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

If It’s Not Happy or Merry?
I explained in an earlier post about why we refer to Holidays in the plural, and how we are...
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December 14, 2021
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Can You Hear Me Now?
From 2002 to 2011, actor Paul Marcarelli was the voice for Verizon pitching their cellular communications with the simple...
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September 28, 2021
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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

As a geriatric care manager, we have knowledge of Alzheimer’s Disease and its progression, less about its causes and its treatment, but we cannot know Alzheimer’s like a patient with the condition can. I recently was introduced to the writings of an “expert” who has gained his insights by being an Alzheimer’s patient since he was first diagnosed with dementia which has been presumed to be Alzheimer’s at age 58. Now 65 years old, Richard Taylor, Ph.D., a psychologist, has written a book titled Alzheimer’s from the Inside Out, and he issues a monthly newsletter on the subject. The following is an excerpt from his most recent newsletter. For those who are caregivers or family members of a patient with Alzheimer’s, this may offer some sense of living with the condition from the patient’s point of view:

“I am Richard, an individual living with the symptoms of dementia, probably (maybe) of the Alzheimer's type. This is my monthly newsletter for February, the month of my birth (Chicago, Illinois/Jackson Park Hospital 4:30 PM), at least that is what my Mom told me. This really isn't a newsletter; it's more like a report of what's happened to me in the past 30 or so days. It is sort of like my book, Alzheimer's From the Inside Out, except this newsletter is free and without charge (at least for now). It will soon be published in five languages - the newsletter that is. Through it, I have made and maintained friends with kindred spirits all over the world.

We all share more than a failing memory and slipping cognitive skills. We all want to know as much about what we "have" as possible. We all want to understand the research that is going on. We all to a greater or less degree are hoping for a cure - whatever the hell that means to each of us- within our lifetime, affordable to our families, with side effects that are significantly less than the symptoms of dementia with which we now live, and oh, by the way, could it reverse at least some of the more intrusive symptoms of this or that form of dementia.

I have spent a lot of time this month thinking and writing about this. I am not a researcher; I am not a physician or a pharmacist. I am just, Richard, a tall guy with a beard who is living with the more and more intrusive and more insoluble symptoms of dementia with which I have to cope if I want to live a purpose full, joy filled, love filled, and complete life. Most times this is much harder than I want it to be. It's not fair, it's not right, it just is. So I most times try to cheerfully embrace today, live in it as fully as I can by myself, and live in it more fully as a result of the enabling support of my family and those who love/like me.

Welcome to my inner and outer world more and more defined by dementia, probably (maybe) of the Alzheimer's type.”

Richard

Please check out Dr. Taylor’s newsletter and more about his book on his web site Richard Taylor PhD

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
You may have heard about music therapy, and you certainly have heard the often misquoted: “Music doth have charms to soothe the savage breast.” But does it work? Music therapy, that is. There actually has been a fair amount of research into how music can address some of the issues that trouble people, and some scientists in the Netherlands have scoured the scientific literature to see if music can be of help with patients who have Alzheimer’s. Specifically, they looked to see if a case could be made that music can help relieve the agitation, aggression or depression of dementia patients. In what is termed a “meta-analysis,” they examined a large body of literature to see what others have reported. While they could not control for variables like the size of groups being tested or the therapeutic elements of the settings, they did offer some tentative conclusions:
1. Music does not seem to have a measureable impact on a patient’s agitation. But the researchers suggest that there may be an effect, but since the therapy sessions may have been too long in duration, the effect may have been clouded by patients’ in ability to be stationary for the duration of the tests. The “calm” that was expected also could have been clouded by social interactions among patients in a group setting.
2. The findings were pretty much the same with aggressive behavior. There is no evidence. They could not sort out all the other background noise – not the music – to say with certainty that music reduced aggressive behavior.
3. What did seem more clear is that patients who had been predisposed to depression seemed to have a lifting of their moods with music. While this was a more consistent pattern, it might also have been confounded by the fact that the music therapy took place in a social setting. And isolation is one of the big causes behind depression.
When it comes down to it, we really cannot conclude that one kind of music will always have the same effect on all people. The fact that there were some positive changes across most studies, however, suggests that it is more than a bunch of notes. Music can make a positive difference for people who have cognitive issues…it simply may not be enough. But at the end of the day, we may come back to the traditional rule about not doing harm. If music is not a problem for people, then let the band play on. 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.
This week I asked Gregory Peebles to talk about the topic of ridesharing from the vantage point of his experience. 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. An Associate Care Manager, Gregory has been a part of my team for over a decade. – Charlotte Ask any teenager in the US, and they’ll tell you when a person becomes a functional adult. The legal driving age in our country is 16, and the license signals independence, freedom, and increased responsibility, including driving to and from a new job. Conversely, it seems also that when it’s time to “give up the keys” we finally start to come face-to-face with the reality that our time as a sovereign individual is finite. Becoming a “rider” instead of a “driver” signals dependence, limited options, and isolation. Getting out of the driver’s seat doesn’t mean all the fun is over, though. The US is just a culture of drivers, and when we lose that one identity, if we don’t substitute another healthy vision of ourselves, we experience unnecessary loss and grief. For example, aging adults stop driving for all kinds of reasons. Because it’s a big conversation, at CCM, we have tended to focus on the cognitive decline aspect, but loss of night vision, reduced hearing, and prescription side effects are still among the top reasons that seniors become “riders.” That means that there are plenty of folks with a lot of life left who may be sitting at home trying to fill the day with meaning when they could be in the world connecting. Caregiver schedules are already often stretched to breaking, so asking for a ride from a caregiver to go to something “fun” is much less likely than securing the ride to a medical appointment. Ridesharing services continue to cover more ground, and in our Chicagoland area, Lyft and Über are the most visible brands offering service. Here are 5 things you should know as you consider ridesharing for your older loved one:
1. It’s safe. – While safety comes down to the specifics of the driver, vehicle, and driving environment, of the two main rideshare choices, Lyft “vets” drivers and vehicles most strenuously. Problems with either service provider however are statistically very low.
2. You don’t have to have a smart phone to benefit from ride sharing. – If you have a technology-loving senior in your care, that’s awesome, but many seniors balk at the idea of a smartphone. So how could they benefit from a service that requires the technology? Your smartphone. You can set the pickup and destination in the app.
3. You keep some control. – There’s a map to follow, so if you’re a worrier, there’s visual evidence of where the car is coming from, when it picks up your loved one, and when they have arrived at their destination. You can keep doing what you need to do while staying connected.
4. It’s usually cheaper than a cab. – Depending on the time of day and how in-demand drivers are (rush hours tend to trigger “surge pricing”), the cost can be as little as $8 for a significant distance. A line share (like a carpool) can bring that price down even to $5.
5. Client assistance is common. – Though it’s not in the contract, drivers are used to helping passengers with luggage or other inconveniences. Your loved one needing a little extra help probably won’t be a problem. However, if you’re truly worried about it, GoGo Grandparent (https://gogograndparent.com) is prepared to help more than Lyft or Über might be. They also make deliveries and will schedule a pick-up, where most rideshares are more spontaneous.
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.
I get asked a lot of times what we do as geriatric care managers, and you can go to our national association's web site (caremanger.org) for their answer. But since we most often get called in to address a life crisis or other life-changing event in the life of an older loved one, I thought it would be helpful to offer what it looks like in action to be a geriatric care manager (a GCM) when the call comes in. As a GCM, what we do best is assess a situation, make a plan and then assist in executing the plan. Most of the caregiver calls we get, however, leave very little time to assess and plan, because it is a family emergency when our phone rings. Mom or dad has fallen with a resulting hip fracture or mom or dad has had a stroke or a heart attack or some other medical emergency. A geriatric care manager is not the first responder, but we are the second responders who help the older loved one's support system find their options and recover some sense of normalcy. Sometimes it becomes a new normal, because life has changed for everyone. Caregivers may not realize how "normal" has changed so instantly at first, because the hospital providers have done a remarkable job of stabilizing the patient and averting a life-ending disaster. And even the course of the hospital trajectory seems normalizing. A discharge planner comes to the older loved one's room and explains how home health will be prescribed or how physical therapy will be ordered and the road to recovery seems pretty clear. At this point, please do not mistake what I am saying for a criticism of hospital discharge planning, but look closely at what they call the process. They do not call it normalizing planning, they do not call it the new normal planning, they do not call it life planning; they call it discharge planning. Their major focus is on getting the patient safely out of the hospital and into the next level of care - it may be a rehab center in the case of a broken hip or a nursing home in other cases or home with a provider coming to them for their care. But who is looking to help create a plan for regaining and optimizing quality of life? Who is there to help make home a safe place for an older loved one with some new physical or health deficits that were not there before? I have just given the job description for a geriatric care manager. GCMs are the people who help make home safer...or if not home, then help to offer the options for a safe place for your older loved one. We are the people who help to find and coordinate the services or physical assists for a person whose life-changing event will not allow life to go back to what it once was. As I tell our clients, we are the option-makers for the decision-makers, and "quality of life" is our goal not just for the older loved one, but for all the caregivers as well. We also are the voice of the caregiver and the older loved one. We are the advocates who will speak up when a referral is not to the appropriate medical specialist or when something in the medical record does not make sense. One of my clients once observed that we "translate medical speak" for the family. And we even go one beyond that by asking questions not every lay person would think to ask. We also recognize what a tough path an older loved one's care trajectory can be for the caregiver. We are there to help care for the caregiver as much as for the older loved for whom they called us in the first place. 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 is not just because of the housing collapse that many seniors have decided to stay in their existing homes instead of moving into a senior community in recent years. It also is because it is easier to make home changes to keep up with the needs of older adults who wish to "age in place." In this two-part series, I am going to take you on a walking tour of an older adult's home with an eye to how to make life a bit easier and safer. If you are a caregiver to an older adult or someone else with special needs, think of it as a checklist room by room.

Front Door. Don't think of those few steps that lead up to the front door as a stairway; think of them as barriers to entry and exit. Recall from an earlier post that osteoarthritis becomes increasingly common with age, and what used to be four easy steps can now become a big challenge. Then, add an armful of groceries or a dark night when things are not as easy to see clearly, and you have an accident waiting to happen. Consider as alternatives either a no-step rehab to the entry way or a long ramp; I say long ramp, because it is important to keep the grade modest to accommodate a wheelchair, a walker, crutches or a cane. And get rid of the threshold - that strip of wood or molding that rises up between the outer wall of a house and the inner wall.

Garage Entry. For the older adult who still drives or is a passenger to someone who drives, getting from the garage to the house can be as daunting as those stairs in front of the house. Consider a hydraulic garage lift, especially if someone requires a wheelchair to get about.

Halls and Floors. Once in the home, turn on the light. Especially at night an older adult will find the abrupt transition from the bright porch light to the dark interior will make it hard for one's eyes to adjust, an invitation for trip or fall. For ease of use consider also replacing old light switches with rocker switches that are much easier for older, less facile hand to manipulate. Then, look at the floor surface as a potential obstacle. Throw rugs are just waiting for an older adult with unsure footing, and a fall is the outcome. Of if the carpet has been aging with the resident in an older home, there may be edges coming loose or seams that may trip the older adult who treads there. For any longer corridors or internal stairways, also consider hand rails for both walls. These rails can be the first line of defense for an older adult prone to slipping or tripping.

In the next installment, I will continue with a room by room walk through as you consider how best to refit your older loved one's home. I'll also add a web site that is full of useful resources for anyone looking to make it easier for older adults to remain at home and independent.
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.
The winter season will soon be upon us, so I have invited Elizabeth Carrollton of Drugwatch.com to guest blog on some of the fall hazards that are part of the ice and snow of winter in the Midwest.

Falls are a serious health risk for seniors. Each year, one of every three adults 65 or older falls, according to the Centers for Disease Control and Prevention. Nearly a quarter of a million of those seniors will fracture a hip when they fall, which requires surgical repair or hip replacement. Traumatic medical events of this nature can change lives, taking a major toll on mobility and health, so it's very important to take measures to help your senior family members reduce their risk of falls.

Strength and Balance Issues: Muscle weakness can make seniors much less stable on their feet, increasing risk of falls. Inactivity is often at the root of that weakness. Encouraging that older adult you care about to exercise can prevent balance and stability issues. Just 30 minutes a day of moderate exercise will do, which can be accomplished with a daily walk after lunch or an exercise class at the local senior center. If instability is already a problem, seeing a physical therapist to improve strength and balance should be a priority to prevent falls and serious hip injury.

Check into Nutrition: Poor nutrition is a common problem in seniors. Appetites tend to decrease as we age and digestive problems or other health issues can affect the body's ability to absorb nutrients. Checking into the eating habits of your loved one and, if necessary, ensuring that wholesome meals are provided can help, as can a good multivitamin supplement that has plenty of B-vitamins, calcium and vitamin D.

Other Safety Measures: Vision problems are frequently a factor in senior falling incidents. Vision can change rapidly once we reach a certain age, so regular eye exams are essential. Clearing the home of tripping hazards is important, like loose rugs or clutter, as is ensuring good lighting.

If a Fall Happens: Sometimes, even when the best care is taken to prevent falls, accidents happen. If your senior family member takes a fall, seeking a medical evaluation as soon as possible is important, even if there isn't an obvious injury. If there are signs of hip injury, such as pain, bruising or swelling, immediate medical attention is crucial. If the hip is fractured, your loved one will need surgery. If hip replacement is necessary, there are some things you should know about hip implants in order to help your loved one choose wisely. Several hip implant products, primarily metal-on-metal types, have been recalled lately over high rates of failure and serious complications. The latest recall involves the Stryker Rejuvenate hip replacement system, which was prone to corrosion and failure.

Some patients who received these faulty implants suffered metallosis, a serious condition caused by the accumulation of metallic implant debris in the body's soft tissues, leading to pain and swelling in the hip and in some cases, tissue death and bone loss. Avoiding metal-on-metal devices might be wise, to reduce risk of complications. Seniors who have already had one of these devices implanted should be monitored for any sign of pain and inflammation that might indicate metallosis.

- Elizabeth Carrollton writes about cautions regarding medical devices and drugs for Drugwatch.com. Please visit their website for more information.

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 their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com. Learn more about our Chicago senior services and how we can help you support your loved one.