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

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In the Caregiver's Words

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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.
There seems to be a cliché for everything, so we’ll start with this go-to for COVID: “We’re not out of the woods yet.” In fact, our scientists/pathfinders cannot tell us how far we may have to go to truly be “out of the woods.” If the “woods” is the COVID Pandemic, the patch of woods many are now in is the “long COVID woods.” Public health professionals are telling us that approximately one in five individuals who do become infected with COVID will also have the added journey of long COVID…and it’s more common in our older loved ones that younger people who become infected. If you have an older loved one who has been infected with COVID – and hopefully been vaccinated – be on the lookout for lingering symptoms. It gets a bit complicated, because many of the long COVID symptoms are similar to those that older adults with heart disease, lung disease or cognitive impairment may be manifesting already. These include difficulty with memory or conversation, tiredness, muscle and bone pain, shortness of breath or heart racing and more. If you don’t seek out attention from their medical providers, you may not recognize the underlying causes of such symptoms in order to treat them effectively. And here’s is the real catch, there is no real test for “long COVID,” and there really is not much consensus for clinical treatment either. First, seek the advice of their medical provider, but be prepared to ask for a referral to a specialist or in some areas, a referral to a long COVID clinic. There are about 66 health systems across the U.S. that have put together interdisciplinary teams to tackle the complexities of long COVID. Go on-line if you have to get access to those clinicians who can really help. Second, be prepared to ask a lot of questions as you call on clinics or providers. It can help to go to the web site of a “long COVID clinic,” so check out what these clinics say about the condition on-line. The University of Southern California may not be in your backyard, but read what they do so you can be conversant in what to expect and what to ask. Third, get a plan for what can be done at a clinic as well as at home. After a clinician determines that it likely is long COVID, they can help you form a plan around restoring your older loved one to full “pre-COVID health.” Also, Google “activities of daily living” for the list of deficits that may need some work to get fully back from COVID. But go slow. Older adults lose endurance rather quickly with the “deconditioning” that comes from COVID, so it may take some time to get back to “normal.” Start low, go slow. Don’t start with long walks; start with very short walks. Don’t start with pressing weights or even push-ups; start with resistance bands to build back lost muscle mass and tone. A physical therapist may be a great help in developing a training program. Fourth, be a cheerleader, not a coach. Encourage your older loved one to be persistent but also have the patience for the time it will take to fully recover. Cheer their successes. Older adults will simply take longer than they may have a couple decades younger to recover the muscle tone and strength that has been lost. Help them pace themselves and reward themselves for small steps toward goal. Otherwise, you may have a setback on top of long COVID. Remember that social isolation and depression are some of the challenges all older adults face, so help them to find a positive path to physical and mental health. And be patient also…long COVID is called “long” because it can stay around for a lot longer than anyone will want. 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.
In health care some basic rules apply, no matter what the medical condition. Number one is that prevention is better than treatment. Number two is that early detection is better than too late…especially too little too late. And now for the “breakthrough;” all of this is changing for the better in Alzheimer’s disease. At the most recent meeting of the American Neurological Association new research was shared that showed not only a very early way to detect Alzheimer’s disease, but the test itself is quite easy to administer. Physicians had been able to detect one of the key biomarkers of Alzheimer’s, a biomarker that identifies if a patient has amyloidosis forming in their brain, but that test required a lumbar puncture for the fluid needed for testing. And add to this PET (positron emission tomography) scanning to confirm the manifestation of the disease. Definitely not tests everyone would want as part of their annual physical, let alone afford to have done with any regularity. Scientists at Washington University School of Medicine have found a way to detect this Alzheimer’s biomarker in a simple blood test. So, it’s easy, but the best part is that the biomarker can be detected in the blood as much as 20 years prior to any other signs and symptoms of the disease. In fact, the researchers have found that an early positive blood test seems more accurate than the PET scanning. That is key, because once a person has the symptoms of the cognitive decline that is Alzheimer’s, the damage is done. None of the current treatments do any more than slow the progression of the disease that has already taken root, and even then only slightly slowing the progression. I’ve talked in the past about the medications currently available for treating Alzheimer’s disease. Three belong to a pharmacologic family of medications called cholinesterase inhibitors: tacrine, donepezil, rivastigmine and another is called memantine. Sadly, they merely slow the disease’s progression. But they have not been tried in really early stage Alzheimer’s disease. There is hope, therefore, that with a highly reliable and easy to administer early test for the disease that cognitive decline may be forestalled for much longer than when treatment was only introduced later in the disease progression. Wider availability of this blood test is still as much as four years out there, but for people who “have Alzheimer’s in their families,” this could be a great break through…and the beginning of a better chance in the fight. 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.
If the classic symbol for Valentine’s Day this past week has been the heart, then the older loved one in your orbit should be their own valentine! By that, I mean they should be taking care of their own heart. I spoke with a gentleman last week who is well only over 70 years old, and he was offering his advice on how to train for a triathlon. I am going to tone it down a bit here and offer some advice from the American Heart Association on a combination of small steps and exercises that can help your older loved one to get into better shape and that goes for more than the heart. From what the American Heart Association recommends, I offer six different exercises that can be done with or without these little guys in the picture. And I encourage your older loved one to take these seven exercises seven times each and then repeat for a total of three times. The first step however is a visit to the physician. If the physician signs off on what the American Heart Association recommends, then you and your loved one are on the way to not only better heart health, but also better fitness overall. Please let me offer a big caveat: ask the physician how many times per week they put into working out. If they do not exercise, you may want to look for a second opinion. Recall my earlier blog posting when I warned against “taking it (too) easy.” You will note that there are no numbers on the weights in my picture here. Find a weight that allows your loved one to successfully complete the seven times for each of the weight exercises…and maybe start with one set of seven per exercise before progressing to three rounds for each. But here are the seven:
1. Arm Raises: With a weight in each hand let the weights down on each side. Then, lift each arm until parallel to the floor. Hold for only a second and then slowly return to arms at sides.
2. Biceps Tone: With arms at the sides and extended, raise the weights up to just touch the front of each shoulder. Lower gently back to fully extended at the sides.
3. Triceps Tone: Starting with a weight in each hand extend arms to the ceiling. Then, gently lower backwards so the weights are behind the head on either side of the neck. Raise vertically again and repeat.
4. Leg Muscles: Without the weights and while sitting, lift a leg from the foot on the floor to the leg parallel to the floor…hold for a few seconds before lowering the foot slowly to the floor. Then try the other leg. Seven times per leg.
5. Stomach Muscles: Again without weights and while sitting lift both feet a few inches off the floor; hold for a few seconds before lowering the feet once again to the floor.
6. Balance: Using a wall or hall rail to steady themselves have your loved one walk heel to toe steps, each foot just ahead of the toe of the other foot for ten steps.
7. Chest stretch: While sitting with their back to a wall, have your loved one clasp their hands behind their neck and gently bring their elbows to touch the wall. Relax and repeat for seven times.
Okay, hit the showers if you wish, and do it again tomorrow. 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.
“I think I could speak clearer and did not wait as long in answering questions,” she said. “Sometimes, in the past, things would leave my mind and I couldn’t remember things.” Let me just start by saying that this could be a quote from the first Alzheimer’s disease patient to undergo a successful treatment to reverse the condition. Not a cure, and no one yet knows how durable the change, but a rather significant clinical step in the right direction. Our medical science staffer, Dr. Steve Steiber, and I have written before about how there are a number of FDA-approved therapies for Alzheimer’s Disease and hundreds I clinical trials, but so far there is nothing that does more than slow the progression of Alzheimer’s cognitive decline. Scientists at West Virginia’s Rockefeller Neuroscience Institute have initiated a “proof of concept” trial on just six 50 to 85 year old mild to moderate Alzheimer’s patients using ultrasound to penetrate the blood brain barrier, a layer that protects the brain itself from all that can invade our blood stream. They used a thousand tiny probes with oscillating ultrasound that used microscopic bubbles that could move into the area of the brain most affected by Alzheimer’s amyloid plaque. The ultrasound seems able to break up some of this debilitating plaque. This first test seems to demonstrate the safety of the technique as well as likely efficacy, but all of this is with a couple caveats. First, it is with a very small number of patients. The real test will come later when a large enough number of subjects can be tried in order to demonstrate cognitive differences that are statistically significant. Second, it is “just” the ultrasound that has cross the blood brain barrier to break up the plaque. Medical professionals see this method as really kind of a transportation test. If they can safely cross the blood brain barrier to the part of the brain where they can address the disease head on, the hippocampus, then they can use the waves and their tiny bubbles to carry actual chemicals that fight the plaque to where they can do the most good. It’s a bit like showing that we can launch a special rocket that succeeds in getting where we want to go; and now we can potentially attach an important payload to this rocket. (Yes, it is brain surgery and rocket science…) The doctors and researchers in this project admit that it may take a few years to begin to realize the full potential of this technique, but it is the patient’s husband who takes our rocket science and brain surgery metaphor a “small step” further. “This is man on the moon stuff,” Mark Polak said of his wife’s success in the first trial. “Maybe we’re on to something?” If you want to read more on the science, please click here; if you want to read more of the personal story of one patient’s experience with the science, please click here. 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. And yes, we may be revising this book a bit sooner than we had anticipated...