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Eight Questions You Should Ask a Geriatric Care Manager
Over the past couple years on more than one occasion I have talked about what a geriatric care manager...
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June 22, 2012
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In the Caregiver's Words

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As many as seven million Americans, in fact, probably had a pretty “blue” Christmas this past season according to estimates from the Centers from Disease Control and Prevention. I have written before about how many chronic conditions disproportionately affect the over 65 crowd, and depression is high on the list. In fact, 65+ year olds comprise about 16% of all suicides in America, so to label their Christmas blue is a bit of an understatement. Depression, often associated with loss, finds older adults to be something of a perfect storm as an age segment. As one ages, there are the inevitable losses in terms of just not being able to do what one used to do easily. And the job that used to define a person’s success and image is now history. And any number of physical illnesses can rob a person of their vitality. Cognitive decline also warps the lens through which older adults may view the world around them …a far cry from the proverbial “rose-colored lenses” of an optimist. Older adults are more likely to have suffered the loss of a loved one such as a spouse, friend or even son or daughter. That, combined with the other physical losses both shrink their social circles and reduce their desire to even get out of their homes. They become isolated which only reinforces any depression they may already have from their losses. And the losses accumulate. But it is crucial to remember that depression is not just an inevitable part of growing older. It is not a “normal” part of the aging process. When you gathered with your older loved ones over the holidays or spoke or Skyped with them did you notice any signs of:
- Crankiness or nervousness
- Fatigue
- Lack of focus or concentration
- Too much or too little sleep time
- Too much or too little appetite
- Vague digestive issues or pains
- Suicidal thoughts or comments?
Act now on any of these signs and symptoms of depression. Most depressed people don’t speak up…they simply accept the way they are feeling and slip another notch into their malaise. There is, in fact, a stigma that many associate with “mental illness” of any sort that may fuel their resistance to help. Insist that they see a professional, perhaps their clergy if not a professional trained in mental illness. Giving them a happier new year would be a wonderful belated gift for the holiday just past. And since this is the 21^st century, there is a text hotline. Just text 741741 for help. 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.
The processed food consumption that has been linked to our global epidemic of obesity is also tied to the rising rates of Alzheimer's Disease world-wide. I don't mean to sound the alarm about sugar, but I came across an article recently that tied together a number of facts and trends that we all may have seen. And we all should be very alarmed! As a geriatric care manager, I often work with older adults who have developed medical conditions that reflect a lifetime of poor health and nutrition habits. We see the elevated blood pressure and the obesity that can arise from sedentary lifestyles and poor diet. One of the more common developments we see is the onset of type-2 diabetes resulting from a lifetime of too many sweets that have resulted in what doctors call "insulin resistance," the pancreas' inability to keep producing enough insulin to process the large doses of sugar it confronts. What you may not know is that the brain also produces insulin, and that when faced with a prolonged assault from more sugar than it can process, its ability to produce insulin may falter and then fail. The result is "type-3 diabetes." The research has been piling up. For instance, people who suffer from type-2 diabetes (type-1 is the form that people are either born with or develop as an immune response) have deposits of amyloid-beta in their pancreas. Sound familiar? Yes, amyloid beta deposits in the brain are the signature marker for Alzheimer's Disease. And this also begins to explain why type-2 diabetics are estimated to be anywhere from 50 percent to 100 percent as likely to also develop insulin-resistant Alzheimer's Disease. Now, it is important to point out that type-2 diabetes does not cause Alzheimer's Disease, but type-3 diabetes is caused by the same over-consumption of sweets that causes type-2 diabetes. This may begin to also explain why the rates of the two conditions both have tripled in the United States in the past forty years. This, along with a lot of other inflammatory conditions related to the heart and the circulatory system. You may have thought that the extra care required for the estimated 5.4 million obese Americans with type-2 diabetes was costing us a lot - $150 billion annually? It is estimated that care for that many Alzheimer's patients is even higher at about $200 billion, the reason being in part because the close supervision for the safety of a cognitively-impaired patient is so much higher than for an obese individual. This is probably one of the situations where I don't have to connect the dots for any of you who are caregivers to an older adult...or attending even to your own well-being. My advice can best be summed up with two words: diet, exercise. Ironically, these are considered first line treatment for people who are obese or who have begun showing the signs of type-2 diabetes. Of all the advice I have digitally-shared these many years, this may be the best for a whole host of reasons. Please pass it on. 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.
Be honest if you’re a caregiver and you can answer YES to more than one of these questions. Sit tight if you can affirm more than one per set.
- Do you feel depressed? Sluggish? Physically Drained? Have Hopeless thoughts?
- Do you feel isolated from your own support system? How long has it been since you’ve been carefree and social?
- Do you find yourself mad about “the little things”? Perspective getting tough to keep?
- Do you find yourself either punishing yourself more or needing more compassion than usual? Do you feel guilty for being independent?
Here come the Holidays, with stress enough to bowl anyone over, but for caregivers, they can be particularly exhausting. Lots of stuff to worry about “going right” for the rest of the family while keeping an eye out for the care receiver. You may also be worried about staving off any old, unresolved family tensions. Who wouldn’t be exhausted just preparing? First things first. You’re doing a great job, and I know you don’t want to hear this, I know you’re tired of NOT hearing it, and I know you’re not sure if it’s worth the trouble of telling someone else how to do what you already know how to do. You deserve respite care. And you can have it. Respite care comes in a few packages:
- Geriatric Care Managers – That’s us at Creative Care Management. Among many helpful options, we coordinate services using experience and trusted relationships so that you can relax when someone else is taking the wheel. We’re happy to help, but you should know your options, and you can start by searching for GCMs in your area here.
- Adult Day Care Centers – These facilities provide a safe environment either for a few hours at a time, or for a full day while a primary caregiver is elsewhere.
- Home Care/Home Health Agencies– These non-medical service providers make home visits and give care so you can catch your breath. Home health can also manage tasks like meals or laundry, or help with smaller errands, like shopping.
Friends and community can also be great, inexpensive resources; however, as they’re on a volunteer basis, they’re not as dependable as professional resources. If your loved one is independent enough, a senior center can also provide enough respite to rebalance. You deserve to have the best holiday available this year. Your loved one deserves you to be at your best. More than anything, if you think you need the break that respite care can provide, pick up the phone and call someone. I’ve been doing this for more than 20 years, and if I can’t help you directly, I’ll help find someone who can. 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.
There will come a time for everyone with an aging parent that the question will arise, “Is it still safe for mom (or dad) to live alone?” And then there will be the checklist to be certain the solution to your older parent’s solitary risk is feasible:
- Is the caregiver I hire trustworthy?
- Is the caregiver I hire affordable?
- Is the caregiver I hire someone whom mom or dad will like?
- Is the caregiver I hire vaxed and healthy?
- Is the caregiver I hire willing to work overnight or weekend shifts?
Your own list may grow even longer as you sort through your prospects owing to your parent’s medical status, challenging personality or isolated geography. But technology may be central to your solution on virtually all counts. We’ve all seen the ads for the portable device that accepts that call of “Help, I’ve fallen and I can’t get up.” But for the majority of incidental needs for the older loved one living alone, being able to summon a first responder may not be the only solution they need. But Alexa may be…or technology with attributes like those ever-present audio monitors a lot of folks use to play their favorite music or to turn down the room temperature or draw the curtains and more. A company called SmartCompanion is taking responsive monitoring to the next level. Set-up in your loved one’s home is actually quite inexpensive - $250 – and includes battery backup and a video screen. Small two-way speakers can be placed strategically throughout the home, and some companies also offer robotic dogs, cats and even birds to stand in for just a piece of tech. The devices can be programmed to offer a veritable menu of outbound calls including which family members as well as first responders. The tech companies that provide these techno-companions are riveted on making them more responsive to a host of unique needs for the hearing-impaired, those with poor eyesight and more. Besides their affordable responsiveness, these technologies are also addressing the larger demographic shift which forecasts a substantial labor shortage of caregivers as the percentage of 65+ year-olds begins to dwarf the available labor force. And your mom or dad’s “Tech Friday” can be programmed to not just respond to urgent or mundane requests, they can be programmed with daily or weekly or longer calendar reminders for pill regimens, medical appointments or family events. From what I’ve seen, these new technological companions may outgrow their intended target market of older and isolated individuals and eventually insinuate themselves into everyone’s households like the George Jetson’s family tech support. “Jane, stop this crazy thing!” 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.
November is National Alzheimer’s Awareness Month. We also shift from Daylight Saving Time to Standard Time…I hope you appreciated the “extra hour” you had over the weekend. But never mind setting your clock back by an hour when we made the change to Standard Time. Get a stop watch! The latest research shows someone in the world develops some form of dementia every 3 seconds. Giving that frightening statistic some local context, every state across the U.S. is expected to experience an increase of at least 12% in the number of people with Alzheimer's disease from 2019 to 2025. Alzheimer's is thought to arise 20 years before clinical symptoms are visible -- a point potentially amenable to lifestyle interventions such as diet. Current consensus is that eating a heart-healthy diet will benefit both the heart and the brain. That healthy food part gets a bit tricky in the 21^st century because so much of our food is processed food…some would say over-processed. Trans fats naturally occur in small amounts in some meats and whole milk. But through a process called hydrogenation many processed foods are infused with unnaturally high amounts of trans fats to make them more stable for longer shelf lives. It may be good for the shelf’s live, but not for yours. It has been well-established that trans fats are associated with an elevated risk of type 2 diabetes as well as cardiovascular illness, and there is a biomarker called serum elaidic acid that health care professionals have followed to assess who is at risk for a “cardiac event.” Researchers in Japan have recently reported that 60+ year olds who started in a panel - with no signs of dementia, but higher levels of serum elaidic acid - were 50% to 75% more likely to develop dementia of any type, including Alzheimer’s disease and vascular dementia in the decade that followed. But this serum concentration of trans fats can be reversed by shifting to a better diet. The first rule is to avoid sweet pastries, the strongest contributor to elaidic acid serum levels. But also steer away from margarine, candy – especially caramels, croissants, non-dairy creamers, and ice cream. But giving up these “bad foods” seems so negative. To make the transition away from trans fats, start with some fresh fruits, real milk in your coffee or something else that will be a delight. 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.
One of my clients recommended a web resource recently, and I am so impressed by it that I am passing it on to you. So often in the process of caring for an elder or other person with special needs we come up against medical language that can be difficult for someone who is not a trained professional to grasp. We can always look up a word in the dictionary, for sure, but the specific way words are used when speaking of geriatric and related issues can be rather esoteric. So, when I can across the glossary of terms offered at the Silverado web site, I just had to pass it along. Please check out: Silverado Glossary. You will get a quick grasp of the differences between amyloid and aneurysm or between dementia and delirium. It also offers really helpful suggestions on the early warning signs of Parkinson’s or Alzheimer’s and more.

The same site also is a wonderful compilation of other web resources that can be very helpful for the caregiver trying to navigate a new medical condition or other complication for which a little support or explanation would be greatly appreciated. They have another window on their site that offers at least a couple dozen resources that may be just what you need. Please check out: Silverado Web Resources. It has everything from links to Alzheimer’s support groups to veteran’s health benefits and more.

If you find resources like these, please do not hesitate to pass them on to me, and I will share them on the blog site. Also, do not hesitate to send me your questions, and I will do my best to answer them.

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.

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Eight Questions You Should Ask a Geriatric Care Manager

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