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

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

In a season with snow already blowing, we may think more about "winter-proofing," but I would like to continue with "fall-proofing." In my last posting, I wrote about how common falls among older adults are and some home improvements that can reduce the risk. I would like to take this conversation a bit further by talking about what are referred to as the intrinsic and extrinsic risk factors for falls. You will see that these offer two more "big picture" ways to both assess an older loved one's fall risk and to safeguard against those risks. Intrinsic Factors: The intrinsic risk factors are those that an older adult carries with them wherever they go, the most common simply is age. With more birthdays will come a decrease in muscle strength and tone, diminished vision and a decline in agility. And with age will come some chronic conditions that may not have been an issue when a person was younger. Increased age also translates into decreased bone density which simply means that the falls that a younger person can incur without complications now can become a hip or long bone fractures for a more mature adult. All of these risks conspire to create challenges to an older person's ability to maintain their balance. Extrinsic Factors: The extrinsic risk factors are those that are introduced to the older person. Many medicines or treatments can cause dizziness by either reducing blood pressure or by interfering with the inner ear's balance. I talked about loss of strength as an intrinsic issue, but a loss of muscle mass in the feet for an older person whose shoes therefore do not fit as snugly can pose its own imbalance and fall hazard. Alcohol consumption can be an extrinsic risk as older individuals' tolerance for alcohol is diminished. And the dehydration that can come from alcohol or any diuretic consumption may cause dizziness. So, if you are a caregiver to an older loved one, what can you do to address what seem to be the human forces of nature and aging? Here are some suggestions from the Centers for Disease Control. Encourage your older loved one to: • Exercise. Regular exercise strengthens muscles and bones for better balance and resilience. • Inventory the meds. Ask a local pharmacist or their primary care provider to review all prescription and over the counter medications for potential interactions or unwanted side effects. • Schedule a regular eye exam. What your older loved cannot see can hurt them, so have their vision checked at least once a year. • Rise slowly. Encourage your loved one to slowly get up from a chair or their bed to avoid the light-headedness that can result in a fall. • Wear shoes. Shoes will give a surer footing both inside and outside. Barefoot or slippers do not give the support or sure footing of properly fitted shoes. • Turn on the lights. Check throughout your loved one's house to upgrade where possible to brighter bulbs and add lighting to any dark or shadowy areas. 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.
How many times have we all seen the commercial with the plaintive actor on the floor crying, "Help, I've _____ and I can't get up." No one would ignore a plea for help from an older person who has fallen and cannot get up. But a lot of caregivers may be ignoring a similar plea with all of the health threat that a fall can represent. It is just that this fall is in slow motion. And it goes like this: "Help, I am so fatigued that I don't feel like getting up." Tired often does not get enough attention in medical circles, but it is a common symptom reported by people age 65 and older. We tend to discount fatigue, because we cannot accept that a person who has retired and now enjoys six Saturdays and a Sunday every week could not be well-rested. And if you are a caregiver to an older loved one, you may find it a bit challenging to muster the sympathy for your older loved one when you already are stretched across your responsibilities for your children, your partner, your job and... Yet, we should all pay attention to the subjective complaints of fatigue in our older loved ones, because tired can be a symptom of more serious medical conditions and because tired can lead to serious physical decompensation. Let's start with the other medical conditions for which fatigue can be a warning sign. Perhaps the most common clinical condition that presents with fatigue is depression, itself one of the most common comorbidities of aging. Depression often can arise from the hallmark aspects of getting older - loss, diminished physical capacity and social isolation to name a few. Chronic fatigue also can be a symptom of sleep apnea, restless leg syndrome, fibromyalgia, chronic obstructive pulmonary disease and any number of heart conditions. Poor quality sleep may also be indicative of musculoskeletal conditions or pain. If your older loved one is consistently tired, it may be time to accompany them on a visit to their physician for an assessment and a conversation. Sleepiness can also be just one more step along the slippery slope to frailty. Fatigue can be a strong disincentive for your older loved one to be as active physically as they once may have been. Fatigue also puts a damper on appetite which in turn reduces the quality of the fuel the body consumes to run the body's engine which leads to increased tiredness and low motivation for physical activity. And all of this translates into decreased mobility and frailty. Medical professionals refer to frailty as a "pre-disability." So, if the tiredness has gone on for an extended time, begin to look for signs of genuine frailty. No surprise, the signs include exhaustion ("hyper fatigue?"). Frailty also is predicted by weakness in grip and slower walking pace. And by weakness, we mean a quantum reduction in ability to grasp, and by slower we are talking a fraction of former strides. All of these point to diminished physical activity. Think of frailty as one step away from a permanent reliance upon a walker or wheelchair. The next time you are speaking with an older individual who reports being consistently tired, it may be time to wake up and take stock of their overall health. 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.
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.
We all know that Boomers - who began reaching age 65 just two years ago - are the largest segment of the U.S. population. Aging boomers are expected to total about 71.5 million by the year 2030, but what you may not know is that as many as one in ten of the Silver Tsunami will be lesbian, gay, bisexual or transgender (LGBT). This is important, because the generations that preceded them who were LGBT simply accommodated the "closet" when they aged. Never mind the ageism and racism we still find in some quarters, a lot of the institutional providers for seniors may not yet have embraced a welcoming culture for people of alternative gender preferences. As a geriatric care manager, I see this as a perfect storm with three fronts, a storm which has the potential to create one of the largest threats to aging well - social isolationism. If you are a caregiver to an older LGBT partner or loved one, you will need to be alert to the potential challenges. For instance, there are likely to be limited or no programs for alternative lifestyle older individuals in rural or suburban areas. And the gay male experience of aging is exaggerated among men where there is a more pronounced premium on being attractive or desirable. Generally speaking being 40+ among gay men can be seen as equivalent to being 80+ in the straight community in terms of being marginalized. The social isolation that is a consequence of "premature aging" and marginalization also increases the gay population's risk for depression, substance abuse, low self-esteem or even suicide. The rate of suicide among gay men is about six times that of straight men. LBT women may have it even worse. More than one-third, according to recent surveys, say that they have not divulged their sexual preferences to their health care providers. They also are less likely than gay and bisexual men to have purchased long term care or life insurance. About one in five LBT women are caring for an aging partner, but they also feel less prepared financially than gay men for retiring. Put all these factors together, and the LGBT community is less inclined to seek attention for health issues for fear of hostile or judgmental providers. Poor health care translates into even earlier institutionalization in long term care facilities. Also, it is ironic that in national surveys that nearly three in four LGBT individuals anticipate that they will be caregivers to another person, but one in five are unsure they will be cared for themselves when the need arises. Adding to this potential caregiver shortfall, many gay couples simply do not have conventional family to care for them. If you are a caregiver to an LGBT elder, encourage the following: • They have a Last Will and Testament that is really according to their "will" o With clear advanced directives/living will • Their partner/spouse has Durable Power of Attorney (health and finance) • Informal caregiving arrangements are clear and followed • Priority rights for hospital visitation are followed • There is Joint Ownership of Property with Rights of Survivorship And for us all: Recognize that all humans deserve compassionate care which respects their personhood and their definition of family and their wishes. 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.
As you prepare for the big holiday feast and potentially the big snowfall that may come your way, we at Creative Care Management wanted to take time out to wish you happy holidays, good health, and an encouraging start to the New Year. This past month we’ve explored all the setbacks that might prevent maximum holiday cheer for the caregiver and how to overcome them. However, I cannot stress enough that the best way to overcome all of these obstacles is to remind yourself what these times are all about. It’s okay to be nostalgic about the past and allow yourself to feel what might be sadness and loss. But try to focus as much as you can on the present. Enjoy the time you have with your family and friends. Laugh, smile, and give yourself credit for making it as far as you have this year. Take time for yourself as needed – to breathe, to reflect, to remain centered.

If you know someone who is also a caregiver, here are some gifts you can give them in order to make their holidays easier.

Someone to listen. The best relief for a caregiver might be just having someone there to listen to their frustrations .

Support. The holidays can be more of a hectic time for caregivers. If you’re visiting a caregiver, offering to help around the house or taking care of some of the tasks on the caregiver’s plate might be an excellent present.

“Thank you.” Sometimes caregivers aren’t able to hear or see how much of an impact all of their hard work makes in tangible ways. Letting the caregiver know that their work is appreciated and that they’re doing so much good for their loved one may brighten up their holiday. It will serve as encouragement to keep going well into the New Year.

All of this said, whether you’re a caregiver or friend of a caregiver - take care of yourself and allow yourself a moment to rest during this joyous time.

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.
Yes, you are supposed to ask why being male and over 65 is a medical condition; so what do I mean by cure? The best "cure" at any age is appropriate prevention, and I would like to offer some prevention guidelines for any of you who have a loved one over age 65. I offer 65 because as we all age, what we should be screening tends to change along with the frequency of screening. I am starting with men in this posting, but I will offer a parallel "cure" for women in my next post. Blood Pressure - everyone should have their blood pressure documented annually, and hopefully by the same provider so that they can track any trends. If your older man already has diabetes or heart disease, this monitoring should be at much shorter intervals. Oral Hygiene - a cleaning and an exam once a year is the minimum, and most dentists recommend a cleaning twice a year. Appreciate that oral health is correlated with heart health, so consider your trip to the dentist to have more benefit that just a great smile. Cholesterol Levels - if your cholesterol have been within normal ranges in the past, you may need to check them only about every five years. As with blood pressure, however, if your older male has heart disease or diabetes, this should be more frequent. Colon Health - guidelines suggest annual stool sample screenings, but a flexible sigmoidoscopy is suggested only every five years and a colonoscopy every ten years. The U.S. Preventive Services Task Force has recommended talking with a provider after age 75 and no invasive testing after 85. All of this is much more aggressive for anyone with colon issues or cancer or who has a family history of any of that. Eye Health - a vision exam is generally recommended every other year as a screen for glaucoma or visual acuity, unless the older patient has diabetes. More frequent testing for a diabetic is recommended to watch for diabetic retinopathy. Immunizations - keeping current is the important part of immunizations. For pneumonia vaccines, every five years is recommended. Flu shots are an annual regimen given the variation in strains that are considered the biggest risks. A shingles vaccination may be a one shot matter, but ask your doctor, and a tetanus booster every ten years is recommended. For other immunizations or other infectious diseases consult a physician. Prostate Health - most doctors will test the size of the prostate during an annual exam, and the doctor also is the best one to advise on how often a patient should take a PSA test. Bone Density - although women are more at risk for osteoporosis than men, the risk increases appreciably after age 50. Taking in calcium and some vitamin D along with aerobic exercise will go far in maintaining bone health, but a physician may recommend how frequently to measure bone density. Everything else - annual exams are a great time to assess weight, height and hearing. It also can be a good time to check your 65 year old for signs of depression as well as go over all medications and any possible interactions or contraindications. 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.