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

Three Words Are the Cure
Some have called it an epidemic. And it’s particularly virulent within the senior population. The epidemic leads to even...
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July 16, 2023
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Spring Tips for the Holiday Caregiver
We all know that that Spring in the Midwest isn’t on a straight line from Winter toward Summer, but...
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March 28, 2023
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How (NOT) to Worry, Stress or Be Anxious
It’s not so much whether you’ll have worries, be stressed or feel anxious…it’s how you’ll manage your worries, your...
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March 21, 2023
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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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Ain’t No Sunshine…
…When She’s Gone.” Or how about, “You are My Sunshine, My Only Sunshine?” or “Here Comes the Sun?” or...
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February 21, 2023
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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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Why Mister Rogers Was Right
Mr. Rogers Told You…but were you listening? And it wasn’t just once that he shared the message; it was...
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August 2, 2022
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Why a Flamingo Stands on One Leg
You’ve all probably heard the old joke about why a flamingo stands on one leg…and we have all seen...
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June 28, 2022
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What You Can and Cannot Change About Dementia
Let me start with the short answer to a question we raised in the email announcement of today’s post. ...
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June 21, 2022
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Age and “Long Covid”
There seems to be a cliché for everything, so we’ll start with this go-to for COVID: “We’re not out...
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June 7, 2022
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In the Caregiver's Words

Recent Client Praise

When we speak of dementia, it almost invariably is about Alzheimer’s Disease, but there are multiple types of cognitive decline that fall under the heading of dementia. In fact, the second most common dementia – accounting for 15-20 percent of all dementia cases - behind Alzheimer’s Disease actually has an important attribute that its more common and better known sibling does not have. Vascular dementia actually can be prevented in much the same way that cardiovascular disease can be prevented…through diet. Over the past decades, we have radically improved lifestyle and health style understanding of what causes heart disease. By extension we also have improved our understanding of vascular health which means we are better able to prevent heart attacks/myocardial infarctions as well as strokes. Most people, if asked, can tell you what their good cholesterol (HDL) and bad cholesterol (LDL) numbers are or at least if they are “good” or “bad.” Surgeons have become quite talented at eliminating blockages around the heart and also in addressing some of the potential vascular threats that could become strokes. They have not become quite as good at preventing or removing the threats of mini- or major strokes. But the vascular element that is shared across the types of strokes could be lumped into two categories of diet that we could refer to as “heart healthy” and “head healthy.” But just as there are people who don’t pay much attention to their diet and exercise as ways to live healthier by being thoughtful of their heart health, there may also be a shortage of people who will work to maintain “head health.” Scientists in France examined a large sample of over 1,600 people whose mean age was 72.3 years and 63% of whom were women. They looked for diet differences that could predict “cardiovascular disease burden” (CVD) which, in turn, could predict vascular dementia. People who were under 75 years of age who also consumed two to three portions of fish weekly helped reduce their CVD risk for vascular dementia as much as having hypertension increased the risk of vascular dementia. For people over 75 years of age the effects were not as strong. So, what does this tell us? First, one has to start early in a healthy diet to have a significant effect on brain health. But it likely is never too late to change diet for the better. You just get more return on your dietary investment before age 75. Something for both you and your older loved ones to “chew on.” Charlotte Bishop is a Caregiver Coach, an Aging Life Care Advisor, 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. She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.
Who thinks it’s a good idea to just blow off Valentine’s Day? I am guessing not many hands will go up for that idea…some might even say that their spouse will kill them if they don’t bring forth at least a sentimental thought. Never mind the flowers, candy or sparkler. Just forget about the day later this week. Well, that probably is what some of us do every day … with our hearts…we just forget about our hearts. And that is why heart attack and stroke are the top two causes of mortality in the United States. So, what do you do to remember of your hearts? Earlier this decade the American Heart Association came up with seven habits to embrace to help avoid heart attack and stroke. You don’t have to wait until February 14^th to start:
1. Exercise - there is a new exercise program recommended almost every week, it seems, but the simple fact is that getting your body moving regularly and vigorously supports a healthy heart…and the rest of the body with it.
2. Eat right - we all know what the good foods are and what the bad foods are; make a healthy diet your Valentine’s Day resolution.
3. Lower blood pressure - you will need a medical provider to give you your actual numbers (not to exceed 12/80), and if your numbers are high stick to the prescription you will be given and follow #1 and #2 along with losing weight and cutting your salt or sugar intake.
4. Lower your cholesterol - focus your diet on fruits and vegetables along with fish, nuts and soy; your doctor can tell you if a statin is indicated.
5. Manage your blood sugar - sugar is not your friend, so limit its visits to your body in order to keep down your weight and not beat up your pancreas…your heart will thank you.
6. Maintain a healthy weight - losing weight should be an outcome of the first 5 instead of a goal in itself, but keeping your weight down lightens the workload for your heart.
7. Don’t smoke - smokers have double the risk of a heart attack and triple the risk of a stroke over nonsmokers; it is not just your lungs that suffer if you smoke.
So this list is the short version of a lot of material I have covered in other posts. If you have questions, you can use key words to search the blog for a related post or you can go to the American Heart Association web site. Make February your heart-healthy month! 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.
What is the most widely used drug by seniors? It’s the same one that is most widely used by all adults: caffeine. It’s estimated that about four in five adults world-wide consume at least one caffeine-containing beverage daily. I am going to share with you not one, but three quizzes on this go to “medication.”
1. Considering caffeine and some common medical conditions, which of these is true?
a. Patients with chronic kidney disease who drink caffeine have significantly lower mortality.

b. Caffeine improves motor function in Parkinsonian patients.

c. The risk for rosacea is dramatically increased with caffeine consumption.
Odd as this may sound, it is “a”. People with chronic kidney disease have a lower risk of dying if they consume caffeine. It was a study among 5,000 chronic kidney disease patients, and those who drank caffeine drinks had a 25% lower risk of dying. Drinking more caffeine did not get more benefit from the caffeine.
1. Which one of these is true about caffeine and heart health?
a. Consuming unfiltered coffee significantly increases the bad cholesterol and triglycerides in the blood stream.

b. Moderate caffeine consumption increases the likelihood of elevated blood pressure.

c. Regular caffeine consumption increases the deposits of calcium in the arteries.

Again, it is “a”. It is all about how the coffee is prepared, because unfiltered coffee can have some bad effects on blood cholesterol. The lesson here must be that filters good; no filters bad.
1. Although this may vary by individual, what is the “toxic level” of caffeine in the blood system of a healthy adult?
a. 400 mg per deciliter.

b. 600 mg per deciliter.

c. 800 mg per deciliter.
Okay, you may be on to me if you said “a”. There is variability across individuals, but 400 mgs is the limit, so more of a good thing can be a bad thing. And the very young have even lower threshold which is a bit scary with all the high caffeine canned beverages available to your people these days. By now, you have to be wanting to know how many milligrams in a cup of caffeine. The answer is about 95 milligrams, but of course, that may vary depending on who is making the coffee. Now, how did you do on the test? If you are satisfied with your score, figure out how much caffeine you have had so far today to see if you should reward yourself with a trip to the coffee maker. 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.
You all have heard about the side effects of FDA-approved medications that make their sales pitches on your television. First, however, you see perhaps a bleak picture of what a medical condition can represent for a patient, but once the medication is brought into the picture, everything brightens and you want to look as healthy and happy as the person on the screen. A voice then slips in a sometimes substantial list of side effects that may be associated with the branded medication being pitched. Research among consumers tells us that the more significant the side effects can be the more confident consumers are that the therapy will be effective. But the side effect that is never a part of this 30 of 60 second advertisement is the bite it will take out of your wallet…although some vague promises often are made about how “if you cannot afford ___, the manufacturer may be able to help.” With the most recent FDA approval that the last two installments of my Blog have focused on, the conversations around what one physician calls the “financial toxicity” of therapies is ramping up. This particular physician was referencing some of the cancer treatments currently being used, treatments that had some positive potential, but had hefty price tags. The Alzheimer’s drug’s (Aduhelm) annual sticker price is estimated to be $56,000, but that dollar amount is likely to vary widely depending on the insurance coverage of a patient. The folks at the Centers for Medicare and Medicaid Services are looking at an annual cost of $29 billion a year for just Medicare patients. So, even Congress is now looking at the price of this medication that was approved based on mixed reviews of its efficacy at best. So, my takeaway for all of you who have an older loved one is to have a serious conversation with your loved one’s physician any time a new prescription is mentioned. Do your due diligence on line to understand as best as you can the efficacy of this new drug, its potential side effects and how it stacks up against what is available currently (recognizing the current drug likely is available generically…and cheaply). Then ask the doctor about price…after you have researched the price yourself. I don’t ever question the doctor’s prescriptions, but I often ask about what they know of price, of the head to head comparisons…and what they would recommend were it their older loved one. And, in fairness, the pharma reps who call on physicians don't talk about price if they can help it, so everyone is in the dark. You may be surprised at how rarely they know what the price actually is. But it’s worth asking. Charlotte Bishop is a Caregiver Coach, an Aging Life Care Advisor, 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. She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.
You may recall nearly two decades ago a George Clooney movie came out that revolved around some men who made their living as fishermen. It was called “The Perfect Storm,” and the title drew upon what happens when not just one storms hits a ship at sea, but two storms. It was quite dramatic. Well, Alzheimer’s disease is like that Perfect Storm, but it is not just two storms. Those with dementia who are 65 years or older have not just two storms; they have an average of four chronic conditions – what doctors call comorbidities – along with the dementia. An average 65+ year old individual has about two comorbid chronic conditions. The most common comorbidities for Alzheimer’s patients are diabetes, urinary infections and depression, but there are also other cognitive aspects to dementia that impact more than memory. We often refer to the manifestations of Alzheimer’s disease as “cognitive impairment.” But cognitive impairment isn’t just about memory issues. If you have a loved one who has had the diagnosis, there is another facet to cognitive impairment called apraxia, and it is the most common manifestation of cognitive impairment. The healthy brain is a complex data processor that routinely connects things. It knows what a fork is and it knows food on a dinner plate when it sees it and it also knows how to use the fork to transport the food to the mouth. Rinse and repeat. But apraxia can put up a significant road block between those two cognitive processes. The brain sees the fork and it sees the food and the brain then comes to a halt…at least until someone helps to move the fork with the food to the dementia sufferer’s mouth. Clearly the apraxia can take on a number of basic forms, and understanding what your loved one is now unable to do can help in getting assistance as well as treatment for your loved one with dementia. Health care providers categorize apraxia along these three lines:
- “Ideational apraxia” describes the cognitive deficit of the person unable to process what an object is for…they see a car key, but don’t know how that enables driving a car.
- “Ideamotor apraxia” describes the kind of activity for which a person with dementia needs to be “primed” to do. They recognize a hair brush, but need to be prompted in how to use that brush for their hair.
- “Dressing apraxia” describes all the roadblocks in what used to be a taken for granted process. Think about seeing buttons, but not remembering how they align with button holes…or how a zipper zips, etc.
These are all important for the caregiver, because if you understand the deficit you can help your loved one and you to minimize the frustration of what have become mind boggling tasks. It will help you in asking for the appropriate assistance in respite or residential care. You can explain that “mom needs help dressing in the morning,” and the staff will understand and be proactive. Or “dad will need help with dinner and cutting meat,” and they can help dad do as much as possible on his own and with the least embarrassment. Within all of this it is about maintaining quality of life for your loved one with dementia, and that takes patience. And your patience can come from knowing what to expect and how to respond. Here are a couple resources on how to address apraxia: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4341309/ https://medlineplus.gov/ency/article/007472.htm. 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.
I have been hearing that the web resources I have been offering in my postings have been informative and helpful. I am regularly reminded that one of my principal roles as a geriatric care manager is to be a resource directing people to others. And that those “others” are not just health care providers.

In keeping with that notion, I have compiled some web resources here that may prove useful for elders and others with special needs who may also be on limited budgets.

These are just a few of the sites that you may find .useful, but may not always pop up in a web search engine when you are looking for answers to your elder law questions:

AARP has a program called Legal Counsel for the Elderly (LCE). You may wish to join AARP – if you have not already – to get full access to this program, but it has much to offer individuals who wish to understand their rights as well as how to get legal paperwork for an elderly family member or loved one in order: Legal Council for the Elderly.

For the latest legal perspectives on legislation affecting elders, legal-financial challenges facing elders and more, you can also go to the web site for the association that represents elderlaw attorneys, the National Academy of Elderlaw Attorneys (NAELA). Simply go to: NAELA Legal Affairs.

The National Senior Citizens Law Center is a non-profit organization whose principal mission is to protect the rights of low-income older adults. Through advocacy, litigation, and the education and counseling of local advocates, we seek to ensure the health and economic security of those with limited income and resources, and access to the courts for all. Go to:http: National Senior Citizens Law Center.

At all of these sites you will also find directions to professionals in your geographic area as well as other web resources that you will find useful.

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.

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