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

4 Geriatric Care Manager Tips for Preventing Falls in Older Adults
We as certified geriatric care managers all hear about older adults falling. Caregivers often do not expect their own...
Read more
October 9, 2013
0
0
Doctors Are Asking Older Patients About Guns
If you are a caregiver to an older adult, don’t be surprised if your loved one is asked if...
Read more
July 25, 2013
0
0
A Caregiver’s Nuclear Option
As a certified geriatric care manager I have written a fair number of posts about distance caregiving. With some...
Read more
July 18, 2013
0
0
Six Geriatric Care Management Tips to Beat Summer Heat
It may be just the first week of summer, but if you are a caregiver to an older adult...
Read more
July 1, 2013
0
0
Four Geriatric Care Management Considerations about Fall Prevention
About one in five adults over the age of 65 will fall in their homes during the course of...
Read more
June 17, 2013
0
0
Making Home Senior-Friendly Part 2
In the first posting of this two-part series, I went no further than the hallway in our tour of...
Read more
March 28, 2013
0
0
Making Home Senior-Friendly Part 1
It is not just because of the housing collapse that many seniors have decided to stay in their existing...
Read more
March 25, 2013
0
0
Tips on Optimizing Senior Living Spaces
Last month, we talked about conversations with older loved ones about residential living choices. While might find this is...
Read more
January 15, 2013
0
0
Senior Care Guest Blog: 4 Tips for Fall and Hip Injury Prevention
The winter season will soon be upon us, so I have invited Elizabeth Carrollton of Drugwatch.com to guest blog...
Read more
October 29, 2012
0
0
At Home Care: 8 Tips to Prevent Senior Home Fires
In my last post, I talked about indoor fire hazards that are specific to the changing of the seasons....
Read more
October 25, 2012
0
0

In the Caregiver's Words

Recent Client Praise

For a what, you may ask? I have either talked about or invited elder law attorneys to talk about advanced directives like Do Not Resuscitate (DNR) orders, living wills, powers of attorney and other documents that will help to assure that an older adult's end of life wishes are honored. And that is where POLST comes in. It is a standardized (by state) document that walks through a patient's wishes for end of life care that falls short of a DNR. POLST is Physician Orders for Life-Sustaining Treatment. The majority of states have enacted such legislation following the lead of Oregon in 1991. It is standardized for the state and is typically a brightly colored single sheet so that it will stand out in a patient's file. (Illinois' form is two pages.) Not only doctors, but first responders and other clinicians will understand the instructions of the POLST. It is not for everyone, but if your older loved one is frail or suffers from a life-limiting illness, you should consider having a talk with your loved one's physician along with your loved one. If your older loved one's physician can honestly say they would not be surprised if that person died in the following year you would be well-advised to start the conversation in order to have the POLST on file. What would that look like in a standardized form? In Illinois, the form asks for all the usual patient-identifying details, contact information for your older loved one's preferred contact, physician contact information and the physician's signature. The rest is pretty much a check list. Check yes or no if your loved one agrees to having CPR in the event their heart stops. If your loved is still breathing and there is a pulse, check yes or no for comfort measures only, for limited added interventions or for intubation for ventilation. To these the physician can add other measures. Finally, check yes or no for what kind of nutritional supplements are desired if your loved one cannot be fed by mouth. The rest is referred to as documentation that this discussion occurred between competent adults. To see the Illinois form, please go to this link (http://www.idph.state.il.us/public/books/dnrform.pdf) As you can imagine, life or end of life decisions are not so cut and dried. There are some potential ethical issues to be addressed here. Clear and sensitive discussion needs to occur among you as the caregiver, your older loved one and the rest of the family. And then there is the real question of whether your older loved one can really understand all the medical speak. It may prove helpful to bring in a professional counselor to talk this through with the family unit so that all voices are heard and all questions or objections are raised. Most important, however, is that your older loved one feels that it is they who are in charge. This ultimately is not about the doctors or the family; it is about the care receiver.
November is National Alzheimer’s Disease Awareness Month, so I am going to give a lot of attention throughout this month to what we know as well as what we don’t know about dementia generally and Alzheimer’s disease specifically. More Americans fear an Alzheimer’s disease diagnosis than fear dying, and that should be no surprise, given that a new Alzheimer’s diagnosis is given every 67 seconds in the United States. But we should all be cautious in accepting any Alzheimer’s diagnosis for a loved one at face value. Research has shown that 24 percent of diagnoses actually are misdiagnoses. Given that there are about 100 different manifestations of dementia, perhaps we should be surprised that the rate of misdiagnosis is so low? And it is important also to bear in mind that the health care provider making the diagnosis may or may not be well-qualified to make the call either for lack of experience or for lack of proper tools with which to diagnose. Our team became involved with the mother of one of our people, because she was showing signs of cognitive decline. He recalls that on one of his visits her common introductions to friends of hers had become “You don’t have a name…this is my son.” He and his sister started making calls to her primary care physician’s office to get a sense of what was going on. In his mother’s file the diagnosis was “organic dementia.” The doctor had further prescribed an FDA-approved medication called Namenda for his mother for that “organic dementia.” First, Namenda is indicated for Alzheimer’s disease (not “organic dementia”) and is to be used in combination with another drug for Alzheimer’s called Aricept. Now with his mother’s doctor on the line, our staff member questioned why the prescription for a condition for which his mother had not be diagnosed and that was to be used only with a medication she had not yet been prescribed? And at $350 out of pocket per month? The doctor mumbled something about whether the son wanted his mother to have an autopsy to diagnose the condition…or was it the money. Stunned at how behind the times the doctor was, the son simply said it was the cost and the doctor withdrew the prescription. Let me get back to the autopsy. A decade and a half ago scientists could not definitively diagnose Alzheimer’s until after the individual had died and an autopsy of the brain could be performed. Now, we have neurologists who can confidently diagnose the condition with MRIs, PET scans and blood tests along with cognitive tests in real time and an historical look at a patient’s records. In these neuro-psych exams, the specialist is able to not only identify the condition, but more importantly what can be done. As it turns out with our team member’s mom, she had vascular dementia, the end result of numerous “mini-strokes” over time that deprived more and more parts of her brain of blood flow. As his mother’s condition deteriorated she was required to move from independent living to assisted care and finally to a memory unit. I have noted before in other posts that there are no cures for Alzheimer’s; well, there was no cure for vascular dementia that had progressed as far as it had for our team member’s mom either. But she lived to be more than ninety years of age and had a quality life. In the end, her quality of life was greatly assisted by those around her who knew the source of her dementia and how best to care for her. And that is as happy an ending as one can hope. For the rest of this month I am going to be talking a bit more about how dementia often gets confused with delirium or depression, as well as Alzheimer’s disease and also address your questions. Please just email me your questions or concerns at info@creativecaremanagement.com . 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.
In my past two postings, I know it may have sounded a bit bleak that we don’t have any FDA-approved therapies that can really address the underlying cause of the cognitive decline that is associated with dementia. That said, with so many health care professionals studying this condition, of which Alzheimer’s is a part, it is refreshing to see that we do find promising approaches with some regularity…or maybe I should say with some irregularity, but with reasonable frequency. I did mention a number of healthful steps that should be taken to reduce the risk of developing Alzheimer’s specifically and dementia generally. Let me add one more healthful step that has recently come to my attention - pomegranate juice. Pomegranate juice is an antioxidant that now has been tested against placebo for its efficacy with dementia, and it shows a positive effect in delaying the decline of what researchers term visual memory decline associated with aging. It was a randomized trial in which 261 participants were assigned to receive either pomegranate or a placebo. After 12 months, both groups were administered a standardized test of “visuo-spatial memory.” Memory decline is generally associated with aging and poor health style. This most recent research is part of a larger body of research that has been going on since at least 2013. In addition to this most recent study, scientists have studied pomegranate juice with animals as well as young to middle-aged subjects. In some of the research pomegranate juice did more than prevent further decline; it actually improved memory. Improvement was not seen in this most recent study, but with only eight ounces of pomegranate every day those who had the juice were statistically better off than those who had not received pomegranate juice. Do you see a pattern here? A whole lot of healthy lifestyle interventions seem to work for a whole lot of healthful outcomes…at the very least dodging some pretty difficult bad outcomes…like Alzheimer’s. Back to pomegranate. The researchers are studying the juice more closely, and have found that the juice is not only an antioxidant, it also is an anti-inflammatory and there is reason to believe that it also has specific anti-amyloid effects. This last one is what brings us back to its potential for Alzheimer’s disease. I will keep you posted on this as well as other ongoing research. 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.
April 22 is Earth Day, a date that has brought together activists and celebrants since its inception in 1970. The really nice synergy with people “of an age” is that you and we know to what the first days of the movement responded and what has improved since then. Rachel Carson’s book, Silent Spring, was first published in 1962 and sounded an alarm about the toxicity of DDT specifically, but also about what civilization was doing to harm the planet. The book resonated with the many people who were moved to become activists, and President Nixon responded by pushing for the establishment of the Environmental Protection Agency. What can you do today?
1. Since those of us who were part of that initial response to the call to arms can recall the call to arms and the urgency of environmental protection, we can share our legacies with our children and grandchildren…Those of us who were there then. Buy a copy of Silent Spring for the younger generations or talk to them about your own social activism.
2. You don’t have to be a 21^st century eco-activist to simply revel in the green that comes with Spring. It’s not just the verdant colors that are now surrounding us. It’s the bouquets and bird songs of Spring. Enjoy!
3. Make a specific Earth Day resolution this year. Add one more sustainable habit to your repertoire as we continue to face the onslaught of plastic pollution as well as the forever chemicals, PFAs, that invisibly are infiltrating our drinking water and food sources.
4. Increase your advocacy through causes that you can support with your dollars or your time. Plan a gathering of family or friends where everything that folks bring to your party must be reusable, recyclable or compostable.
5. Make your past experiences learning opportunities and teachable moments for the younger generations with whom you interact. And set a great example by showing them instead of simply telling them how to assure a sustainable environment for future generations.
Now, go out for a breath of fresh air (O2 created by the green plants coming into bloom), and when you exhale know that you’re returning the favor to the plants that count on you and your CO2! Charlotte Bishop is an Aging Life Care Advisor, Retirement Lifestyle Coach and founder of Creative Care Management, LLC, 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.
Don’t ask just any doctor…and don’t just ask your primary care provider (although they may have some insight)…ask a cardiologist who has lived to 95 years of age about the lifestyle choices that can get one to the “really big numbers.” A profile of a 95 year-old cardiologist hit the news recently. This nonagenarian has eight lifestyle recommendations for those who wish to not just live a long life, but to live a great life. Hint: it does not include a list of preferred video-streaming services. Whatever your age, see if you’re up to what this 95-year-old does everyday to give himself a better chance of doing it all over again the day after today.
1. Walk – you don’t have to be a truly early riser to follow the simple rule of this 95 year old…and you don’t have to be 95. He starts his day with a 30 to 60 minute walk which will chalk up the first 7,000 steps of his day.
2. Workout – We’re not talking Muscle Beach, but strengthen and flexibility training according to a routine will help avoid the worst risks of older individuals. A trainer I know refers to this as “muscle-confusion” training…different ways to work your muscle groups that are essential to avoiding falls or back strains and more.
3. Communicate – reach out to folks personally, via phone, via social platforms or any other means of communication. Isolation so often leads to depression among older adults. Or, even if you’re single, you don’t have to live by yourself.
4. Write – Keeping a journal or diary may seem a bit old-fashioned, but it may resonate with your older family member. Or, in the case of my partner, he is writing and illustrating a monograph on what his father taught him about life…to share with our kids as well as their kids.
5. Create – We have a friend who has been as delighted as a kid with a new toy when he bought a state of the art wood lathe. He has moved beyond carving beautiful wooden bowls to all manner of artistic creations. And his art doubles as upper-body strength training.
6. Hobbies – Ideally one should try a hobby that involves activity, memory or creativity. I’m not saying that stamp-collecting cannot be fun, but learning to play the harmonica or guitar or piano may get the blood flowing a bit more.
7. Nap – This one was a bit of a surprise for me, especially when I read that this 95 year-old favored more than one 30 minute nap a day. Yet, I’ve talked to a number of friends whose eyes light up when they talk about the ideal time or times of day they prefer their naps.
8. Eat – Consume a variety of foods and eat full meals three times a day. You know all that you should eat, but the main rule is to steer clear of highly-processed foods. Our nonagenarian includes fine wines in his menu. I won’t get into the biochemistry of consumption, but it is the amount and the rest of your lifestyle choices that should help form your habits around a bit of spirits. (Nonetheless, ask your provider.)
You may not be ready to turn 95 just yet, but you should get yourself in shape for that stage so that you can enjoy every day and year of that vintage on your way. Live Well! 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.
Caregivers tend to be very dedicated to caring for others, typically an older parent or disabled member of the family, but they often do not do so well in caring for themselves. It is not that caregivers do not need at least a bit of help themselves, but it can be a very conflicted issue for a caregiver to ask for help. It may stir up guilt about not caring for mom or dad or inadequacy at not being able to do it all. And it is not that caregivers are alone. They have other siblings, they have friends or neighbors, and they also have respite care available to help. Respite care is not just one type of service, it is a whole continuum of in home care services as well as out-of-home services available in most communities. For at home care, respite care can provide a needed break for the caregiver who needs to also work a day job, run their own personal or household errands or simply have some time to recharge. Family, friends or other volunteers can be crucial in giving this time to the caregiver as well as providing stimulation, conversation or some fresh energy to care for the receiver of care. Personal care or skilled care providers also can assist with the "heavy lifting" like activities of daily living (ADLs) such as bathing, dressing, toileting and more. Area residential care facilities can provide an even wider range of support where caregivers can drop mom or dad for short breaks, overnight care, or short intervals to cover vacation time. For more comprehensive needs of those who need help with ADLs, there are facilities in most communities for adult day care that may be a full 9 to 5 or 7 to 7 to help with caregivers who also have work responsibilities. If you are looking to recruit an individual who will be coming to assist in senior care for mom or dad in the home, be sure to ask for references. Also be clear about services you expect, make certain of compensation (and no prepayments), and even consider a background check so that everyone has peace of mind. If you are going though an agency, go through the same process as well as ask about bonding and other assurances you and your loved one will be secure. If you will be looking to a facility with its own personnel, you should ask about:
And you may ask to spend an afternoon or a day at the facility to observe how well they deliver on their promises. Don't be afraid to ask questions of caregivers in order to really assess if the people in place are engaged in the service they provide. People who like what they do will do a better job than those who just have a job. 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. Read more about Our Story and Charlotte's mission.