Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • Geriatric Care ManagerChicago's Geriatric Care Manager Center of Excellence

Spring Tips for the Holiday Caregiver
We all know that that Spring in the Midwest isn’t on a straight line from Winter toward Summer, but...
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March 28, 2023
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How (NOT) to Worry, Stress or Be Anxious
It’s not so much whether you’ll have worries, be stressed or feel anxious…it’s how you’ll manage your worries, your...
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March 21, 2023
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Scammer v. 23.1
Call it Ocean’s 65+…instead of Ocean’s 8 or Ocean’s 11…but it doesn’t have a caste of Hollywood stars, and...
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March 7, 2023
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Another Side to the Story
It was just a year ago that Bruce Willis’ family disclosed that the actor would be retiring from acting...
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February 27, 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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How to Say ‘NO’ to Dementia
It was about two and a half months ago that we posted about the diagnostics telling Chris Hemsworth he...
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February 14, 2023
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Long COVID’s Long List of Symptoms
The COVID pandemic is not yet done with us in the United States, and the story certainly is different...
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February 7, 2023
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Passing on Personal Possessions is Perplexing for People: 6 Pointers
As you gathered with loved ones over the holidays, you may have realized it’s time to start discussing how...
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January 10, 2023
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A Viral Trifecta?
To get to the question in the email first, the Spanish flu of 1918 did not get its start...
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December 13, 2022
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One More BIG Addiction?
If you’re old enough to remember 1969, then you are old enough to remember this bold addition to the...
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December 6, 2022
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In the Caregiver's Words

Recent Client Praise

42 million is a big number. That is how many caregivers to older loved ones AARP estimates there are in the United States, and no surprise, the number of sons and daughters and husbands and wives of older adults with needs is growing. We do not see this mushrooming segment of the population, but it is changing the lives of the caregivers in fundamental and often unhealthy ways. One of the reasons we do not readily see caregivers is that the AARP survey reported that 44% of the caregivers simply do not talk about the unpaid job they do. No one, it seems, wants to look like the unloving family member who is having difficulty performing their caregiving tasks. As a result, about one third of caregivers report they are either sad or just plain depressed. Another third avoid any decisions that might give them a break or better leverage their time with their loved one. And another third simply go it alone, isolating themselves from their friends, colleagues or any support networks. Fully 38% report they are sleeping less, and nearly a quarter are eating more on top of that. Caregiving can be bad for the caregiver's health! Most of this symptomatic profile of the stressed caregiver owes to the simple fact that caregiving is their "other job;" more than six in ten caregivers age 50 or older also have a full-time salaried job. As geriatric care managers (GCMs) caregivers are the people with whom we work in support of their care receivers, and the services we provide to the caregivers can be every bit as important as those that we offer their older loved ones. If you or someone you know is a "stressed caregiver," please consider the following from a professional "stress reliever" to stressed caregivers:
1. Ask AARP. The AARP website is a veritable wealth of information for caregivers to older loved ones, and they have a dedicated portion of their web site devoted to caregiver resources.
2. Involve the Family. Don't try to go it alone if you have siblings or other family members. Not only can many hands make fast work, but fresh perspectives and energy can help the caregiver doldrums that arise from too much solo stress.
3. Catch a Break. If you do not have siblings, check your community for respite care services. If there is a senior residential community in your locale, they often have drop off facilities for non-residents...which gives everyone a break.
4. Talk to Your Employer. This is in step with not going it alone. If you are stressed with caregiving it will show at the workplace. Rather than be judged as a suboptimal producer, talk to human resources about possible flex time or a leave.
5. Call a GCM. To more fully explore your options, call the option-makers for the decision-makers. You can find a GCM in your locale by going to the association web site.
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.
You already know that depression is far more common among older adults than among younger people. But everyone is at risk for what we used to call "cabin fever" or the winter blues, and it is real. If you or someone you know goes through a period of feeling down after winter has over-stayed its welcome - but recover in the spring - it may be seasonal affective disorder (SAD). If you are a caregiver to an older person who seems to be out of sorts this time of year, there is help.

Most experts suggest that SAD is a simply result of too little natural sunlight, but the symptoms may vary. Common signs of SAD include:

1.    sleeping longer, yet still feeling tired during the day

2.    eating or craving more, especially for foods high in carbohydrates

3.    weight gain due to increased food consumption

4.    less enthusiasm for what used to be a significant interest or activity

5.    generally bad temper or crabbiness

The good news is that the symptoms are not just an inevitable part of the season. Those who suffer from the condition are not resigned to simply wait until spring. There is some consensus that the best treatment is to offer what is most lacking in winter - light. Special lights that offer the broadest spectrum can help. Experts suggest that the light be available early in the day either by sitting in front of what they call "bright lights" or by slowly turning up a light in the morning to simulate an earlier rising sun.

Some people who suffer from the condition find that talk therapy similarly used in treating depression can help to limit the effects of SAD. Exercise is a way to release endorphins and also help re-energize one's body. If you are a caregiver to an older adult suffering from SAD, however, be sure that a doctor approves of any new exercise regimen.

Some suggest that anti-depressants can be a help for more serious cases of SAD, but it is important to stick with the medication once started. Some people may begin to feel better, and sensing that their condition is remedied may go off their medication. This only serves to allow the SAD to settle back in.

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.
Within the past two weeks the Food and Drug Administration (FDA) has issued a number of warnings that concern me as a geriatric care manager, and they should concern caregivers and the elders in their charge as well. The FDA has announced new warnings for three different classes of medications, those for pain and inflammation, those that lower cholesterol and those that help treat anemia in some patients. In my next three postings, I am going to tackle each, so that you will have a clearer picture of how to safeguard your own health as well as the health of an elder for whom you may be a caregiver.

I am going to start with a group of drugs commonly called non-steroidal anti-inflammatory drugs or NSAIDs. You would recognize the brand names, Aleeve, Motrin, Advil, or Nuprin as well as their generic names, naproxen or ibuprofen, and a lot of people use them to good effect. Many people use these medications for their arthritis or other acute and chronic pain, and they are available over the counter (OTC) as well as by prescription. You may remember from an earlier posting (Please see: Bad Medicine) that older Americans consume about twice as many prescription medications as younger people and they buy about 40-50% of all the OTC drugs sold.

In an international study titled INVEST, 22,576 people were followed for nearly three years, and the American portion of this large group was followed nearly 8 years. The overall study group included chronic and nonchronic NSAID users as well as people who were on no such medications. Those using NSAIDs were more likely to suffer a non-fatal stroke, a myocardial infarction or heart attack or death from any cause than those not using NSAIDs. In the long term follow-up, researchers found that people who already had a history of either blocked arteries to the heart or high blood pressure were even more at risk for an adverse event that the others.

The researchers suggested that people with high blood pressure or heart disease should look for some other alternative for their aches and pains. Fortunately there are some alternatives for pain. I recommend a sit-down session with the patient’s primary care physician to do a medication audit. As a geriatric care managere, we can do these audits, but only your physician can prescribe medications. If the doctor is not aware of the OTC pain meds a patient is on, then it is hard to make a good decision. The other obvious right steps would be diet and exercise. For high blood pressure and for arterial blockage, minimizing bad cholesterol in the diet and reducing weight are real winners. As always, consult with a physician before embarking on any exercise or diet program.

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.
As a geriatric care manager, I have to admit that we are very skilled at not only providing senior care options for those among our clients with medical conditions, but translating medical speak into a language that clients, caregivers and families can process. A lot of these are chronic conditions that progressively impact the caregivers' loved ones, and some have some rather scary names. But one of the medical "conditions" that does not have a name associated with it is every bit as important as those medical jargon labels like chronic obstructive pulmonary disease or congestive heart failure and more. It is called "functional status." If you are a caregiver, you may have seen your loved one's chart at some point, and it has a lot of information on it. A fair bit of it covers the ongoing record of a patient's vital signs, measures like heart rate, blood pressure, temperature and more. But you will not see a measure called functional status, what some in our field these days are calling the "sixth vital sign." The key reason to know your loved one's functional status is because that is a really good predictor of how easily or rapidly they will recover from, for instance, a hospitalization. If your loved one is going through chemotherapy, it will also dictate how aggressively the doctors can treat the cancer. They call it performance status. But for every discharged patient, functional status is also a very important predictor of whether they will be re-hospitalized within the next 30 days. How well one is able to take care of oneself is really critical to a healthy recovery. And functional status is all about self-care like bathing oneself, taking one's medications when they are supposed to be taken, preparing a nutritious meal and more. Functional status is what gets a discharged patient back on their feet, and being up and about is one of the best ways to avoid having other problems like pneumonia or bed sores. Getting back to re-hospitalization, Medicare is starting to take functional status very seriously, at least indirectly. Starting in October they will be monitoring hospitals' readmission rates, and those who are above the national average will begin to pay penalties. So, doctors should start paying attention and recording their patients' functional statuses. Because it will not be the patients' medical condition alone that will put them back in the hospital; it will be that interplay between how they take care of themselves - their functional status - and their medical condition. It is interesting that we, as providers of senior care solutions, have been focused on those two dimensions all along. We call the combination of good functional status and a medical condition to be "quality of life." If you are a caregiver, you can really help your loved one by helping them to be as active and self-sufficient as possible. If they cannot be totally independent, then assistance in any of the activities that challenge them can still improve their net quality of life by leveraging their functional status. It will be better for your caregiver quality of life as well. Charlotte Bishop is a Geriatric Care Manager and founder of Creative Care Management, certified professionals who are geriatric advocates, resources, counselors and friends providing senior care options to older adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.
While we are well aware that we are a long way from a "cure" for Alzheimer's Disease (AD) or any of the other manifestations of dementia, research is starting to suggest that lifestyle can hasten the progression of the disease or it can slow it. On the positive side, we may only be slowing a disease progression, but with more studies on interventions that help in this direction we could one day get to the point that Alzheimer's will not be the game ender it now is. So, the positive first. It is called mindfulness-based stress reduction, or MBSR. Researchers have long known that stress fuels mental deterioration with some recent data showing that stress increases the risk of developing mild cognitive impairment (MCI) or AD. The research further shows that more than half of patients with MCI will continue to develop full-blown dementia within five years. Researchers at Harvard Medical School wanted to see if stress reduction in prime AD candidates could make a positive difference so they created a very small clinical study, what they call a proof of concept study. In this study, they divided 14 individuals with mild cognitive impairment already into two groups. The MBSR groups received training in mindfulness meditation and yoga, and the control group received the usual care of MCI patients. Over the course of eight weeks, the MBSR group received a two-hour treatment weekly and were given 30-minute meditative audio recordings for daily home listening. Both groups were given MRIs at the beginning of the study and at the end. The experimental group had less progression at the end of the study than the control group, but the results were only just barely statistically significant (because of the small samples). In fairness, the study was very small and lasted only a short time, so can we really say that everyone should get on board with meditation and yoga to slow cognitive decline? One of the researchers said it best when he simply stated that it couldn't hurt, and that it might actually help, and it deserves more attention. Your call on this one. Contrast this with research that we have been hearing about in which individuals with traumatic brain injury see an acceleration of their cognitive decline. This is confirmed by autopsies of the brains of individuals who have died. Those with a history of trauma have more deterioration than those who do not. But TBI represents an extreme case. If you are a caregiver to an older adult, you might consider exposing them to meditative or yoga programs on a fairly regular schedule. And if your older loved one has any history of concussive or trauma events, starting earlier rather than later may be a good idea. Like the doctor said: it could help, and it will not hurt. 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.