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

How to Say No to Cancer
Who would say “yes” to cancer, you may be thinking, but saying “no” means you’re committed to the lifestyle...
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July 23, 2024
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LIFE: What Are You Going to do About It?
I had the good fortune this past weekend to attend a Billy Joel concert, and he had a great...
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June 24, 2024
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Lessons Learned are Lessons to be Shared
The classic profile of an older person speaking to a younger person sometimes misses the point. Yes, grandkids love...
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June 18, 2024
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What’s Your Complaint?
If you grew up in a family as I did we were taught not to, or shown role models...
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June 11, 2024
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Are Your Prepared?
Have you ever taken a trip that was planned by a third party… maybe a National Geographic voyage or...
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June 3, 2024
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Well, Don’t Do That
I have to believe that you’ve heard the one about the patient who shows up at the doctor’s office. ...
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April 30, 2024
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The Synergy Between Seniors and Earth Day!
April 22 is Earth Day, a date that has brought together activists and celebrants since its inception in 1970. ...
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April 22, 2024
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Can’t Find Your Keys?
When I speak to some clients our conversation moves from their work lives and forward to their retirements now....
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April 16, 2024
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Are You in the First Half or the Second Half of Your Life
A philosopher/theologian whom I regard quite highly talks about the first half and the second half of life. Life...
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April 2, 2024
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Another Side Effect of COVID: SCAMS
Just when you thought you’d heard everything about COVID! We early on learned how to be vaccinated, and most...
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March 12, 2024
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In the Caregiver's Words

Recent Client Praise

You may have heard the noise about a new drug for treating Alzheimer’s disease and other dementias. It would make sense that there would be some noise, because we’re talking about a new treatment with a new target and new data on how well it works (or doesn’t). A lot of the noise, however, was not fanfare about a new drug as much as the red flags that Medicare (CMS) was raising about covering the new therapy's use. That, and it’s been since my book was released in 2017 that any new way to address the devastating effects of Alzheimer’s has come on line…and that's just about six years! I won’t go into the details of those “older drugs,” except to say they didn’t have anything close to the dramatic results that consumers or physicians wanted:
- Cholinesterase Inhibitors (Donepezil, Galantamine and Rivastigmine); and
- NMDA antagonists (Memantine, Memantine and Donepezil combination).
You can read more in Chapter Seven of the book if you want to understand their mechanisms of action as well as other healthy lifestyle habits that can make a difference in addressing both the progression of Alzheimer’s and how the medications work. I had mentioned the “noise” about a more recent addition to the inventory of FDA-approved treatments for Alzheimer’s. The new drug, Leqembi, was approved for treating AD, but there were a number of caveats imposed by the Food and Drug Administration from the get-go. When FDA gave its initial approval of Leqembi as “safe and effective,” the Centers for Medicare and Medicaid Services (CMS) placed some rather onerous restrictions on the use of this therapy. What restrictions? Patients can of course be prescribed Leqembi, but it will be “covered” by CMS only if their prescribing provider is part of a registry to monitor the use of the drug. This position has been a bit relaxed from their earlier restriction that patients could be prescribed this therapy only if they were involved in an extended clinical trial. And this is a first for CMS to require this sort of data-collection after FDA approval. FDA’s approval was based, it seems, on the therapy’s ability to reduce amyloid beta plaque in patients’ brains in a 79 week trial among 856 patients. The manufacturers of Leqembi had completed the trial with up to 93 percent reduction in plaque at Leqemi’s highest dose. CMS has made restrictions for drugs yet to complete an approved clinical trial, but Leqembi was already done with that. What’s missing in this picture? Since this is going to take a bit more space to unpack, I’ll leave with you a question to be answered in “part 2:” What about maybe judging a therapy based on measures of Cognitive Decline? 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.
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Dr. Oliver Sacks explains neuroplasticity in his editorial, “This Year, Change Your Mind,” in the New Year’s Day editorial page of the New York Times. As a geriatric care manager, I have encountered clients whose injuries have induced deficits of some sort from which recovery plans are designed and executed. Physical injuries such as lost limbs, vision, hearing or others have fairly clear rehabilitation trajectories, and the injured individual can learn and work through them to recover as much of a productive life as possible.

Neurological injuries like those Dr. Sacks offers as examples require remolding an organ that we do not see from injuries that also may be invisible. As Dr. Sacks explains, neuroplasticity offers the means by which the brain can remold itself to overcome a deficit. For a geriatric care manager, the deficits do not have to be as dramatic as a spinal cord injury, the onset of blindness or even a stroke. We see every day the consequences of older adults’ inactivity and the cumulative deficits that can grow out of the under stimulated life. The brain does lose some of its pathways through natural attrition, and it is critical for a vibrant life for the aging individual to keep working in order to maintain the pathways they already have as well as to create new ones as some of those may become unavailable. A colleague likens it to commuting in the brain. There may be detours and rerouting, but an active individual will always find a route home.

There is a case of a 70+ year old client whose spouse is suffering from Alzheimer’s inexorable progression. While there is little to do to forestall that condition, he takes it upon himself to exercise at his facility’s gym three times a day, he is a voracious reader and he is an active participant in his wife’s care team so that he can be both physically and mentally able to care for his wife to whom he is entirely devoted. Or the 90+ year old woman who will keep up with her grandchildren when they come to visit – as exhausting as it may be. She is a brilliant conversationalist, she rarely repeats herself and she completes the New York Times crossword puzzle. What do they have in common? They both push the boundaries of the envelope.

They both are pushing the plasticity of their brains.

Dr. Sacks exhorts us to “change our mind” this year as part of our 2011 resolution. I would expand that to include all of those on whom an elder or person with special needs depends, and encourage those caregivers to help push the envelope for those in their care in order to effect a change of mind and a robust life in 2011 for all.

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.

Copyright ©2011
One of the big challenges of the holidays can be all the hype about "over the river and through the woods..." along with all the mandatory "holiday cheer." If that is the way reality works, why is it that when you visit Grandmother or Grandfather, they appear more blue than merry? Depression during the holidays is very real, but it also is different from "clinical depression." And when you visit your older loved ones, you may see the signs of holiday depression. So, what will you be walking into and what can you do about it? What is holiday depression? First, of all, there are a lot of expectations for "jolly holidays" that simply do not square with reality, and we can thank the popular press as well as Hollywood for some of that. But there is more. Holidays are times when we all come together to celebrate family. For older adults, some of those people who used to be such important parts of the family celebration may now have died. So instead of holiday cheer, there is a real sense of holiday loss. This is all the more acute for the "firsts." The first holiday without mom or dad is really poignant just as the first anniversary of their passing or the first of their birthdays without their being present can really bring a person up short. A holidays this year also will be framed by all the holidays that have preceded this one and all the people that were part of the earlier celebrations. Christmas or Hanukkah or Kwanza have been defined by the people who were present then, but absent now. Some do's and don'ts. If you have an older loved one who seems to be feeling the seasonal blues, encourage them to be socially involved where they can. Do not let them fuel the depression by being isolated as well. Also, pay attention as we move through and beyond the holidays If the blues last months instead of weeks, the depression may be clinical. Clinical depression should be addressed by a professional who can help a person get back to a better path. And an important "don't" - don't tell the -person they should not be depressed or tell them to simply "snap out of it." The blue feelings they have are valid, and people do not choose to be depressed. Ask if there is anything you as a caregiver can do to help. Talking can help to get some of the sadness out. And getting back to that potential for social isolation, offer to take an older loved one who is depressed out. They may enjoy some "shopping therapy," or the preparations in the kitchen or other venues where people are gathering to prepare for or to celebrate the holidays. Simple physical activity can be part of the catharsis to help combat the holiday blues. So, celebrate the past, but let go. Encourage your older loved ones also to engage in helping others, in giving to others. The reaching out will do much for helping them to feel integrated as well as offer a sense of validation of self. 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.
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
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.