Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • elder care servicesChicago's Geriatric Care Manager Center of Excellence

The Synergy Between Seniors and Earth Day!
April 22 is Earth Day, a date that has brought together activists and celebrants since its inception in 1970. ...
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April 22, 2024
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The Risk Factors AND Ways to Prevent Alzheimer’s
Alzheimer’s Disease affects nearly six million people in the United States according to estimates from the CDC, and that...
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January 22, 2024
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It’s Never to Late for Hip
We’ve had a nice trend over the recent years, a trend in which hip fractures in America had been...
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November 28, 2023
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How Old You Really Are
One of my staff worked with a senior community in upstate New York near Elmira a number of years...
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August 8, 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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Burn Calories to Reduce Dementia Risk
We most often think about exercise as a way to work off the calories that we may have consumed,...
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August 30, 2022
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Food Fight
When you hear the word cancer a lot can come to mind such as “cancer survivor,” “living with cancer,”...
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August 23, 2022
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Before or After the Fall
I came across an informative piece in the Washington Post about a week ago, and it brought to light...
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July 26, 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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When Being in Demand Isn’t Healthy
If you’re a musician, you want to be busy, because gigs represent a better living. If you’re an actor...
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May 17, 2022
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In the Caregiver's Words

Recent Client Praise

September is Alzheimer’s Awareness Month, and this is the second of four posts we’ll offer on the subject. A fair number of folks have a right to be disappointed that we don’t yet have a cure for Alzheimer’s Disease (AD) or at least some way to effectively slow the disease. Right now, there are nearly three thousand clinical trials underway that are focused on preventing, slowing or curing Alzheimer’s Disease, but there has been no success yet. I’ll talk about that in a later post this month, but better and earlier diagnoses of this dreaded condition are worth a lot to the families that need to adapt to a loved one with Alzheimer’s Not that long ago, the only definitive way to diagnose Alzheimer’s disease was following the patient’s death when an autopsy could reveal the telltale signs of this scourge. One contribution that researchers have made is in helping families and loved ones of a potential Alzheimer’s patient to better and earlier sort out when Alzheimer’s may be showing itself. Mayo Clinic has published an extraordinarily long list of “tells” of AD that include:
- Difficulty in remembering, planning, concentrating and problem-solving;
- Confusion or problems in seeing tasks to their conclusion;
- Visual, spatial and navigational difficulties;
- Word-finding and judgment problems; or
- Changes in personality, social engagement or other behaviors.
These are not definitive, but medical professionals also have become far more adept at neuropsychiatric exams that can quantify the verbal and cognitive difficulties that can be the hallmarks of AD. And the technical ability to link this information with far more precise diagnostics using cerebrospinal fluid markers and imaging techniques applying MRIs, CT scanning and PET Scanning makes earlier and more accurate diagnoses possible. These diagnostic techniques also are important elements in clinical trials to demonstrate the efficacy of new therapies in development. To date, no one has been able to bring home the prize, a therapy that physically shows improvement both these biomarkers and actual cognition. We certainly have seen a therapy like Aduhelm fall down on cognitive testing when it seemingly was addressing the underlying physiology of Alzheimer’s dementia. But we are getting closer, and I’ll talk about some of those thousands of clinical trials and where we may see the first glimmers of real hope to make this scourge a chapter of history. Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of, 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.
We as certified geriatric care managers all hear about older adults falling. Caregivers often do not expect their own loved one to have an accident at or around home. The simple fact is, however, that about 20 percent of adults over age 65 will have a fall in any given year. Sadly, most fall can be prevented with some simply safety precautions:
1. The Feet aren't Fit. Yes, it is true that a lot of falls happen because there are hazards all over an older adult's house, but falls are not inevitable. De-conditioning happens in older adults who do not really exercise their balance and their gait. They become less nimble, and you can see it in the "elder shuffle" many of them manifest. You may not be able to help them dance again, but you can get rid of worn carpet or what we call "shatter rugs," or scatter rugs. For an older person who does not lift their feet, these can be a fall waiting to happen.
2. Other Hazards. Anything on the floor and potentially in traffic can be a fall hazard. Look for uneven surfaces, footstools, electrical cords, stairs and similar clutter on the floor. You don't need to make your older loved one's home a sterile and barren place, but you can clear the traffic routes to eliminate risks before they become a broken hip.
3. Line of Sight. If they cannot see it, they will fall on it. Older vision inevitably becomes less acute, but sight also can be obscured by cataracts, macular degeneration or other conditions of older eyes. You can address some of this by seeing that they have annual vision tests and necessary upgrades in their eye wear as well as enhanced lighting throughout the house.
4. Medication Side Effects. Many medicines have side effects that cause dizziness or low blood pressure upon standing. While their main effect may be necessary, the side effects can make navigating an otherwise safe path incredibly difficult. Talk to the health care provider about any side effects and ask about reduced doses or a change in meds altogether.
Charlotte Bishop is founder of Creative Care Management, a team of geriatric care managers, certified professionals, advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecasemanagement.com.
For this week’s post, Charlotte asked Rebecca Bloomfield, partner at Jerry S. Pearlstein Insurance, to speak to caregivers about long term care insurance. She and Jerry head up a unique agency of trusted advisors, helping individuals and families to take control of their personal financial planning … and more. Please describe the concept of long term care insurance. “Long Term Care Insurance (LTCI) pays for services when more than 90 days of continuous care are required. It’s contingent upon an individual’s inability to do at least two of the six activities of daily living: bathing, continence, dressing, eating, toileting, transferring.” How early should a person look for coverage? “Most people come to us when it is too late. The lowest premiums are when one is youngest. You can start early with a progressive sequence of plans with upgrades along the way, many times without medical exams required. Most people look at life insurance when they start a family, and that is also a good time to look at the long term picture.” Sounds like it is for caregivers… What is the right level of plan a caregiver may need? “Traditional LTC insurance has been based on a person being in a nursing home. You anticipated how long you would anticipate be in a facility and how much that might cost. Today, 80% of people want to stay at home when they cannot do two of the ADLs. They want to stay in community. So, there are now plans that cover the cost to do that by paying caregivers, or adult day care centers, or drivers…and you stay out of a facility.” Can my older parents get covered? “Once you are over 70, it is tremendously expensive. …and then there are pre-existing conditions. When you are young and healthy is when to start. Care receivers cannot get new insurance…but it is the right time for the kids who are the caregivers to get their plan.” Anything else caregivers should know? “The biggest misconception of people who come to us is that Medicare will cover long term care. It is not designed to cover sustained care over 90 days. Medicare is diagnosis-based and is built on a plan of care for a person to get better. Long Term Care Insurance should be seen as a way to assure the ability to live a long and happy life without being a burden to the children. …and to preserve your choices.” 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.
Yes, you are supposed to ask why being male and over 65 is a medical condition; so what do I mean by cure? The best "cure" at any age is appropriate prevention, and I would like to offer some prevention guidelines for any of you who have a loved one over age 65. I offer 65 because as we all age, what we should be screening tends to change along with the frequency of screening. I am starting with men in this posting, but I will offer a parallel "cure" for women in my next post. Blood Pressure - everyone should have their blood pressure documented annually, and hopefully by the same provider so that they can track any trends. If your older man already has diabetes or heart disease, this monitoring should be at much shorter intervals. Oral Hygiene - a cleaning and an exam once a year is the minimum, and most dentists recommend a cleaning twice a year. Appreciate that oral health is correlated with heart health, so consider your trip to the dentist to have more benefit that just a great smile. Cholesterol Levels - if your cholesterol have been within normal ranges in the past, you may need to check them only about every five years. As with blood pressure, however, if your older male has heart disease or diabetes, this should be more frequent. Colon Health - guidelines suggest annual stool sample screenings, but a flexible sigmoidoscopy is suggested only every five years and a colonoscopy every ten years. The U.S. Preventive Services Task Force has recommended talking with a provider after age 75 and no invasive testing after 85. All of this is much more aggressive for anyone with colon issues or cancer or who has a family history of any of that. Eye Health - a vision exam is generally recommended every other year as a screen for glaucoma or visual acuity, unless the older patient has diabetes. More frequent testing for a diabetic is recommended to watch for diabetic retinopathy. Immunizations - keeping current is the important part of immunizations. For pneumonia vaccines, every five years is recommended. Flu shots are an annual regimen given the variation in strains that are considered the biggest risks. A shingles vaccination may be a one shot matter, but ask your doctor, and a tetanus booster every ten years is recommended. For other immunizations or other infectious diseases consult a physician. Prostate Health - most doctors will test the size of the prostate during an annual exam, and the doctor also is the best one to advise on how often a patient should take a PSA test. Bone Density - although women are more at risk for osteoporosis than men, the risk increases appreciably after age 50. Taking in calcium and some vitamin D along with aerobic exercise will go far in maintaining bone health, but a physician may recommend how frequently to measure bone density. Everything else - annual exams are a great time to assess weight, height and hearing. It also can be a good time to check your 65 year old for signs of depression as well as go over all medications and any possible interactions or contraindications. 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.
We hear a lot of news these days about the obesity epidemic, and it is important to appreciate the impact of excess body weight/fat on the heart and the circulatory system. Some also point to the impact that excess weight has on a burgeoning epidemic of Type 2 diabetes, the type that does not require insulin injections to manage blood sugar levels. But some doctors like Dr. Robert Lustig are saying that it is not fat that makes for the increasing rate of diabetes, but it is the consumption of processed sugar like fructose. While Dr. Lustig is a pediatric endocrinologist, his advice has a lot to offer older adults also.

It is true that sugar is not really good for us, but it is more important to recognize the differences between good sugar versus "bad sugar." Honey is a natural, or good, sugar and a lot of fruits and some vegetables also contain complex carbohydrates which can be beneficial foods. But beware of thinking orange juice is as good as eating a whole orange, for instance. Most products actually add sugar to the orange juice to make it more appealing, so that they have made a good food into a potentially bad food. Look for the "bad sugars" on the label with names like fructose, diastatic malt, dextran, ethyl maltol, panocha and sorghum syrup.

And being overweight is not inherently the real problem. If you are a caregiver to an overweight older parent or loved one, you may have seen the futility they feel when they exercise but cannot seem to lose weight. Lustig suggests that it may be okay to be fat and fit. That is, it is simply harder for some overweight people to lose pounds, especially if they are older and really do have slower metabolisms. So the real issue is about avoiding the bad sugars.

Lustig also points out that almost all the successful diet books have two suggestions in common. They recommend meals that are high in protein and are high in fiber. In other words, encourage your older parent or loved one to eat fewer processed foods. Lustig goes so far as to suggest that if the food has a label to read, that already is a bad sign as processed foods are so typically light in protein and fiber, but also high in sugar (and salt). He points out that naturally-occurring fructose like that in sugar cane, fruits and some vegetables is "protected" by quantities of fiber. He also jokes that honey - also high in fructose - is protected by bees.

You may wish to go the source: Robert Lustig - Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity and Disease.
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.
We all know that Boomers - who began reaching age 65 just two years ago - are the largest segment of the U.S. population. Aging boomers are expected to total about 71.5 million by the year 2030, but what you may not know is that as many as one in ten of the Silver Tsunami will be lesbian, gay, bisexual or transgender (LGBT). This is important, because the generations that preceded them who were LGBT simply accommodated the "closet" when they aged. Never mind the ageism and racism we still find in some quarters, a lot of the institutional providers for seniors may not yet have embraced a welcoming culture for people of alternative gender preferences. As a geriatric care manager, I see this as a perfect storm with three fronts, a storm which has the potential to create one of the largest threats to aging well - social isolationism. If you are a caregiver to an older LGBT partner or loved one, you will need to be alert to the potential challenges. For instance, there are likely to be limited or no programs for alternative lifestyle older individuals in rural or suburban areas. And the gay male experience of aging is exaggerated among men where there is a more pronounced premium on being attractive or desirable. Generally speaking being 40+ among gay men can be seen as equivalent to being 80+ in the straight community in terms of being marginalized. The social isolation that is a consequence of "premature aging" and marginalization also increases the gay population's risk for depression, substance abuse, low self-esteem or even suicide. The rate of suicide among gay men is about six times that of straight men. LBT women may have it even worse. More than one-third, according to recent surveys, say that they have not divulged their sexual preferences to their health care providers. They also are less likely than gay and bisexual men to have purchased long term care or life insurance. About one in five LBT women are caring for an aging partner, but they also feel less prepared financially than gay men for retiring. Put all these factors together, and the LGBT community is less inclined to seek attention for health issues for fear of hostile or judgmental providers. Poor health care translates into even earlier institutionalization in long term care facilities. Also, it is ironic that in national surveys that nearly three in four LGBT individuals anticipate that they will be caregivers to another person, but one in five are unsure they will be cared for themselves when the need arises. Adding to this potential caregiver shortfall, many gay couples simply do not have conventional family to care for them. If you are a caregiver to an LGBT elder, encourage the following: • They have a Last Will and Testament that is really according to their "will" o With clear advanced directives/living will • Their partner/spouse has Durable Power of Attorney (health and finance) • Informal caregiving arrangements are clear and followed • Priority rights for hospital visitation are followed • There is Joint Ownership of Property with Rights of Survivorship And for us all: Recognize that all humans deserve compassionate care which respects their personhood and their definition of family and their wishes. 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.