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

COVID’s Other Deadly Toll
During this pandemic, over 13,000 more Alzheimer’s and other dementia patients have died than expected from these cognitive disorders,...
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September 22, 2020
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It’s Not a Sprint
I think it occurred to me Sunday afternoon last week, and I was anticipating Monday. But Monday was Labor...
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September 15, 2020
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When Confusion Is Good for You?
Confusion usually means we are not getting something right, but in physical training and even physical therapy, muscle confusion...
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September 8, 2020
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That’s Not A Senior Moment
We all hear the phrase used as an excuse for a bit of memory lapse … that it’s just...
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September 1, 2020
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The Other Epidemic
…you know, the epidemic that predated this COVID pandemic … the one that will be made even worse by...
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August 25, 2020
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Heard or Herd?
I am really, truly, seriously, absolutely in need of good news – heard news and herd news. Today, I...
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August 18, 2020
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Hold Your Friends Close and Stangers Closer
Miss your friends, your older loved ones and those summer get togethers in the backyard? We can get together...
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August 11, 2020
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And Don’t Forget to Brush
Dental health and mental health are linked. That’s right, dental and mental well-being are medically linked. I have posted...
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August 4, 2020
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COVID-19 and Alzheimer’s?
We all have been in desperate need for a ray of sunshine during this COVID-19 quarantine. Well, this week,...
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July 28, 2020
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Pre- Instead of Post-?
When was the last time you studied after a test? Or prepared your dinner after you had dined? Or...
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July 21, 2020
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In the Caregiver's Words

Recent Client Praise

There is a lot of advice that goes around for older loved ones in our orbits when we see the first signs of winter setting in, and most parts of the country have seen some near record lows already this season. But there also are some threats to an older person’s well-being that are more a part of the relentless part of winter the longer the season tests us all. We know to help our older loved ones to dress warmly and to avoid ice and more. Here are five threats to look out for as we all endure more of the season for sneezin’:
1. Be vigilant about depression – The severe and sustained cold can make it for harder for older adults to get out and socialize as much as they can in fairer weather. The toll the isolation takes can manifest itself in a situational depression.” If you live at distance from your older loved one, be alert to changes in their demeanor, their voice, their affect. Call on your way home from work or after your lunch…daily contact can be very cheering.
2. Winter is hard on their car – The human body is not the only body that takes a hit with winter cold. If you are able to drop by, check on your older loved one’s windshield wipers, the tire air pressure and the battery as well. Especially if the car does not leave the driveway frequently, the winter can shut down the car. Be aware of your loved one’s capacity to drive on ice and suboptimal road conditions.
3. If the power goes down – Winter storms can take out the power grid and with it your older loved one’s ability to keep refrigerated food cold or even their own bodies warm. Help by checking to be sure there are enough warm blankets and maybe a battery-powered radio or charge stick for their cell phone. This may be another reason to check on your loved one’s with greater frequency as well.
4. Vary the foods available – It’s easy to not visit the grocery story with the same frequency when the weather is the disincentive. Be sure your loved one has a variety of fruits or vegetables. Milk and fish also are a great source of vitamin D as well as leafy veggies. A varied diet also will help them feel the extra perk that can stave off the blues.
5. When you stop by to visit, especially if there has been a significant snow accumulation, check around the exhaust vents of the furnace, the clothes dryer, the fireplace, etc. And be sure that the carbon dioxide and smoke detectors are in place and with fresh batteries.
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.
In the first of this two-part series, I talked about conversations involving changes in life where you as the child of an older parent may be required to step up to help your parent or see that proper help is available. This second part is devoted to conversations about preparations for end of life, life's final transitions. As with Part 1, these conversations also are a lot about making sure that one's wishes are fulfilled, in this case those of your older parent. As with the other conversations of Part 1, you may find that it is even easier to talk with your older parent about end of life issues if you have attended to your own documents as well.

Last Will and Testament. In the past I have interviewed an elder law attorney about the legal issues surrounding wills and advanced health directives. I am going to break these out a bit. It may surprise you to know that the majority of Americans do not have a written will, and you may be one of them. It may very well be that your older parent is entirely justified in believing that his or her needs will be attended following their demise, and that everything will be divided up equitably among the survivors. But the court system will still intervene in the form of probate to settle these issues legally, and that can only serve to diminish what is there for the heirs. Plus, if one wishes to share mementos or memorabilia with special meaning with an heir, this will carry even more import if the benefactor has written a note about the history of that object. As with some of these other difficult discussions, they may be easier if you make it personal by drafting with your attorney your own will.

Advance Healthcare Directives. And then there is the other will - a living will, which is part of anyone's advanced healthcare directives. The last thing an older parent would probably want in the event of a health crisis is to have a disagreement among family members about what mom or dad "would have wanted." Here again, it can be very helpful to have a family attorney guide you through what documents are needed to preserve end of life choices as an older adults wishes. Once the paperwork is done, it is important also that these documents are part of a parent's medical record and their personal physicians are aware of the document(s) and have a copy in the chart. Also, if a parent is living in a facility, a copy should be on file there. Finally, a copy should be on file at the hospital your parent would use if needed. One last time, by taking care of your own personal documentation you have a great way to introduce the subject to a parent in a very nonthreatening way. Remind them also that you will be quite distressed in such an event and that their decisions and choices in a calmer moment ahead of time would provide better choices.

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.
For how many years have women been told they need to take some sort of calcium supplement even before they advance in years to avoid osteoporosis? Okay, it’s a big number, but that’s not the point if you have an older loved one in your life. It’s more than calcium that is needed in a person’s diet to get the benefit of bone density that the calcium is credited with preserving. Calcium intake throughout a person’s life is needed to grow or maintain bone mass. It was the early sailors that understood that a person also needed fruits containing citric acid in order for the body to actually put the calcium to use maintaining serum calcium levels. They didn’t worry about osteoporosis’ they worried about scurvy. So this is another part of the more complicated calcium story and what the body really needs. First of all, food is the preferred way to access calcium, because foods containing calcium also contain other nutrients. Getting your calcium through food also avoids the mega doses of the mineral that can be associated with cardiac risks. In addition to calcium, vitamin D is needed to help the body absorb calcium. Vitamin D has the added benefit of improving muscle performance and balance. It keeps your bones strong and your muscles nimble. And vitamin D is activated by sunshine, so it is not just eating food with sufficient vitamin D and calcium, it is getting out in the sunshine…although there are nutrients that can help the body utilize the vitamin D in the absence of sunshine. Researchers also have shown some benefit of phytoestrogens, some of which are found in soy products, with women. Omega-3 fatty acids that you have heard about in conjunction with Alzheimer’s prevention also confer benefit to the skeleton especially in conjunction with calcium because they contain phytoestrogens. Antioxidants like flavonoids found in some vegetables, wines and fruits offer beneficial bone effects as well. Vitamin B12 and magnesium also are being actively investigated for their bone health benefit. On the flip side, researchers advise against fish products like cod liver oil as they can work against bone health. What is the big takeaway? First, calcium is important, but it works best in conjunction with some of these other vitamins and minerals. And all of this works better in association with diet in general, not as pills or supplements. The best dietary supplements are a range of fruits and vegetables, many of them found in your salads or even dinner wine. And what is the best thing about a balanced meal? The good company that can come with dinner can also improve life for your older loved one who may be more at risk for social isolation than malnutrition. It is rarely just one thing! So invite mom or dad to dinner. 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.
COVID 19 was not in my calendar for 2020, and I strongly suspect it was not in yours either. I often have said that family life crises don’t make appointments; they just show up. And I am usually talking about how to be prepared for the inevitable call from or about an older loved one in your orbit…AND how to be prepared for your and their next steps. Well, this time, preparing for a crisis could be closer to home, because all of us need to be prepared so that the people who may get the call that we have taken ill can be prepared. What do you need to do to make a Plan? When I have spoken in the past, some people back off from talking about a loved one in a crisis. This list is about you, so please forgive me for getting “personal.” Here is my “short list” of the documents you need to have and make them available to your partner, your kids or other close friend … sometimes with no notice:
- Medical Release – the document you need so your medical providers to speak with your loved one’s about your health status, medications and prognosis.
- Power of Attorney (POA) for Finance - a legally binding document that gives a person (referred to as the “agent” or “attorney in fact” permission or power to act on your behalf in matters of property or finance.
- Power of Attorney (POA) for Healthcare - a legally binding document that gives a person power to act on your behalf in matters of medical treatment. The “power” typically is in force when it is deemed the person in question can no longer act for themselves or if they are not conscious.
- Practitioner Orders for Life-Sustaining Treatment (POLST) – a document (varies state by state) that specifies in advance what measures you wish to have in the event you cannot expressly grant permission yourself. These orders typically revolve around life-saving measures; they are sometimes referred to as advanced directives and are placed in your medical files. The forms are downloadable at your state’s web site.
- Health and Life Insurance Policies – the health policy will help everyone involved understand what is covered and which physicians and other providers are available to you. The Life insurance policy should be in a safe place so that it can be readily accessed should that become necessary.
- Estate Plan – is (potentially) a wide-ranging document that let’s everyone know how any real estate or other holdings are titled and what the “plan” is for when your will is executed.
- Trust documents – help to identify how your estate is to be transmitted to beneficiaries. Trust names need to be consistent with life insurance, will and holdings in order to be in effect.
- Last Will and Testament – the legal document by which you express your wishes of how property is to be distributed at death, and names one or more persons, the executor, to manage your estate until its final distribution.
- The Grab and Go – This is a list that typically is sealed in a plastic bag. It includes your medical insurance documentation, a list of allergies, a list of medications, primary care physician contact details and in case of emergency (ICE) contact information.
Please email (info@creativecaremanagement.com) me with any questions on any of these…as well as how to take the next steps which is your plan. Do yourself a favor…don’t wait. 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.
"It has been forever! You look so different!" Joyful cries of greeting such as these are so common at the holidays that we don't notice them. However, if someone has changed but we don't feel comfortable mentioning it, that's a very important change. Modern families see each other less and less. Work and/or geography get in the way, and the most face-time many of us get with our extended families is at the holidays. We all want to keep an eye out for the ones we love, and the line between wanting to honor the autonomy of adults and wanting to prevent problems is difficult to walk. However:
Did you notice anything like this over your holiday visit?
1. Are there bruises? Signs of a fall? Noticeable loss of weight?
2. Are they wearing messy, baggy clothes? Poor hygiene? Smell of urine anywhere?
3. Is the refrigerator full of spoiled or moldy food?
4. Do they have trouble finding words used regularly in conversation?
5. Are they moodier than you remember them? Not interested in their hobbies anymore?
If you did, you're not being nosy. These are real signs of decline, and you need to address them with your loved one with respect and care. They could be fixed as easily as adjusting medication, but they could also be real indicators that it's time to sit down and have a serious talk. It's never easy, but change rarely is. The good news, is that we've done all this before, and we're here to help if you want to talk. If you just found out that this is your life, and you suddenly need answers, I can help with a consultation. If you don't know what to do, just call. We'll figure it out together.
In my past two blog postings I have talked about some recent warnings from the Food and Drug Administration (FDA) that concern me as a geriatric care manager, and they should concern caregivers and the elders in their charge as well. This most recent and third warning was about some of the dosing for drugs that are used for people who may be anemic or suffer from chronic kidney disease or be on chemotherapy of some sort. As you may suspect, this is a relatively smaller segment of the adult population, and as you will see here, it gets even smaller as we are mainly talking about people with chronic kidney disease. But one of these medications has been part of one of my client’s standard monthly routine for some time, so it struck closer to home.

You may know these drugs by their brand names if you or a loved one has one of the conditions. The brand names are Procrit, Epotin or Aranesp, and they help the body increase the red blood cell count for people with some types of anemia. These drugs, referred to as erythropoiesis-stimulating agents or ESAs, are also now known to increase patients’ risk of cardiovascular events. As with the other two warnings I have posted, these risks only became known over time as more and more people were given these medications. This is because the actual cardiovascular events they can cause are still fairly rare.

All of these drugs already had had warnings of one sort or another on their packaging, so doctors have been aware of those. The new warnings, in fact, are most particularly a danger for patients whose medications move their hemoglobin levels above a given point. These drugs were intended to replace the need for certain patients to have red blood cell transfusions which also pose their own risks. The new guidelines have been made clear to doctors in new warnings on the package inserts of these drugs, and they specifically make it clear that patients with chronic kidney disease and on dialysis should be treated differently from patients who are not on dialysis.

As with any warning from an agency like the FDA, this may call for a conversation with your provider. If you or an elder or other special needs person for whom you are a caregiver have chronic kidney disease, you should talk with your specialist about steps that may be taken to minimize any unnecessary heart risks.

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.