Alzheimer’s disease

Alzheimer’s: A Cure at Hand?
I have posted before that the currently approved therapies for treating patients with Alzheimer’s disease are not really very...
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January 21, 2020
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Alzheimer’s Disease State of the Nation
It is sadly ironic that it was former president Ronald Reagan who designated November as National Alzheimer’s Awareness Month...
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November 20, 2019
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In the Caregiver's Words

Recent Client Praise

There is a lot of news about the "older market" or other stories featuring someone who has reached the landmark age of 100 years and more. In my geriatric management experience, while working with elder adults and their families, all of what I see in the news is just snapshots of people at a certain age. What I have found is that who a person is at 80 or 90 is really a product of experiences that preceded the present. A long term study of aging by the Harvard Study of Adult Development followed a cohort of Harvard sophomores along with a group of young men in Greater Boston since the 1930s. My title stretches their findings a bit, because of course no one lives forever, but the study did offer some great insights into living long and living well:
1. Get rid of the cigarettes. The Harvard Study showed that men who did not smoke clearly out-lived those who were smokers. Other research continues to show that giving up smoking is a positive influence on health and longevity at almost any age.
2. Practice competent coping. It is not about the hand that life dealt these study subjects; it is about how they played the hand they were dealt. People who adapted to the events of life overall have lived longer than those who did not.
3. Waistline leads the lifeline. The researchers found that those subjects who maintained a "healthy waistline" and weight fared better than their obese counterparts. It is not about being stick thin, but it is about avoiding the other extreme.
4. Regular exercise contributes. Any kind of regular exercise improved both the physical and mental health of the men the study followed. Exercise also likely contributed to that healthy waistline and positive attitude.
5. Be mentally engaged. It starts with pursuing an educational degree, but those who lived longer also always seemed to have something they were excited to explore whether it was keeping a journal or studying a new subject. Intellectual activity seemed as important as physical activity.
6. Make and keep friends. That also includes the person one marries. The researchers found that those who were the most socially engaged also tended to live longer.
I have not talked about how old one's parents lived or one's cholesterol. These factors did contribute to longevity, but the researchers noted that they contributed less than expected. Even stress in a study subject's life was not a negative predictor of longevity as much as how the subjects coped with the stress. Charlotte Bishop is certified in geriatric management and founder of Creative Case Management, led by professionals who are advocates, resources, counselors and friends to elder adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.
The holidays have gone by in a great rush, but you may have noticed someone in your orbit who seems a bit down during these past days and beyond. We have all heard somebody comment that New Year's or Chanukah or Christmas are hard because that is when a mother or a father or other loved one died. And it becomes a poignantly sad moment when that date on the calendar rolls around each year.

It has been my experience that it does not even have to be a specific date that can bring a spouse who has lost their partner or a caregiver who has lost the individual for whom they cared down. It is the memory of holidays with that person who is no longer here to share in festivities. This makes the time of year particularly hard. And if it is the first Christmas or the first New Year's or any other "first," it can be all the more difficult.

Not everyone will be willing to share the sources of their holiday sadness with others, but you can be alert to some of the common signs:

1.    Sadness that just seems to settle in. Everyone has the occasional bad day. This sadness will be over an extended time, and you may notice the deep sighs as your loved one tries to break the hold that the reminder of loss can inflict.

2.    Fatigue that sleep does not cure. You may notice that your loved one who is mourning a loss may fall asleep easily, retire earlier or rise later than usual; yet they never seem to be refreshed.

3.    Preoccupation when engaged in conversation. You might need to repeat yourself. You may notice that faraway look – as if they are lost in thought. They are.

4.    Forgetfulness or absent-mindedness. Again, it may be distraction about items on their list of things to do that fade into the background, because they are caught up in the sadness of their memories.

            The single best thing a friend can do for these seasonal lapses is to empathize. You don't need to be their analyst, but you can validate their feelings of sadness. You can also ask about what in particular makes the holiday sad for them. It can be helpful to ask about any special, positive memories or experiences they can recount of their lost loved one. Recalling the positive is not intended to convey that they ought not be sad as much as to give the person an opportunity to balance the context within which they remember their loved one.

            Even good memories may not be enough to offset the blues. If you find that this melancholy lingers well beyond the holidays that now are past, encourage your friend or loved one to seek some help. Their primary care physician may be a starting point or even a clergy member if they belong to an organized religion. Crying can sometimes get one's sadness out and talking can do the same. It helps to lift the weight that some carry through the holidays.

      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.
Every 25 seconds, somewhere in America someone experiences a coronary event, most typically a heart attack. Although 70 to 90 percent of these sudden coronary events are among men, heart attack is the leading cause of death in women 65 years of age and older. If you are a caregiver to an older loved one, this is an important risk to understand...but for a reason you may not expect. Ageism! The care that older adults receive may be different from the care a younger individual receive, but age should not deny care that will offer better health and quality of life. Yet, that can happen. If you are that caregiver to an older adult who has just suffered a heart attack remember first that time is critical. A heart attack happens when the small vessels that bring blood to the heart muscle are sufficiently blocked that an area of the heart muscle is being starved of oxygen. The longer that vessel remains blocked more of the muscle will die. Ageism may be the obstacle to surgical intervention that can not only save an older adult's life, but also restore better quality of life. Listen for the three words: "Not a candidate." Many physicians practice medicine by the birthdays, and there are still physicians who will look at an 80 year old patient as someone who is not a good candidate in their opinions. But, as Harrison Ford once said, "It's not the birthdays; it's the mileage." In fact, there is perhaps greater variability in the relative fitness among 80+ year olds than any other age bracket. They should not all be lumped into the "unqualified" category. You may very well find one patient who truly is frail, but another who still runs marathons. The procedures to revascularize an older patient's heart can be successful, but patients must be carefully selected. If you are the advocate for your older loved one with a heart attack, listen for ageism, but be sensitive also to gender differences. Women tend to be smaller than men, and they also tend to have smaller blood vessels. This may preclude their being good candidates for surgery. A patient who has already had bypass surgery also can be a relatively poor candidate for revascularization. Some patients with other comorbidities like diabetes or dementia or pulmonary conditions also may not be good candidates. But it is not their birthdays alone that may disqualify them. Even in such cases, there are some relatively new and less invasive procedures that may be very appropriate for those who otherwise may not be good candidates for conventional revascularization. There are new laser procedures that do not require a full "open procedure." And we all have heard of balloon angioplasty or implantation of stents. There is even catheter-based aortic valve replacement as a new option for certain patients. You do not have to be a heart surgeon to be able to speak with your older loved one's doctor about options. But as a caregiver you need to be very attentive to the ageism that may harm your loved one more than their medical condition. 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 will be heading home for any of these seasonal holidays you will find that it can be a wonderful trip back in time as you revisit your own family history in the context of your mom’s or dad’s house. But when you visit, take a closer look at how safe that house may still be for your older parent living there. Some parts of the home interior landscape may be just like you remember them, but they may now pose hazards to your older parents.

    Start with electrical fixtures. Check for where the cords to lamps or telephones and other household appliances are. If they are in the flow of traffic, consider arranging furniture differently. Also, remember that extension cords are really only meant for temporary use, so it is a good idea to move fixtures to be closer to outlets. If you must use an extension cord, place it against a wall to reduce the trip hazard. If there are electrical cords under furniture, check for wear on the insulation to avoid fire risks. Cords under carpeting or rugs also can wear to the point that the floor covering becomes a fire hazard. And, of course, frayed or cracked cords should be replaced. Finally, check to see that all outlets have secure cover plates so that no wires are exposed. Do the hands-on test as well to be certain no outlet is unusually warm to the touch, a sign of potential overloads and therefore a fire risk.

    The Consumer Product Safety Commission has estimated that thousands of people 65 years and older each year are treated in hospital emergency rooms for falls associated with rugs or floor runners. Older adults have less agility and some shuffle as they walk making the trip hazard even greater, so remove rugs that cannot be securely attached to the floor. It is easy to use double-sided adhesive tape to secure rugs or use rubber matting under the rug cut to size is an alternative.

    In addition to replacing batteries in smoke detectors, make sure there are enough detectors placed throughout the house. Especially if one of your older parents has any difficulties with hearing, you will want to have multiple detectors, and they typically come with instructions on where they optimally should be placed in the house. Adding a carbon monoxide detector also is important if there are any fuel-burning appliances in the home. Even homes with electric kitchen appliances may have gas-burning heating units or water heaters.

Because accidents can still happen despite all these preventive measures, make sure emergency numbers are close to every telephone in the house. Include the local Poison Control Center along with a trusted neighbor’s number and your own family ICE (in case of emergency) contact. Write these telephone numbers in large print and tape conspicuously near each land line. Check also that phones and contact numbers are accessible to your parent in the event that an accident leaves them unable to stand.

    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 Bishop.
Part 2: Five Important Tips for Caregiving and Self-Care
In my last post, I gave you some tips on distance caregiving that arguably could be called the 30,000 foot perspective on distance caregiving. But even from afar caregiving is deeply personal and the caregiver needs to be as...
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February 18, 2020
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Tips for Distance Caregiving: Up Close and Personal at a Distance
If you think being a caregiver to an older loved one is hard–with all the trips to help them do laundry, the meals prepared, the trips to the grocery store, the calls received all hours of the day or...
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February 4, 2020
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Five Things You Need to Know about Coronavirus
Okay, there may be more than five things you want to know about the coronavirus, but these five basics are what applies to coronavirus as well as to all new cases of viral diseases. First, always take special precautions...
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January 28, 2020
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Alzheimer’s: A Cure at Hand?
I have posted before that the currently approved therapies for treating patients with Alzheimer’s disease are not really very effective. And they cannot change the ultimate course of the disease. In news released just this last week, however, medical...
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January 21, 2020
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How to Spot and Fight Pneumonia
We have all heard someone this season say, “It’s just a cold,” or “I have a touch of the flu,” or similar expressions that pretty much write off a lot of what is going around. And nobody gets pneumonia,...
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January 14, 2020
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Number One Cause of Stroke…and the Other 8
The number one cause of stroke is unavoidable, but the next eight are not. Number one is birthdays, and the older one is the greater the chance for a blockage of some part of our arterial system which can...
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January 7, 2020
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Not Just Pride Before a Fall
Birthdays are a leading cause of falls that can result in an emergency room visit, and every year this takes a particular toll on those 65 years of age and older. The 65+ year olds represent 2.5 million visits...
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December 17, 2019
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Medigap and Other Scams Targeting Seniors
Let me first say that Medicare is absolutely a boon to older adults who will face many medical issues associated with aging at the same time they also are on more modest fixed incomes than they had enjoyed in...
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December 12, 2019
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Well, not exactly, but if you or an older loved one goes to the hospital, beware of what can happen that is not outpatient, and it is not inpatient. They call it Observation, and it may seem like your loved one has been admitted for an overnight stay, because they do get “discharged” – but in this case in just about 23 hours. Because it is NOT an inpatient stay, it has a different payment requirement and according to recent research, it seems to unfairly target poorer Medicare-eligible Americans. According to the longstanding rules of Medicare, patients with this coverage pay a fixed cost for an inpatient stay and that is going to cover the majority of costs incurred while in the hospital as well as follow-up nursing care and even repeat hospitalizations that occur within two months of that first visit. There are also rules for the short stay that is less than 24 hours; they call this an “observational stay.” And if you are a caregiver to an older loved one, you will want to ask for a very clear answer whenever your loved one is in the hospital. You will want to ask the registration people or the nurse on their unit if this is an observational stay or an inpatient stay. The reason you need to ask is that there are substantial cost differences. A patient under “observation” will be billed for a one time out of pocket fee along with 20 percent of any hospital services bills and the tab for any medications. If you are told that this is to be an “observational” visit, get in touch with your loved one’s physician and have them go to bat for you. The hospital makes more money on an observational visit…and it may not be warranted. There is more. The poor pay more…more often that is. In a recent study by some policy researchers published in The American Journal of Medicine, they looked at the Medicare claims data for some 132,000 hospital observations across 97 percent of all the U.S. counties. They compared the wealthiest quarter of these patients with the poorest quarter and found that the patients in the poorest quartile were 24 percent more likely than their more affluent counterparts to have three or more observational stays in a year. We would like to think that no hospitals are looking to take undue advantage of poorer patients, and there is the potential for Medicaid to offset some of the difference. It does suggest, however, that less affluent patients may not have someone who goes to bat for them, someone who will ask the right questions. So, if you are a caregiver to an older loved one, now you know to ask the right questions. And you know what the answers should be. 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. She also is the Amazon Bestseller and author of How Do I Know You: A Caregiver’s Lifesaver for Dealing with Dementia.

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Alzheimer’s disease

Alzheimer’s: A Cure at Hand?

Alzheimer’s Disease State of the Nation

Part 2: Five Important Tips for Caregiving and Self-Care

Tips for Distance Caregiving: Up Close and Personal at a Distance

Five Things You Need to Know about Coronavirus

Alzheimer’s: A Cure at Hand?

How to Spot and Fight Pneumonia

Number One Cause of Stroke…and the Other 8

Not Just Pride Before a Fall

Medigap and Other Scams Targeting Seniors

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