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March 17, 2020
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In the Caregiver's Words

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It was just a year ago that Bruce Willis’ family disclosed that the actor would be retiring from acting owning to a diagnosis of aphasia, a neurological disorder that affects language speaking, hearing, reading and writing. Only recently has the family made the further disclosure that Mr. Willis’ aphasia is actually a symptom of fronto temporal dementia (FTD), the common form of dementia among individuals under 60 years of age and affects about 9 in 100,000 people between age 60 and 70. I often talk about what to look for if you have an older loved one, but with FTD, it can be anyone from age forty and older. There are a good many genetic markers for this relatively rare condition, but individuals with family members who have been diagnosed will have a forty percent greater likelihood of manifesting the condition. Diagnosing FTD. It’s all about “executive-function” in neurologist speak. This covers a lot of territory, but it comes down to losing abilities that a person may have had like:
- Planning ahead, following or formulating recipes;
- Setting priorities or goals;
- Repeating words or phrases again and again;
- Impulsive or inappropriate language or actions;
- Losing interest in what everyone else in the family may be doing.
Treating FTD. As with most forms of dementia, there is no cure or magic bullet to stave off the inexorable cognitive decline of this condition. But there are steps caregivers and patients can take to help delay the degeneration:
1. Encourage regular daily exercise – anything that increases blood flow and cardiac wellness;
2. Promote sleep 7 to 8 hours a night - pretty much as with anyone…in this case because it can help the brain do its nocturnal clearing and cleaning;
3. Go Mediterranean – which translates into heavy reliance on plant-based meals, fish and whole grains as well as healthy fats like olive oil;
4. Flex the brain – apply the daily exercise routine to that muscle between the ears …and mix it up by learning new games and avoiding screen time;
5. Engage socially – encourage civil and community and family engagement to avoid brain decline as well as depression;
6. Lead with the heart – lower sodium, lower blood pressure and lower alcohol consumption while definitely eliminating tobacco.
Now that Mr. Willis has been diagnosed, you can be assured that the press will give this rare condition more attention. Stay tuned to what will be learned and shared. Follow Mr. Willis’ role model of fitness, diet and as with most of his movies … tenacity. 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.
There are nearly 40 million people in America 65 years of age or older, and that number is expected to increase to more than 70 million by 2030 as more Boomers mature. But as these individuals turn 65 a number of changes can be seen between men and women. In part because men still do not have the same life expectancy, fully 40 percent of women are widows. Older men, however, are much more likely to be married than older women by almost a two to one ratio. Fully 72% of men are married or remarried versus only 42% of women. This leaves 8.1 million women living alone and 3.2 million who are singles.

As a geriatric care manager, you can imagine that the numbers mean that a lot of my clients will be single older adults. It also means that a lot of their caregivers may be a bit challenged with how to help their single loved ones cope with a social environment that is different than the one they grew up in as well different from that of the caregiver.

The first concept a caregiver should approach is that of "quality of life." Older, single loved ones want quality of life just as their younger caregivers do, but it is a different quality of life. If you are a caregiver to an older and single loved one, you might start a conversation with your loved one about that kind of quality of life they want. They may not have put it to words yet, but if you start with the right questions, you will first be able to empathize with their challenges and you second will be able to perhaps help them to find it.

The World Health Organization (WHO) says that quality of life is a person's "perception of their position in life." But their position is culturally defined and is in the context of their personal histories and values. It is about personal goals, expectations, worries and beliefs. It is about how they see their independence and their social or personal relationships. Chances are that your older loved one who may be widowed had a life partner who really understood all that, but you may not as easily grasp when they want to be alone and when they want to be active. Moreover, being active is even subject to differences in interpretation. It is not necessarily about training for a marathon or even going for long walks. It is about being engaged, involved and stimulated.

Now, it gets interesting. As people get older, they may not feel up to what they used to do to be active, activities that you remember your mother or father doing when you were younger. And all of this may be compounded by the losses they have experienced or a real depression. An attentive geriatric care manager or caregiver can listen with an open mind, and doing so will benefit the loved one greatly – just by giving words and ultimately activity to their need for quality of life. And helping your loved one find others of like mind and age in a community setting may be a very positive step forward. But do not be afraid to call upon a professional who can reach your loved one and help translate "where it hurts" to where it helps.

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
We’ve all heard about COVID’s symptoms…the GI upset, the shortness of breath, the fever, the added symptoms of the long-haulers, the after effects among those who survive COVID and more. We don’t hear much about the other big side effect among even those who don’t actually come down with the disease – depression. In the years leading up to the pandemic and quarantine more than 18% of people 65 years of age and older showed signs of depression. Dr. Kathleen Rogers of the Cleveland Clinic warns that depression or anxiety may be something akin to their own pandemic as a consequence of the isolation of 2020 and beyond. If you have an older loved one with whom you are only just now beginning to restore contact, be watchful:
- Those who have lost friends or loved ones to the pandemic are highly likely to be depressed.
- If your loved one talks with you about loneliness, isolation, lack of socialization...be attentive for a “down countenance” or even suicidal ideation.
- Signs of disorientation or memory lapses also can be indicators for depression owing to disengagement.
- Don’t be misled by the mom who always took care of things; women are almost twice as likely to have depression.
Signs of depression ought not be taken lightly, because depression is linked to other conditions like cardio-vascular health, dementia and more. People do not just “snap out of” a clinical depression. If you see or hear any signs of depression with your older loved one – and this is harder to discern over the phone or on ZOOM -reach out to:
- Your loved one’s primary care provider who is able to schedule an appointment for an initial assessment.
- The social worker or community case manager of the setting in which your older loved one may live.
- Your local city or community health department; they are likely to have a social worker or an advocate who can go to bat.
- The hotline - The National Substance Abuse and Mental Health Services Administration or dial 800.622.HELP.
We’ve talked before about “if you see something, say something.” Well, we are working with blinders still on as we all move back toward a new normal, so we may not visually see things as we once did. Follow your instincts and emerging from the pandemic and quarantine may actually be a return to “normal.” 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.
For this week’s post, Charlotte asked Rebecca Bloomfield, partner at Jerry S. Pearlstein Insurance, to speak to caregivers about long term care insurance. She and Jerry head up a unique agency of trusted advisors, helping individuals and families to take control of their personal financial planning … and more. Please describe the concept of long term care insurance. “Long Term Care Insurance (LTCI) pays for services when more than 90 days of continuous care are required. It’s contingent upon an individual’s inability to do at least two of the six activities of daily living: bathing, continence, dressing, eating, toileting, transferring.” How early should a person look for coverage? “Most people come to us when it is too late. The lowest premiums are when one is youngest. You can start early with a progressive sequence of plans with upgrades along the way, many times without medical exams required. Most people look at life insurance when they start a family, and that is also a good time to look at the long term picture.” Sounds like it is for caregivers… What is the right level of plan a caregiver may need? “Traditional LTC insurance has been based on a person being in a nursing home. You anticipated how long you would anticipate be in a facility and how much that might cost. Today, 80% of people want to stay at home when they cannot do two of the ADLs. They want to stay in community. So, there are now plans that cover the cost to do that by paying caregivers, or adult day care centers, or drivers…and you stay out of a facility.” Can my older parents get covered? “Once you are over 70, it is tremendously expensive. …and then there are pre-existing conditions. When you are young and healthy is when to start. Care receivers cannot get new insurance…but it is the right time for the kids who are the caregivers to get their plan.” Anything else caregivers should know? “The biggest misconception of people who come to us is that Medicare will cover long term care. It is not designed to cover sustained care over 90 days. Medicare is diagnosis-based and is built on a plan of care for a person to get better. Long Term Care Insurance should be seen as a way to assure the ability to live a long and happy life without being a burden to the children. …and to preserve your choices.” 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.
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A family crisis doesn't make an appointment. Therefore, you've got to be ready when it shows up. In excess of 8 million Americans have some form of dementia, As a caregiver to a loved one with dementia, it can wear you down, stress you, worry you and make you sad. It may create a financial hardship for you or your loved one. It can become your other full-time job. And it can burn you out! This book focuses on what we know that can be your lifesaver to ease your pain and help you find the best way to address your problems. It also will help you to care for you, the caregiver. There is no "one size fits all" plan, but we think you will find parts of your plan in the case studies we share in this short book. The key to peace of mind is to have a plan, even if you have to make adjustments along the way. Let us be your companion and guide as you navigate this challenging time…

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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.