crisis management

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COVID 19 and Stress
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May 5, 2020
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In the Caregiver's Words

Recent Client Praise

From 2002 to 2011, actor Paul Marcarelli was the voice for Verizon pitching their cellular communications with the simple question, “Can you hear me now?” When that contract ended, Marcarelli was approached by the carrier Sprint who asked him to change his tune to “Paul Switched.” But the inability to hear clearly and consistently is much more than a business proposition. Hearing loss affects as many as 48 million Americans to some degree. And only one-fifth of those who could benefit from a hearing assistive device actually use one. Of course, the first line of defense is to protect your or your loved one’s hearing by avoiding extreme noise or by blocking it out, and this “technology” – disposable ear plugs – was patented over a century ago, 1914. Hearing loss is an acute problem for older adults with one in three individuals between 65 and 74 years of age having some degree of hearing impairment, and half of those over 75 have difficulties hearing. Men surpass women with hearing challenges in their middle years, but as they age women and men have very similar rates of loss. While most hearing loss is in the upper ranges of sound, women tend to lose more of the lower registers as they age and “catch up” to men in their incidence of loss. Ear infections are the most common source of hearing difficulties among children, but among older adults hearing loss is more often linked to cognitive decline and even depression. Heart disease and diabetes are also tied to hearing loss. Prolonged or consistent exposure to loud and sustained noise are the greater sources of hearing loss among most individuals. Yet, many individuals, especially older loved ones, may resist getting their hearing tested, let alone actually use assistive devices for all the stigma attached to them. We have come a long way since the days of the “ear horn” or more recently the large, hang over the back of the ear devices. There are hearing devices so small and they so easily fit within the outer ear canal that their manufacturers call them “invisible.” If you have an older loved one in your orbit, encourage them to seek assistance from any of the professional diagnostic facilities available. Ask your loved one’s primary care provider for a referral, or even go to this site to find a testing and equipment center in your community. It’s never too young if you have a child in your orbit to teach them healthy “ear hygiene,” like a bit less volume with their favorite music and perhaps quiet time outs for reading a book … with maybe even a trip to the library. Remember that our younger generation also learn more from what they see us do than from what we tell them! Charlotte Bishop is a Caregiver Coach, an Aging Life Care Advisor, 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. She also is the co-author of How Do I Know You? A Caregiver’s Lifesaver for Dealing with Dementia.
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.
I have asked our vice president for geriatric care management and senior services, Dr. Steve Steiber, to share a guest posting about the recent Tylenol news. He has nearly two decades experience in pharmaceutical medical device consulting prior to joining CCM about 8 years ago.
By now most of you have heard the latest on the potential for possible deadly skin rashes owing to an allergic reaction to acetaminophen, or Tylenol as the branded medication is called. Before we all suddenly quit using this pain agent, it is important to understand the magnitude of the potential problem. And it all starts with how long Tylenol/acetaminophen has been available here in the United States. Tylenol turns 44 this year following its release to the market in 1969 as an analgesic that was quickly embraced for its ability to turn off the brain pain signals and relieve the consumer with minimal side effects. All drug companies are required by law to report all adverse events that could be associated with their drugs to the FDA. Now, FDA releases information that covers the period from 1969 to 2012 which show three types of significant skin reactions that have resulted in 67 hospitalizations, and twelve of these have resulted in patient deaths. Spokespersons have rightly pointed out that over the 44 year life span of Tylenol, to date, the drug has provided pain relief to millions and millions of people. In fact, it took that many cases of Tylenol use to find this many extreme reactions. To the twelve who died, the drug clearly should not have been used. Tylenol spokespeople maintain that any kind of rash or skin reaction ought to be taken seriously and a person should find an alternative to Tylenol. They conclude, in effect, that the benefits outweigh the costs. Now, the other panic button... Not two years ago, acetaminophen was linked to liver damage when used above certain quantities. FDA subsequently limited the milligrams of acetaminophen per dose to 325 milligrams. But that in itself is not enough. If you are a caregiver to an older loved one, be aware of how many doses within a 24 hour period your loved one is taking; that quantity should not exceed 3,000 milligrams. Sounds like an unbelievably large number, but we need to recognize that acetaminophen is not just a stand alone pain reliever. It also appears in cough and cold medicines, in sleep aids and in other pain medications along with opioids. If one takes two of these every 8 hours, and then takes other medications that may also contain acetaminophen in combination, it becomes very easy to meet or exceed the 3,000 limit. And as I have talked about in other postings, older individuals have less fluid in their tissues and they process foods and chemicals more slowly. So, arguably the total quantity of Tylenol intake ought be monitored more closely than with a younger person. So, let's use the occasion of this most recent panic on acetaminophen to resound the alarm on something we have already known. Maybe it is a good time to have a conversation with your older loved one and maybe even visit their medicine chest with them. Please let Steve know if you have any questions about geriatric care management, 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 elder care management experts, geriatric advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to info@creativecaremanagement.com.
Most of us have become familiar with generic drugs. We now have a new category in your medicine cabinet called “biosimilars,” so I have again asked our Vice President, Steve Steiber, Ph.D., to talk to us about what we may not know - but should know if you are a caregiver to an older loved one - about the evolving federal rules and science around biologic medicines and the new medicines who are enough like them to get FDA approval. Steve has over twenty years of experience as a consultant to the pharmaceutical and biologic industry prior to joining us at Creative Care Management: We all have heard of some of the (mostly) injectable medicines that have changed the lives of people with rheumatoid arthritis, Crohn’s disease, psoriatic arthritis and some other conditions that are part of a larger category called autoimmune diseases. They have been around for about twenty years and have become names many of us know from television and magazine ads. We also mostly know what a generic medicine is. It is the same chemical molecule as one that a drug company brought to market with a “brand name,” but it is manufactured by another company after that brand drug’s period of patent exclusivity expired. All drugs discovered by a company can be patented for 20 years so that no one can make and sell the same drug until that patent expires. Companies apply for patent protection well before they go to FDA for approval, so they do not have a full 20 years alone in the market following FDA approval. For instance, once Aleve’s patent expired, you had other companies flooding the market with naproxen sodium (the generic name of Aleve). And once Motrin’s patient expired you got ibuprofen, and Tylenol gave way to acetaminophen, and so on. Well, one of the provisions of the Affordable Care Act (ACA) was to change the rules for biologics to be like that process. Before ACA changed those rules, any medicine patterned after one of those approved biologics like Humira, Remicade, Cimzia and others had to go through a process just like a new medicine. Now, like the generics, a medicine can apply to be a biosimilar to a brand medicine simply by proving it is as good as that medicine. Hence, the name biosimilar. Don’t ask me why they couldn’t call it “generic,” but it amounts to pretty much the same thing. So, if you are a caregiver to an older loved one on a biologic, you may soon have a cheaper alternative available. Generics and biosimilars inevitably will be cheaper than the brands they are like. It also means that in most states the pharmacist can substitute the biosimilar for the brand medicine if you agree … even if your physician writes the branded name on the prescription slip. Do your research so that you know the clinical evidence on the new biosimilars as you make that decision at the pharmacy or in a conversation with your care receiver’s doctor. Think of it as getting a BMW-performing car without the logo…and without the price tag. But ask your physician for their thoughts. 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.
Tell me if this has happened to you. You arrive at a friend of a friend’s house for a social gathering, you notice that the average age of the people there trends a bit older and you come across a couple people chatting at the refreshment bar. They’re in an animated discussion about one of the medications they’ve been prescribed and how much a month it costs. You sidle down the table and someone comes up to you and says, “You look like a runner.” Which of these conversationalists is older? With which do you want to have a conversation? Which of these conversationalists is likely to live a longer, happier and more fulfilling life? Choose wisely. A professional with whom I work offered the explanation that people of retirement age and older may no longer have a professional job, or a current resume, but they all have an ache, some other symptom or a recent visit to their health care provider. Good health care is part of a longer healthier life, to be sure, but talking about aches and pains does not add to a longer or healthier life. Yet, it is a go-to conversation for many folks of an age and it negatively impacts our mind-set about aging and about ourselves. Having a positive view of aging, according to a longitudinal study of 660 older adults, quantified this. Those who had a positive perspective around aging had lower blood pressure, a reduced risk of dementia and lived an average of seven and a half years longer than those who had a negative view of aging. The negative views of aging can start early in life with way too many stereotypes of crochety old men yelling at neighborhood kids encroaching on their grass. So, this age gestalt is like a lot of the ideas we have – it starts early and tends to find experiences or other people who will reinforce the world view. Choose differently. You may recall the 1994 movie, Shawshank Redemption, in which a wiser inmate, played by Morgan Freeman, informs the newly-incarcerated inmate, played by Tim Robbins, that each day you decide if “you’re living or dying.” That’s a bit of drama, but a pair of authors, Crowley and Lodge, offered a roadmap of a book titled “Younger Next Year.” They tone it down a bit suggesting that the simple choice of being active versus being sedentary has huge implications for our well-being…and it’s built into our DNA. Hunters and gatherers not only fed themselves, but they signaled their bodies that they were up for thriving. Those of their peers who slunk back from the challenges told their bodies they had given up, they had given in to decay instead of moving to thriving. So, what can you do? Choose taking a long walk, preferably with a friend or spouse, over sitting on the couch with the control in your hand. Choose friends who talk about what they do, what they’ve done and what they plan to do over those who only talk about aches and pains. Start journaling – today - about every example you witness of an older individual. After accumulating examples for a week or two, then sort them out into positive and negative role models. And then the best part…follow the good examples. Be involved in civic activities, be actively engaged in walking, swimming or pickle ball. Set goals and look for more role models, not platitudes. Don’t practice being overly sweet and complimentary: “Oh, you don’t look a day over…number filled in here.” Practice being a “positivity seeker,” and you’ll see the positive even in yourself. The more you practice this, the more positive you’ll become, the more folks who also are positive will seek you…and you’ll feel better and live longer. It’s not just the snap of your fingers that will magically transform you, but your new positive outlook and lifestyle will serve you well and put more candles on your birthday cake. 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 know the New Year is approaching when we start seeing the use of “lists” everywhere. You’ll probably see an increase of “Top 10” lists for 2012, shopping lists, To-Do lists, and a list of resolutions for the next year. Now is a great time to think about making a resolution list for yourself if you’re caring for a loved one. You might ask yourself what aspects of caregiving has been a big struggle this year or things you’d like to see happen in the coming year. Here are some resolutions we’ve come up with in hopes that 2013 is a good year for caregivers and their families.
- Take time out. Try to make it a goal not to let stress overwhelm you. If necessary, remind yourself to take breaks – whether it is for 5 minutes to breathe, or a day or two in order to rejuvenate.
- Treat yourself. It is easy to forget to give yourself a break while you’re caring for someone else. Allow yourself to do something you enjoy every day or at least every week next year.
- Have a positive outlook. You may find that a simple change in mindset would be a great resolution.
- Get support. To make the upcoming year better, joining a caregiving support group in your area or other support groups may be beneficial. You can find many communities for various caregiving subjects in our resource tools page.
- Journal. Writing your thoughts and frustrations down on a regular basis may help you process and synthesize the everyday difficulties that my come with caregiving.
- Educate yourself. You never know what you might gain from simply seeking out information. Learning as much as you can about your loved one’s condition may help you be better prepared for any unexpected struggles.
- Organize your life. A goal to organize records, papers, and keep logs of appointments may be a cathartic thing to consider.
- Care plan for yourself. Caregivers often don’t have time or are so focused on their loved one to consider care plans for themselves. Be strategic and tactical; think about mortgage, finances, insurance and your health.
Perhaps a good resolution overall would be to evaluate the quality of life for you and your loved one over the course of the year with the help of a third party. You may find that a GCM, a cleric or health professional can consult with you and your family to help find effective ways to live life while caring for a loved one.

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.

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