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

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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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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Abuse Thrives in Pandemic
Guest post author Gregory Peebles is a team member at CCM whose work focuses on helping aging adults and...
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June 16, 2020
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In the Caregiver's Words

Recent Client Praise

In a posting last week, I shared some advice from a Senior Relocation Expert on how to help an older parent or loved one make their decision to move (or not) from the family home. Picking up where we left off, I have had the good fortune of meeting with Erin Marcus, a Transition Specialist with a company called Caring Transitions. ( www.estatemoveglenviewil.com ). I posed some questions about the move itself and how a Transition Specialist can make it as easy as possible for a senior dealing with a life's accumulation of "stuff."

            What are the major obstacles to making a successful move?

"It most often is the emotional attachment to the 'stuff'. If you are helping an older person prepare for a move, be cognizant that you are dealing with an adult...it is their stuff. You shouldn’t just be making decisions for them on what to keep based on what makes sense to you. Not only that, but it really is not even about the object; it is the emotions and memories associated with the object."

            How do you help an older person adjust to a new home?

"I have found in most homes, there is an area that you can tell a person spends most of their time. It may be the den or the area around a television, for example. When we help someone move into their new home, I make it a point to recreate that environment so that they immediately have a piece of their old home in a new home."

            Is a move different if the senior is moving to senior residential housing?

"Look for not where you will sleep at night, but how you will spend your days. Somewhere close to family…even closer to children tends to rank high. And Senior residential communities tend to really meet the social needs or an older adult."

            Can you give an example of what makes for a really successful transition?

"It really begins in the sorting process. It can make it go much more quickly with a third party involved. It eliminates the arguments. With the benefit of a third party helping, you relieve the stress on the family members to let them worry about the people and not the stuff."

            Any other insights from having been in the business?

"The first month in the new home is extremely important and can set the stage for a long time to come. Its important the people know they are not being put away or being ignored. Also, keep an eye on the routine and the adjustments that are being made."

Erin Marcus is the president of Caring Transitions, Chicago & North Suburbs.   Erin helps families through the process of moving, downsizing or liquidating their items as they move through life’s transitions. He can be reached at emarcus@caringtransitions.net or 224-374-1996.

            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.
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.
I have written in past postings about some of the interactions between medicines that older adults may see if they are placed on multiple medications for their multiple ailments. But it is not just interactions that should get our attention. As a geriatric care manager I am increasingly focused on my clients’ medication even if they are on only one prescription. The reason for my renewed focus is in that flimsy sheet of paper with the really small type that you will find included with every prescription a pharmacist dispenses; it is called the package insert. And beyond reminding you how and when to take the medicine, it gives the patient and their caregiver some important warnings about the potential for side effects that particular medicine has.

Dr. Jon Duke of Indiana University and some colleagues reported recently in the Archives of Internal Medicine on the startling rise in the number of side effects that medications are listing in the package insert. We have all seen the television advertisements with those incredibly long lists of side effects they include at the commercial’s end. Dr. Duke and his associates found an average of 94 side effects for new drugs released following the Food and Drug Agency’s guidelines for package inserts. And these labels make for some interesting reading with side effects like “compulsive gambling.” But they also list some side effects that are both troubling and widespread. Who wants to feel worse after taking a medicine, but nausea is found in 75 percent of the drug labels according to Dr. Duke.

One of the reasons the lists are becoming so long is that companies are listing everything that showed up during the clinical trials required for the drugs’ approvals as well as anything reported to them after the drug began to be prescribed by providers following approval. Drug companies defend this relatively new and exhaustive approach to listing side effects as a fair warning to patients and their physicians, but Dr. Christine Cheng wrote a letter that appeared in the same journal issue as Dr. Duke’s article. In her letter she talked about the “information overload” that this labeling represents. These exhaustive listings of everything and the kitchen sink may include side effects that are not at all related to the drug itself, and only confuse prescribers and patients alike. You can find in the same drug’s label a listing of both drowsiness and insomnia, for instance, or diarrhea and constipation.

My recommendation to caregivers and the elders and others for whom you care is to talk with the prescriber or go on-line to read what other patients on the same medication are experiencing. Find out what is likely to have a real effect on the elder in your care. There probably is no medicine without side effects, but instead of being over-informed, you need to be well-informed by the providers who care for your elder or other person with special needs.

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.
Steve Steiber, Ph.D., our vice president for senior services, completes his two part posting about how time of day of dosing can impact the effectiveness of a care receiver's medications. Steve has more than two decades experience in pharmaceutical consulting prior to joining CCM about 8 years ago. He reports: In the first installment on this subject, I had written about some of the general rules regarding when to take medications that are dosed once a day. In general, once a day doses should be taken at night. Let me get down to the differences across certain classes of drugs and the conditions they treat.
- Cholesterol - If your older loved one is taking any of the statins (e.g., Zocor, Lipitor, Crestor, etc.) to lower their cholesterol, they should be taken before retiring at night. Oddly, while much of the body is shutting down a bit, the liver produces more cholesterol after midnight than any other time of the day.
- Asthma - This condition is an early riser with a real spike in attacks between 4 a.m. and 6 a.m. Given how long it takes the inhalers to max out, it is recommended that the inhaled dose be taken in the afternoon in order to cover the early morning risk interval.
- Allergies - Allergic reactions will climb through the night and peak in the morning, so help your older loved one to take the single dose (for once a day) or one of the doses if the medication is a twice daily dose before retiring for the night for best coverage.
- Osteoarthritis - Dosing for this one should be dictated by when your older loved one is most active and will therefore be most pained. Read the label to see at what intervals the NSAIDs may be taken and back off from the high pain point by two to four hours.
- Reflux - There are two kinds of medications: proton pump inhibitors (PPIs) and H2 antagonists. PPIs are longer acting but slower to build up; once your loved one has reached an effective level, be sure that they dose before dinner so as to keep up the dose during the last meal of the day and through the night. With H2 blockers, have them dose as much as an hour ahead of dinner in order to cover the meal and night time. Why night time? Two to three times as much acid is produced in the stomach between 10 p.m. and 2 a.m. than at any other time.
- Hypertension - This gets more complicated with age. Have your older loved one take at least one of their medications before bedtime to cover their sleep time and the early morning spike. Younger individuals will have a natural lowering of BP at night, but older individuals with high BP may not have this dip, thereby exposing themselves to a greater risk of a cardiac event overnight.
As I emphasized in the first part of this series, be sure that you or your older loved one consults with their doctor before making any changes in their medication dosing. Be prepared also that older physicians simply may not be aware of some of this more current research on medicine and the body's clock. Please let Steve know if you have any questions about drugs, their side effects or the unique medical challenges faced by older adults or others with special needs. Please email to: Steve Steiber.
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.
Everybody forgets something! There is a heightened awareness - even fear - of Alzheimer's or other forms of dementia especially as we all advance in years, but simple forgetfulness does not inevitably lead to a dementia. And if you are a caregiver, the older adult in your orbit may be very self-conscious or worried at having misplaced the car keys. Or maybe it is blanking on a favorite author or the name of a friend that they happen upon on the store. No one of these events means that dementia of any sort is encroaching on their faculties, but sometimes it is not enough to reassure an older adult that it is not what they fear. It can be helpful, however, to take specific actions that are known to help keep one's brain healthy and sharp.

            Let me share five helpful tips from a well-regarded neurologist named Dr. Majid Fotuhi. You may have seen him on Dr. Oz, if you follow the program. Some say Dr. Fotuhi's advice can even prevent Alzheimer's; you be the judge. At the very least, these steps can help to strengthen the brain of virtually anyone who puts in the effort.

1.    Cross-Train: Anyone who exercises routinely knows that it is important to trade off the activities of your work out; they call it cross-training. Try changing which hand you use to comb your hair or take a different route to the store or use a soup spoon with your non-dominant hand. It is not easy, but it challenges your brain to learn something new, and as the brain adjusts to this shift it rises to the challenge by using areas of the brain that may have been under-utilized before.

2.    Relax: Stress is not just bad for your cardiovascular system; it is harmful to the brain because it releases a stress hormone called cortisol. So, several times each day, go to a quiet, darkened room and practice deep, slow breathing. Change out of clothing that may be restrictive and remove your shoes to signal your brain you are serious about relaxing. Do this for seven minutes.

3.    Mnemonicize Something: Okay, so the real word is simply "mnemonic. Challenge your brain to remember five spices from a recipe by making a word out them: Salt, Pepper, Oregano, Tarragon, Sage. See how long you can make the word or use the first letters to make a silly sentence.

4.    Increase Blood Flow: If your doctor says you are sufficiently healthy, walk up and down the stairs a few times, do ten push-ups, or do twenty sit-ups. All of these will raise your heart rate and increase blood flow to the brain, and that will grow new brain cells.

5.      Infuse DHA: There is a nutritional supplement called docosahexaenoic acid which is an omega-3 fatty acid which just happens to make up a large part of your brain matter. You can get it from fish that come from colder sea water, and it also can be purchased in your drug store or health food store. It has been shown to promote a healthier, even younger brain.

If you want to learn more about any of this, Please check out Dr. Oz's web site.

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.