations we routinely get from medical professionals about fruits and vegetables and maintaining reasonable portions, but it does offer us a chance for a “healthy” dessert. And the science in their clinical study is pretty solid. Most other studies that have cited the beneficial effects of chocolate have done that based on simply observing some people over time, but Dr. Taubert and his colleagues actually set up a clinical trial with a placebo group and all the customary scientific controls.

This study was particularly relevant to me as geriatric care manager because all the study subjects were 56 to 73 years old. Half the group received 30 mg daily of polyphenol-rich dark chocolate, and the other half of the adults got no polyphenol in their chocolate. Polyphenol is the stuff in dark chocolate that is supposed to confer the benefit. Well, 18 weeks later, Dr. Taubert and colleagues found what a lot of people have been claiming all along. Without any changes in their body weights or their lipid or glucose levels, the group who got the good stuff in their chocolate had their incidence of hypertension decline from 86% to 68%.

To add to the credibility of Dr. Taubert’s research, it was published in 2007 in the Journal of the American Medical Association. You can click on Cocoa Intake and Blood Pressure to see the article. But seriously, don’t eat chocolate just to lower your blood pressure. Do like I do: eat chocolate and savor the flavor.

geriatric care Chicago

…and Happy Belated Valentine’s Day.

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.

Copyright ©2011
Caregiving is not like a switch that we turn on or off, that we are either caregiving for an older loved one or we are not. What I have found in my work as a geriatric care manager working with family caregivers is that there is a line that is crossed at some point. That line distinguishes what I would term the occasional caregiver from the immersed caregiver; a line that distinguishes the younger daughter or son who routinely looks in on mom or dad from one that suddenly is thrust into a role of scheduling and coordinating care for their loved one. Any caregiver can be caught by surprise when they get the call that mother has fallen and fractured a hip, that dad has had a stroke or that their loved one is hospitalized for any of a number of acute conditions than are suddenly life changing events. But for most caregivers, there are not-so-subtle signs that it is time to become more involved. Note that I said more involved with, not more in control of your loved one's life. One of the reasons that even a loving caregiver may not see the signs that they should be stepping up is that their parent wants to still be in control. The fact is that they can always be in control, but they may need more help with some of life's day to day tasks that are becoming a challenge.
1. Look into the Details. I have talked in other postings about activities of daily living as a number of facets of what we all may take for granted until we begin to lose some our abilities to take care of ourselves. For instance, are there bills that have not been paid on time, are there signs that mom or dad has not been preparing regular meals, do you notice that your older loved one is not keeping up their personal hygiene? Is there slippage? Gently ask to help with some errands or to bring in groceries or cook a meal - perhaps their favorite dish? Remember that you are not taking over; you are just helping out.
2. Become Part of the Conversation. Mom or dad might appreciate a ride to their next doctor's visit, and ask if they have any questions the doctor has not addressed. They may or may not have raised the questions, but they did not track with the answers. And you may have some questions about how well they are managing a chronic condition like diabetes, congestive heart failure or chronic obstructive pulmonary disease. Again, you are not usurping control; you are simply participating because you also care.
3. Everybody Has a Role. As you are seeing what else can be done to help your older loved one, remember to listen for what they want to control and what they are happy to relinquish. Find out from the provider what the larger goals are, and then work with your loved one to devise a game plan in which they actively participate. If they are not an active participant, they will not own the goal. You already have made it possible for them to understand the changes in their health; now make it possible for them to participate in their success.
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.