depression

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

I have asked our vice president for geriatric care management and senior services, Dr. Steve Steiber, to share a guest posting about the recent Tylenol news. He has nearly two decades experience in pharmaceutical medical device consulting prior to joining CCM about 8 years ago.
By now most of you have heard the latest on the potential for possible deadly skin rashes owing to an allergic reaction to acetaminophen, or Tylenol as the branded medication is called. Before we all suddenly quit using this pain agent, it is important to understand the magnitude of the potential problem. And it all starts with how long Tylenol/acetaminophen has been available here in the United States. Tylenol turns 44 this year following its release to the market in 1969 as an analgesic that was quickly embraced for its ability to turn off the brain pain signals and relieve the consumer with minimal side effects. All drug companies are required by law to report all adverse events that could be associated with their drugs to the FDA. Now, FDA releases information that covers the period from 1969 to 2012 which show three types of significant skin reactions that have resulted in 67 hospitalizations, and twelve of these have resulted in patient deaths. Spokespersons have rightly pointed out that over the 44 year life span of Tylenol, to date, the drug has provided pain relief to millions and millions of people. In fact, it took that many cases of Tylenol use to find this many extreme reactions. To the twelve who died, the drug clearly should not have been used. Tylenol spokespeople maintain that any kind of rash or skin reaction ought to be taken seriously and a person should find an alternative to Tylenol. They conclude, in effect, that the benefits outweigh the costs. Now, the other panic button... Not two years ago, acetaminophen was linked to liver damage when used above certain quantities. FDA subsequently limited the milligrams of acetaminophen per dose to 325 milligrams. But that in itself is not enough. If you are a caregiver to an older loved one, be aware of how many doses within a 24 hour period your loved one is taking; that quantity should not exceed 3,000 milligrams. Sounds like an unbelievably large number, but we need to recognize that acetaminophen is not just a stand alone pain reliever. It also appears in cough and cold medicines, in sleep aids and in other pain medications along with opioids. If one takes two of these every 8 hours, and then takes other medications that may also contain acetaminophen in combination, it becomes very easy to meet or exceed the 3,000 limit. And as I have talked about in other postings, older individuals have less fluid in their tissues and they process foods and chemicals more slowly. So, arguably the total quantity of Tylenol intake ought be monitored more closely than with a younger person. So, let's use the occasion of this most recent panic on acetaminophen to resound the alarm on something we have already known. Maybe it is a good time to have a conversation with your older loved one and maybe even visit their medicine chest with them. Please let Steve know if you have any questions about geriatric care management, drugs, 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 elder care management experts, geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecaremanagement.com.
You have heard me make some pretty big claims, and you may think this one is over the top, but 80 year olds who run every day have the body of a 40 year old who does not exercise. I have seven suggestions that will help anybody to stave off the ill effects of aging and maybe even turn the clock back. 1. Re-engineer your Genes: We are programmed to age by losing about 5 pounds of muscle per decade and gain about 10 pounds of fat. Exercise experts tells us that we can retrain our muscles to act younger. In fact with just 6 months of strength training a body can learn to preserve muscle mass, in effect, rolling back the biological clock. 2. Re-learn to Lift Properly: Lower back injuries are among the most common maladies of older adults, because we do not lift correctly. Men should squat to lift with their toes pointing forward. Women should modify this with a slightly wider stance and with the toes pointing out more. 3. Confuse your Muscles. Mix up the exercise regimen so that your muscles do not stop using certain groups and overuse others. You have heard that doing brain puzzles makes the brain more nimble. The same can work for the muscles of the body by what trainers call "muscle confusion." The result is stronger and more agile. 4. Confuse your Brain too: Well not confuse so much as make both halves of your brain work with each other. If your exercise includes crossing your limbs over to their opposite side as one does in dance exercise or lunges or yoga, it further strengthens how your brain's hemispheres can work and respond to change. 5. The Important Muscle: When you work out aggressively, your heart works aggressively. Trouble is that most of us do not exercise the heart enough. Current guidelines suggest 150 minutes of cardiovascular exercise a week, but some new research suggest that optimal heart conditioning comes from closer to 240 minutes a week. More is better! 6. Impact is Good: Just as muscle density can diminish with years, so also bone density wanes over the years. This accounts for why astronauts lose bone density in zero gravity - no impact. Dancing, walking and jogging are essential for maintaining bone heath. 7. 10,000 May Not Be Essential: We have long heard that we are to take 10,000 steps a day. I know someone who tracks it with his phone, and there are people who wear pedometers to keep up the pace. Canadian researchers actually have moderated this to 7,500 steps a day - a bit over four and a half miles. Doing more is fine, but don't beat yourself up. This is where I have to add that you speak with your health care provider about any new exercise regimen just to be sure it is safe for you. But when your doctor says yes, look forward to winding back your clock. 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.
When you consider the place a typical senior calls home, it has not changed a lot since it was full of kids and a much younger family. But what may not have been a fall hazard back in the day might become one as parents age in place. This is a list of just some of the senior care precautions one should take to make home as safe as possible for an older adult whose feet just are not as nimble as they once were. Throughout the home:
In the bath:
In the bedroom:
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. Learn more about What We Do and how we can help you support your loved one.
To anyone with a loved one who has been diagnosed with Alzheimer’s disease we geriatric care managers work to give them options in the midst of losing their loved one a day at a time as the condition worsens. We get a profound sense of their feeling of loss, because the person they are seeing looks the same on the outside, but there is the continuing erosion on the inside. But what about the patient, the one who has the awful diagnosis? What do they feel? Clinicians tell us that in addition to the confusion, they will feel indifference, lack of interest, lack of enthusiasm, lack of concern, disinterestedness, unresponsiveness, impassivity, dispassion, lethargy, languor, ennui. And that detachment, that apathy, hastens the progression of the neurodegeneration of AD and leads to a lack of self-care and motivation. So, apathy may be a side effect of AD, but it also speeds up the neurodegeneration of the disease. "We have to look more closely at apathy, which is easy to miss because the apathetic patient is not the squeaky wheel," Prasad R. Padala, MD, associate professor, Department of Psychiatry, University of Arkansas, and associate director for clinical programs, Geriatric Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, Little Rock, told Medscape Medical News. Not only that, but there is hope for a treatment that can actually address the apathy and therefore the disease’s progression. It’s called methylphenidate (brand name Ritalin) and has been used for attention deficit disorder. It directly addresses and reduces the apathy, and in research it has been shown to improve cognition in older, community-dwelling male veterans with mild AD, some new research shows. Those in the study also showed improved functional status and fewer signs of depression versus those who were given placebo, or sugar pill. Researchers in the past have tried to treat AD patients’ depression in an effort to motivate patients, but they have had limited success. And there had been some other studies of methylphenidate, but the trials lasted only half or month or month and a half. The new study cited by Dr. Padala was a three month study and utilized a number of cognitive tests to assess changes during that time. Patients who received the agent showed improvement at both the two month and three month mark versus those receiving placebo. "Ritalin [methylphenidate] is used in children with attention- deficit/hyperactivity disorder, so we know it improves attention, but this really caught us by surprise, because it was much more than just attention," said Dr Padala. Scientists are looking to see if the results also can be found when methylphenidate is used with other dementias as well as if it works equally well among women and men. (The research here was just among men.). In this post and throughout the National Alzheimer’s Awareness month we will be offering a $10 discount off the retail price of our caregiver book on Alzheimer’s Disease: “How Do I Know You: A Caregiver’s Lifesaver for Dealing with Dementia.” If you would like $10 off the Amazon price, please follow this link and enter the discount code: ZH3VK3U6. 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.
As I look to the close of November which has been National Alzheimer’s Awareness month, I thought it would be helpful to allow someone who was diagnosed with has Alzheimer’s to give this devastating disease a voice. Richard Taylor, Ph.D., a psychologist from Houston, Texas, died in 2015 from cancer, but he also died with dementia. Early in the progression of his condition, he committed to writing about his experience so that others with a loved one who has dementia might gain some personal understanding of what dementia is like. When he was seven years into his diagnosis, at age 65, Richard Taylor wrote Alzheimer’s from the Inside Out, and he followed this with a monthly newsletter on the subject. The following is an excerpt from an edition of his newsletter in 2011: “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.” 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.

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