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

Long COVID’s Long List of Symptoms
The COVID pandemic is not yet done with us in the United States, and the story certainly is different...
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February 7, 2023
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To Sleep, Perchance to Dream
No, this isn’t a refresher course on Shakespeare and the famous Hamlet soliloquy. (Spoiler Alert – Hamlet was ranting...
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January 2, 2023
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Saying “No” May be the Right Answer
Saying “yes” when someone asks you to do something can be like eating candy. It feels right or good...
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November 15, 2022
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Become a Dementia Detective by “Talking the Talk”
Today we have a guest Post from Christina Padilla, a speech-language pathologist and Certified Dementia Practitioner living and working...
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September 27, 2022
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Diagnosing Alzheimer’s Disease
September is Alzheimer’s Awareness Month, and this is the second of four posts we’ll offer on the subject. A...
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September 13, 2022
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Food Fight
When you hear the word cancer a lot can come to mind such as “cancer survivor,” “living with cancer,”...
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August 23, 2022
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Before or After the Fall
I came across an informative piece in the Washington Post about a week ago, and it brought to light...
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July 26, 2022
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What You Can and Cannot Change About Dementia
Let me start with the short answer to a question we raised in the email announcement of today’s post. ...
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June 21, 2022
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Age and “Long Covid”
There seems to be a cliché for everything, so we’ll start with this go-to for COVID: “We’re not out...
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June 7, 2022
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When Being in Demand Isn’t Healthy
If you’re a musician, you want to be busy, because gigs represent a better living. If you’re an actor...
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May 17, 2022
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In the Caregiver's Words

Recent Client Praise

According to the Centers for Disease Control (CDC) adverse drug reactions or overmedication result in more than 700,000 hospitalizations a year. And many of these could be avoided by following advice offered by the American Geriatrics Society. The AGS’s Foundation for Health in Aging offers advice for all of us who care for older parents or adults in our orbits. Here is a summary of the six major recommendations.
1. Ask before taking OTC drugs: Never assume that just because you can buy a medication in a drug store without a prescription that it will be harmless. Most of these drugs started out as prescription meds. Ask the doctor or pharmacist if an OTC drug is a risk by itself or in combination with a prescription your elder may already be taking.
2. Make/update your List: A lot of medical offices are very good about asking patients on every visit what medications they are taking and keeping it in their records. With every visit the provider needs to add new medications so that everyone is aware of what your elder is taking.
3. Question your provider: When you or your elder receive a new prescription ask questions about when to take the drug, with or without food, what to do if a dose is missed, is it available in generic form and what are the common side effects?
4. Read the labels and follow them: There is a fine print insert of patient instructions that comes with every prescription. Don’t be intimidated by the scientific jargon; look for the indications and usage section as well as the adverse events sections. And then take them as directed – don’t add a dose for better effect or stop just because you feel better.
5. Report any ill effects: There is a saying in geriatric circles that every symptom in an older adult should be considered a side effect of a drug until proven otherwise. Especially if there is sudden difficulty breathing or swallowing, light-headedness or irregular heart beat. If you cannot reach your loved one’s provider call 911.
6. Review your medications with your provider: At least once a year you should talk with your elder’s provider about the medications, the doses and any changes you may have noticed. And do not leave out vitamins, supplements or herbals.
For more information go to the American Geriatrics Society web site as well as refer to a list of drugs that have known side effects or other issues. This is called the Beers List .

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 Charlotte Bishop
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.
I have talked before about the FDA-approved medications indicated for Alzheimer’s disease. The short answer is that they are not very effective – statistically effective, yes – but not appreciably effective and not for very long. That all deserves some clarification and specificity that I won’t get into, because I want to share something that literally has withstood the test of time. I have mentioned a London health panel study call the Whitehall II Study before. This was one of those really big population studies over a very long time. By very big, I mean they followed over 10,000 people, and the study began in 1985-88 with those thousands of people in the civil service between the ages of 35 and 55. They took measurements six times over this roughly 30 years. The measurements included dementia assessments at three of the time points and cognitive ability (verbal memory and reasoning) was measured at five time points. They linked all of this to clinical and mortality data bases as well as documentation of all of the civil servants’ age, gender, ethnicity, socioeconomic status, education, health behaviors, employment status, and marital status. They also measured “social contact;” this was contact with friends and could not be with family members or friends who lived with them. In a nutshell what they found was that more frequent social contact – after taking into account all those variables – in mid-life was associated with better cognitive function. It gets better. By age 60, those with better social contact had a statistically significant decrease in their dementia risk. You read the list of the other factors. Of course people with better socioeconomic health and better overall health tend to be in better cognitive shape as well. But even after taking into account all of those variables I cited earlier, social contact with friends made a positive additional statistical difference in cognition and dementia incidence. So, yes, friends don’t let friends have dementia. Please note that this is not a case of if you hang with friends, you will not have dementia. It is a pattern where people who hang with friends regularly are less likely to have cognitive issues or dementia. It’s is like if you don’t smoke you have a lower risk of lung disease. It’s not a guarantee; it is a better chance at better health. There is an author named Neil Pasricha who has a number of books out about living better and mental health. One of my favorites, The Happiness Equation talks about the importance of four S’s…sociability, structure, story and stimulation are the “S” cornerstones for Mr. Pasricha:
- sociable – engage with others
- structure – have a routine that engages you every day
- story – have a reason, a calling for what you do
- stimulation – challenge yourself and your friends.
In a break from my usual focus on what you can do for your aging loved one, this one will be good for you also if you are the caregiver. And it will be fun! 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.
I am not saying that music is not helpful in your digestion or in your love life, but a recent compilation of multiple scientists’ research makes a strong case that music is a wonderful assist for your older loved one’s sleep … or for your sleep or anyone’s sleep. When I say multiple scientists’ research, it is a method called meta-analysis that systematically analyzes findings from a series of studies of a given subject and quantifies the consensus or lack of consensus. All of us at one time or another have “lost sleep” over some worries or events or maybe something we ate. But it’s estimated that as many as 40% to 70% of older adults have fairly routine sleep disturbance, and it takes a toll on these individuals’ cognition, not to mention mood and general temperament. Analyzing their data from five randomized trials, these researchers found that music statistically significantly improved sleep quality. There also was a statistically significant difference with those who listened to more “sedative” music reporting better sleep outcomes than those listening to more “rhythmic” music. And the longer subjects listening to their settling music, the better their sleep patterns. So, what does this translate into for your recommendations to your older loved ones or to put into practice for yourself? Sedative music was more clearly defined as having a slower tempo of about 60 to 80 beats per minute, a smoother melody line, no percussion and a lower volume. In short it’s music that is all the things that a rock concert is not. And that four week difference I cited. When cultivated as a long term habit, music can improve one’s sleep … and therefore, life … in a very tangible and sustainable way. So, next step is to sort out your music library, and then, well sleep on it. 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.
When I get a call about our geriatric care management services, most people are not asking for a geriatric care manager, per se. They are asking a question about something they have noticed or been told about their older parent or loved one. The question most often is about a change in the older parent that sets off the caregiver alarm that something is just not quite right. In this posting I am going to go through some of the questions I hear and then explore some of them in more detail in later blogs. Please also let me know any questions you may have or any telltale signs you may have seen in an older loved one that give you concern.

Change in eating habits: Have you noticed that your loved one's clothes are fitting more loosely, that they miss meals or that they just don't have the appetite they used to? Losing interest in food or eating significantly less are not normal or inevitable parts of aging. But older stomachs do empty more slowly than a younger adult's, and food may be less appealing because the sense of smell and taste are diminished. Yet, the fact remains that malnutrition is a serious health threat to an older adult. “There’s a fair amount of evidence that suggests if you lose appetite as an older person, in the next six months, you’ll have a higher chance of dying.” This is according to Dr. John Morley, professor at the medical school and Director of Geriatrics at Saint Louis University Hospital.

The cause may not be directly tied to food losing its appeal, per se. It may be that your older loved one simply has poor fitting dentures that just take the joy out of eating; it is actually painful. Loss of appetite is also potentially a sign of depression among older adults.

Older adults also have had a lifetime of losses, such as retirement, debilitating chronic disease, death of a close family member or simply not being as socially engaged as they once were. And these losses can become a huge emotional burden that detracts from appetite.

Any of these causes that lead to a diminished appetite can also ultimately lead to malnutrition which is a slippery slope. Malnourishment can lead to a reduced immune system and the ability of the body to resist diseases or other assaults. Small cuts or bruises will be slower to heal or even be more prone to infection in a malnourished older adult. As the malnourished body looks for nutrition it will feed upon itself, particular muscle. Once an older adult's muscle mass is diminished they will, in turn, be more susceptible to falls or even degradation of bone mass and fractures. And it is hard to put the healthy weight back on.

So, when next you visit the older adult in your life or have a meal with them, take note of the food they consume and what gets left on the plate or not served. Also, check their refrigerator if they are living independently. Look for how well-stocked it is, signs of food well beyond expiration dates or spoiling. It is not just about eating a full meal as much as fueling a healthy, older body.
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.
We can no longer deny that the seasons are changing and for older adults still living in their own homes, the transition to cold weather can represent a number of unique safety hazards. If you have an older adult for whom you are a caregiver or if there is someone you simply look in on occasionally, here are some tips to help make them safer in their homes as the temperatures drop.

1.    Have furnaces and their chimneys checked to be sure that they are burning cleanly and venting properly. Carbon monoxide is a gas that is colorless and odorless, yet lethal. It is a byproduct of combustion and can accumulate in an older home that is closed up tight against the cold in the fall and winter.

2.    Check the hot water heater for the same reason you would check on the furnace. Be certain it, too, is venting properly. And while you are checking, look to see that the temperature setting is 120 degrees or less. As with the other senses, older adults’ sense of heat is less acute as they age, and they may scald themselves before they feel the heat when climbing into an overheated bath.

3.    We have seen fairly stable energy costs lately, but there is talk of a spike in home heating prices as we move into the winter. Be alert to your older adult who appears to be rather bundled up in heavier clothes around the house. They may be conserving the heat, but they also are at risk for catching fire while cooking in bulky clothes over a stove top. Heavier clothing also can be trip hazards throughout the house.

4.    Portable heaters can seem like a cost-effective way to heat small areas, but they represent a number of hazards. If they burn fuel, they can be carbon monoxide hazards, and if they are electrical, the cord can be a trip hazard. In electrical heaters, the coils are a fire hazard if they touch clothing or papers.

5.    Finally, the change to standard from daylight saving time for those of you who reset their clocks twice a year is a reminder to check two other appliances any senior home should have. Replace the batteries in both the smoke detectors and the carbon monoxide detectors, and be sure they are strategically-placed throughout a house. Also, detectors on only one floor of a multi-level house are not sufficient protection. Your local fire department personnel will be glad to come out for an inspection and offer recommendations; some even offer free or discounted detectors.

Now that you have made home safer for the older adult in your orbit, button up your coat and enjoy the change of season.

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.