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

Why Mom May Not Be Moving Out
April is what most realtors consider to be the beginning of the “market season.” Winter has nearly – I...
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April 25, 2013
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The VA’s Best Kept Secret…
I have spoken with Matt Margolis, an Elder Law attorney with Heartland Law Firm recently about VA benefits to...
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April 15, 2013
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Forgetfulness-A Caregiver’s Warning Signs
There are an estimated 30+ million cases of dementia worldwide according to the latest statistics. That amounts to a...
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April 11, 2013
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Malnutrition: A Caregiver’s Warning Signs
When I get a call about our geriatric care management services, most people are not asking for a geriatric...
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April 1, 2013
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Making Home Senior-Friendly Part 2
In the first posting of this two-part series, I went no further than the hallway in our tour of...
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March 28, 2013
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Making Home Senior-Friendly Part 1
It is not just because of the housing collapse that many seniors have decided to stay in their existing...
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March 25, 2013
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The Biggest Pain in Growing Older
Osteoarthritis (OA) is the most common source of disability in older adults. Specifically, it is OA centered on the...
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March 23, 2013
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Six Tips for Better Sleep in Older Adults
We’ve all used the expression, “Don’t lose any sleep over it.” Turns out that losing sleep is one thing...
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March 18, 2013
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Three Tips for the Diabetes Caregiver
If you are a caregiver to someone with diabetes – Type 1 or Type 2 – then you know...
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March 4, 2013
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Tough Talks with Parents – Part 2
In the first of this two-part series, I talked about conversations involving changes in life where you as the...
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February 28, 2013
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In the Caregiver's Words

Recent Client Praise

If you are a caregiver to an older loved one, you likely have heard of it, but maybe you were not sure if it is a real syndrome…or if it is, what you can do about it. I am referring to what is termed “sundowners syndrome,” and let me tell you, it is real. Sundowners can affect anyone with Alzheimer’s or any of the conditions along the dementia spectrum as well as those who may simply have some cognitive impairment or diminishing of their executive function. How do you spot it? Well, you may have noticed that there are times of day when your older loved one is simply less lucid or unable to respond to others in their midst, and it actually does coincide with the end of the day…sundown or late afternoon. Do they become anxious or nervous? Are they more demanding or even fearful of people whom they know? Are they just confused or disoriented or just plain cranky? They may shout or begin to walk about, have a change in mood, talk to someone or about someone who is not there. Okay, so you may see some of these in your older loved one; what can you do? Follow these recommended steps:
- Keep to a regular, daily routine with your loved one so that they do not have to process new information late in the day; they simply cannot be intellectually nimble.
- Avoid having dinner being a heavy meal, and avoid sweets, caffeine or alcohol.
- Limit naps to earlier in the day; make sure they have not had a chance to nap within four hours of their bed time.
- Keep the lights on, but close the curtains to limit the shadows they must process or navigate, and limit noisy distractions.
- Be calm and reassuring, and if they make an assertion about a loved one who is no longer alive, do not argue – acknowledge and then redirect.
- If none pf these work, it may be more than just sundowners; talk to your loved one’s physician.
And take care of you, the caregiver. I had a client who talked about the transition from having six hours of uninterrupted sleep a night to having six hours of interrupted sleep. That is a recipe for disaster – your own. Take naps or breaks during the day for yourself, and do not lose contact with friends and hobbies. Get respite care; reach out to the senior communities within your locale for a place to drop off your loved one or for home care personnel who can come to your loved one. You also will get support as well as good ideas from a local caregiver’s support group; yes, it does take a village. Charlotte Bishop is an Aging Life Care Professional and 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.
In a recent post, I shared what Allyn Rawling said about what to consider when mom or dad are moving out of the family home. Ms. Rawling addressed some of these factors, especially the benefits that assisted living can provide – eliminating possible isolation, ensuring safety, among others. Here are some other aspects to look for when you next visit your loved one.

First, you may notice and overall unraveling of your loved one’s quality of life. For instance, the home itself isn’t well kept and there are safety hazards that have gone unnoticed. You may find that your loved one isn’t taking care of themselves as well as they should, especially when it comes to grooming, bathing, and feeding themselves. Bills might be going unpaid. It is important to note however, that some of these factors may be fixable with some caregiving consultation and changes around the house. However, moving out of the home may be an option that your parents might have to consider.

Second, the family home may simply no longer be safe for your loved one. If the stairs are too steep or if help is not readily available when there is a need, a safer residence may be in order. If mom or dad show bruises, but do not admit that they have fallen - perhaps more than once - it may be time to talk to your parents about independent living. Remember to underscore the "independent" in the living option, because they may have images of the last generation's "old folk's home" or some other outdated stereotype.

Third, it is a tough topic to bring to your parents as they’ll want to keep their independence as long as possible, again a reason to emphasize the "independent" in independent living. Be patient. Start the conversation well before an immediate decision is required. Also, help to make it their decision, their process and their terms. If your older parent does not own the decision, guess who will own it, and that will be a costly bit of ownership for you as a caregiver.

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.
It was about two and a half months ago that we posted about the diagnostics telling Chris Hemsworth he had the APOE4 genes that predispose a person to Alzheimer’s disease. Clearly Mr. Hemsworth has embraced, and will continue to embrace, specific habits to deny Alzheimer’s Disease an opportunity to take over. An article recently released in The British Medical Journal has documented six healthy lifestyle habits that you don’t have to be Chris Hemsworth to follow…good thing, because no one can really compete with Thor. Without getting too granular, the researchers recruited nearly 30,000 individuals with a mean age of about 72 years and no evidence of dementia and then followed them from 2009 to 2019 with measurements every two years. They measured participants’ statuses on six “lifestyle factors”…factors that are within the control of participants and therefore modifiable: Exercise, smoking (or not), alcohol consumption (or not), healthy diet, cognitive activity and sociability. Here is a link to the research if you want to drill down into what comprises “exercise,” “healthy diet” etc. Take a moment to rank these from most important to least important before I share the results! The first four are all significant at the p<.001 level…translated, this means that the odds that these factors do not influence cognitive health are less that one in a thousand. Lower levels of significance, like those for the last two lifestyle activities are at a p <.05. In other words, the odds that they do not influence cognition are about one out of twenty were one to replicate the research. From most impact to least – but all statistically significant:
1. Healthy Diet – a daily measure of consumption of 12 food groups such as products like dairy, fish, vegetables, fruits and such;
2. Physical activity – measured as the participants’ weekly amount of time devoted to cardiovascular exertion;
3. Cognitive Activity – consists of reading, playing games like chess or mahjong and writing…I think Wordle and crossword puzzles also apply;
4. Social engagement – includes participation in meetings, clubs and even parties as well as travel or even online chatting;
5. Smoking - simply ranked as “never,” “former” and “current” smokers is among those activities that count for something, but appreciably less than the top four;
6. Alcohol consumption – is measured by categories: “never drank,” “drank occasionally,” “low to excessive drinking,” and “heavy drinking,” and it has the least impact of the six categories.
Okay, we’ve moved beyond New Year’s resolutions, so maybe these are part of what can be our commitments to retaining our cognitive function? Worth the effort? 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.
They call it Trendelenburg gait. You may have noticed it in the way your older loved one walks. It is a side to side upper torso sway for men and a side to side sway of the hips for women. It results in about a four degree shift in the opposite hip from the leg that is stepping forward, and that doesn’t sound like a lot, but it really impacts the knee on the side that is shifting…a 23 degree shift. Over time, the knees get a lot of exaggerated grinding which will wear down the cartilage. Parkinson’s or even dementia can encourage this exaggerated gait, and hip replacement and the gait pattern that can follow surgical recovery also can set it in motion. But Trendelenburg gait is not inevitable. We all have to grow old…versus the alternative, but we do not have to “walk old.” Physical therapists recommend a few exercises that help to strengthen core muscles that can prevent that side to side gait:
1. The Walk-Over – Stand in front of a mirror so that you can monitor your exercise. Standing upright with feet shoulder-width apart and a towel rolled up in front of one of your feet, simply lift your leg up and then step over the towel. Tap your foot to the ground in front of the towel while keeping your hips horizontal, and then lift your foot again and tap behind the towel. Do this back and forth for 30 seconds and then switch to the other leg. Do the exercise twenty times. This can be twenty times in one exercise or over multiple “exercise breaks” in a day. It’s a strengthening exercise, so picture yourself getting stronger the more repetitions you do. Do this as many days of the week as you can with three to four days as your target.
2. The Plank – You may wish to “Google” this so that you can see it. We are talking side planks which mean that you lie on your side, preferable on a soft carpet or exercise mat. With your elbow lifting your upper body, you form a straight line from your feet to your head and hold for 30 to 60 seconds. Alternate this pose and holding with the other side. Go back and forth between sides about three times and do this as many days a week as you are able.
3. Chair Sits – Begin by standing in front of a wooden chair with your arms folded across your chest and your fit about shoulder width apart. Lift one leg forward to form about a 20 degree angle with the other leg that is vertical. Slowly sit down with that leg extended. Once you have made contact with the seat of the chair keep the pose while standing back up again. Change to the other leg and repeat. Do this as many repetitions as the plank and as many sets.
I have been talking about helping your older loved one, but this may be perfect for us all so that we all can grow old…without walking old! 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.
Okay, "Grain Brain" is not something that immediately tells you what it is all about. Grain Brain is the phrase that neurologists and other brain scientists are using to describe a link between blood glucose levels from high carbohydrate consumption and dementia. A book by the same name is going into its 15th straight week on the New York Times bestseller list, so the concept is getting a lot of attention. But what does it mean for you or an older loved one in your orbit? In a scientific study recently published in the prestigious New England Journal of Medicine, researchers followed a large group of men and one of women for an average of almost seven years. During this nearly seven years they regularly measured the individuals fasting blood glucose levels. At the end of the study they found that people with higher blood glucose levels were more at risk for developing dementia that those whose levels were not as high. They found this to be true even with people who did not have diabetes. It is true, that this kind of study cannot say that increased blood sugar levels actually cause dementia, but the link is sufficiently clear that the New England Journal would publish the findings. Scientists also find that not all grains have the same negative effect on cognitive ability. Those with the highest gluten content seem to be the worst offenders. This is not the first research to show negative health outcomes associated with elevated blood sugar. Researchers have well-established proof that a high carbohydrate diet and the associated elevation of blood sugar poses a risk to one's heart and to the immune system. And there are other studies. in a 2012 study in the Journal of Alzheimer's Disease, researchers reported that risk for cognitive decline was 89% greater among those on a high carb diet; those on a high fat intake diet saw a 44% decrease in their risk for cognitive compromise. And researchers in another British journal, Lancet Neurology, estimated based on their findings that as many as 54% of the cases of Alzheimer's Disease in the United States could be avoided with exercise, weight reduction and steps to reducing blood pressure. This last study really drives home a great point. If you are a caregiver to an older loved one, you both will see great returns on a few basic investments of time and effort. Increase the daily amount of exercise, reduce the carb intake and the rewards will be weight loss, reduced blood pressure, a healthier heart, a more vigorous immune system and more acute cognition. Sounds like a really great return on investment to me. So, will you and your older loved ones be among those who avoid the "grain brain?" 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.
As a geriatric care manager, I have the chance to work with all manner of caregivers and the elders or others with special needs for whom they care. Sometimes a caregiver becomes significantly more than the person who may help a loved one with shopping, cleaning or other personal needs. There are occasions when that individual becomes sufficiently frail or mentally compromised that they need the support and control of a guardian.

I recently spoke with an attorney, Gordon Gault, who specializes in trusts, wills and probate among other legal areas. We talked about what a guardianship means and when it is appropriate as well as how it comes about. Gordon first explained that a guardian is substantially different from just a caregiver in that a guardian must be appointed by a circuit court judge. That appointed guardian is then able to act on behalf of the individual who is either under the age of 18 or is deemed disabled in some other way.

How can a guardian be useful? I have talked about elder abuse and fraud in another blog posting. A guardian can be appointed when it is concluded that the individual is giving away money or other assets to individuals who may be manipulating to their own ends. This appointment is intended to protect the individual and only happens after a court hearing complete with a physicians’ or other professionals’ opinions being weighed.

I have talked about powers of attorney for health care and for finances in an earlier blog posting, but a guardianship clearly takes this up a notch. But it is important to recognize that not only must a judge be convinced that the individual in question is unable to take care of themselves, but that judge also will oversee the guardian’s activities. As you can see, a guardianship pretty much takes control of an individual’s affairs, but this whole process does not all have to be left to attorneys. Gordon highly recommends that anyone who has a family member growing incompetent, get the powers of attorney signed as a first step. Anyone over age 60, he says, should sign these POA papers so that they can be available should a need arise. And later if you have to get a guardian appointed, you may be able to do it on your own if it is just the individual and their care. If it is an estate worth more than a couple thousand dollars, according to Gordon, you will need an attorney for the paperwork.

If you have questions, please feel free to reach out to Gordon Gault using this link. Gordon is a Chicago-based attorney.

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

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