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

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November 30, 2015
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In the Caregiver's Words

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This marks the 100^th posting on our blog since its inception October, 2010, and it gave me pause to stop and reflect on what one learns at 100. So, whom better to ask than people who have had 100 birthdays, made it to that milestone and have been paying attention along the way. I have gathered together here a short compilation of wisdom from some centenarians whom I felt had something to offer the rest of us. You tell me what you think.

    Ruth offers advice on life and style. Appreciate that Ruth lifts weights everyday and practices Pilates weekly, an activity she just picked up when she was 92. Perhaps her most memorable piece of advice is about time and age; she says, “Don't look at the calendar just keep celebrating every day.” This, from a lady who does not wear blue jeans and makes herself get up and out every day for at least a short walk. (And she is a real believer in the values of skin moisturizer.)

    Ephraim is a doctor still in practice at age 100 His advice to all of us starts with choices. The two important choices that top his list include “choosing the right parents” and then “choosing the right spouse.” The doctor still has a sense of humor, and you will appreciate that if you go to his site to see the rest of his advice which include “keep breathing.”

    Jessie is the other side of 100 at 105. She commends that peace is the root of happiness. She does not count her time in years, but rather in minutes and the promise that each minute holds for her. She also stays active and only just recently gave up her favorite activity, swimming, at the age of 101.

    Patsy is a quiet man at age 100. His secret is to simply enjoy life. Part of that includes his weekly treat from the local pizzeria, one slice of thin crust sausage pizza. And when he is asked what he means by enjoy, he responds: “I like to be sociable with everybody.”

    Fauja finished the Toronto marathon last year. This stands as a Guinness record, and Mr. Singh was very excited to make the distance on behalf of local charities. Perhaps the secret to being able to run that far at age 100 is to not start, as Mr. Singh did, until you are 80 years old and also to surround yourself with friends as Fauja did for his run.

So, the common thread? Maybe the lesson we can take from centenarians is that it is not about a destination as much as it is about a journey. It is not about having lived to 100; it is about having lived each day along the way.

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 .
You have heard from me before about how there is a new Alzheimer’s Disease diagnosis in America every 67 seconds…about one a minute every day and every night! According to medical professionals it is becoming even more prevalent worldwide. By the year 2050, this rate is expected to double to one new case every 33 seconds. It is ranked as number one in prevalence of all neurodegenerative conditions affecting 5-6 million Americans and as many as 47 million people across the globe. Translated, that means about one in eight individuals over age 65 will be affected by Alzheimer’s and that climbs to almost half of those 85 years and older. It has been studied for more than 100 years with little headway on what causes Alzheimer’s Disease, let alone how to treat it. I am going to talk more about treatment, and there are some avenues that show promise, in a second installment to this two part series on Alzheimer’s. In this part, let’s go over how Alzheimer’s is diagnosed accurately today than ever before. Not that long ago, Alzheimer’s could only be diagnosed after a patient had died when they could actually investigate how much beta amyloid plaque had accumulated in their brain. That is so yesterday. There are now three ways to arrive at an Alzheimer’s diagnosis in a patient. The first starts with a genetic marker that predisposes an individual to developing Alzheimer’s. It’s called the APOE4 gene, and about one in seven to one in ten people carry this gene. Those who have one copy of this gene are about two to three times as likely to develop the dementia as those who do not have the gene. And if a person has two copies of this gene the likelihood shoots up to 12 times that of a person with no copies of the gene. Should everyone get the genetic test? Well, talk to your doctor, but as medical professionals have consistently shown early diagnosis can be the first step toward more effective treatment of any condition. A second step toward diagnosis will be what is termed a neuropsychological test which assesses a person’s cognitive function. It should be conducted by a neurologist, not just a primary care physician. Combined with the genetic test, it can help to pinpoint Alzheimer’s Disease, but not without the third test. Brain-imaging can not only help to look for the signature of Alzheimer’s activity the brain, but also rule out other issues like hemorrhage or tumors that may be causing mental difficulties. It will also more concretely assess the extent of any Alzheimer’s spread in the brain. This latter testing can be done by a number of technologies like CT or PET scanning, but the most common test is MRI. Look for Part 2 next week when I review the existing as well as new, promising treatments for this condition. You all may recall that I have a book that I have co-written on what a caregiver should know about Alzheimer’s…it is noted in the closing paragraph here. If you want to save 20 percent off the Amazon price, please just send me an email and we will send you a copy for $19.97 which includes shipping and handling. 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.
You have probably put off a vacation or most any travel for more than a year with the threat of the pandemic making taking a flight seem about as safe as jumping into a tank of alligators. But with the majority of adults in America vaccinated and you with your own vax card you can now make plans…and so can almost every other American including your older loved one. Your mom or dad will be anticipating the crowds at the airport, so they are looking to bring their TSA precheck clearance current. They also will perhaps be receiving all manner of solicitations from hotels, resorts, cruise companies and more. But there is cyber danger out there. One of the principal rules of cyber security is the cyber criminals know to go where the people are, and the more people the better the odds of scamming more of them. It’s not unlike fishing where your chances of catching more than one fish are much better if you can find where the fish are gathering. One of the folks in our orbit went on line to renew their TSA status which had lapsed during the pandemic. After all, who needed that when no one was flying anywhere? Having entered “renew TSA” in the search bar they were offered a number of links from which they chose the one that told them what they wanted to see. They proceeded to fill out the tedious government reapplication form and got to the end where credit card information was requested, and they provided that as well only to get an alarm that the information could not be processed. Frustrated, they entered the card information again and received the alert again. They tried another credit card with the same result. The next day both credit card companies called and emailed fraud alerts, both helped them close the cards and both issued replacements. Story over? This is where the story can be just beginning, because the scammers still retained name and birth date and address information. Scammers compile many thousands of such identities so that even when their charges don’t get processed they can merge the data with other scammed data available on the dark web. The size of these data bases gives new meaning to “mega data.” A cyber security expert, Bryant Wallace, CEO of WallScott Solutions, tells us that the first sting of this scam may be just the beginning. Scammers will continue with mail sent to the prey’s home address, to their email address, or they may call. The credit card may have been neutralized, but the scammers are now laying siege to their targets. If you have an older loved one who is starting up their post-pandemic travel plans, Mr. Scott offers these warnings:
- Beware of sites that do not have the right domain suffix (government sites are .gov)
- Beware of unsolicited email offers that seem awkward in their language or logos (English may not be the first language of the scammers)
- Beware of solicitations that know more about you than they should (Because you have shared it with someone in their orbit)
- Beware that the address begins with https:// (It means it’s a secured link)
- Beware of the same issues with mailed correspondence.
Notice that we have not even talked about hacking. These hazards to which older individuals are particularly vulnerable are traps into which they easily fall. Hacking is fraud gone nuclear, and Mr. Wallace can explain the steps that need to be taken to avoid being taken for a ride…and we’re not talking a flight to your older loved one’s paradise vacation. Take care of mom or dad, and travel safely. 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.
I was just reminded of a very important aspect of senior residential options that can get overlooked in conversations between caregivers and the elders with whom they discuss their residential options. As a geriatric care manager, I often am asked to facilitate the discussion that a family will have with mom or dad or other loved one as they consider moving out of what can be their lifelong home.

Let’s start with the stuff we always address. Surveys among older adults usually tell us there are three important touchstones for seniors making these decisions:
- Safety – Older adults can become a bit fearful about going out at night or live in fear of break-ins and more. Senior residential options offer a very safe alternative, often with security personnel and gated grounds.
- Helping Hands – Seniors have had a lifetime of cleaning up the house, mowing the lawn, and more. Senior residential communities can give them the independence to do for themselves what they want to do and the freedom from the “heavy lifting.”
- Medical Security – We have all seen the ads for “help, I’ve fallen…” Senior residential communities have behind the scenes staff to respond to emergent needs as well as support independence with help for activities of daily living.
But there is another facet of senior residential living that can be overlooked - a sense of community. I have a client who is now 85 who had tried a senior residential community when she was in her seventies. She and her husband moved back out within a year, because they did not feel “that old.” A few years later, the now-widowed wife moved back in to the same place, because she wanted all those items above. But also because she wanted a sense of community. The residence, it seemed, acted like her more manageable size version of a neighborhood. For her, it was a group of people she could play bridge with in the afternoon after lunch dishes were cleared away in the common dining area. It was a place where just down the hall (what used to be just down the block) were people she could just drop in and visit with when she felt like it. In fact, a lot of her neighbors keep their doors open all day so that people who walk by can feel welcome to do just that.

There are weekly events and daily activities at most senior residential communities ranging from book club meetings to – yes, bingo - and sing-alongs and craft clubs. If you listen to any of these people, they like “being active.” And for them, active is all of the above. They even have gatherings to get really active in yoga or stretching classes adapted to their older bodies and more limited range of motion.

So, if you are a caregiver having a residential discussion with your older family member or friend, listen for the cues. Do they talk about feeling lonely, isolated or just not being close to friends? And if they have been active in clubs and groups, but lately are not as active? This may be where it may be time to talk about a neighborhood where everything is within a short walk.

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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When you were young, you may have dreamed of being like Superman or Wonder Woman. They both had remarkable powers that made them more than just better than the average person or even the best among the average humans. They had powers that came from something very special about their makeup, in the former case, well, “super powers.” Scientists at Northwestern University’s School of Medicine are using similar language now to refer to a rather small subset of people who live to be not just over 90 years of age, but some to be old enough to celebrate their 120^thbirthday. They are “Super-Agers.” Are you a super-ager? Well that depends. The physicians involved in the research are looking at a lot of factors that may help make a superager like psychosocial factors, education, family history, genes, physical health and the brain. And they are looking at people over 80years of age who have the memories of those 30 years younger as well as a control group of “average” people. For instance, they have found that super-agers have a thicker cerebral cortex, the important outer layer of the brain responsible for memory, attention, language and thinking. It was thicker than the normal agers, about the same size as members of the younger, middle-aged control group. There were other exceptional facets of the super-agers’ brains such as that part of the brain that controls social behavior. The scientists also have taken blood samples to further assess the DNA of the superager. So, if it is all based on the genes we receive, or as some say the parents we have chosen and that these people may be less numerous than only one of every hundred within the overall population, what’s the point? Well, one of the researchers points out that you don’t have to be the one who has the right genes to live longer. If they find that the superager’s’ genes turn off a certain protein or turn on a certain metabolic process that contributes to longevity, then you don’t have to have better genes to live longer. You just have to have some help to adjust the proteins, the metabolic processes or whatever it is that works the magic. So, there may be good news for us all. If you have an older loved one in your orbit who shows signs of being a superager, encourage them to reach out to NU’s medical school…today. 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.
I was at an event this past week and had a conversation with an attendee about her parent and driving, but it was more than just aging and driving. It was about her parent and their cognitive decline and the ability to competently get behind the wheel. It’s complicated. I have talked before about the different types of dementia and how they all have an effect on an individual’s ability to cognitively process what they experience into memories and even react to situations in real time. Each of the major types of dementia – Alzheimer’s, vascular, frontotemporal, Lewy body and Parkinsonian – also has a different kind of impact on one’s ability to drive. But it also has to do with the degree to which a dementia has progressed. As soon as the doctors use words like “moderate” or “severe” the ability to drive safely is pretty much out of the question no matter what kind of dementia it is that affects your loved one. One of the more telling statistics on the effect of dementia on driving capabilities is that accidents are almost twice as likely in dementia patients versus healthy individuals in the three years prior to diagnosis. Starting with the most hazardous diagnosis, it gets a bit more complicated with Parkinsonian patients with dementia because the motor as well as cognitive functions of these patients are affected. While the data are relatively sparse, it appears that more than 80% of these very mild to mild dementia patients cannot pass a driving test. In vascular dementia (owing to strokes) 70% patients with very mild to mild diagnoses fail a driving competency test compared with 11% of same age, but healthy adults. The risk increases with more strokes even moving from just the first stroke to a second event. Even “mini-strokes”, often referred to as transient ischemic attacks (TIAs) can cause this driving impairment. Frontotemporal dementia patients are only slightly less driving-impaired than vascular patient. About 50 – 60% of these patients who are categorized as very mild to mild will fail an on-road test. Alzheimer’s disease drivers particularly have difficulty remembering directions, routes or landmarks, but they also misjudge distances and are slower to react to conditions. It’s about their inability to orient themselves in real time that makes them a risk to themselves and to other drivers. About 55% do not pass a driving test. Dementia with Lewy bodies shows a typical fail rate among very mild to mild patients of 35 – 40%. In simulator tests, however, Lewy body patients show a higher rate of collisions in testing. So, you can see that it is a matter of degree when it comes to driving, and when an older loved one progresses to moderate or severe dementia, no one should drive. The real takeaway here is that if you have an older loved one with even early stage dementia of any sort, they should be tested for their ability to drive…or maybe just for whatever constraints should be in place to assure a safe driving experience. And as a loved one sees these limitations on “their freedom,” be sensitive to all the other limitations they may be facing in their day to day lives. With the potential for depression looming always, be sensitive to how you communicate and do all that you can to support their sense of self-worth and independence. To get ahead of the curve with your loved one, AARP offers driver safety course at locations throughout the region; please check it out. 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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