Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • elder resourceChicago's Geriatric Care Manager Center of Excellence

Elder Resources – Free Legal Advice
I have been hearing that the web resources I have been offering in my postings have been informative and...
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December 30, 2010
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Where There is a Will You Still Need an Advance Directive
About 50% to 70% of Americans will die without a will. So, you can imagine that the percentage without...
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November 22, 2010
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Becoming Educated about Elder Resources
Making decisions on behalf of a loved one is not always easy. Yet the challenge can be eased with...
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November 17, 2010
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Maximizing Well-Being for Everyone
Independence is as much about the caregiver as it is the older adult or special needs individual who receives...
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November 7, 2010
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In the Caregiver's Words

Recent Client Praise

Birthdays are a leading cause of falls that can result in an emergency room visit, and every year this takes a particular toll on those 65 years of age and older. The 65+ year olds represent 2.5 million visits to the ER according to the CDC, and that makes them the most susceptible of any age group. Sadly, one in three of this 2.5 million will be back again within a year of their first visit having fallen again, some within days of the first fall. So, keep your older loved one in the safe confines of home, right? No … researchers report that a substantial percentage of these falls are trips, slips and stumbles right at home, the bathroom and kitchen being particularly dangerous fall hazards. As any physical medicine doctor can tell you, walking is actually controlled falling. We learn this skill at a very early age when we are all thankfully closer to the ground. If this isn’t clear, just watch an infant struggling for that first milestone step…a lot of falls precede the successful step. As we age, we don’t forget how to walk safely, but older adults go through health and physical changes which challenge their agility and some medications are also culprits in this gravitational conspiracy. Here are some tips to help your older loved one to a safer gait:
1. Make a specific appointment and go with them to visit their doctor: be sure to cover their medications for any side effects, talk about any history of falls and explore whether any health conditions may be potential contributors.
2. Encourage a daily regimen that includes more than just walking - perhaps a physical therapy regimen or yoga or strength training, because strength and changing up the training – what some refer to as “muscle confusion” – is good for agility.
3. Outfit the feet: “sensible shoes” may be a dirty word in fashion circles, but help your older loved one to have properly fitted, effective footwear with soles that have traction – avoid high heels, floppy shoes, bunny slippers, etc.
4. Conduct a home safety inspection to declutter, eliminate trip hazards, upgrade poor lighting, and make home more accessible with everyday items within easy reach. Remember, baths and kitchens are particularly hazardous places.
5. Be sure your older loved one’s house is well-lit, and this goes for middle of the night trips to a rest room or early morning risings during this season of short daylight. Encourage a flashlight at bed side.
6. Upgrade home safety with hand rails on all stairs or even longer hallways, non-slip treads on stairs, adaptive toilet seats and grab bars in the bath.
7. There are professionals who can help – physical therapists can help with a “workout and flexibility regimen,” and your local senior ombudsman also can recommend area craftspeople who can make home accommodate your older loved one.
So, when you visit your older loved one during the holidays take along a pad of paper or your smartphone to make a list. This is not the naughty and nice list; it’s the safe and non-safe list! I have a home safety checklist I will be happy to send you if you just email me. 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.
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.
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.
As you can tell from now a third installment about other medical conditions that can mimic dementia, it's not a quick diagnosis once one sees cognitive difficulties in an older loved one. And the isolation of this past year’s pandemic and quarantine certainly have created the perfect storm for health and environmental issues to conspire to make folks seem “not quite in touch.” When I asked for you to guess one of the remaining medical conditions that can mimic dementia, nobody got the right answers, despite the fact that nearly one in five of you who read the last email clicked through to the post. Well, no more suspense, here are three more “look alikes”. Did you know that…
1. Hearing or Vision Loss can create dementia-like symptoms. It stands to reason that those among our loved ones who have trouble hearing, will have difficulty also in processing what is said to them. And those who cannot see clearly will face challenges in orienting themselves in the world. As we all come out of hibernation, encourage your older loved one to have an eye exam as part of their annual preventive health measures. And if you are asked to repeat yourself in conversation, or if it seems your loved one is not registering what you’re saying, ask their doctor for a referral to an audiologist.
2. Urinary Tract Infections are relatively common in older adults and they can precipitate dementia-like symptoms. The key here is that there is relatively rapid onset of the symptoms, which are your sign if you are a caregiver to get your older loved one to the doctor. With the appropriate antibiotic, the condition and the delirium can be cleared up in a week or so.
3. Some Medications can induce dementia-like symptoms as an unwanted side effect. Anticholinergics, like diphenhydramine, are a classic case of a medication that has side effects that can be as powerful as the originally designed main effect. Also know as Benadryl, this medication is marketed perhaps even more often as a sleep aid, not an allergy aid. But these drugs also can block brain chemicals important in cognitive processes as well as some motor functions.
As we wrap up this triathlon of posts on dementia mimics, the common learning for those of you who are caregivers to older loved ones is very basic. Be observant for changes in cognition in your older loved one and ask questions. Your best ally in this likely will be your loved one’s health care provider who also will have a history with your loved one. They also will be able to discern even small changes in mental processing and will be quick to make the appropriate referrals, if indicated. But you will be the primary advocate, the one who will get your loved one to the provider in the first place. It is becoming very safe for the vaccinated people to get to medical providers, and the providers themselves are taking all the right precautions as they “open up.” And did I mention that now that we all are getting our vaccines, we can slowly begin to relearn hugs. Give one and get one…a vaccine and a hug, that is. 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 the Caregiver
Make Care Giving Work
Peak Over the Wall
The Caregiver Blues

For the Family Caregiver

For the one leading the charge, the drains are not always visible.
Care giving can be just as demanding as a full time job. Days are long and it is hard to take a break. This is why it is so important to watch for your own symptoms as a caregiver. You want to be as good for yourself as you are for your loved one who depends on you.

Are you…

missing a lot of work?

not exercising and instead eating a lot of unhealthy foods?

having nightmares or disturbing dreams?

feeling lethargic or maybe even depressed?

angered by minor issues, or are you impatient with your loved one?

MAKING CARE GIVING WORK

While keeping yourself and your family strong
Family care giving is the single biggest contribution to an older adult being able to stay in their own home and age in place. Caregivers do everything from transporting the older adult to and from medical appointments to coordinating the services of other medical providers, managing multiple medications and advocating on behalf of their family member. It takes time and weighs heavily on the caregiver who still must balance everything against a full-time job, parental responsibilities and a marital partner. Caregivers often don’t get much explicit attention as part of the tremendous contributions. The most recent report on family care giving published by AARP is required reading for caregivers and their families. It provides a sense of the huge and important work that caregivers are providing for their families in America today.

Creative Care Management recommends three points that cannot be repeated often enough.

One, caregivers’ contributions need to be appreciated by the entire family who benefits.

Two, the whole family also needs to help in caring for the caregiver.

Three, it takes a village for all of the above.

PEEKING OVER THE WALL

After surviving the climb

5 Steps Towards becoming a Better Caregiver:

Become educated about your loved one's condition in order to be as effective as you can be.

Recognize that you are not superman or superwoman; set some limits on what you and others can expect from you.

Do not beat yourself up about feeling angry, afraid or even resentful; instead find ways to vent

Talk is important as a principal way to vent – especially to a therapist, counselor, clergy member, and even trusted friends.

Lift smart. As a caregiver, be smart about not hurting your back when lifting, pushing and pulling; keep yourself in shape and use an assistive waistband if your physician recommends it.

For more tips for the caregiver, Chicago IL care resources and more, don't forget to visit Charlotte's Blog and please make sure to learn more about what we do at elder care services page.

THE CAREGIVER BLUES

Building a Prevention Strategy
With the amount of stress and pressure caregiving can produce, many choose to ignore signs of caregiver depression. The sad irony is that the caregiver feels guilty about even talking about the dark cloud that seems to be hanging over them, guilty that they do not feel the fulfillment of taking care of the parent who once took care of them. This, despite the fact that the caregiver of an older adult more often than not has other family responsibilities already. More than 20 million Americans suffer from depression, and family caregivers are more likely than the average person to get something that is not just the "blues." We all recognize the time and work that a caregiver puts in to help an older adult, but they also may be giving up the time they would have been spending with their spouse or significant other –or the nights out with friends and acquaintances, the moments during any given week that would give a break from the routine, make them laugh or fulfill them.

Love, Live, Laugh

Tips for Caregiver Blues

Include you; make time each day to do something that delights, relieves or distracts you.

Make lists; prioritize your caregiving duties, make lists and you will see you are making progress even when there remains more to do.

Request help; appreciate that it is gratifying to the others whom you may ask for help to be of help to you and your elder.

Leverage your abilities; the others who can give you respite are actually better equipped for what you may delegate than you are.

Make yourself laugh; hard work like caregiving can seem devoid of fun, so you have to take time to have some fun.
What do hearing aids, exercise, support groups and travel have in common? They all are ways that individuals suffering from Alzheimer’s Disease, specifically, or dementia, generally, can fight these diseases’ progression. Even more important, they help to fight the personal isolation that accompanies these frightening conditions.

We often associate dementias with older adults and the stereotypic confusion that can characterize the individuals with the diagnoses. But it is not just a condition of older adults as the recent public disclosure of The University of Tennessee women’s basketball coach, Pat Summit, highlights. Ms. Summit is just 59 as she goes public with her diagnosis, and it helps others to understand that it can happen as early as 30 and 40 years of age. Younger onset Alzheimer’s Disease technically speaking is the manifestation affecting those under age 65, and there are 250,000 new cases in America every year. Yet, there are ways to fight the downward spiral of dementia.
1. Hearing aids may seem an unlikely fix for dementia. Yet, it is simplybecause hearing aids enhance the clarity of communication and therefore the connection between dementia patients and others that they help alleviate the isolation and bolster memory. When dementia patients can hear more clearly, that connection also helps calm the anxiety that they may otherwise feel when living in a world that is confusing. Hearing aids cannot “cure” dementia, but they can help a patient navigate more confidently.
2. Exercise can be a helpful boost as well as it improves the blood flow and releases calming endorphin into the bloodstream. For a variety of medical conditions, health care providers often talk about the role that “performance status” plays in a patient’s ability to cope. Being more fit helps dementia patients cope just as being fit also helps cancer patients while they fight a tumor or surgical patients as they recover from a procedure.
3. I had mentioned the importance of being connected for a person with dementia of whatever sort. Support groups become the new circle of friends who can truly understand what it is like. This is common across a whole host of medical predicaments from grieving widows and family to returning wounded warriors or recovering cardiac or orthopaedic surgery patients. Somebody else who has been there understands what co-workers, friends or even family cannot quite fathom.
4. Travel is a bit of all these. It is a way to have fresh new experiences that challenge a patient cognitively. When a person experiences what should be familiar settings like home as frighteningly unfamiliar, it can be reassuring to share travel experiences to strange and different places that – well – everyone will find strange and different as well.
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.