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A Forgotten Element of Exercise for Seniors – The Voice
In past postings I have talked a good deal about the importance of exercise for seniors who need care...
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September 19, 2013
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In the Caregiver's Words

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It was back in the sixties and seventies that so many folks embraced the mantra: “You are what you eat.” So, what we eat influences how much weight we gain or not, what we eat influences how much of the important vitamins or minerals we are processing, and more. What we haven’t heard nearly as much about, however, is how what is already in our gastro-intestinal tract affects our brain and how we feel, sense, think and act. And this connection between the brain and all that is in our gut is hard-wired through a nerve called the vagus nerve. Scientists are finding some examples of the microbiomes of our gut affecting how we feel, and they, of course, also are finding that signals from our brain to our stomachs also affect our physical and mental health. Evidence is gathering that suggest the presence of certain microbes in our digestive system can affect mental disorders like depression or anxiety. They call these beneficial microbes psychobiotics, and they’re the anchor to what is termed the “microbiota gut-brain axis.” It's still largely animal studies, and most animals have different digestive microbes than humans, yet there are important parallels across many mammals. In experiments that raise mice in sterile environments, scientists have introduced “good bacteria,” and the mice subsequently have reduced stress, less depression or lower anxiety. In human experiments, researchers have found that ALS patients have lower levels of vitamin B3, so these researchers are devising plans to introduce supplemental B3 to gauge any beneficial effect. There is reason to be optimistic based on other early studies that have found adding probiotics like bifidobacterial and lactobacilli may be behind a reduction of stress. Other studies are finding quantitative associations between other bacteria and depression. As with most human traits there is a wide range in the kind and amount of bacteria in people’s gastrointestinal tracts. In controlled experiments, however, scientists have found that increasing whole grains, some fermented foods and lots of fiber created a stomach flora that was associated with reduced stress. Both control and experimental groups had similar GI microbes but the different foods gave off more beneficial chemicals. In another study prebiotics enhanced the problem-solving capabilities of patients with psychoses. The two key takeaways are very simply: (1) eliminate processed foods from your diet; and (2) increase the volume of foods with high fiber content such as colorful fruits and vegetables. And you can’t have it both ways. If you over-consume hot dogs or pizza, you cannot simply offset their negative with high fiber add-ons. 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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Home Health
Home Health involves licensed medical professionals (often nurses or physicians) trained in providing aid to those who need health monitoring and assistance. This service is ideal for those who have recently been hospitalized, are in need of rehabilitation or medication assessment, or have suffered a decline in physical mobility.

Home Care
Home care provides services for those who need help with ADL (Activities of Daily Living) tasks. For instance: transportation to doctor’s appointments, grocery shopping, house cleaning, and other every day needs. This service is ideal for a family caregiver who needs someone they can trust to take care of their mom or dad while they are away. It is also helpful to those who need short-term assistance after a hospital stay or during physical rehabilitation.
If I were to ask for a show of hands, I don’t think anyone would say they actually wish to be diagnosed with Alzheimer’s Disease or any related dementias. And yet there are a number of lifestyle and health choices that each of us makes any given day that make us look a lot like “dementia volunteers.” Let me share with you some of what the Centers for Disease Control and Prevention (CDC) has found when they dug into the preventable risk factors for dementias that Americans report. In 2019 the CDC surveyed 162,000 adults 45 years of age and older about a range of lifestyle and healthstyle habits that can impact a person’s likelihood of developing Alzheimer’s disease or related dementias (ADRD). The most common factors that can precipitate ADRD are high blood pressure and failure to engage in regular aerobic physical activity. Almost half of those surveyed fell into this risk category, and another one-third reported being obese, almost one in five had diabetes, and nearly as many were chronically depressed. But that’s not all. One in ten of these adults were binge drinkers, 11% had hearing issues and 15% smoked cigarettes. What effect do these “lifestyle choices” have on the risk of developing ADRD? For starters, one in every nine of those in the study reported subjective cognitive decline, a strong indicator of later ADRD. For those with no risk factors from the list above, their risk of developing subjective cognitive decline was only 4%, but that risk rose to 25% for panelists who had four or more risk factors. Looking at just those with subjective cognitive decline, more than one third had four or more risk factors. It extended to the other risk factors as well. Compared with the base, three in ten of those with depression, one in four with hearing loss and one in nine reporting binge drinking also reported subjective cognitive decline. So, it’s a veritable checklist to reduce the risk of these serious cognitive issues. Think of such measures as the equivalent of using seat belts in cars. Their use is up to the driver, but using them makes a huge difference in the event of a crash. Seat belt use in the most recent year available from U.S. government sources reduces death by 45% and serious injury by 50%. Buckle up! Other research in UK found that modifying 12 risk factors – yes, there are more – over one’s lifetime prevents or delays 40% of dementia cases. So, review this list with an older loved one - or any loved one for that matter – and manage your way and their way to better cognitive health. What you do will make a measurable difference for everyone. 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.
Medicine today is full of miracles. But Aging Well magazine (Jan/Feb, 2009) reports that although the over 65 set in America constitute only about 13% of the population they account for about 30% of all prescriptions filled. Their share of over the counter (OTC) drugs is estimated to be closer to 40%-50% of all retail meds sold. The report goes on to say that nearly two in five hospitalizations each year are a result of medication issues associated with elders. The elderly are fully half of all prescription drug-related deaths annually.

Let me tell you about a list you should know about. If some drugs have added baggage beyond the healthy effect sought by a prescriber and a patient, a doctor named Mark Beers, MD, and his associates have been the “baggage handlers” since 1991. That is when they first came out with the “Beers List.” Beers and his associates were concerned that certain commonly prescribed as well as OTC drugs were causing what are referred to as adverse drug events (ADEs, sometimes shortened to just AEs). Beers, a doctor specializing in geriatric care, found that the elderly were particularly susceptible to many of the undesirable effects of these drugs because their older bodies tend to have less water content and more fat content than younger individuals. This, coupled with their bodies’ diminished efficiency in metabolizing or processing chemicals through their systems helped to account for the disproportionately high rate of AEs and associated hospitalizations and deaths among the old.

Beers' most recent list of 48 drugs and drug classes has been published in the Archives of Internal Medicine and has been embraced by the Centers for Medicare and Medicaid Services (CMS). Beers and his associates have established a set of criteria for determining if a drug poses a risk, that is, is it a potentially inappropriate medication (PIM) for the elderly. Using an expert panel of internationally-recognized experts, Beers and associates were able to find consensus on the drugs that are part of their list of potentially-hazardous medications. It is an important elder resource you should know.

The Beers list has a number of “old friends” as well as exotic medications of which most of us have never heard. You will find the likes of over the counter Naprosyn or Aleve (generically known as naproxen sodium) as well as Benadryl (diphenhydramine) and Chlor-Trimeton (chlorpheiramene). There are also household names like Valium (diazepam), Tagamet (cimetidine) and Prozac (fluoxetine). It is important not to take the Beers list as a blanket generalization that these are simply drugs to avoid. It is not quite that black and white. Some agents are on the list because they can cause complications among specific groups such as diabetics, asthmatics, or insomniacs. Others are contra-indicated for individuals with balance or gait problems because they become prone to falls, some for individuals who have bladder outflow compromise or still others who suffer from chronic obstructive pulmonary disease, emphysema.

The list goes on, and in some cases it is simply a dosage or extended release formulation warning that justifies being included on the list. Check it out: Beers List

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.
June is National Alzheimer’s Disease and Dementia Awareness Month. I will be having a number of postings on related news this month, and the good news is there is, in fact, good news on a number of fronts. Most of us have heard of the importance of using imaging of brains to identify the telltale beta-amyloid deposits and plaque in the brain for earlier diagnosis of Alzheimer’s disease. Researchers at Washington University in St. Louis, Missouri, are suggesting that Alzheimer’s protein tau may be a better biomarker of the disease than even beta-amyloid. Everyone develops protein tau in their brains as a normal part of the aging process. But these researchers have shown that it is not whether one develops protein tau, but where one shows it. When the protein spreads to the lateral temporal areas or into the parietal region, that is the trigger for Alzheimer’s symptoms. It also is when only mild cognitive impairment has begun to surface, and that early warning may work hand in hand with one other piece of promising news…actual treatment to stave off the progression of the disease. You may recall an earlier posting in which I discussed the brain’s response to excessive carbohydrate consumption as being “type 3 diabetes.” Qian Shi, a doctoral candidate at Tulane University, is analyzing Veteran’s Affairs data in a retrospective longitudinal study of neurodegenerative disease. Ms. Shi is reporting preliminary findings that link metformin use with a substantial reduction in neurodegenerative disease. Metformin appears to be having a similar effect on type 3 diabetes as it has had historically on type 2 diabetes. It reduces the inflammation that negatively affects both the pancreas and the brain. Until very recently, most research has found little support for the benefits of nutritional supplements or nutraceuticals in either preventing or slowing the progression of neurodegenerative diseases. But Jennifer Lemon, a research associate in the Department of Medical Physics and Applied Radiation Sciences at McMaster University in Canada, has conducted controlled studies using laboratory mice that show real promise. (Note: Animal studies, such as those using mice, are almost always the first step toward research that will move to human subjects later, and virtually all mammal brain functions are similar metabolically.) Dr. Lemon gave a mix of vitamins and minerals, along with nutraceuticals, such as beta carotene, bioflavonoids, cod liver oil, flax seed, garlic, and green tea extract to one group of mice. Relative to other mice receiving no nutraceuticals, the treated mice maintained better brain cell numbers and mass and cognitive function over the duration of the study. The treated mice seemed also to preserve their sight and sense of smell, two capabilities associated with neurodegenerative decline. Much research remains to be done, but we ought not be too hasty in giving up on the supplements you can purchase at the corner health food store. 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 the past two postings I have been talking about the warning signs of caregiver burnout as well as what caregivers can do to care for themselves. At the center of a lot of what can be done for the caregiver is a very simple philosophy: “Don’t try to do it all alone.” As a Geriatric Care Manager, this is where I often get the call. The caregiver or someone close to the caregiver needs somebody to help make decisions, take over some of the workload, stand up for an elder or other individual with special needs or counsel the caregiver on self-care.

There are other resources that can provide decision-making support, take on some of the caregiving responsibilities, advocate for an elder or caregiver and offer professional counsel on just coping with the responsibilities of caregiving. There are services to help caregivers in most communities, and the cost is often based on ability to pay. Look to programs such as adult day care centers, home health aides, home-delivered meals, respite care, transportation services, and skilled nursing.

Some steps you can take include:

-Find the local Area Agency on Aging. It may go by other names, but a Google search or even government or yellow pages search can give you some options. Check the Illinois AAA .

-If the elder or special needs individual is a Vet, the Veterans Administration is source of a good many support services,some of which are free to a veteran. For a map of service locations, go to VA MAP .

-There are other “affiliation groups” that can offer a range of support services. This can include the Elks, the Moose Lodge, Masonic Lodge and more. We should not overlook what religious denominations also can do along these lines. It may only be telephonic check-ups or meals or companionship, but it can be just the support or respite a caregiver needs.

-Transportation may be challenge for the elder in which case your state or local Area Agency on Aging can again be a resource.

-Just having a reliable agency to call on your elder who is relatively independent can also give piece of mind to a caregiver, and the Area Agency on Aging also offers pre-scheduled calling to homebound elders that can take some of the check-in responsibilities from the caregiver.

-Many local hospitals or long term care facilities offer day care for older adults. Because they already are equipped to meet the special needs of older adults, they often extend day services to area clients at a nominal charge.

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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A Forgotten Element of Exercise for Seniors – The Voice

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