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February 22, 2011
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In the Caregiver's Words

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Although Alzheimer’s disease is the most common type of dementia, there are over 100 different causes of reduced brain function and cognition…dementia. Although we are all hopeful for a cure...or should I say cures. So, it is huge when we begin to learn what factors predispose someone to reduced cognition and how we can modify behavior or the environment to reduce the risk and that cognitive outcome. Let’s take them one at a time:
1.Dementia has been statistically tied to high mid-life blood pressure
Longitudinal research recently reported in the British journal Lancet Neurology statistically linked higher and rising blood pressure in early to middle age with a higher incidence of dementia in later life. In this research “middle age” was defined as 36 to 53 years of age, and “later life” was defined as 69 and older.1.Dementia is linked to decreased brain size This is where it is all linked. The higher blood pressure or rising blood pressure in early life is also linked to a smaller brain volume. In the British study they followed people from birth to older age with 20 measurement points along the way. The link between brain size adjusted for early life cognition is not necessarily a direct one. We talk about “adjusted for early life cognition,” because people who have cognitive issues early in life tend to have more as they get older. But those with smaller cranial size have an even great incidence of cognitive impairment. The researchers speculate that it is the clear link between reduced brain mass and the development of white matter brain lesions that gives rise to the dementia, not just a matter of brain size.
2.White matter brain lesions are linked to the later onset of dementia
Here is where the link becomes really concrete. The researchers showed that a given increase in blood pressure yielded quantifiably more white matter lesions. Back to brain size, the same sort of trade off was demonstrated with brain size…more pressure yields smaller brain mass. The bigger the increases in blood pressure the greater the incidence of white matter and the smaller the brains.
3. 30% of dementia cases are modifiable
Yet, blood pressure alone was not directly associated with cognitive function at any given point in time. It was the early rise and sustained high blood pressure that created the brain size and white matter problems later. These were tied to diminished cognitive abilities. And this now gets back to modifying risk factors for dementia, and it is pretty clear. Everyone gets their blood pressure check early and regularly…and gets it under control if it is elevated!
4. All of the above
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.
At CCM, home and safety are as important to us as to you, so it’s no surprise that it’s a common topic of our discussion. I have asked Gregory Peebles to talk about this topic from the vantage point of his experience. 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. An Associate Care Manager, Gregory has been a part of our team for over a decade. – Charlotte Home. Not only is there no place like it, conveniently located wherever you hang your hat, that fits--like an old, comfortable shoe, but it’s also a place that once we leave, to which we can never return. While most find this very stressful, some are secretly happy for a new chapter. Indeed, lots of people confirm they like adventure, but small is the number who enthusiastically embrace major residential change. So what’s the difference? Well, for one, the direction of action: people elect to go on adventures, but change just seems to happen to us. This is a major life change, and those inclined deserve the opportunity fully to grieve their loss of home sweet home. However, once the initial grief has been addressed, we’ve got work to do! Change isn’t the end, and there’s plenty of life and happiness yet to be found no matter the location. Where that happens is up to you. The diversity of the experience of aging can be exciting, and, with the number of Americans joining the group of aging adults, the kinds of communities that now exist will only become more varied. Right now the kinds of accommodations available generally fall into a few groups.
- Active Adult Communities – Often neighborhoods with individual bungalows, these communities are based on the model of so-called “snow birds” who opt to transition to such a residential community rather than maintain a larger space. Living in one of these communities requires a high level of independence (and income). Individuals or couples with highly social personalities thrive in this setting.
- Independent/Congregant Living – Facilities of this type, while slightly less luxurious than an Active Adult Community, feature many of the same accommodations with a denser population. In an urban setting, they are often high-rise apartments indistinguishable from nearby housing, with dining, health care, and leisure activities on the premises. If considering this type of facility, be sure to keep nearby entertainment and accessibility in mind.
- Assisted Living – A senior for whom it has become difficult to care for themselves either because of physical limitations or decreasing independence will often find an exciting new life in such a facility, either through public assistance or private pay, where skilled staff are present to provide diverse care. If the care receiver is also living with cognitive decline, such a facility with a “Memory Unity” may be advisable.
- Skilled Nursing – On average, aging adults who become residents within skilled nursing facilities – SNFs - are those who have health problems, who require 24-hour care, and whose ability to manage the Activities of Daily Living is severely impaired. Nursing home care, too, is expensive, but public assistance programs such as Medicare or Medicaid relieve the cost.
Change is difficult, but not unmanageable. New identities await us and are only limited by our willingness to embrace them and the imagination we bring to our experiences. Change is scary, and rightly so, but when we weather even the most difficult transitions together, and our lives are no longer recognizable from before, we may--if we choose to--learn that home is something that we take with us wherever we go, and that it is recognizable not by its address, but by the love shared and the people with whom we share it, common to both our memories and our futures. One final thought: This is when people often reach out to Aging Life Care Professionals to help smooth the transition to a new residence and to ensure ongoing care. CCM has helped countless families like yours succeed in this new chapter. Contact us today and let us assist you. 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.
When you hear the word cancer a lot can come to mind such as “cancer survivor,” “living with cancer,” and a host of “cancer treatments,” but eating our way to beating cancer may not be top of mind. We see on our media platforms a huge array of cancer therapies that claim ever-greater success in extending the lives of patients who’ve received this dreaded diagnosis. We don’t as often associate fighting cancer with what we’re planning for breakfast or lunch or dinner.
It's no one food that can take on cancer, but a host of foods actually offer a body a great deal of support in helping rid a person of a number of cancers. It starts with a simple formula: no more than one part animal-based food for every two parts plant-based nutrition. Here are some examples of what to include in the plant-based category.
1. Pick your plants based on their color, because the more colorful, the more nutrients in these fruits and vegetables. The best colors are deep green, red and orange fruits and vegetables. A great byproduct of these choices will be weight loss; too many of us are carrying around excess body weight that is unhealthy.
2. Foods rich in the folate in a Vitamin B supplement are very effective in protecting the digestive tract and breasts. Strawberries, melons and oranges as well as multi-grain and fortified breakfast foods are great sources of folate.
3. Folate is not just for breakfast. It is also abundant in beans and sunflower seeds as well as asparagus and leafy vegetables like spinach and romaine lettuce. Pregnant women have always been encouraged to take folic acid supplements, so you will readily find these in the nutrition aisle of your drug store.
4. It’s also important to avoid certain foods, especially those that are highly processed. But the deli counter is the big locus to avoid – cut out hot dogs, bologna, ham and other processed meats. While you’re in the passing lane, take a pass on sugar as well. Sugar is not so much a cause as a chemical that blocks other healthy foods.
5. Water also is in a strong supporting role, in part by diluting a lot of what we consume as well as simply cleansing our bladders. If you want to add green tea leaves to your water, there is evidence that it is helpful in fighting cancer in the colon as well as the liver, prostate and breast.
6. And as you shop for what you’ll take home to eat and live healthier look for food labels like antioxidants and phytochemicals. Antioxidants are abundant in foods like blueberries and phytochemicals are available in strawberries and raspberries and beans.
If you would like to peruse the entire list, visit this page on the WebMD site. 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.
I am sometimes asked why we have that phrase on our brochure and web site that says "Your Sister in Chicago." The Chicago part is not where the question arises, but some ask why we talk about the "sister." Well, we have discussed that among our own staff, but it really comes down to how roles sort out when it comes to caregiving. Aside from the fact that research shows that it is spouses who are more often the caregivers to one another than anyone else, it most often is the daughter than the son who is the caregiver to an older parent who needs the help. The University of Michigan collects data from Americans every two years in what they call their Health and Retirement Study. It's a survey of more than 26,000 adults over age 50 in America, and some of the recent findings shed some light on how caregiving sorts itself out by gender among adult siblings. The averages begin to tell the story. Daughters, the survey shows, perform 12.3 hours of caregiving to an older adult in an average month compared with fewer than 6 hours for the average son in a family. And when there are both a son and a daughter in the sibling mix, this sibling gender mix reduces the sons' average hours while it increases the hours the daughters will spend in caregiving. According to this survey, the pattern has remained essentially unchanged for more than two decades. There has been a consistent gender gap, and it is more pervasive that just elder caregiving. If you look to see who the stay at home parent is when families sort out responsibilities, women still outnumber men as the stay at home caregivers to children. The authors of the research suggested that it is not up to the daughters of America to more actively recruit their brothers to be involved in caregiving to mom or dad. They argue that the brothers ought to assert themselves into the mix as a remedy for the stress that daughters will experience as the disproportionate caregivers. Women may provide more care to the parents, but they also take on a larger share of the caregiver stress. Yet, this gender gap is not always because men do not step up. We see cases in our own sphere where it seems that the sons' voices do not get heard as much as the daughters, so maybe adult siblings of all genders need to do a better job of sharing the family caregiving responsibilities. But until we can proudly say that we are your "sibling" in Chicago, we will continue to be a sister to both the daughters and sons who are looking for a care navigator to help them with their care receivers. 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@cr eativecaremanagement.com.
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We all lose sleep sometimes, because we all can carry to bed with us the worries about the concluding day or the day ahead. I have been taking an informal poll on what keeps caregivers awake, and some consistent themes emerge. I am going to list out what I have been hearing along with some suggestions to help you get a better night's rest if you are a caregiver to an older loved one or other special needs individual.

When you are on call as a caregiver so much of the time, it is hard to simply "turn it off" at night. Being a caregiver has been termed the "36-hour day" by at least one author. Everyone needs to be able to clock out of the job to rest and refresh. Set a quitting time for your caregiver duties, and as a way to signal the end of your shift, consider writing a list of what you will do tomorrow as you pick up where you left off. By making the list, you will not be obsessing about it as you try to fall asleep, and you will not have to think about what you will do when you rise. It is ready to pick up, and you need not give it any more thought.

You end up doing everything because it takes more time to explain it to someone else than it does to simply do it yourself. It really is a problem of delegating. Consider partnering with another caregiver. You can take care of their loved one at certain times in exchange for their help in taking your mom or dad along with them for designated times. Caregivers will be quick learners for one another, and they really do understand that it is not "babysitting." Also, make a list of what others can do for you, like shoveling your walkway, cooking a meal or shopping for you.

You always think you should be doing more. Guilt can be a very unforgiving motivator, and I believe that all caregivers have something to learn from Bruno Bettelheim who wrote about "The Good Enough Parent." Turning his advice around just a bit, the caregiver's role is not to make an ideal parent or loved one out of the person for whom you are the caregiver; it is to simply help your loved one be what they wish to be and for you to accept that as "good enough."

Feelings of isolation or even depression can haunt a caregiver. It comes back to one of my principal tenets of caregiving: You will take better care of someone else if you are taking care of yourself. Seek out respite care for your loved one so that you can meet with friends for coffee or just a break from your routine. And do not hesitate to seek the counsel of a cleric or professional if the blues become more than just a down day. You deserve some help in coping with what is a stressful job.

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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