Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • Alzheimer’s diseaseChicago's Geriatric Care Manager Center of Excellence

Get Smart!
Would you look for advice from an investment counselor who simply promised a lower rate of loss on your...
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August 24, 2021
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Breaking News for Alzheimer’s … part 1
The big splash on the medical news this past week gratifyingly was not COVID-19, but instead an approval of...
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June 15, 2021
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To B or Not to B12?
I have written a lot about dementia over the years as well as other issues that can mimic the...
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May 11, 2021
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Diseases that Mimic Dementia…But Are Treatable-part 3
As you can tell from now a third installment about other medical conditions that can mimic dementia, it’s not...
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March 22, 2021
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Diseases that Mimic Dementia…But Are Treatable – part 1
Dementia is the condition that adult Americans fear the most, and tragically there are conditions that can give a...
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March 9, 2021
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A Game Where Everyone Wins
Pick your metaphor. If you want your knife to slice easier, you sharpen it. If you want to improve...
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March 2, 2021
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Would You Want to Know?
Americans fear Alzheimer’s disease more than any other condition including cancer, heart disease, stroke or any other life-threatening diseases...
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February 23, 2021
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What Tony Bennett Can Teach Us
Tony Bennet has arguably been one of those “one in a million” kind of musical talents, but sadly he...
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February 9, 2021
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Better than a Resolution
After nearly a year of a pandemic and its quarantine, we are all ready to get back to normal. ...
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January 12, 2021
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One More Sign of COVID?
I have written about Alzheimer’s disease…a lot, its warning signs and caregiving probably more than any other topic. Even...
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October 6, 2020
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In the Caregiver's Words

Recent Client Praise

For a what, you may ask? I have either talked about or invited elder law attorneys to talk about advanced directives like Do Not Resuscitate (DNR) orders, living wills, powers of attorney and other documents that will help to assure that an older adult's end of life wishes are honored. And that is where POLST comes in. It is a standardized (by state) document that walks through a patient's wishes for end of life care that falls short of a DNR. POLST is Physician Orders for Life-Sustaining Treatment. The majority of states have enacted such legislation following the lead of Oregon in 1991. It is standardized for the state and is typically a brightly colored single sheet so that it will stand out in a patient's file. (Illinois' form is two pages.) Not only doctors, but first responders and other clinicians will understand the instructions of the POLST. It is not for everyone, but if your older loved one is frail or suffers from a life-limiting illness, you should consider having a talk with your loved one's physician along with your loved one. If your older loved one's physician can honestly say they would not be surprised if that person died in the following year you would be well-advised to start the conversation in order to have the POLST on file. What would that look like in a standardized form? In Illinois, the form asks for all the usual patient-identifying details, contact information for your older loved one's preferred contact, physician contact information and the physician's signature. The rest is pretty much a check list. Check yes or no if your loved one agrees to having CPR in the event their heart stops. If your loved is still breathing and there is a pulse, check yes or no for comfort measures only, for limited added interventions or for intubation for ventilation. To these the physician can add other measures. Finally, check yes or no for what kind of nutritional supplements are desired if your loved one cannot be fed by mouth. The rest is referred to as documentation that this discussion occurred between competent adults. To see the Illinois form, please go to this link (http://www.idph.state.il.us/public/books/dnrform.pdf) As you can imagine, life or end of life decisions are not so cut and dried. There are some potential ethical issues to be addressed here. Clear and sensitive discussion needs to occur among you as the caregiver, your older loved one and the rest of the family. And then there is the real question of whether your older loved one can really understand all the medical speak. It may prove helpful to bring in a professional counselor to talk this through with the family unit so that all voices are heard and all questions or objections are raised. Most important, however, is that your older loved one feels that it is they who are in charge. This ultimately is not about the doctors or the family; it is about the care receiver.
So last week, the turkey turned out really great, the pumpkin pie was awesome, the home football team prevailed, and most of the family showed up for the annual feast. Everybody ate, laughed and played together nicely, but you feel like crying. It just was not the same without mom or dad or some other loved one in the picture. You're not alone if you have this feeling of being let down or even depressed as you try to put on a happy face and enjoy the holidays that used to be so wonderful.

Psychologists call these responses to holidays or other special times of the year "anniversary reactions." The holiday itself may bring back memories of a time when there was a lot to enjoy - which makes holidays without a loved one all the more empty now that they are gone. Or the holiday may be the time when your loved one passed, and it is hard to find the good times in what now is a memory of profound loss.

It is not just about dates on a calendar. There are other potential triggers that bring on a sense of grief and loss almost as fresh as the moment of the initial loss itself. Certain places when we come "home for the holidays" can be triggers for melancholy. Certain smells like those of a favorite dish or of the frost in the air or the candle smoke as the Chanukah candles burn down or the Christmas tree that may soon stand in the corner. And there may be the sounds that open the flood gates as we all shift to the holiday music that will be with us until the day after Christmas. But you don't have to simply resign yourself to the blues; here are some ways to reconstruct a more positive version of your holidays.

1.    Crying gets the sadness out. It's okay to be honest about how you feel by simply letting the emotions out. Crying can be a great emotional release and a relief that will let you then get back on with more positive holiday emotions.

2.    Reflect back on the positive activities that you had enjoyed with your deceased loved one. Find someone - children or grandchildren - with whom you can share the activities, and you may find they begin to give you a new satisfaction.

3.    Memory of loss can stand in the way of other positive experiences that preceded the loss. Talk with close friends or relatives, some of whom may have shared those positive events. By reconstructing the positive, you re-experience moments you had cherished with your loved one.

4.    Collect some of the photos of the good times you have enjoyed with your loved one. Or maybe it is a letter written or other memorabilia that you can place in a special box or album so that you can have stimuli that help to re-experience the moments that have been special.

      These suggestions are not intended to take the place of professional counseling if your depression weighs heavily on you, but they are steps that may help restore the "happy" in your holiday.

      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.
As November (National Alzheimer’s Awareness month) is winding down and we continue to see efforts to educate people about this disease, it is easy to lose sight of why it is so important to build awareness year round. For some, it may seem like people are generally aware of the damage Alzheimer’s can cause, the fight for a cure, and the advancements for treatment that could be made. However, there are many things people may not know about the disease and assumptions that could be debunked by those who experience Alzheimer’s in their daily lives.
1. Most cases of Alzheimer’s aren’t detected until its late stages – meaning people usually either don’t spot the symptoms or they ignore them to be a sign of old age. In some cases, people feel like Alzheimer’s cannot be treated so they bypass medical assistance all together.
2. There are treatments for Alzheimer’s – in that you can delay its progression significantly. Medical advancements have helped patients live longer when they maintain healthy habits and keep careful track of their condition.
3. Certain practices earlier in life can increase a person’s risk for Alzheimer’s disease, such as not eating right or not getting enough exercise.
4. In some cases, people who have experienced Alzheimer’s – sufferers, their families and friends - are afraid to talk about the disease. Sufferers may feel they might be treated differently.
Of course, there are more reasons to educate people about Alzheimer’s and participate National Alzheimer’s Awareness month. There are also even more reasons to continue after November is over - as often and as much as possible – for families, sufferers, and caregivers.

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.
Yesterday, we talked about dealing with stress and melancholy during the holidays. Here are even more tips that you can use to cut down on stress and post-holiday blues while caring for a loved one. Remember, it is okay and understandable to feel down during and after the holidays. But the more you are prepared, the better your holidays may be.
1. It’s okay to say no. When it comes to holidays, if you feel the need to cut down on the amount of gatherings you’ll be able to attend this year – there’s no need to worry. Pace yourself – you’ll have a much better time, especially you tend to feel overwhelmed when running around place to place.
2. Keep gatherings small. You may find that scheduling festivities with smaller groups is much easier to manage as well as much more comfortable for you and your loved one.
3. Communicate. If you plan to host a gathering or go to one, be sure to talk to your loved one about it often so he or she is able to anticipate being social. In addition, talk to your guests beforehand about your loved one’s condition if they haven’t visited in a while.
4. Give yourself and your loved one a break. Realize that it is okay to take time out for yourself as a caregiver. You may find that setting aside a bit of time to relax is just what you need to reduce stress levels. Recognize that your loved one may need some quiet time too.
Last but not least, monitor how you’re feeling as you go through the holidays. If you’re feeling melancholic during festivities because you’re remembering how things were in the past, understand that this is okay and you should let yourself feel them. However, it may be a matter of focusing as much as you can on positivity, your loved ones, your happiness, and the present moment. You can find more these tips at Caregiver.com.

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.
I have written in a number of blog postings and we also have had a number of guest contributions on how to facilitate good residential/moving decisions. There is no doubt that a senior residence takes away the burden of the household chores like mowing lawns, shoveling snow or heavy cleaning.   It also offers a greater sense of security, because the campuses of these centers typically are well-insulated from most community threats that can unsettle older adults aging in place. But as a caregiver to an older adult, don't think that all possible worries or headaches are going away.

            Here are some suggestions based on my experience with senior residential living:

1.    What happens if your older loved has a fall or other accident that demands attention? You will want to speak with the staff at a facility to identify what kinds of alert systems they have in place, who responds in the case of an emergency and where a loved one may be taken in the event of a medical emergency. You may find that you need to request or supply an alert mechanism for your loved one.

2.    Who is coordinating your loved one's medical care? Some - but not all - residences have transportation to and from medical appointments, but others simply leave that to the individual or family unless they are in assisted living. Check into the options available and if someone actually accompanies your older loved one to a medical appointment, be sure they record what is discussed, ask appropriate questions and be sure that all the providers are communicating and coordinating with one another.

3.    Is there a care plan for your older loved one? Almost all facilities have some level of health care present such as nurses who are available to check in on residents. Many also have physicians or other providers who will pay visits to attend to certain medical needs like foot care. But a care plan is really all about establishing clear goals for your loved one, identifying what will be done to reach the goals and who is responsible for what parts of the plan. Otherwise you are at risk for simply bouncing from one crisis to another.

4.    Is there stimulation for your loved one? One of the great things about senior communities is the relatively easy access to all those neighbors within a protected environment. There are structured activities and events on a fairly regular basis, but who really is attending to and caring for your loved one? The staff at most facilities are just too stretched to provide much personal attention to each of the residents, and without the stimulation from regular interpersonal contact an older loved one declines. If one does not use their social skills, they lose their sociability. You may need to get an aide to spend a certain amount of time with your loved one regularly to help them to be engaged.

            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 Charlotte (info@creativecasemanagement.com ).
Do you have pain in your back, particularly your lower back - that area around your belt line or slightly lower? If not, please consider yourself lucky, but also just wait. According to some experts, about four in five Americans will at some point in their lives experience low back pain...chronic low back pain. What may be surprising is that most of these cases have no specific cause that can be diagnosed. As a geriatric care management professional, I hear about this a lot. And if you are a caregiver to an older adult, you may hear this from your loved one as well, or you may be experiencing the pain yourself. So, as a consequence, doctors are seeing more and more of these patients, and without having a specific cause to address they may be tempted to treat the pain. While surgery may be an option for serious spinal conditions, most of this low back pain does not reach such a level of acuity to justify surgery. A lot of doctors have started giving injections into the site with anti-inflammatories, opioids, or in some cases vitamin B-12. Injections would be great if they worked, but there is not much evidence to suggest that the injections are any more than a short term fix for the pain. A research commentary, reported earlier this summer in the Journal of the American Medical Association, says that there is almost no evidence in the larger literature that injections have any positive effect over the long term. Other reports suggest that they likewise do not substantially reduce the likelihood of surgery later. There was one research study published in February that actually showed the opposite; patients with pinched nerves in their lower back receiving injections showed less pain relief than a control group who received no injections. The JAMA authors are now recommending against injections. What are the alternatives? Here are :
1. For those with above average weight, especially belly fat, weight loss can be very beneficial.
2. Strengthen the back muscles with more exercise. It could be as easy as taking longer walks, swimming or riding a bicycle.
3. In a journal called The Clinical Journal of Pain, doctors recommend yoga or Pilates as a somewhat more aggressive approach that has showed good results.
It does not have to be confusing. According to some physicians, we seem to have made a symptom into a diagnosis. That is to say that pain is the result of something being wrong, and we ought to treat the source of a problem. Yet, most doctors do not like to prescribe long walks or losing weight, because patients ask for a "quick fix" to their problems. We have come to view pills as a solution to our problems instead of changing our lifestyles. I have talked in other postings about helping older adults to have more active lifestyles, because it will be helpful for their sense of well-being. Being more active, it seems, also will be good for addressing low back pain. Do it in small measures at first, but be persistent and grow the number of minutes, laps, blocks or other measure of investment in an active life. If you as a caregiver are walking with your older loved one, you also may find that the social activity of conversation is a health boost. Make sure their shoes give them solid support. The pain may not totally go away, but chances are that there will be relief at least during the exercise. And the relief can continue to grow. Charlotte Bishop is a Geriatric Care Management professional 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.