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Saying Goodbye to a Loved One
Elisabeth Kubler-Ross introduced her five steps of grieving for a loved one who has died four decades ago in...
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February 1, 2011
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In the Caregiver's Words

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Fetch! Come! Sit! Stay! Remember! So, I've given away that I’m a dog owner rather than a cat or other pet, but the commands here underscore findings from research reported at a recent meeting of the American Academy of Neurology. In short, the researchers from the University of Michigan reported that pet owners preserved their cognition better than non-pet owners in a six year study that followed 1,369 people who started with an average age of 65. Cognitive decline was slower for older adults who had pets. It has long been observed that pet ownership (some say that this is the other way around) is associated with lower rates of depression. The researchers here decided to delve into a potential relationship between pet ownership and cognitive decline in a large scale University of Michigan study called the Health and Retirement Study (HRS). Of the 1,369 people in this study, 53% owned pets and a majority of these were long term pet owners. People whose cognition was impaired at the outset of the study were excluded from the research. As the researchers followed both pet owners and non-owners, they found a statistically-significant advantage in the cognition measured among the owners. They also found that longer term owners had the edge over everyone else in cognitive retention. Those study subjects who were Black or college-educated or male had a more pronounced positive effect on cognition. While the researchers go on to say that this is not a cause and effect study, the findings favoring pet owners were statistically meaningful. Although the researchers stop short of advising all older adults to rush out and purchase a furry companion, they do point to additional positive effects of pet ownership. Other studies have demonstrated that pet ownership can mitigate loneliness and depressions. Still other research among military veterans not only improved the mental health of those with PTSD and worked to lessen depression as well. I would also add that the study found this positive effect on participants who were responsible for the care and maintenance of their pets. That is, just having a therapy animal show up regularly will not have the same cognitive benefit as hands on pet care and maintenance. Part of pet maintenance are the two or more daily walks for the pet and the owner if this is a dog. Let’s face it: the walks are good for more than cognition if both the furry friend and the owner put in the steps every day. Back to not using this study as a platform for advocating pet ownership. The authors did recommend that the data were sufficiently strong that they could strongly encourage that older adults with pets be supported in keeping their pets. Taking a pet from an older adult who may require alternative housing arrangements should not be considered without also considering how the pet and owner can be supported together. 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.
You know what makes a real difference between grade school children and adults over the age of forty? We could go down an entire list of physiological and intellectual and stature differences, but there is one you may not have considered, because it’s in your head. Ask most kids in primary school how old they are and you’ll get a fair bit of “I’m going to be ## in whatever month their next birthdays are. Ask someone over forty a similar question as a group of Danish researchers did of 1,470 study subjects and it flips pretty dramatically the other direction. On average, these researchers got answers that were 20 percent younger that the subjects’ actual ages. Across all of these study subjects the age deflation was a fairly consistent 20 percent difference which led the researchers, and probably you as well, to ask, “Why a consistent twenty percent?” What age do you think yourself to be in your head? I attended a seminar a number of years ago, and one of the lectures was from a recently-retired university professor who introduced his session with a simple rule: “You have to get older, but you don’t have to act your age.” He promptly plopped a beanie on his head and proceeded to elaborate. I spoke with him on our break and asked him what motivated him to retire from his tenured position and his university and take his subject matter to other venues. I did not then know to ask him how old he thought himself to be, but his story suggests that he wanted to put a brake on aging. His best friend on the faculty had died in the past year which gave him pause to take stock and reroute his life. Or, did he refuse to get to be “that age” but changing lanes to a track that felt more vital, younger? This is not an uncommon story line for “aging adults,” although the details of each person’s story will be different from the others. Some of this phenomenon may also be that our society tends to discount what an older adult can bring to the table. Ask anyone who still wishes to stay on their career path into their sixties or seventies…until they report to that new 35 year old manager. Our society and most western societies tend to attach less value to older workers’ wisdoms. Yet, Asian cultures celebrate age for its place within a hierarchy where chronological age is correlated with prestige. Their brain age to chronological age gap is also smaller and smaller yet is the gap between how old an individual is and how old they feel in their minds in Africa. These latter also tend to be a bit more culturally homogeneous and socioeconomically more homogenous as well. All of this does underscore that age divide, but it should not stop you from enjoying the gathering for your next school reunion or the music they play that “takes you back” to your youth. At the end of the day we are all an accumulation of countless experiences across our years, and you should feel to travel back to whenever you want. To answer the title’s question, what’s in your head may be worth revisiting whenever you choose. Enjoy your trip! Charlotte Bishop is an Aging Life Care Advisor, Geriatric Care Manager and founder of Creative Care Management, LLC, 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.
National Geographic has a new documentary series, Limitless with Chris Hemsworth, starring, of course, Chris Hemsworth of Disney’s Marvel Universe. You may be more familiar with him by his major screen name, Thor! Mr. Hemsworth, as you likely know, is a pretty ripped 39 year old man who in this series goes through a fair bit of testing – both physical and biomedical. In the series’ course, Mr. Hemsworth consented to some genetic testing to help with a storyline about how to make the best body out of the genetic code you’ve been born with. How does one fight aging while also maximizing fitness and performance. Chris Hemsworth was willing to take all the tests as well as go on camera as the results were shared with him, and one of the tests was for the genes that predispose a body to Alzheimer’s disease, APOE4. He was informed on camera that he had not one of these genes, but two of them. He says he is thankful to know so that he can gather together a veritable arsenal of tools…diet, exercise and more to give him better than the predicted odds. Let me talk a bit about diet and exercise and the long overdue need for an effective medication to take on Alzheimer’s. Regular exercise, the 10,000 steps, upper body strength and endurance do not begin to describe what “Thor” was willing to do to improve his odds, to fix the game more in his favor. His operating mantra is effectively that this test is not a diagnosis; it is a warning. Thor went so far as to train with Navy Seals. Exercise as Preventative: Walking or swimming are the low, but effective, bar to clear. The old rule of thumb was 10,000 steps a day for walking, but for those over 65, 6,000 may still work well. The World Health Organization recommends 150 minutes of moderate exercise per week, or 75 minutes of more vigorous exercise. These are to be complemented by strength training twice a week. There is more that can be done, but that would be a post unto itself. Diet as Preventative: Mediterranean, MIND and DASH. The Mediterranean Diet which revolves around fruits, vegetables, whole grains, beans and other legumes and seafoods. It’s important also to steer clear of saturated fats, choosing instead olive oils. Minimize (really, not aspirationally) your intake of sugar, red meat and to some extent eggs. The DASH diet has a more cardiovascular focus that looks to reduce salt intake, because it also reduces cerebrovascular and Alzheimer’s issues. Medical Therapies as Brakes: There are no drugs to stop or cure Alzheimer’s disease yet, although some of the new or upcoming approvals from FDA may slow the progression of the disease, albeit modestly. The future of Alzheimer’s treatment likely will be using complementary drugs in combination as is often the case in cancer or cardiovascular conditions and more. You probably have already heard of the FDA approval of aducanemab (branded as Aduhelm) within the past year. What was initially received with great excitement … well … fizzled. The efficacy of this once-heralded drug to fight the accumulation of amyloid plaque had significant downside. It didn’t improve cognition based on tests, and it had an unfortunate tendency to cause cerebral and related hemorrhaging, headache, dizziness and confusion. Did I mention that it was an IV-administered therapy and Medicare did not approve payment to cover the drug? Biogen and Eisai (developed Aricept), of late, have a more promising therapy to address amyloid plaque build-up, lecanemab. This drug has met both primary and secondary endpoints in clinical trials which include cognitive measures. It is not yet approved, but shows real promise. Other drugs that have moved to Phase 3 trials are showing complementary efficacy to lecanemab. One, Cassava’s simufilam is in Phase 3 Trials having already demonstrated cognitive efficacy using an altogether different biopathway. In its Phase 2 trials, it registered impressive improvements in cognition by restoring the normal shape and functioning of a protein called filamin A that becomes warped in the brains of people with AD with very minimal side effects. There were Wall Street traders who sought to make Cassava another GameStop opportunity to "short and distort," but that is a whole other distraction. Another, Annovis, has been addressing another impact of Alzheimer’s disease, the proteins that are neurotoxic in the brain. Buntanetap is the working name of this agent which also is an oral medicine that repairs the axonic transport lines within the brain, restoring normal function. There are more. Some address the agitation often associated with later stage AD and others address enzymatic, neural or other pathways susceptible to Alzheimer’s attack. Visit the federal Clinical Trials registry to learn more, but be prepared to spend some time. There is a lot happening within the Alzheimer’s disease space…but that is the good news for Chris Hemsworth and for the rest of us with aging loved ones. At the end of the day, ask yourself “What Would Chris Hemsworth do? In his words: “…if I didn't know this [Alzheimer's] information, I wouldn't have made the changes I made. I just wasn't aware of any of it, so now I feel thankful that I have in my arsenal the sort of tools to best prepare myself and prevent things happening in that way." What would you do if you knew? Chris’ route is not one of denial, but of knowledge-based proactivity that we all can benefit from following. Get your sneakers on! 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 came across an informative piece in the Washington Post about a week ago, and it brought to light a useful perspective on falls and injuries and recoveries. I’ve talked a bit in earlier posts about preventing falls, especially with your older loved ones. Preventing a fall is arguably the best place to be, but as the more recent article highlights, how we recovery from a fall is also critical. What do you think?
Before the fall. If you have an older loved one, don’t wait for the phone call; here are some simple steps you can take to assess your care receiver’s risk as well as help bolster their safety:
- Assess your loved one’s risk for falling using the CDC’s questionnaire.
- Make certain your loved one gets an annual eye exam, and keep their glasses (if needed) current with their vision.
- If you accompany them to their doctor visit, ask about their feet, posture, leg strength and agility.
- Help assess and address any clutter or other safety issues in your loved one’s “space,” and remember that a lot of this revolves around lighting and ease of access.
This last one has a lot to it. If you would like, we have a home safety checklist that you can use to identify potential trouble spots in your loved one’s house. Just email me at info@creativecaremanagement.com , and I will send you a copy. You may have noticed that I have nearly 600 postings in this blog. Please just type in “home safety” or “fitness” in the search box on the Blog…or any other keywords that are top of mind for you about your loved one’s safety. After the fall. The author of the recent piece, Elizabeth Heath, quotes a “mental recovery expert” on what to acknowledge post-fall: “Decreased confidence and fear of reinjury are two common side effects of any injury.”
- Appreciate that the mind has to recover from a fall just as the body does…and it may take longer; consider counseling to help with constructive self-talk and “baby steps.”
- Set realistic goals…you don’t need to get back on the proverbial horse right after being thrown; the same is true for falls while walking…start with an easier path.
- Age is an important consideration, so engage a personal trainer for your older loved one so that they can be re-trained in “getting their nimble back;” that’s “trainer talk” for using multiple ways to work the muscles to keep them responsive to surprises on their path.
- Don’t battle through the pain; your older loved one’s body will show remarkable resilience in recovery if they are allowed to give the body the time it takes…which may be a bit more time than it would have decades ago.
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.
We’ve all had times when we desperately need our own space…time to ourselves, just ourselves. And it’s good to retreat periodically from the frenetic work pace, the demands of family or just the congestion of living in the 21^st century. But for older adults, being alone can become their way of life with the loss of friends or a life mate, no longer being employed, perhaps unable to move easily about, a lapsed driver’s license…and life becomes very, very small when it is just one. It’s a bigger problem than many people may think. The National Institutes of Health estimate that 28 percent of older adults live alone; that’s nearly 14 million people on their own. Living alone can lead to depression, poor self-care and ultimately an exacerbation of pretty much every other chronic condition that a person can have. A 2010 study found that socially-isolated older adults were 509% more likely to die prematurely. Being alone too much can contribute to other health issues, so much so that some health insurers are developing more comprehensive and holistic models for caring for our older adults. One of the major insurers of Medicare Advantage programs that will offer “enhanced” care, and they have come up with a model that can be imitated by all of us who may be caregivers to and older loved one. We all may look in on mom or dad, make a regular call or accompany our older loved one to their physician office visits, but there is more you can do. Consider:
1. Checking your loved one’s refrigerator for variety of food as well as expired products. Food insecurity is one of the big threats to health and well-being among older adults.
2. Ask about your older loved one’s friendship network, and get specific. Think about how often you make connections – probably daily – and help your loved one to do the same….be creative.
3. Be sensitive particularly to hospital discharges when an older loved one will be lest ambulatory. Help them even get to a “silver slippers” program at a local gym or to respite care so that they not only physically recover, but also socially recover.
4. Use tech. A Miami-based company called Papa connects older adults with local college volunteers that they sometimes refer to as “grandkids on demand.” Check it out to see if a campus near your older loved one can offer that support.
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.
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