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

Negative Thinking Causes What?
What could be worse than a COVID pandemic? How about the uptick in depression and anxiety that mental health...
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July 7, 2020
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Abuse Thrives in Pandemic
Guest post author Gregory Peebles is a team member at CCM whose work focuses on helping aging adults and...
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June 16, 2020
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Distance Caregiving Through a Wall
I’ve written numerous times about distance caregiving, and one of the observations I have offered is that distance is...
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May 19, 2020
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Caregiving During COVID: Four Tips for Reengagement
You may recall that I have recommended limiting your news consumption, because it really does add to our stressed...
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May 12, 2020
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Listen to an Astronaut about COVID-19
A small percentage of us may be coping with symptoms of COVID-19 or we know someone who is, but...
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March 24, 2020
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Trusted Voices on COVID-19
The news cycle calls the COVID-19 crisis a rapidly developing story. It unfortunately also has been one with a...
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March 17, 2020
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One is Number One Threat to Seniors
We’ve all had times when we desperately need our own space…time to ourselves, just ourselves. And it’s good to...
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March 10, 2020
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Helping Your Older Loved One – AND You – Avoid COVID19
All of us here know how to prepare for a blizzard, people in the South know how to prepare...
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March 3, 2020
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Part 2: Five Important Tips for Caregiving and Self-Care
In my last post, I gave you some tips on distance caregiving that arguably could be called the 30,000...
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February 18, 2020
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Tips for Distance Caregiving: Up Close and Personal at a Distance
If you think being a caregiver to an older loved one is hard–with all the trips to help them...
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February 4, 2020
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In the Caregiver's Words

Recent Client Praise

The past couple of entries have been about facing difficult decisions about transition with an older parent, perhaps toward independent living and out of the family home. The initial conversation of moving is very difficult and challenging for a number of reasons. Memories of watching children grow up, birthdays, anniversaries, and more still live within the space. It’s hard to give up the home you’ve worked for, lived in, and raised a family in. Therefore, if you do believe that moving out is an option that your parents should consider, approaching them compassionately and openly will help make the conversation easier.

The most important thing you can do in a conversation like this is to schedule time away from other personal distractions. Make sure you have time to really listen to your loved one as this conversation may not be resolved in one sitting or even two. However long it takes, it is important to really understand your loved one’s concerns and try not to be or seem dismissive. As stated in a previous entry, this decision should ultimately be theirs to make. You might find yourself focusing on convincing or persuading rather than investigating how they feel about their options. By listening, you may discover that there are other options for them you wouldn’t have otherwise considered.

Another important tip is to come to the conversation prepared. Learn about independent living communities that they might be interested in. Once you’ve heard their concerns and worries, you might be able to address them in a more informed manner. It is also important to avoid pushing the issue if you feel they’re getting angry or upset – try to come back to it at another time.

Most of all, it is best to be understanding without trying to rush the decision. This is why it is never too soon to have this very important talk.

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.
We have probably all used some expression about being "only as old as you feel" or know someone who is "young at heart" or my favorite that "you do have to grow older, but you do not have to grow up." Well you get where I am going. It is a medical fact that chronological age is not a truly accurate assessment of how well a person really is. If you are a caregiver for an older loved one, you may at times would like to know how well they really are, not just how well they may be cared for by their provider. Some researchers in Norway have come up with a way to calculate a person's fitness age, and this may be one that caregivers and older adults may both want to know. Fitness experts for a long time have known that one of the best ways to measure fitness is to measure an athlete's peak oxygen intake. To do that they run that athlete to their maximum exertion and then measure their VO2 max, or how effectively the body is delivering oxygen to the cells. In many big clinical studies, this has proved to be a pretty good predictor of how long a person may be expected to live. Well, not too many of us have access to the apparatus to measure our peak oxygen intake, so these Norwegian researchers found a reasonable alternative for estimating how old a person's health is using some measures that we all can record. First, the researchers measured the real peak oxygen intake of nearly 5,000 people whose ages ranged from 20 years old to 90. They also took a lot of other measurements and ultimately found that five really basic measurements do a very reliable job of predicting the fitness that peak oxygen intake measured. The five include:
- gender
- calendar age
- waist measurement
- resting pulse; and
- frequency and intensity of regular exercise.
For that last item, they have a brief check list for you to approximate the rigor of your weekly fitness routine, and for resting pulse, just find a quiet place and count your pulse for 30 seconds and then multiply times two. To let their algorithm tell you what your or your older loved one's fitness age is, just go to http://www.ntnu.edu/cerg/vo2max and plug in the numbers. No one can control their gender or their birthdays, but the exercise part and the waistline part are controllable. So, this is a way not only to find your "real age," but also to take years off that number. Good luck on that and Happy Birthdays.
Most of us have grown up with the faith that when we have a medical issue, there is likely to be a drug to take to alleviate the problem. Yet, we as geriatric care managers have found that more than 700,000 hospitalizations each year result from adverse events or side effects of drugs or because patients are over-medicated. Most of these patients are older adults, despite the fact that those over age 65 years of age represent only about 13.5 percent of the population. If you are a caregiver to an older adult or other person with special needs, you should pay particular attention to the following to keep your loved one out of the hospital:
- It is not just prescription drugs that should concern you. Most of the medicines that we all purchase over the counter (OTC) were once prescription medicines. They can represent potentially harmful side effects like Tylenol with its potential for liver toxicity. And don't forget that even aspirin is an acid; but it was on the drug store shelf before there was an FDA to protect us from its stomach slide effects.
- Keep track of all the medicines your elder may be taking (and include the OTC meds). Most doctors' offices are getting very good about asking what medicines are being taken with each visit, but be prepared with your loved one's lists at each visit. And ask if any can be dropped; you may be surprised at how many prescriptions handle the side effect of another medication.
- Be careful about how a medication is to be taken. Make sure your older loved one and you both understand the time of day a drug is to be taken, with or without food or how it might interact with another medication or even certain foods.
- Read the fine print. Every prescription has something pharmacists call the package insert or PI. Read the indications and usage section of this long page and call your provider with any questions. Also read the adverse events to make note of anything that has a greater than 5% incidence - and what steps to take should that event happen.
- Make sure you watch for anything out of the ordinary and ask your loved one how they feel. It may be just a dry mouth, or it may be hard stools or other side effects they may not volunteer. Everything is important to monitor. And if your loved one suddenly has any difficulty breathing or feels anxious, call your provider.
Underlying all of these caveats, appreciate that your older loved one has less fluid per pound than a younger adult. Their metabolisms also function more slowly. And most drug trials are conducted only with younger and healthier adults, so side effects may be minimal and less consequential. Birthdays and drugs may have bigger side effects than the pharmaceutical companies may have found in their trials. Charlotte Bishop is founder of Creative Care Management, a team of geriatric care managers, certified professionals, advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecasemanagement.com.
Our vice president for geriatric care management services, Steve Steiber, Ph.D., brought some startling information to my attention recently, and it concerns the risk we don't often think of when we hear that an older loved one has been hospitalized. He has nearly two decades experience in pharmaceutical medical device consulting prior to joining CCM.
For older adults, who are admitted to a hospital intensive care unit, it would seem that discharge from the hospital means they are out of the proverbial woods. Not so, according to researchers affiliated with Vanderbilt University Hospital. They studied older adults who were discharged from the hospital after a stay in the ICU. What were they were looking for? Complications from what they termed Potentially Inappropriate Medications (PIMs) and Actually Inappropriate Medications (AIMs). Very simply, AIMS are medications whose side effects or likelihood of adverse events outweighed the potential benefits the medications were supposed to confer. PIMs were seen as medications where the jury might still be out. In short, they were looking to see what negative outcomes were associated with the patients' prescriptions separate from their medical conditions. This is a big deal if you are a caregiver to an older adult, very simply because drug-related admissions for 65 to 84 year olds have increased by 96 percent between 1997 and 2008. And approximately half of all drug-related hospital admissions are among adults 80 years of age and older. As we all know the over 65 age group is growing more rapidly than the population at large, so we can only expect this risk to grow. Getting back to PIMs and AIMs, about half of all older adults are discharged with at least one PIM, and four out of five of these older adults are discharged with an AIM. This is all the more exaggerated among patients who have been in the ICU, since 85% are discharged with at least one PIM and more than half are prescribed at least one AIM. The lessons the researchers learned is that some of the AIMs that patients were discharged with were appropriate and useful in the ICU, but should have been discontinued upon discharge. As a caregiver, be aware of the new medications that your older loved one was started on in the hospital ICU, and ask your attending physician if they should be continued at home. The most common AIMs that patients carried home with them on discharge were:
- anticholinergics (37%) - These drugs are used to treat asthma, COPD, incontinence, stomach cramps, and muscular spasms. They can be used to help patients sleep when they are hospitalized.
- nonbenzodiazapene hypnotics (14%) - These are almost always used as a strong sleep aid, but if a patient takes them home beware of their effect with alcohol.
- opioids (12%) - These are indicated for significant pain, most often associated with trauma or in post-surgical recovery. There is significant addictive potential, and these should not be maintained long term.
So, if your older loved one carries home any of these prescriptions, ask the provider why they are appropriate for use at home. If they are appropriate, also then inquire for how long the patient will be taking them safely or for what kind of side effects you should be looking. Please let Steve know if you have any questions about drugs or their side effects or the unique medical challenges faced by older adults or others with special needs. Please email to: ssteiber@creativecaremanagement.com.
Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends who deliver geriatric care management services to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecaremanagement.com.
Associate Care Manager Gregory Peebles returns with a series on the Internet and aging. Gregory is both a Certified Senior Advisor (CSA) and Certified Dementia Practitioner (CDP) whose work focuses on helping aging adults and folks with limited independence by providing resources and support to help them discover and lead their best life. Gregory has been a part of CCM, Inc. for over a decade. – Charlotte Back in 2007, when the Internet was still being settled, I was in one of those lines that stretched around the block to ensure that the day it came out, I had a brand new first generation iPhone in my greedy little hand. Once acquired, friends and family were all amused by the machine, but saw little use for it in their own lives. The revolutionary, all-in-one device was an expensive fad that they imagined would calm down. Life had changed though, and I knew it was just a matter of time before what was in my pocket was the norm instead of a curiosity. Five years later, my retired mother, more than a little bored, adopted a smartphone baby, shortly thereafter becoming an excellent texting conversationalist, casually sharing with me links to favorite YouTube finds. She blossomed online and is currently the Facebook page administrator for one of her social groups. My mom is a special case. She’s very curious and took to virtual reality like a duck to water. Not everyone is as interested. It takes all kinds. In 2017, more than 2/3 of adults over 65 have cause to be online, with well over half of that number identified as being active Facebook users. That means that chuckling over technology-challenged grandparents has an expiration date, and it’s now! The cohort we call “oldest old” (85+) still tends towards pencil-and-paper or maybe typewriter modalities (and that doesn’t look likely to change), but aging boomers have rushed online in droves. Some overeducate themselves regarding proper safety, locking their identities down in privacy settings to the point that “social media” loses meaning. Meanwhile, others prefer to bleed important personal information to anyone listening. At CCM, most of our Internet discussion to-date has been dedicated to sharing with you the ever-changing scams Internet predators use to prey on vulnerable users of all ages. (We’ll talk some more about those, too.) But for the next few sessions, we’ll focus instead on the ways aging adults are using the Internet socially to enhance the quality of their lives. From best practices in social sharing to recognizing bots in chat, we’ll be engaging in eye-opening discussion about the real online lives of your older loved one and answering questions like:
- What can seniors expect from online dating?
- Where are seniors online?
- What services or sites have engaged them as a group?
- What does a secure and social Internet experience look and feel like for aging adults?
We hope you’ll join us for this topic each Monday for the next four weeks, commenting and sharing this important, somewhat unusual conversation with your own corner of the Internet.
I have a small pillow in my living room that speaks to me. In stitched letters it says, "What? Chocolate is not a food group?" My family knows that one of my favorite "food groups" is chocolate, and I don't mean because I am on a health kick looking for the benefits of dark chocolate; I just like good, old-fashioned milk chocolate. But let me tell you that when I have a chocolate craving, my body may really asking me for something more than my brown, sweet treat.

There is a growing body of literature that explains many of our cravings as our body's signals for what it really wants; we just don't speak the language. We fail to translate the cravings in quite the way our bodies are trying to communicate. This has real implications if you have an older loved one for who you are a caregiver. As one ages the taste buds become less sensitive, and appetite wanes. And if you are taking your older loved one's interest in foods or cravings too literally as you listen, you may think you are satisfying their body's nutritional needs when, in fact you are not. Let me start with my own craving.
1. Chocolate. If your elder expresses a craving for chocolate, they may really be translating their body's need for magnesium, a very important electrolyte in the human body. While chocolate can offer some magnesium there are better sources. Chocolate is okay - thank goodness - but your body will benefit from a variety of magnesium sources such as certain vegetables, nuts and seeds. So if your elder has a regular craving for chocolate, try offering legumes, nuts and seeds to avoid the sugar and fats that accompany the magnesium in commercially-available chocolate.
2. Potato Chips. I see this in our household where a certain family member would prefer a bag of potato chips rather than a handful or two. So much for portion control. Potato chip craving may actually be an expression of an iron deficiency. This kind of deficiency triggers a craving for crunchy foods, and potato chips -while crunchy - come up short. Iron-rich alternatives include dark meats, fish, poultry and darker green vegetables. And this overlooks the huge intake of sodium that potato chips offer and nobody needs.
3. All of the Above. This is where the psychology gets interesting. Let's say your older loved one can still smell the peanuts that you just had, but they had been disciplined and translated their craving into having a portion of raw carrots. But a half hour later, they still can all but smell the peanuts and they cave in and subsequently gorge on the peanuts. They should actually feed some of their craving when it expresses itself, but in moderation. That still leaves room for the healthy foods they will eat later and moderates the caloric intake that has become such a national epidemic.
At the end of the day, it is about balance and understanding what our bodies are telling themselves. If you are that caregiver to an older loved one, don't become the food police, but perhaps there can be a role for a food translator to help them understand their own bodies' language when cravings make their voices heard.
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.