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August 24, 2011
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In the Caregiver's Words

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As you prepare for the big holiday feast and potentially the big snowfall that may come your way, we at Creative Care Management wanted to take time out to wish you happy holidays, good health, and an encouraging start to the New Year. This past month we’ve explored all the setbacks that might prevent maximum holiday cheer for the caregiver and how to overcome them. However, I cannot stress enough that the best way to overcome all of these obstacles is to remind yourself what these times are all about. It’s okay to be nostalgic about the past and allow yourself to feel what might be sadness and loss. But try to focus as much as you can on the present. Enjoy the time you have with your family and friends. Laugh, smile, and give yourself credit for making it as far as you have this year. Take time for yourself as needed – to breathe, to reflect, to remain centered.

If you know someone who is also a caregiver, here are some gifts you can give them in order to make their holidays easier.

Someone to listen. The best relief for a caregiver might be just having someone there to listen to their frustrations .

Support. The holidays can be more of a hectic time for caregivers. If you’re visiting a caregiver, offering to help around the house or taking care of some of the tasks on the caregiver’s plate might be an excellent present.

“Thank you.” Sometimes caregivers aren’t able to hear or see how much of an impact all of their hard work makes in tangible ways. Letting the caregiver know that their work is appreciated and that they’re doing so much good for their loved one may brighten up their holiday. It will serve as encouragement to keep going well into the New Year.

All of this said, whether you’re a caregiver or friend of a caregiver - take care of yourself and allow yourself a moment to rest during this joyous time.

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 is November, and for most of us that means gearing up for the holidays, family and memorable events. The first two are true of almost everyone, but the third one - memorable - can be a huge challenge to caregivers and patients with Alzheimer's Disease. Caregivers to a loved one whose mental faculties are declining from Alzheimer's Disease can face a lot of challenges, not the least among them the guilt that can come from hosting a holiday get together when things just cannot be the way they used to be. Here are some tips for caregivers to a loved one with Alzheimer's or any of the dementias that may affect memory:
1. Take care of the caregiver: The person whose needs most often are at the bottom of the list is the caregiver to an AD patient. Do something for you, and it will make it easier to do all those other things for all those other people.
2. Be realistic: We all tend to have a notion about what the "holiday is supposed to be." That may not be feasible when a loved one has Alzheimer's, so work within the capabilities and the comfort zones of all concerned.
3. Include everyone in the plan: If you talk over plans for the holiday with all the family, it can help all to enjoy the event. Everyone will have had a say in what happens and expectations will be better met.
4. Avoid over-doing the alcohol: There is a great deal of loneliness in being a caregiver to a loved one in decline, so avoid the inclination to self-medicate. If you as a caregiver already feel melancholy, alcohol will only fuel the depression.
5. Let visitors know: If visiting family does not know exactly what to expect from a loved one with AD, they probably will not act appropriately. Help them to understand about talking and living in the moment.
6. Let your loved one know: For patients with early onset AD, there can be moments of lucidity as well as confusion. Help them to also be in the moment and not lapse into the sadness or even the angry outbursts that can come from AD's confusion.
7. Manage the environment: AD can be confusing enough without exacerbating the challenge with a noisy environment. Helping your loved one to engage people in quieter surroundings can help everyone communicate better.
As you navigate through the holidays, appreciate that they may not be as they once were before the intrusion of Alzheimer's, but you are making new memories for you and the rest of the family. With attention to some of these tips, you will find that the new experiences will help everyone's holidays to be their own new memories to cherish. 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.
In my last posting I shared geriatric care management services for caregivers communicating with a loved one who may be suffering from dementia. If you have a loved one who has Alzheimer's or one of the other types of dementia, you know all too well that they are not the same person they once were. But have you actually spent some time trying to understand who they are? Have you tried to understand what it is like inside dementia? Try this hypothetical situation. As you awaken tomorrow morning, you make note of the time, and you know that the dogs need to be walked because they have been in their crates all night. You have just enough time to walk them and then have breakfast and get to work. As you go downstairs to the kitchen, the crates are not there, the dogs are not there. In a minor panic, you turn to your wife who is there and ask where on earth the dogs and their crates are? If your wife of many years tells you the dogs have been dead for six years and that you have dementia which is making you confused, how do you feel? ...probably confused, anxious, frightened, and then sad - very sad. That used to be what professionals recommended to caregivers of individuals with dementia - a bit of reality-grounding, but today, the more accepted approach is one of empathy or what therapists call redirection and validation. So, this kinder approach to the situation might be to apologize for not letting your loved one know that the dogs are being groomed and that if they wish you can prepare a breakfast for them. A patient with dementia may suffer from delusions or hallucinations, and these can be intense and stressful events. So, affirming their feelings and then helping them to shift to something more soothing can be very helpful. This older adult who just happens to suffer from dementia still is the person with feelings who is just behaving in what they perceive to be a rationale manner. By validating their feelings and then redirecting their behavior, you are helping them to cope with the world as they see it. Some therapists even suggest that this helps to restore a sense of self-worth that will be helpful in avoiding some future episodes or anxiety:
1. First, ask questions that will help you understand what has triggered the response. I had a client who saw little people around the perimeter of the room painting the baseboards. Once we understood that these people did not speak or harm him, we could incorporate them into his world while still interacting with him.
2. Don't think that it all has to be logical. It is more about how your loved one feels than it is about if it makes sense. Just go with it.
3. Especially if your loved one is upset, try to gently find out what makes for the upset. Then, validate by agreeing that you would be troubled also if its happened to you. You will find that the anxiety for both of you will subside.
4. The bottom line for all of this is to gently give your loved one an out and a chance to save their self-esteem.
Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends who provide geriatric care management services to older adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.
Osteoarthritis (OA) is the most common source of disability in older adults. Specifically, it is OA centered on the knee that debilitates more older adults than any other single condition. Why? OA takes time to develop and those adults who make it to an older age have had the time to get there.

We are all born with shock absorbers on the bones that have articulated joints - that is, the bones that connect to other bones. Those shock absorbers are the soft tissue at the ends of joints that keep the long bones of the leg, for instance, smoothly joining together as we walk, run, jump and more. With the passing of years and the mileage we all accumulate the cartilage begins to wear down and perhaps entirely erode away. When that finally happens we have bone on bone instead of the formerly soft tissues meeting soft tissue, and the resulting friction causes inflammation and ultimately debilitating pain.

While there may be no cure for OA, there are steps short of knee surgery that can help the older adult you may know who has that popping, grinding, painful knee. They should see a provider, typically their primary care physician, who then likely will refer them to an orthopedic surgeon for definitive diagnosis with an XRAY. If the referral physician determines that surgical intervention may not be needed there are options that can be explored.

The treatment options that can be discussed with the care provider include:

1.    Exercise - in cases where building up the muscles surrounding a joint may take some of the pressure off the bone, this may be one of the easy fixes.

2.    Physical therapy - it may be helpful to have a professional who specializes in the mechanics of the body put your older adult through the paces and/or introduce other interventions like heat, cold or more.

3.    Diet - if a person is sufficiently above ideal weight, simply losing some of that excess weight (I know "simply" may be a stretch) can make a dramatic difference in how much pressure the joint receives.

4.    Injectable medications - using any one of a number of anti-inflammatory agents injected into the joint can sufficiently reduce the inflammation and a patient will see a marked relief in pain.

5.    Assistive devices - in some cases a different shoe or a modification to the shoe may make a huge difference in how walking transfers (or does not transfer) its impact up the leg or using a cane can help.

6.    Oral medications - There are prescription and over the counter (OTC) medications that can provide relief from the pain by reducing the inflammation; these are called non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen, naproxen sodium and others.
So, if you have noticed the older adult for whom you are a caregiver gives that telltale wince when they stand or climb stairs, it may be time to accompany them to a visit to their provider; bring your list of options with you. 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.
Dementia is the condition that adult Americans fear the most, and tragically there are conditions that can give a false alarm to trigger that fear. What walks like dementia and quacks like dementia may not necessarily be dementia! There are a number of medical conditions that mimic dementia – quite convincingly – until the condition is examined more closely and treatment is administered. So, in a real sense, dementia is a diagnosis by exclusion…diagnosis by eliminating the “look alikes”. Did you know that…
1. Thyroid disease can mimic dementia– Physicians can readily diagnose when the thyroid gland is producing too much or too little hormone by calibrating the levels of Thyroid Stimulating Hormone in the blood. But it often takes a specialist, an endocrinologist to make the definitive call. They talk about “subclinical characteristics” such as fuzzy memory along with others like dry skin or fatigue or hair loss. Hypothyroidism is one that can be readily treated by a thyroid supplement and symptoms simply fade away.
2. Diabetes can mimic dementia – As if it is not difficult for a diabetic to manage sugar and carbohydrate intake to avoid “running high or low,” the condition can actually affect memory as well. In older adults who have not yet been diagnosed with type 2 diabetes, they may appear irritable and confused or may have difficulty with recall. These mental states are caused by changes in the body’s blood vessels which may not give enough flow to the brain resulting in dementia-like symptoms. If diagnosed early the problems can be reversed and normal cognition restored.
3. Alcohol abuse can mimic dementia – We all have seen someone who has been “over-served,” and that person is not only an impaired driver, but their brains generally are not sharp. Well, the next day that same person recovered motor and cognitive functions, and life is normal again. Repeat offenders, however, will create more lasting effects on the brain and memory shortcomings. The memory issues may not be dementia, but they can only be reversed if a person stops the abusive behavior early enough, and for some the cure is to abstain entirely.
So these are three conditions in which dementia can be the wrong diagnosis, and they are also issues that can be remedied. There are more conditions that can pose as dementia, but they are not. They may not just go away on their own, but unlike dementia, they can, in fact, “go away.” More to come next week. 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.
I am really, truly, seriously, absolutely in need of good news – heard news and herd news. Today, I am happy to say that I can share good news about both! Let me start with the first part - a quick story for folks who have a harder time hearing, then I'll tell you what I heard about the herd. First, the heard news. A church-going friend of mine comments on the upside of not being able to attend in person religious services at his place of worship. Yes, this is someone who has become a Zoom fan! He talked of so many areas in his place of worship where the sound quality was virtually non-existent, but at his home computer all the speakers and singers were positioned properly with their mikes, and he had control of the volume. He considered that something of an upgrade. But the upgrade doesn’t hold true for everyone during this time of masks and social distancing where some older adults just are out of reach and out of hearing range. With the sound quality dampened by masks and distance posing a hearing obstacle, they are at an even greater disadvantage in this pandemic. But there is a new hearing device that a lot of people are bragging about, and its success owes as much to the ear bud’s popularity as it does to the cool technology of the new device. Oh, sure, there have been cool hearing technologies in micro before, but unless one has as much as $5,000 in discretionary funds, improved hearing is rather out of reach. Enter the Olive Smart Ear. The really great part is not only the apps for getting the setting just right for anyone’s hearing needs, but the price is less than a tenth of some of the micro-technological devices previously available. And everyone wears an ear bud these days for their smart phones and for their music and more. The Olive Smart Ear blends into the fashion and taste of the 21^st century really well. If you have an older loved one whose hearing and attitude could use a bit of a boost, please check out www.oliveunion.com. And then there is the herd news. You may recall early on in this pandemic that there was talk of herd immunity. Well, it is not the kind where the COVID is going to just disappear, but there was talk about when we would get to the point that about 70% of a community had had the disease with or without symptoms, and then the rate of spread would dramatically drop off. Scientists had estimated that the magic 70% mark was the point at which any given individual who contracted COVID would spread it to less than one person on average. Now, it seems that the threshold is as low as 45 to 50% of people having been exposed to confer “herd immunity.” Cities like New York City or London or other European cities or even Mumbai may not see a second wave after all. And while there still is no guarantee that we will have a vaccine before the end of the year, our herd may be a lot closer to turning the corner on this pandemic than we initially had thought. Until then, keep your distance, wear your mask and practice really good hygiene, and be something that you may not have been for some time…be hopeful! 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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