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

Three Milion More Victims…
We see the numbers on a daily basis. How many have died from COVID, to date, we all probably...
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April 27, 2021
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Three Steps to the Now Normal
Yes, it has been a long year, maybe in part because it has been more than a year of...
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April 6, 2021
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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...
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March 30, 2021
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No Vaccine for the Other Plague
You’re fortunate that you haven’t contracted COVID, and you may even have received your first dose of a vaccine,...
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February 16, 2021
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The Other Global Health Crisis
Wearing a face mask is the new front line of defense against the spread of the war on COVID-19,...
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November 17, 2020
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COVID’s Other Deadly Toll
During this pandemic, over 13,000 more Alzheimer’s and other dementia patients have died than expected from these cognitive disorders,...
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September 22, 2020
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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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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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In the Caregiver's Words

Recent Client Praise

When I get a call about our geriatric care management services, most people are not asking for a geriatric care manager, per se. They are asking a question about something they have noticed or been told about their older parent or loved one. The question most often is about a change in the older parent that sets off the caregiver alarm that something is just not quite right. In this posting I am going to go through some of the questions I hear and then explore some of them in more detail in later blogs. Please also let me know any questions you may have or any telltale signs you may have seen in an older loved one that give you concern.

Change in eating habits: Have you noticed that your loved one's clothes are fitting more loosely, that they miss meals or that they just don't have the appetite they used to? Losing interest in food or eating significantly less are not normal or inevitable parts of aging. But older stomachs do empty more slowly than a younger adult's, and food may be less appealing because the sense of smell and taste are diminished. Yet, the fact remains that malnutrition is a serious health threat to an older adult. “There’s a fair amount of evidence that suggests if you lose appetite as an older person, in the next six months, you’ll have a higher chance of dying.” This is according to Dr. John Morley, professor at the medical school and Director of Geriatrics at Saint Louis University Hospital.

The cause may not be directly tied to food losing its appeal, per se. It may be that your older loved one simply has poor fitting dentures that just take the joy out of eating; it is actually painful. Loss of appetite is also potentially a sign of depression among older adults.

Older adults also have had a lifetime of losses, such as retirement, debilitating chronic disease, death of a close family member or simply not being as socially engaged as they once were. And these losses can become a huge emotional burden that detracts from appetite.

Any of these causes that lead to a diminished appetite can also ultimately lead to malnutrition which is a slippery slope. Malnourishment can lead to a reduced immune system and the ability of the body to resist diseases or other assaults. Small cuts or bruises will be slower to heal or even be more prone to infection in a malnourished older adult. As the malnourished body looks for nutrition it will feed upon itself, particular muscle. Once an older adult's muscle mass is diminished they will, in turn, be more susceptible to falls or even degradation of bone mass and fractures. And it is hard to put the healthy weight back on.

So, when next you visit the older adult in your life or have a meal with them, take note of the food they consume and what gets left on the plate or not served. Also, check their refrigerator if they are living independently. Look for how well-stocked it is, signs of food well beyond expiration dates or spoiling. It is not just about eating a full meal as much as fueling a healthy, older body.
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.
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For a very long time scientists have told us that there are no cures for Alzheimer’s Disease and that even the approved medications do very little to slow the progression of the disease. But researchers at the University of Copenhagen, Denmark, are onto what they suspect may be a preventive measure. It’s lithium. Lithium is the lightest of the metals among the elements, and you may have seen it as a component of some of the longer-lasting batteries, but for dementia? Well, it actually has been used historically to treat the manic episodes of bipolar disorder, but it can have side effects and it is dosed in extremely small quantities – micrograms. Yet, some new research holds promise for treating Alzheimer’s disease. Animal studies reported by scientists have shown that Lithium has neuroprotective qualities that improve learning and memory. In humans, observational studies suggest that it could be beneficial in slowing the progression of dementia in patients with bipolar disorder. The Danish researchers collected data on more than 800,000 citizens going back to 1986. About one in ten of these people had been diagnosed with dementia since 1986 and the rest were the “control” group. They examined “naturally occurring” levels of lithium in drinking water across geographic residences of the study subjects. Since most of the study subjects did not move around over their lifetimes, this worked reasonably well. Their conclusion was statistically clear. Individuals with the higher levels of lithium in their natural drinking water were simply less likely to develop dementia that those with lower levels. Some observers are already making comparisons to the fluoride that has been added to public water for generations in order to prevent dental caries. Could this be another “easy fix” as well? While the results of these early efforts are statistically compelling, a bit more research is encouraged to be sure that it is not something else entirely that is making the difference for the Danish subjects or if Lithium just happens to be in the right water at the right time. We will keep you posted. And we also will need to keep this and subsequent studies in mind for a second edition of our recent book, How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia. Please check it out, and please also be so kind as to review it for Amazon and for us. In the book, we cover what we know about dementia, what can be done to stave off the effects of dementia and most importantly what caregivers can do for their loved ones with dementia and for themselves. We also offer a lot of resources, many of them accessible on-line. 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.
I have written about “aging in place” a number of times in the past, and that really is an apt way to frame the conversation that many of us who are caregivers will have with our aging loved ones. It is about your loved one…and how well they can manage independent living as they age, and it is also is about how well their home (place) may be suited to their present needs. In this posting, I am revisiting the first part of that with a short check list for those of you with an older loved one in your orbit. I’ll provide the second half of the conversation, a home fitness test, in the next post. (You can also get a downloadable version in the White Paper illustrated here.) If you as a family are unsure about a loved one’s ability to safely live independently, you can start with an assessment of how that person handles the basics of what we call activities of daily living (ADLs). Here is a checklist of the six basic categories of ADLs and how you can make an initial assessment yourself:
- Hygiene: Do you see signs that they are not bathing, brushing, grooming as regularly as they once did?
- Continence: Are there signs of “accidents” that they or their spouse may be trying to hide?
- Toileting: Very simply, can they manage the bathroom on their own?
- Dressing: Do they have the balance or strength to change in and out of clothes?
- Eating: Do they have the dexterity to bring a utensil from the plate to their mouth, cut their own meat, etc.?
- Transferring: Can they get from a chair to the bed, from the bed to another location, in and out of a car, etc.?
Take the example of one of our clients; I’ll call her Rose. Rose was living independently. The first sign she might be having trouble was when one of her adult children found a significant accumulation of soiled laundry at the foot of the basement stairs. Rose had been able to take her dirty clothes and linens as far as the door to the basement, but navigating stairs up or down was not as manageable. Fortunately, Rose also was unable to dust the floors, so the adult children could see a clear path through the dust to her favorite chair from her bedroom. They also noted some “science projects” in the refrigerator that spoke to how well Rose was able to feed herself. You can fill in the rest of the story. The good news was that with scheduled home care from an agency, Rose could still remain safely in her home. Had this been a story about “forgetting” to turn off her gas stove burner or consistently burned toast, and more, it might have been a different discussion and solution. When going through the checklist, I recommend two members of the family collaborate. It will be more “objective” then, and two can also better prepare for “that conversation” with mom than one. 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.
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.
November is National Alzheimer’s Awareness Month, and that means it is a good time to talk about how to deal with this frightening condition. There has been ample press and research in recent months about how Alzheimer’s works, the damage it produces, as well as insights into how to arrest or cure the condition. However, the fact remains that an estimated 5.5 million people of all ages are coping with this degenerative condition. And more than 19 of every 20 of these individuals are 65 years of age or older. So, the question for caregivers to those people is how can we support their quality of life as they cope with the condition?

       A lot of research from around the world focuses on how to address Alzheimer’s and other dementias, and some of this has shown that there is a lot to be said for more than just the medical care these patients receive. Part of a growing body of work on “patient-centered” care has shown the benefit of modifying certain environmental factors for people with Alzheimer’s. A study of long term care facilities in Spain showed the positive impact of modifying such environmental factors like temperature, light and noise.

       Among samples of dementia patients from each of these facilities, the researchers took measures of quality of life either from the patients directly or by proxy indirectly from staff. Quality of life measures included patient mood, interaction with others, physical comfort and their relative abilities to manage standard activities of daily living. As researchers measured these factors, they also took measures of temperature, light and noise in areas the patients occupied during any given day – their own rooms, the living room, the dining room.

       They found that higher temperatures were consistently associated with lower quality of life among residents. Low lighting, they found to be associated with depressed moods among residents, and the greater the noise, the lower the social interactions among residents. To get quantitative, noise levels above 50 decibels were consistently associated with more negative quality of life for residents. In a positive vein, when day time hours had brighter light and evenings had lower light, sleep and mood patterns for residents were significantly improved. The researchers also found that higher daytime temperatures resulted in more demands from residents for care or attention from the staff.

       If you want to be an informed advocate on behalf of an institutionalized family member or loved one with dementia, please check out the rest of the findings. They can be found in the Journal of the American Geriatric Society.

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. Visit our For The Caregiver page for more information and resources.