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

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...
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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...
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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...
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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...
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January 21, 2020
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A House is Not a Home (Part 3)
At CCM, home and safety are as important to us as to you, so it’s no surprise that it’s...
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June 18, 2017
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Drugs and Birthdays May be Bad Chemistry
Most of us have grown up with the faith that when we have a medical issue, there is likely...
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October 10, 2013
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4 Geriatric Care Manager Tips for Preventing Falls in Older Adults
We as certified geriatric care managers all hear about older adults falling. Caregivers often do not expect their own...
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October 9, 2013
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Four Caregiver Health Safety Tips
I have written a number of blog postings on safety in the home, and most of them have focused...
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September 10, 2013
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Caregiver (Sibling) Rivalry
Raise your hand if you ever had a disagreement with a brother or sister as you were growing up. ...
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September 5, 2013
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Nine Geriatric Care Management Guidelines for the Caregiver
About one in ten American adults, or approximately 44 million people who provide unpaid care to another adult, are...
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September 3, 2013
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In the Caregiver's Words

Recent Client Praise

I have asked our vice president for senior services, Steve Steiber, Ph.D. to share a guest posting about some recent research on a couple of blood thinners which have been found to be big risk factors for dementia. He has two decades experience in pharmaceutical and medical device consulting prior to joining CCM about 10 years ago. Everyone has doubtless heard about taking low dose aspirin as protection against some heart complications, especially if a person has had a stent or other hardware implanted in their hearts. And most have also heard about the benefits of warfarin in patients prone to atrial fibrillation (AF) or coronary artery disease. What some researchers had been seeing, however, was an apparently greater incidence of dementia in some of these patients, and they set out to determine if this was, in fact, the case and what could be done to reduce or eliminate the risk. These researchers recruited more than a thousand AF patients with no history of dementia, but who were on a regimen including warfarin plus low dose aspirin or Plavix. The patients were followed for their blood levels of these medications over time and any diagnosable dementia, because they suspected that it would be the patients who strayed into higher blood levels who would be more at risk. (Warfarin is a drug they call a "narrow therapeutic index" drug which simply means that even very minor changes in blood levels of this drug can make a big difference in a person's health.) What the doctors found was quite remarkable. Patients who trended about their target range of warfarin in the blood 25% or more of the time were twice as likely to develop dementia than those who were above their therapeutic range 10% or less of the time. This is remarkable, because the patients who were above their target range actually had been well within their range fully 75 percent of the time. The researchers believe that the dementia may come from small bleeds in an area of the brain called the hippocampus that will precipitate the onset of dementia. And they offer some recommendations for anyone who may be a caregiver to an older loved one on this combination of warfarin and some other blood thinners like aspirin or Plavix. First, do not take the aspirin unless directed by the doctor. Second, take the lab tests ordered by the doctor regularly, because what can start as the right amount of medicine to be protected from clotting may not be appropriate as the patient's body adjusts to the medication regimen. And, of course, never make any changes in your older loved one's medication without consulting the physician prescribing those medications. 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: ssteiber@creativecaremanagement.com. 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.
When I get a call about our geriatric care management services, most people are not asking for a geriatric care manager, per se. They are asking a question about something they have noticed or been told about their older parent or loved one. The question most often is about a change in the older parent that sets off the caregiver alarm that something is just not quite right. In this posting I am going to go through some of the questions I hear and then explore some of them in more detail in later blogs. Please also let me know any questions you may have or any telltale signs you may have seen in an older loved one that give you concern.

Change in eating habits: Have you noticed that your loved one's clothes are fitting more loosely, that they miss meals or that they just don't have the appetite they used to? Losing interest in food or eating significantly less are not normal or inevitable parts of aging. But older stomachs do empty more slowly than a younger adult's, and food may be less appealing because the sense of smell and taste are diminished. Yet, the fact remains that malnutrition is a serious health threat to an older adult. “There’s a fair amount of evidence that suggests if you lose appetite as an older person, in the next six months, you’ll have a higher chance of dying.” This is according to Dr. John Morley, professor at the medical school and Director of Geriatrics at Saint Louis University Hospital.

The cause may not be directly tied to food losing its appeal, per se. It may be that your older loved one simply has poor fitting dentures that just take the joy out of eating; it is actually painful. Loss of appetite is also potentially a sign of depression among older adults.

Older adults also have had a lifetime of losses, such as retirement, debilitating chronic disease, death of a close family member or simply not being as socially engaged as they once were. And these losses can become a huge emotional burden that detracts from appetite.

Any of these causes that lead to a diminished appetite can also ultimately lead to malnutrition which is a slippery slope. Malnourishment can lead to a reduced immune system and the ability of the body to resist diseases or other assaults. Small cuts or bruises will be slower to heal or even be more prone to infection in a malnourished older adult. As the malnourished body looks for nutrition it will feed upon itself, particular muscle. Once an older adult's muscle mass is diminished they will, in turn, be more susceptible to falls or even degradation of bone mass and fractures. And it is hard to put the healthy weight back on.

So, when next you visit the older adult in your life or have a meal with them, take note of the food they consume and what gets left on the plate or not served. Also, check their refrigerator if they are living independently. Look for how well-stocked it is, signs of food well beyond expiration dates or spoiling. It is not just about eating a full meal as much as fueling a healthy, older body.
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.
Who doesn’t love indulging during the holiday season? Rich food, delicious drinks, and decadent desserts make every gathering something to look forward to. This is a time of year to celebrate, but it’s not a time to stop thinking about how we can still encourage healthy behaviors from our loved ones and from ourselves while enjoying the season you celebrate to the fullest.
1. Waist Watchers – This seems the one time of year when no one’s worried about what’s on anyone else’s plate—unless it’s to note something delicious missed on a buffet. A happy holiday is a healthy holiday, and most Americans, not just seniors, would benefit from limiting their intake of red meat. Make sure to have leaner versions, like turkey and salmon, available as alternatives. Similarly, make sure some sweets are heavy in fruit instead of processed sugar. Dark chocolate, rich in antioxidants, is an excellent choice for the conscious party planner.
2. Walk It Off – It’s especially easy to ignore exercise after a heavy meal when it seems impossible to move. If this is you, plan ahead and get a walk in before you eat. Grab a buddy, a light jacket in this unseasonably warm weather, and go looking at decorations. For those with limited mobility, or even those temporarily immobilized by calories, seated stretching is a great way to keep moving or get moving again.
3. Riddle Me This! – Research continues to show that mind consistently challenged is less likely to suffer significant cognitive decline. Puzzles and skill-based games and crafts aren’t just fun that everyone can enjoy; they’re also ways for your loved ones to stay sharp. Just remember to keep the competition friendly for everyone, and no slamming the table when Aunt Viv puts a hotel on Boardwalk.
4. Ritual and Remembrance – As adults age and lose independence, some seniors may become homebound, meaning that holiday celebrations might be the only significant interaction they get through the season. Helping to making sure that a senior’s holiday is special and celebrated in a way that they find familiar and comfortable, either by co-attending a religious service, or just singing a favorite holiday song together, helps the senior and caregiver alike, fostering good will and cross-generational relationships. It might be the most inexpensive gift you give all season, but it also might be the one that is most cherished.
In my Tuesday posting, I spoke to some of the issues of caregivers about helping their older, single loved ones to find meaningful quality of life. In part, that may translate into helping a loved one to find social and age peers within their communities as their lives and perhaps even the meaning of quality of life may have changed. It also can extend to their desires for maximal independence, developing or preserving meaningful friendships, or even finding personal connections or intimacy. Intimacy? Yes, and you may have thought that your first talk with your parents about sex when you were an adolescent was awkward. Hold on.

As a geriatric care manager, part of the job description is about helping older clients with the challenges of aging, and part of it is about helping caregivers to appreciate their loved one's changing predicament and embrace those changes as well. "Mature intimacy" is one of those dimensions that call for equal portions of each.

If you have an older loved one who is single and wants to have a meaningful relationship, you likely need some guidelines:
1. The first thing you need to do is set aside the old "tapes" that may be in your head, your old beliefs about what intimacy is for you or was for your older loved one. Things are different now.
2. Now, turn that around and appreciate that your older loved one's early experiences will not guide their quest for a meaningful relationship now. The world has changed and age also has intervened. As a caregiver, you can gently help them to feel more comfortable with life's changes.
3. Appreciate that you may be asked about life and intimacy, and if you are not comfortable talking about it with your older loved one, encourage a conversation with the family doctor or a counselor or even sex workshops in some communities.
4. If you do break the silence remember that intimacy is more than intercourse. Just touch - as in holding hands - is something that older adults may long for. Try to set aside arbitrary expectations about what sex is that are based on what sex was. Encourage your older loved one to relax and enjoy the company.
5. Recognize your limits as a caregiver. A lot of parents had their children read books about intimacy before having "the talk." There are books available for mature sexual encounters as well (e.g. "Older, Wiser, Sexually Smarter: 30 Sex Ed Lessons for Adults Only).
6. Safe sex is critical in a time when STIs are potentially everywhere. There is a web site called SaferSex4Seniors. They also are on YouTube.
7. There are professionals who can help your older loved one. Check out the web site for the American Association of Sexuality Educators, Counselors and Therapists.
Now, that was not so bad was it?

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.
What do ObamaCare and geriatric care managers have in common? You probably have heard a whole lot about what is called ObamaCare - more accurately the Affordable Care Act - but you probably have not heard so much about geriatric care managers...let alone geriatric care managers and the Affordable Care Act. It works like this. The new law that has given more access to more Americans has also worked to have everyone in health care working toward the same goal. Raise your hand if you have ever had an older loved one admitted to a hospital. When that event happened, what you wanted most was to get your loved one safely recovered from what brought them to the hospital and to get them discharged. At the point they were discharged, what you wanted least was to face the prospect of seeing them readmitted to a hospital. Unfortunately for the Medicare-age population, that readmission was happening a lot. So, ObamaCare built in a program where everyone is working toward keeping older people healthy once they are discharged from the hospital. But let me take you back a number of years. There was a time when all health care providers - including hospitals - were paid fee-for-service. Every office visit, every hospital visit, every procedure was a charge, and the providers were paid more for more volume. Then some of the rules changed so that health care was "managed" by insurers who made more money if they paid providers less. The first system rewarded volume, and the second one rewarded cutting care. Under the new model, providers and hospitals are rewarded for working together to improve quality and efficiency. And what do the people running these new organizations say is most instrumental in making all this work? In a survey conducted this last year among executives of ACOs, they were asked what was most effective and most important in keeping people healthy and out of hospitals: telemedicine, pharmaceuticals, electronic medical record-keeping, pharmaceuticals, home health care or care managers? It is not computers, it is not the providers, it is not new medicines; it is care managers who are viewed as both more effective and more important. What makes it all work better are the care managers who can assess a person's health and their home, and then develop a plan to help a person get back on their feet. That same care manager is the one who will advocate on behalf of an older patient to get help at home or to get in to see a doctor to help avoid an unnecessary trip to the hospital. This is not to toot our own horns; we will leave that to the CEOs at the new health plans to do that for us. 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.
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