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

Pet Pals Trip Up: Older Friends Take the Fall
There were 39 million injury-related visits to the emergency room last year according to the Centers for Disease Control...
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March 19, 2019
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Add One More to the Dementia List
In my past two postings, I know it may have sounded a bit bleak that we don’t have any...
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March 12, 2019
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Alzheimer’s Update – Part 2
This is the second in my two-part update on what we know about Alzheimer’s disease. There are more than...
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March 5, 2019
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An Alzheimer’s Update – Part 1
You have heard from me before about how there is a new Alzheimer’s Disease diagnosis in America every 67...
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February 26, 2019
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Midlife Inflammation Leads to Cognitive Decline
You have to start early to ward off Alzheimer’s disease or other forms of cognitive decline. It seems to...
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February 19, 2019
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Seven Reasons to Not Ignore Valentine’s Day
Who thinks it’s a good idea to just blow off Valentine’s Day? I am guessing not many hands will...
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February 12, 2019
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When Being Down is Not Just a Feeling
We have all heard that pride goes before a fall. It turns out that feeling down often precedes falling...
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February 5, 2019
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The Other Four Winter Hazards for Older Adults
You don’t have to be a meteorologist to know that winter can be particularly challenging for older adults in...
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January 29, 2019
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The Best Prescription: Stay!
It was a story about a prescription shared over lunch recently. During the course of a lunch with a...
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January 22, 2019
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Don’t Sugar-coat It
What if I told you there is a threat to your mental health that is three times more common...
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January 15, 2019
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In the Caregiver's Words

Recent Client Praise

Nearly 32 million people in America have measurable hearing loss, and more than one third of those people are 65 years of age or older. In fact, one's age is a fairly good predictor of whether and to what extent a person may have hearing loss with the prevalence increasing with age. Hearing loss also is much more common among men than among women. But one fact that you perhaps did not know is that hearing loss also is linked to dementia.

What, you say? Did I hear you right? Yes, a researcher named Frank Lin, MD, at the Johns Hopkins University School of Medicine, has reported on the link between hearing loss and one's gait, and on the incidence of falls and most recently on the ties between hearing loss and dementia. Dr. Lin and his associates have been sorting through data collected over a long time and have found that people who have difficulties also have higher incidences of cognitive issues. And people with cognitive issues like dementia also are more likely to have hearing difficulties. In other words, they do not yet know which causes which.

One explanation is that people who have difficulty hearing are not as socially active - maybe even isolated - and so their mental processing tends to lag. Their second explanation is that people with trouble hearing are straining so hard to just hear the words that their ability to actively listen and respond becomes more diminished over time. Imagine that you are struggling so hard to hear that by the time you have deciphered what someone has said they already are on to the next sentence. It could be very confusing.

But potentially even more troubling, it may be that some common issue is causing both hearing loss and cognitive loss. Is that common issue a genetic defect, something in one's space, something about people's hearing aids, or something else entirely? The scientists are still at work, but the findings offer a cautionary note.

If you are a caregiver to an older adult or anyone who begins to show signs of diminished hearing, get immediate help for a clear diagnosis and then an intervention. We tend to think that a physician should catch a hearing problem, but that is far from the case with only about 13% of physicians routinely testing for hearing capacity. And don't forget that a physician's office tends to be a relatively quiet environment where patients can more easily hear what the doctor says because the background noises are minimal or nonexistent. Depending on which of the three possible explanations of hearing loss and dementia you accept, getting your loved one's hearing check will help their hearing, their social integration, their mental health or all three!

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.
One of the most common health issues that seniors deal with is depression. According to the National Institutes of Mental Health, the prevalence of depression among the elderly is 1 to 5 percent overall. Yet, it is not a “normal” part of aging; the incidence of depression increases to 11.5% of the hospitalized elderly and 13.5% of older individuals receiving home care. As a caregiver, I get calls from caregivers and clients who are dealing with not just sadness, but real depression. While some of these older adults will respond to anti-depressants, it is perhaps even more important to address what may really be just situational depression. As a geriatric care manager, I am not a diagnostician and I cannot prescribe medications, but I can prescribe some changes in activities that can help the situational sadness that a lot of seniors may experience.

Seniors – along with the rest of us - have bad days and good days, and some of the bad day part can begin to accumulate like mud on our shoes. All of us can get caught up in the bad days and what has happened that was bad, and we subsequently miss also seeing the good that typically is part of every day. There is a new movement in psychology that some people are calling “gratitude journaling” or “three good things,” and it can work as well for elders as it does for the rest of us. It goes like this. Have your elder keep a journal. Every night before going to bed, they should be instructed to write down at least three good things that happened that day. It may have been as easy as someone said something special when they said goodbye, or it was nice walking the dog, or anything that was just uplifting…a thank you or a courtesy. You might try this yourself first, and see how you feel after a week of writing down the “three good things.” It makes it easier to convince someone else to try something if you already have seen it work, but even if it leaves you neutral, it can still work for the elder in your care.

The experts on this “happiness psychology” tell us that it also can be as simple as exercising regularly, or it may be the experience of gratitude from someone. Because the sources of happiness probably are different for everyone, the experts suggest trying a number of different things to see what clicks. One expert suggests that as much as 40% of our personal happiness is under our personal control. Another 50% is genetic, and only about 10%, they suggest, is about our life circumstances. It is not about good looks or loads of money, and there are a lot of philosophical sayings about that.

A lot of good science speaks to the fact that if we do something, it begins to reform our attitudes. So encourage the elder in your care to write down the three good things each day. It may not only be soothing, but it may excite them to get up tomorrow to see what good is in store. So, it becomes not about what has happened that has been good; it is about setting the stage for what will be even better tomorrow.

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., geriatric care manager Chicago, geriatric care Chicago
Excess weight is not healthy and obesity definitely is not healthy, right? When it comes to your older parent or loved one, the answer is a bit more ambiguous. Picture you have been going to the physician with your older mother for a number of years, and mom has been “robust,” BMI 29, but not what would strictly be termed obese. (BMI, or body mass index, is calculated from a person’s height and their weight, and technically 30 or higher is considered obese.) This year, however, mom’s BMI is up to 30, yet she has not gained a pound. So, by the book she is “obese?” Not necessarily…this is part of what is termed the “obesity paradox.” As a person grows older, there is a tendency to lose muscle mass, and it can get replaced by body fat. There is also a tendency to lose height while maintaining a stable weight as in the case with “mom” above. As people age, they may accumulate more “protective weight,” weight that can be a reserve against unintentional weight loss. Among the young obesity is associated with adverse health impact in the form of risk of hypertension, diabetes, heart disease, certain cancers and a negative effect on most organs of the body…and reduced life expectancy. Yet, some older people who are patently obese have dodged these ill effects. These are also part of the “obesity paradox.” The fact is that a lot of their younger cohorts may already have succumbed to disease before they got so old, not unlike the octogenarian who has smoked a pack of cigarettes a day and continues to smoke without any seeming impact on their health. So, should mom lose weight? If it is all weight around the mid-section, weight loss is called for. Appreciate that any weight loss regimen is likely to result in loss of muscle as well as fat and therefore deconditioning. The rule is that weight loss in the 5 to 10 percent of body weight range tends to have positive effects. Also, weight loss that owes to real life style changes such as diet and exercise are positive. This kind of program should also include sufficient intake of protein to be safe. The American College of Sports Medicine also recommends exercise at least twice a week. This exercise should include strengthening exercise and resistance training. They identify what some call “muscle confusion” training which simply means changing up the regimen frequently to encourage a more nimble and flexible gait, balance and core strength. It is also helpful to involve your older loved one’s primary care physician to assure that their medications do not introduce issues of balance or body hydration. But beware of the physician who cautions against exercise for a “person of this age.” Don’t let them discount mom because of birthdays. Get a second opinion. And remember that it ultimately is about quality of life…and a healthy weight. Charlotte Bishop is an Aging Life Care Advisor, 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 co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.
The next time anyone tells your older loved one to take it easy, be sure to clarify that taking it easy does not mean just sitting around. Medical research has begun to document that too much sedentary time is bad for one’s health. It leads to obesity, elevated blood pressure, elevated blood sugar and metabolic syndrome, and all of these lead to cardiovascular disease and even cancer. Researchers compared the health of adults who spent less than two hours a day in front of a television or other screen format versus those who spent four hours or more as the proverbial couch potatoes. Those who spent more screen time had dramatically elevated risk for cardiovascular events like heart attacks as well as death from any cause. Screen time is simply unhealthy. It may be no surprise why some are calling sitting the new smoking, likening it to the health risk of cigarettes. For any of you who are caregivers to an older loved one, this health risk is particularly worrisome, because older adults risk being isolated as they age. The 2010 U.S. Census found that 28% of people 65 years of age and older, or about 11 million people, lived alone. Granted, living alone does not automatically mean a person will be isolated, but it makes it easier to slip into that rut. Older adults outlive their friends with whom they have socialized in the past, and they may be less able to get out and walk or drive themselves to social events. They may resign themselves to just sitting and taking in the only seemingly accessible entertainment available – the screen. In fairness, we cannot tie all of this to television; any prolonged sedentary activities such as reading, sewing or knitting also can be a risk to the sitter. The same researchers who did the study of the health consequences of sitting offered some advice you can pass along to your older loved one:
- Encourage standing over sitting for small tasks like a phone call or even lunch.
- Use a higher counter so paying the bills can be a standing task.
- For social visits, consider walking and talking rather than sitting and talking.
And there are a lot more benefits; people who sit less are less inclined to depression, cognitive decline and dementia. Your more active, older loved one also will be less likely to be a target of elder abuse and less likely to need long term care. So, a lot less sitting and a lot more of everything else. 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.
The wait is over – for me, I mean. I have been really excited to share our book, How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia. Now, I am going to share a special discount to those of you who have been following my blog, but it’s just for this week. Of course, if you want to pay full price, you can do directly to Amazon: https://www.amazon.com/s/ref=nb_sb_noss?url=search-alias%3Daps&field-keywords=c.+charlotte+bishop But if you would like $10.00 off the Amazon price, I invite you to follow this link: https://www.createspace.com/7325804 Apply the discount code: ZH3VK3U6. I am offering the discount for just this week. Please let me share one of the case studies from our book. This is a real-life experience from one of the more than 30 Care Managers whom we interviewed to compile 350 case studies. We call this Case Study 1.4: • Elopement is a home security risk from the inside out • Dementia is a risk for scams, assault and exposure • Identify what can still be done safely – independently or with help The caregiver is the 59 year old daughter, one of six siblings, who are dispersed around the country. Their father, a widower, is an insulin-dependent diabetic, but in good physical health otherwise. The father manifests some frontal lobe dementia, a condition which increases impulsivity, and which has caused him to lose almost a million dollars on women and gambling, the combination of which has placed him at risk for bankruptcy. Enter the professional care manager into what amounted to a five-alarm fire. With a coordinated intervention, the father was placed on a strict budget with his son, a banker, overseeing his bankruptcy proceeding - which is about to be resolved. While the father is under financial control, he still must be kept in a monitored environment as he is too aggressive with younger women owing to his poor impulse control. He has been successfully moved to assisted living to help mitigate his elopement risk and better manage his blood glucose levels. The father has been “a handful” in the words of the staff, but once trust had been established, he could be cajoled into responding to reasonable demands. His long-term prospects are very favorable. OUR TAKEAWAY: Helping the father get to a facility and to care that could set appropriate boundaries and protect him from exploitation could not have been possible without proper legal paperwork in place. While guardianship may not be a necessary part of a solution in a case like this, having powers of attorney for both healthcare and finance had been key. The professional care manager extolls the virtues of the staff who could gain the care receiver’s trust, and soon he was relatively easy to redirect – or as she put it, cajole – him into more socially-appropriate behavior. In the book, we cover what we know about dementia, what can be done to stave off the effects of dementia and most importantly what caregivers can do for their loved ones with dementia and for themselves. We also offer a lot of resources, many of them accessible on-line. 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.
I recently spoke with one of the financial advisors we list on our Geriatric Care Management Support Tools page, Andy Vass, Advisor with Planning Works Chicago. He raised a point that we tend to take for granted, and that is that Boomers have begun to retire. Even though they are caregivers to older loved ones, they also could benefit from some tips on Medicare. He offers the following advice to Caregivers who may be looking at their 65th birthday in the not so distant future:
- "You don't have to wait to be 65 to sign-up; you can sign-up for Medicare three months before you turn 65, and you can receive benefits starting the first day of your birthday month.
- Most boomers will not pay for their hospitalization insurance (Part A), and Part B coverage is only $104.90 per month unless the retiree's income is above $85,000.
- Medicare has deductibles, copays and coinsurance, and there is no limit on what a participant may expect to pay out of pocket.
- That leads to the need for what they term Medigap, or supplemental, insurance to Medicare. You must sign up within six months of your birth month, and no insurer can say no to you.
- Your first physical under Medicare is free, and when you have this physical you also can learn about all the preventive services available to a retiree.
- With the new provisions of the Affordable Care Act, many of the preventive services are now free to Medicare beneficiaries. This includes bone mass measurements and breast exams.
- Beware about what Medicare does not cover like routine dental care and dentures as well as vision care and hearing aids. Medicare also does not cover long term care in a nursing home or assisted living facility. There is separate commercial insurance for that.
- Government had been setting aside enough to fund Medicare, but they slipped into the red in 2008. These funds are projected to run out by 2024."
Andy Vass and his associates provide Life Insurance, Guaranteed Lifetime Income and Long Term Care insurance, representing 40 insurers. They provide solutions to the Retirement Perfect Storm:
1. Market Risk
2. Longevity Risk
3. Government Policy Risk
4. Inflation Risk
5. Spending Risk.
You can reach him at Planning Works . Charlotte Bishop is a Geriatric Care Management professional 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.