Chicago's Geriatric Care Manager Center of Excellence – Since 1991 • geriatirc care managerChicago's Geriatric Care Manager Center of Excellence

Safer Senior Living – The Kitchen
In my last posting I spoke to ways to improve the safety and accessibility of the bath for seniors...
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April 10, 2011
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Caregiver or Guardian
As a geriatric care manager, I have the chance to work with all manner of caregivers and the elders...
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December 10, 2010
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In the Caregiver's Words

Recent Client Praise

If you are a caregiver to an older adult, don't be surprised if your loved one is asked if there is a gun in their home during the next doctors' office visit. In the past. such questioning was usually out of concern for young children in a home who may find a loaded weapon in the house. And we have all seen the reports in newspapers across the country when a youngster discovers a sidearm in a parent's room. Now, as geriatric care managers, our profession also involves talking about gun safety among our clients. Why? In an article published just this past week in the Annals of Internal Medicine, doctors are now being encouraged to ask their older patients about firearms in their homes. Doctors are rightly pointing out that the higher rates of dementia, depression or memory issues place older adults at a high risk for suicidal behavior. According to the latest data available, firearms account for more than seven of ten suicides among adults 65 years of age and older. This is compared with just 51 percent among the population as a whole. For those 65 and older, the suicide rate is 14.6 per 100,000 versus only 11.4 per 100,000 of the population overall. And suicides with handguns outnumber homicides with handguns. There is no denying the second amendment rights of all citizens, but the suicide risk is a matter to address. Physicians are now being encouraged to ask about guns in the home among their older patients, which places this at the level of a national health issue. I recently heard a local official talking to an audience of older, middle-aged and younger business professionals about what we may call geriatric suicide. He asked for a show of hands for all those who at some point in their lives have owned motorcycles. I was a bit surprised by the relatively large number of hands that went up. He asked those that no longer had motorcycles to lower their hands, and it was mostly the older contingent who took their hands down. He asked one of the older folks why they no longer owned a two-wheeler, and then another and another. The answer? It wasn't safe for them anymore. A lot of heads nodded. Some may feel that the same reasoning should be applied to those who own firearms. I am not pro-gun or anti-gun, but I am a professional advocate on behalf of older adults. Give the medical guidelines a read to see if this may be a discussion you wish to have with your older loved one. Also, please comment on this posting if you have an opinion you would like to share. Like so many issues that are important for us to address, there are no easy answers. Charlotte Bishop is founder of Creative Care Management, a team of geriatric care managers and certified professionals who are advocates, resources, counselors and friends to older adults and their families in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.
Excess weight is not healthy and obesity definitely is not healthy, right? When it comes to your older parent or loved one, the answer is a bit more ambiguous. Picture you have been going to the physician with your older mother for a number of years, and mom has been “robust,” BMI 29, but not what would strictly be termed obese. (BMI, or body mass index, is calculated from a person’s height and their weight, and technically 30 or higher is considered obese.) This year, however, mom’s BMI is up to 30, yet she has not gained a pound. So, by the book she is “obese?” Not necessarily…this is part of what is termed the “obesity paradox.” As a person grows older, there is a tendency to lose muscle mass, and it can get replaced by body fat. There is also a tendency to lose height while maintaining a stable weight as in the case with “mom” above. As people age, they may accumulate more “protective weight,” weight that can be a reserve against unintentional weight loss. Among the young obesity is associated with adverse health impact in the form of risk of hypertension, diabetes, heart disease, certain cancers and a negative effect on most organs of the body…and reduced life expectancy. Yet, some older people who are patently obese have dodged these ill effects. These are also part of the “obesity paradox.” The fact is that a lot of their younger cohorts may already have succumbed to disease before they got so old, not unlike the octogenarian who has smoked a pack of cigarettes a day and continues to smoke without any seeming impact on their health. So, should mom lose weight? If it is all weight around the mid-section, weight loss is called for. Appreciate that any weight loss regimen is likely to result in loss of muscle as well as fat and therefore deconditioning. The rule is that weight loss in the 5 to 10 percent of body weight range tends to have positive effects. Also, weight loss that owes to real life style changes such as diet and exercise are positive. This kind of program should also include sufficient intake of protein to be safe. The American College of Sports Medicine also recommends exercise at least twice a week. This exercise should include strengthening exercise and resistance training. They identify what some call “muscle confusion” training which simply means changing up the regimen frequently to encourage a more nimble and flexible gait, balance and core strength. It is also helpful to involve your older loved one’s primary care physician to assure that their medications do not introduce issues of balance or body hydration. But beware of the physician who cautions against exercise for a “person of this age.” Don’t let them discount mom because of birthdays. Get a second opinion. And remember that it ultimately is about quality of life…and a healthy weight. 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.
Eating healthy should be a priority no matter what your age or health condition. Of course, during Thanksgiving, we are all tempted to indulge a little more than we would on a normal basis. Imagine if we were to reverse that thinking and made a more conscious effort to eat better during the holidays? If you’re preparing this year’s big feast, think about serving a mix of foods that align with a more healthy diet. For instance, if you’re caring for an elder adult, or an Alzheimer’s patient, you might want to consider a Mediterranean diet.

Studies have shown, as reported by ABC news, that a Mediterranean diet is great for preventing stroke and dementia. In general, the diet has exceptional nutritional value, with benefits that keep the body healthy and improve mental cognition at the same time. The American Academy of Neurology studied brain scans of those who exhibited various degrees of commitment to the Mediterranean diet. Those who stayed with the diet were 36% less likely to have infarcts – strokes in the brain that usually don’t produce any symptoms.

Another study by the American Academy of Neurology shows that the Mediterranean diet can improve the long-term health of Alzheimer’s patients. A focus on high fruit and vegetable consumption as well as low meat consumption seems to create benefits for mental and overall health.

So how do you infuse a bit of Mediterranean in your thanksgiving meal? First, if you’re a caregiver for a loved one, give them a few options and ask them what they prefer. It could be as simple as adding a salad to the meal, or trying a new and healthier way to prepare the stuffing. A quick search online will offer new ideas for side dishes and entrees. You may find that your efforts will encourage healthier eating habits for everyone at the Thanksgiving table, including yourself!

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. Visit our For The Caregiver page for more information and resources.
Miss your friends, your older loved ones and those summer get togethers in the backyard? We can get together at distance with friends and family in manageable numbers while maintaining distance, but there is no chatting around the water cooler or dropping by the grandparents or social hour at a local establishment like there once was. All of that is mostly lost, at least if you’ve been following the guidelines, and the isolation you and your older loved ones feel is not unique. Odd to talk about isolation and then offer that you are not alone, but… Research is showing that strangers may be every bit as important to your emotional well-being and your older loved ones’ well-being as the friends that you all may now be missing. If you’re like a lot of folks, you are walking more, perhaps with a dog in tow. Or you many be shopping for groceries in the less crowded grocery stores. Or you may be at home to have the mail delivered as your retired parents are and meet the letter carrier or the delivery person from those on-line purchases we all have been making in greater number. I am not exactly an extrovert, but I always make it a point to at least say hello to all of these people with whom I have casual contact. And my husband, the extrovert in the family, may spend minutes chatting up a neighbor we had not met until the recent months or the person from the pizza parlor who delivered tonight’s guilty pleasure or someone eight blocks from home on his long walks with our now physically fit dog. Well, those casual encounters may be helping his and my mental health in a way that we used to think only close friends or confidents could according to a book I came across. The book, titled “Consequential Strangers,” is co-authored by a psychologist and a science reporter who analyzed the importance of those “weak ties” that we all have on a daily basis. In fact, the authors contend, those strangers are as important as family in best friends in giving us a strong grounding in the world. And the authors further point out that the more ties we have with “consequential strangers” the less likely one is to become depressed. Some of the benefits also include better sleep patterns, more productive work effort and just about all of those parts of daily living we value. To truly be healthier during this extended break from normal, ask strangers how they are faring…and then how their family’s health is…and maybe what they have been bingeing lately. You will have primed the pump for your better health. Now, do the same for your older family members and friends and you are passing it forward. Remember, we all will get through this, and we will get through it in much better shape if we hold our strangers closer. 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.
Why a kidney alert for caregivers to older loved ones? Because nearly half of adults over the age of 70 in America may have chronic kidney disease and many of them may not even know it. That means that for those of you reading this who have an older loved one, about half of you should be paying attention to your older loved one's risk factors for chronic kidney disease. As a geriatric care manager for caregivers and their older loved ones we often get the call only after a crisis has occurred, but chronic kidney disease is one of those silent crises affecting as many as half of our client caregivers' loved ones. Here are the risk factors you should be looking for if you are a caregiver who wants to avoid the crisis in the kidneys:
1. Does your older loved one have high blood pressure? We tend to think of hypertension as a condition that affects the heart and the circulatory system, and it does. But it also affects the kidneys' ability to filter the fluids in your loved one's body. If kidneys are impaired, all the other major organs of the body are compromised.
2. Does your older loved one have diabetes? If the diabetes or even prediabetes is not well-managed by diet or insulin, the kidneys pay the price. Those extra glucose molecules that stick to the red cells begin to gum up the kidneys, and that again puts everything else at risk.
3. Does your older loved one smoke? We all have heard about how smoking is bad for a person's heart and lungs, but a lifetime of smoking also compromises the kidneys. It does this, because the smoking raises blood pressure, and as I said, high blood pressure will compromise the kidneys' ability to filter fluids.
4. Does your older loved one have a weight issue. It's very simple. Extra pounds translate into elevated blood pressure, and you can see where that takes your loved one.
5. How old is your older loved one? Birthdays are not exactly the problem that can result in kidney compromise, but a lifetime of exposure to any of the risk factors I have highlighted will harm the kidneys' function. As a caregiver, you should help your older loved one also appreciate that kidneys do more than just filter the fluids we consume each day. They clean the blood and help to regulate blood pressure. The kidneys also help in regulating the calcium that is available to your older loved one's bones which can be why some people develop kidney stones (which are calcium oxalate). So, all of this is to help show that geriatric care managers also help families use nutrition to improve the health of their older loved ones which translates into not only increased quantity of life, but also enhanced quality of life.
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@cr eativecaremanagement.com.

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