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Distance Caregiving Through a Wall
I’ve written numerous times about distance caregiving, and one of the observations I have offered is that distance is...
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May 19, 2020
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Mittens Before the Frost
I was asked today about the “mitten test.” It was one of our colleagues who had remembered something I...
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September 18, 2018
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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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A House is not a Home (Unless You’re There)
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 5, 2017
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In the Caregiver's Words

Recent Client Praise

I have again asked our vice president for senior services, Steve Steiber, Ph.D. to share a guest posting about some new research which studies what predicts cognitive decline. Steve has more than two decades experience in pharmaceutical and medical device consulting prior to joining CCM about ten years ago. He reports: "Keep you r friends close, but your enemies even closer," is advice that has most often been attributed to Sun Tzu, a Chinese military strategist of 6th and 5th century China. Maybe this is good advice for military matters, but researchers are finding increasing evidence that it is poor advice for mental matters. In fact having stressful friends as early as middle age is a statistical predictor of cognitive decline in later years. Scientists at University College London report that negative interactions with others - which they characterize as "unpleasant social exchanges" - lead to declines in cognitive test scores over the ten-year period of their study. They actually measured the cognitive profiles of nearly 6,000 British civil servants over this period, and those with more negative social relationships reported even more rapid decline in their mental capabilities. Those in the top third of "negative associations" aged cognitively as much as a year more than those in the bottom third. The differences, while small, were statistically significant. In parallel research recently reported by physicians at the Washington University School of Medicine in St. Louis, it is not just the "crabbiness" of others that can precipitate cognitive decline. These physicians were looking for leading indicators of Alzheimer's Disease in more than 2400 patients in 34 Alzheimer's Disease centers between 2005 and 2013. They tested patients for their functional capacity, general depression, a host of other neuropsychiatric conditions and dementia. The patients all started out "cognitively normal" on all these scales at the outset of the study. They found that irritability, depression and disturbances in nighttime sleep patterns preceded mental decline in these patients. But it got even more granular than that. It was like following a road map with first, irritability, depression, and nighttime behavioral changes; these were followed by anxiety, appetite changes, agitation, and apathy. Last came elation and motor disturbances which were followed by hallucinations, delusions, and disinihibition. Rather startling. What do we take away from these findings? First, we should not make any sweeping generalizations without more research to corroborate what these researchers have found. But at the very least, it suggests that if you have a loved one who is middle age or older, be aware of the people whose company they keep. It is not mentally healthy to immerse oneself or your loved one in the company of irritating people. (Maybe that is good advice for us all, regardless.) The second research suggests that we perhaps can seek professional help earlier with symptoms that may precede forgetfulness or other cognitive decline. The list is here. Take seriously the signs of melancholy or poor sleep patterns or changes in mood or appetite. And if a loved one shows consistent signs of irritability, it may be more than their impatience. At the most general, think of these bodies of research to be not unlike the research we have always seen about diet and exercise along with not smoking. The research here, however, is not about physical health; it is mental health we can safeguard with better vigilance. 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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Associate Care Manager Gregory Peebles returns with a series on the Internet and older adults. Gregory is both a Certified Senior Advisor (CSA) and Certified Dementia Practitioner (CDP) whose work focuses on helping aging adults and folks with limited independence by providing resources and support to help them discover and lead their best life. Gregory has been a part of CCM, Inc. for over a decade. – Charlotte The Internet is a safe place if you know how to navigate is safely. It’s user-friendly if, like the youngest generation, you grew up using it all the time. Most, however, have not had that advantage. We learned on our own, and any self-taught amateur will tell you that without a teacher, you can learn a lot of things wrong. There’s no shortage of helpful information on scams directed at older adults who have ventured onto the Internet. At CCM, we try to feature this type of content as it becomes available. Today’s post, however, is about common, globally unsafe habits from which we’ve witnessed our clients and their families struggle to recover. Have these conversations with your older loved one before you have to clean up a digital mess or reclaim a stolen identity.
1. Passwords. Plural. There should be a different password for each online account, and they should change with some frequency. It’s annoying, but at least it’s easy. You know the “best practices” – upper and lower case letters, numbers and even the “other” characters (@, #, etc.).
2. The Not-So-Funny Joke Forward. Sometimes a dangerous link gets inserted into those joke message forwards. Anyone curious/unlucky enough to click on it gets a nasty surprise. Tell your loved ones Don’t click on links unless they are in a personally directed communication from a trusted source.
3. Oversharing. Social media encourage us to tell everyone everything, first among which is how we feel, where we are, what we’re doing. Older adults - not as fluent in the standard practices of safety - are most likely to fall prey to those seeking to benefit from oversharing, an example of which might include updating a status about leaving town for a while. Predators are looking for exactly this type of information, especially if they know their prey’s address already.
4. Oversharing: The Sequel. Similarly, older adults are much more likely to give out personal information casually in a public forum (as in a comment). Not only will it overwhelm your loved one with junk mail, placing them at higher risk for scams, but someone looking to take advantage can get an incredible amount of information from just a name, a phone number, and an email address.
5. Shopping the Black Market. Non-secure websites don’t even pretend to protect your information. How can you tell if a website is secure? Nothing is 100%, but if the URL you’re shopping at does not begin with [https:], leave immediately. The extra “s” is for “secured”, and without it, online shopping becomes a huge risk. Noting this one thing can save lots of money and trouble.
Internet safety could be its own series, but with these five tips, we’re confident your loved one will be safe exploring all the Internet has to offer. 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.
As if dementia sufferers don’t have enough quality of life challenges, we can add to the list dehydration. In addition to the other short term memory issues older adults with dementia may not recognize that they are dehydrated … or they simply forget to drink enough water. We have long known that older adults in general often do not drink enough water, in part because they just don’t feel thirst as acutely as younger people do. Some also worry about incontinence, so they cut back on that risk by taking in less water. Older adults also often are on medications that can deplete their water, and this is especially the case for older adults on some blood pressure medications or antidepressants. Add to this the simple fact that older adults need as much as fifty percent more water daily than their younger counterparts to function optimally, and you get the potential for a thirst epidemic. Forgetting to hydrate can have real health consequences. As an adult grows older and begins to take in less water, they effectively can amplify the effects of some of the medications they take, increasing their dose without changing their intake. Dehydrated adults are also prone to some infections, particularly urinary tract infections. They also are prone to dizziness, headaches, confusion and difficulty walking. Enter a British college student named Lewis Hornsby. Hornsby was a design student who noticed that his grandmother who suffered from dementia seemed simply to have little interest in drinking water, and this led to a perpetual dehydration for her. Hornsby came up with a concept he calls “Jelly Drops” that are brightly colored balls contained a bit more than an ounce of flavored water…a hydrating finger food. As a design student, we was very conscious of not making it look like a medicine, hence the bright colors in packaging that could have been suited to a box for chocolates or gummies. Jelly Drops may not be available where you or your older loved one resides, but that doesn’t mean you can’t engage your loved one with more appealing hydration. Try popsicles or smoothies. Some folk make prefer milkshakes, Ensure or sports drinks or any of the burgeoning number of bottled waters. Maybe add bubbles…just try to avoid carbonated drinks that also add sodium. 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.
According to research reported in the New England Journal of Medicine, approximately one in five Medicare beneficiaries discharged from a hospital will end up back in the hospital within thirty days. It usually is for the same reason they were admitted originally. This means that it not only is bad for the patient who has to go back to the hospital, but it typically represents an expense that could have been avoided. And it is these sorts of statistics that give me a chance to talk about a question I get asked a lot: “What is it that geriatric care managers do?” Let me explain.

The typical picture of an older patient who is readmitted is one without a lot of social support locally, and this older patient:
- May not fully understand their discharge instructions.
- May not be taking their medications as instructed.
- May have complications they cannot handle.
In most of these cases, if the patient had had someone to be the information processor, interpreter and implementer, the readmission would not have been necessary. A geriatric care manager would be available to make sure the discharged patient understands any limitations on activity that the medical professionals have stipulated or understands how active they should be to recover from being in bed for the number of days they were in the hospital. A care manager can help to make sure that all the patient’s medications are organized or that a new prescription gets filled and its dosing gets integrated into the daily regimen. (Remember that seniors are about 13% of the population, but they represent about 30% of all the prescriptions written.

The National Transitions of Care Coalition offers a checklist your care manager or you as a caregiver can use with an elder for whom you are responsible as they leave the hospital:
1. Have a method in place to assure safe use of all medications.
2. Have a plan to facilitate the big change from hospital to home.
3. Engage all members of the family and personal network of the patient.
4. Share important information with all care providers and caregivers.
5. Find and read any educational materials about the patient’s condition.
6. Facilitate any follow-up provider visits, therapy, etc.
As a caregiver (or through your care manager) advocate for the patient to physicians, discharge planners or other providers responsible for the continuity patient’s care.

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.
In my last post, I gave you some tips on distance caregiving that arguably could be called the 30,000 foot perspective on distance caregiving. But even from afar caregiving is deeply personal and the caregiver needs to be as much a focus as the care receiver. You might call this my “do unto yourself as you do unto the other” post. I’ll start with the “other:”
1. Caregiving is a team sport – to be successful you have to be part of your care receiver’s team. Most health care providers, especially the residential ones, have what they call a “Care Team.” That could include a nurse, a physical therapist, a social worker, and a physician, and this last could include any number of specialists. You are part of the team, and you do not have to have power of attorney to be a team member…but you do need your care receiver’s written permission for the rest of the team to talk with you.
2. Successful teams bond with one another – you need to have a relationship with key members of the Care Team. And everyone needs to own their position on the team. Regular check-ins happen…well…regularly. Everyone keeps notes and lists of “to do” items. You also need to get into that habit.
Now, about you.
1. Take care of you - If you know anyone who is a therapist or social worker seeing clients in an office, they do not work all their hours in one-on-one therapy. They take time to process, and they take time to recover. In short, they take care of themselves. The lesson here is that self-care is very important to successful “other-care.” I recall an individual who confided in me that he had gone from six hours of uninterrupted sleep a night caring for his mother to six hours of interrupted sleep a night caring for mom. That is not good self-care.
2. Avoid burnout - When you have a call with your care receiver or members of the care team, set a time limit as you begin. Make notes following the calls, and these include assessing how you feel about what you have heard. Have the local care team take care of what happens locally…you cannot.
3. Set loving limits – I followed this advice when I was raising my children as well. You have to recharge your batteries. Some people workout, others write in a journal, some people go to the art museum, and some listen to their favorite music. Do what feeds your spirit so that your spirit will be there for both you and your care receiver.
In the end, everyone on the team wins. If you are a caregiver, it’s important to be part of a winning team. 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.