in home care for seniors

GOOD NEWS FOR CHRONIC CARE
Associate Care Manager Gregory is a Certified Senior Advisor (CSA), Certified Dementia Practitioner (CDP), and Medicare Counselor, whose work...
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August 6, 2018
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Long-Term Doesn’t Mean Put It Off Until Later
Gregory Peebles is a Certified Senior Advisor (CSA), Certified Dementia Practitioner (CDP), and trained Medicare Counselor, whose work focuses...
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June 24, 2018
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In the Caregiver's Words

Recent Client Praise

I have not taken a real opinion poll, but from feedback I get as a geriatric care manager from my clients what scares them most is not the prospect of dying. It is the prospect of losing their mental abilities. Alzheimer’s disease is high on the list of “feared medical conditions" even though it is down at number seven on the list of overall causes of death among Americans. With “National Memory Screening Day” coming up on November 16, I thought it would be a good time to share a few perspectives on Alzheimer’s and related cognitive conditions.

Alzheimer’s is just one of the three major types of dementia that health care experts talk about. Dementia is any disease that can cause progressive loss of memory or function. Alzheimer’s has a lot of “name recognition,” but there also is vascular dementia. Vascular dementia is a result of the arteries that bring blood to the brain hardening. Just like the kind of hardening of arteries that starves the heart over time, vascular dementia starves the brain. Finally, there is a third category that covers a number of conditions like Lewy Body, frontotemporal dementia and even Mad Cow disease, but these are quite uncommon.

There also are “dementias” that are reversible. Depression can be confused with other dementias, and it is very common among older adults. Other medical conditions like hypothyroidism, Lupus, vasculitis, some venereal disease or B12 deficiency can cause reversible dementia. Substance abuse – common among older adults – is a source of reversible dementia. And other prescription medications can impair recall and cognitive function.

Some of the classic signs of the onset of Alzheimer’s disease you can look for include when the individual:
- Tells the same stories
- Asks the same questions
- Has difficulty with numbers
- No longer does the things they commonly have done (cooking, sewing)
- Gets lost in unfamiliar places (restaurants)
- Neglects their own self-care
- Defers to a caregiver (“Ask my spouse”).
A person can do a small self-check as well. I suggest to my clients that each evening they write down a short list of notable events from that day. The next morning they should review what they wrote the night before to determine if they can remember them. It gives them peace of mind, because we tend to forget that everyone forgets some things along the way.

There is a lot more ground to cover on this, and I will get to more in later postings. For more answers or resources, go to the web site of the Alzheimer’s Foundation of America. I also would like to address your concerns or questions in future postings, so please e-mail me at Charlotte Bishop.

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.
Last month, we talked about conversations with older loved ones about residential living choices. While might find this is a suitable option, others may be able to retrofit their houses for senior living in Chicago, to keep daily living familiar to their local location and make it more comfortable for their aging loved ones. It is only a matter of making certain adjustments in your home, though this task might not be as easy for some as it is for other. Below are some pointers on how you might be able to make your home a positive environment for your loved ones.

Fall-proof

Leg strength wanes as people get older. Because of this, even the most innocuous fixture or furniture, or the most routine activity in the home can cause a fall. Start fall-proofing your home by making sure that all the walkways inside your house are well-lighted, and the spaces in your rooms are cleared of clutter, to provide ample space to move around. Reroute wires, should you find them crossing walk paths, and remove unsecured decorative rugs. It’s important to fix worn carpeting on which one might trip.

Fall-proofing your home works both ways. Talk openly with the elders on ways they can avoid fall accidents. Ensure that they get their vision and hearing regularly checked, and help them keep their senses sharp so they cannot miss fall hazards. Encourage them to use canes and other aids if you feel that these will help them.

Sleeping Arrangements

It is most ideal to situate their room in the first floor of your house. This gives them easy access to the main parts the house such as the living and dining rooms, and the common bathroom. Not only will that save them from straining their legs walking up and down the stairs, but will also keep them safe from fall risks.

Emergency Kit

Aside from keeping your emergency kit stocked with bandages and medicine, make sure that you keep phone numbers handy in case of medical emergencies. Include your mobile number, the number of the local hospital and your loved ones’ physician, and the contact information of your neighbors. Leave these close to the telephone, on the refrigerator door, or other visible spots.

Hire Help

Hiring a caregiver in Chicago can help lighten the load. As a care manager, I’ll be able to help assess the home and provide a plan in order to make the environment safer. Enlisting help can ease your worries about getting professional care for your parents and loved ones while you’re away.

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.
It is no secret that we at Creative Care Management are all about what families can do to help older loved ones … as well as help themselves. I often have said that a caregiver can be their best caregiver if they also are taking care of themselves. I came across some research that may be suited to a caregiver’s loved one or to the older caregiver who may be “at retirement age” but still in the work force. A lot of folks are electing to work beyond the traditional retirement age of 65 years…give or take. There is ample evidence that we as Americans are mostly living longer, because we are healthier, and some just find that they need to anticipate a bigger nest egg because we are also, in fact, living longer. Running out of money is considered a “bad retirement plan.” Research published by some Health Economists from The Netherlands suggests that working may be detrimental to one’s longevity…or conversely that retiring earlier could prolong one’s life. These Dutch researchers took advantage of a temporary change in retirement eligibility among male government workers to compare those who had retired early versus those who waited. Five years after the early retirement they compared the mortality rates of the retired men who were at least 55 years old when they quit with those who worked longer before retiring. Those who worked longer showed a 2.6 percent higher mortality five years out than those who retired early. It is not a huge difference, and a person could argue that civil servants have a more stressful work environment…maybe. But studies ion the U.S., Israel, Germany, England and some other European countries had similar findings. Other research even shows that retirees are more socially active than once thought; so much for the social isolation and depression theories. We simply cannot overlook the fact that some jobs…maybe more than we had thought…are just stressful. Long hours get in the way of working out, and high stress can disturb good sleep or even lead to higher alcohol consumption. So, early retirement could be in the cards for us all, but with a few caveats. Work on a nest egg that will be sufficient so that finances do not become a post-retirement stressor. Be active, especially if your career job involved high activity. Stay active so that obesity does not become a challenge with a new sedentary lifestyle. Continue to be socially engaged. 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.
This month we’ve addressed ways to mitigate holiday blues and that familiar feeling of melancholy for both the caregiver and the loved one throughout the season. However, for an older loved one, that feeling of unhappiness, especially if it lasts well after the holidays may be signs of depression. Depression can be common in older adults and can come in many different forms. There are also many different reasons why depression might be triggered – including being associated with various medical conditions. For instance, depression has been linked to viral infections, malnutrition, stroke, lymphoma, hyperthyroidism, and others. Some medications are also commonly linked with depression.

Moreover, when an older adult or parent starts to lose some of the independence that they once had – whether caused by a deterioration of mental or physical capabilities – they might develop thought processes associated with “learned helplessness.” This happens when the loved one starts to see their failures (whether perceived or not) as a sign of being completely helpless and having no control over their own lives. Also, as mentioned in previous entries, the sense of loss can weigh heavily on a senior parent. This is not just due to loss of another family member, but also the loss of their previous capabilities, roles, or responsibilities.

It is extremely important to not diagnose depression on your own. Have your loved one assessed by a professional. What they may be experiencing might not be a disorder at all. It may be signs of another issue. However if you are certain your loved one has depression, here are three different eldercare solutions you may want to consider:

Antidepressants. This is usually provided as primary treatment for moderate to severe cases of major depressive disorder if preferred by the patient. Be sure to double check with doctors to ensure that these medications don’t interfere with anything else your loved one might be taking.

Psychotherapy. For those who are uncomfortable taking medication for depression, this is a suitable option. Psychotherapy helps identify factors in your loved ones lives that might be contributing to depression as well as teach valuable coping skills.

Depression Care management. This is a great treatment option for those who already are within an in home care system or care management program. Care managers will help identify signs of depression and facilitate treatment options, including ensuring that a healthy regimen is kept while working alongside a psychiatrist or physician.

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.
There are an estimated 30+ million cases of dementia worldwide according to the latest statistics. That amounts to a new case diagnosed about every 7 seconds, and the prevalence is projected to increase to more than 100 million people by the year 2050. This represents all the manifestations of dementia, not just the most dreaded dementia, Alzheimer's Disease. With this rising prevalence, you won't be surprised to hear that one of the more common questions I get from the people with whom I work as a geriatric care manager goes something like this: "Is it dementia in my parent or is it just forgetfulness?"

Let me start by reassuring you that we all forget some things some of the time, so just forgetfulness is not the cause for alarm we may think. But at the same time, the forgetfulness or other early manifestations of dementia can be hard to spot, because loving caregivers tend to cover for their partners so that outsiders will not know. Let me share some of the signs that your older loved one's memory may deserve some attention by a professional.

1.     Is the forgetfulness obvious in the form of an accumulation of unopened mail or newspapers and magazines piling up, seemingly unread? Does your loved one miss appointments with increasing regularity or have prescriptions that have gone unfilled? While no one case like this should be a huge cause for alarm, a pattern can suggest the beginning of something more serious that just forgetfulness. Be careful to look for larger patterns, not just the occasional slip.

2.     If you are at all involved in your loved one's finances such as helping to pay bills or to balance the check book, do you notice irregularities? Have they paid a bill more than once or missed a recurring bill entirely? Are they losing money or hiding stashes of cash? Beware, because some of these may also be signs that your loved one is being financially exploited.

3.     Do you notice telltale burns or bruises that show some lack of attention to kitchen duties or other work around the house? Yet, don't make a lot of a little as these may also be signs of weakness that are just part of getting older.
          If you have noticed any of these warning signs, please appreciate that they may be warning you of something other than dementia. Has your loved one's alcoholic consumption changed recently, or are their medications manifesting some side effects or interactions? Something as basic as your loved one using diphenhydramine (Benadryl) can cause forgetfulness the day after using it for allergies or as a sleep aid. And alcohol consumption can exacerbate this fuzziness. One of the more common ailments of older individuals is depression which can distract them from the attentiveness they may have shown when they were younger. Be alert to recent losses or changes that may have precipitated the blues as an explanation for forgetfulness or absent-mindedness. 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.
I have again asked our vice president for senior services, Steve Steiber, Ph.D. to share a guest posting about a concept that is gaining more attention these days, especially among health care providers caring for older adults. It is all about what time of day is best for your care receiver's medicines. Steve has more than two decades experience in pharmaceutical and medical device consulting prior to joining CCM about 8 years ago. He reports: If you are a caregiver to an older loved one, you probably have seen all the medications in their cabinets, and part of the label of each of those is a clear statement of how often to take them. Prescription medicines used to have abbreviations like B.I.D., T.I.D., Q.I.D., Q.D. of less commonly Q.O.D. which translate into twice a day, three times a day, four times a day, once a day or once every other day, respectively. Thankfully, prescriptions now say things in plain English so caregivers or the care receivers do not need to know medical shorthand to understand when to take their medications. One element that has been conspicuously absent from the labels, however, has been any mention of when to take the medications, and that is getting a lot of attention in some circles. Very simply put, your body does have a clock that works pretty much on a 24 hour cycle which is why most people have a typical time to go to bed, a time to rise and fairly regular times for their meals throughout their daily cycle. The new focus, of course, has a name, and this research into when is the best time to take a given medication is called "chronotherapy." The focus of chronotherapy is on optimizing the timing of medications to give the best clinical effect with the fewest side effects. In very general terms, the best time of day to take a once a day medication most often is at night time. Treatment for certain types of colon cancer, for instance, work better at night because the body's normal cells are resting and less sensitive to the agents while the cancer cells are more vulnerable. And for medications with a drowsiness side effect, why not take them at night to actually benefit from the side effect instead of fighting it. For certain blood pressure medications, it is important to take them at night time so that they are at their best in the morning. That is because when the heart is just starting to "wake-up," there is a spike in body hormones that can stress an unhealthy heart. Cardiac events are much more common early in the day versus any other time of day. Drugs that are part of a category called "narrow therapeutic index" (NTI) drugs are most effective when taken at the same time every day because their doses typically are measured in micrograms instead of milligrams. Small changes in dosing can make a big difference in effectiveness. For any medications, make sure you also are paying attention to whether it should be taken with or without food. And, of course talk with your physician before you may any changes in your medication schedule. In the second part of this two-part series, I am going to get into some specifics of certain classes of medications and how to use your clock to maximize their benefits. And just so I say it again, please do not make any changes in your care receiver's medication regimen without first talking to their physicians. 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: Steve Steiber. And check next Tuesday for part 2.

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Long-Term Doesn’t Mean Put It Off Until Later

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