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July 1, 2013
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I have written in earlier blog postings about dementia: “preventing” Alzheimer’s Disease, Alzheimer’s from the inside out, maternal genetic links to Alzheimer’s, and women’s predisposition to Alzheimer’s. I would like to share some research that shows dementia to be tied to a number of other chronic conditions we often find among the elderly. This posting is about monitoring and managing other medical conditions in order to reduce the chances of developing dementia, and it underscores one of the most important parts of geriatric care management specifically or caregiving generally.

Dementia is more common among people with diabetes than among the non-diabetic population. Diabetes seems to be more related to vascular dementia, but research shows also some risk for Alzheimer’s among diabetics. One study found that even a 1% rise in long term glucose levels (referred to as A1c) was associated with declines in three different measures of cognitive function. Researchers have long known that poorly controlled diabetes is associated with renal and cardiac complications. These same micro-vascular issues associated with diabetes can lead to brain disorders, with some suggesting that Alzheimer’s disease could be considered “type 3 diabetes.”

Another risk factor associated with higher rates of dementia is elevated blood pressure, or hypertension. And the flip side is true as well with one clinical study documenting that well-controlled hypertension actually reduced the risk of dementia. And blood pressure registering above 140/90 evidently encourage Alzheimer’s or other dementias.

Finally, alcohol use taken to excess can lead to impaired cognitive function for anyone. For older adults, excessive alcohol consumption has been associated with dementias and also have been found to aggravate existing dementia or Alzheimer’s disease.

A care manager or caregiver should always be alert to any signs of impaired executive function in an older adult as this may mean that the diabetes or hypertension are not well-controlled, or that there may be alcohol abuse. Be alert to an elder’s:
- poor organization,
- loss of attention or train of thought,
- poor judgment sorting good from bad ideas,
- faulty short term memory, weak reasoning and even
- lack of awareness of their deficits.
A medical provider can assist in administering a Mini-Mental State Exam to confirm any deficiencies as well as address these other co-morbidities. Acting early can save an elder from the slippery slope that is dementia.

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.
New research recently reported sheds some light on what we need to know about Alzheimer's as well as what we may not want to know. Please allow me to explain. You likely have heard of some of the genetic advances that now allow labs to identify certain individuals who are more likely to develop Alzheimer's disease (AD) based on the apolipoprotein E ( APOE) ε4 allele risk factor for AD. Very simply, those who have this gene are at a higher risk of developing late-onset Alzheimer's, but how this happens is not yet fully understood. Scientists conducted a study among people with this genetic expression by dividing the individuals into two groups based simply upon whether they knew they had the gene or not. All individuals had the gene expression, so if they were randomly divided into groups one would expect that any person would have the same chance of having cognitive problems as any other individual. What the scientists found was quite remarkable. These study subjects were asked to rate their own memory performance and mental processing on a number of tests. Their actual performance was also quantified by the scientists. At the end of the testing, those people who knew they had the gene performed the same as those who did not know on the objective tests. When they scored themselves, however, those who knew they had the gene did worse than those who were unaware they had the gene. So, a person has to ask whether they will be better off knowing that they have a predisposition to AD or not? In a more upbeat bit of clinical research among Alzheimer's patients scientists offer a glimmer of hope for even those who may be predisposed to AD. It is a federally funded study and the largest and longest duration study of this type. Over a period of five to six weeks the experimental subjects were exposed to a number of hour long sessions in either reasoning, memory or processing speed, cognitive abilities that often decline as individuals age. All individuals were tested for cognitive ability at intervals up to five years from their initial training, and those who had been trained did better than those without the training. Even ten years out, there was a positive difference between the two groups, but the trained group did tend to decline somewhat from where they had been. So, if you are a caregiver to an older loved one, you may have one question along with one certainty. First, do you want them to have the test if knowing can be its own down side? Second, you should know that you want to encourage them to be socially active and intellectually challenged. 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.
Nearly a million people in America have a heart attack each year, and for two-thirds of these people it is their first episode. Beyond heart attacks, there are many more individuals who may suffer from some other form of heart disease or may have any of a number of surgical and other interventions involving their hearts. Older adults are more at risk for all "cardiac events," but for those who get a second chance following a cardiac episode, improving heart health should be a priority. Improving heart health is what cardiac rehabilitation is all about.

Who can benefit from cardiac rehab? The simple answer is everyone, but people who have had a cardiac episode may need the support of family and their health care provider to gain the confidence they need to exert themselves and get into better shape. Those who would benefit include anyone who has experienced:

·         a heart attack, or myocardial infarction - this results from one of the blood vessels which feed the heart being so clogged that it starves a portion of the heart muscle;

·         heart conditions such as angina, congestive heart failure (CHF) or coronary artery disease (CAD); or

·         any of the cardiac surgical interventions like heart bypass, percutaneous coronary intervention (balloon angioplasty), stent implants, valve replacements or implanting pacing devices or defibrillators.

            What does cardiac rehab look like? Cardiac rehab can be adapted to patients of any age, and it starts with:
- medical evaluation to determine where to start and how far to take rehabilitation;
- medical monitoring throughout all activities as a patient rebuilds their cardiac fitness and aerobic health;
- counseling on one's condition as well as how to cope with some of the psychological aspects of a cardiac event like depression or anger;
- education on better diet, smoking cessation, stress reduction and simply being "normal."
What are the benefits of cardiac rehab? Very simply put, most people can achieve more than just recover from a cardiac event; they can improve their health to an even higher level. Such as:
- regular physical workouts to improve your heart health as well as the strength and fitness of your entire body;
- cardiac fitness which lifts the spirits with a boost from the endorphins, a byproduct of working out;
- cardiac counseling which helps the heart patient learn more of what they can do to avoid future events.
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.
Today's Blog is a guest posting from Cindy Levitt, founder of peace by piece professional organizing and design. Moving can be one of life’s most stressful events, or it can be one of the most liberating. Studies rank moving right up there with death and divorce. However, with proper planning you can minimize much of the stress. Are you helping someone to move? Or are you the one organizing your own move? It can be very emotional and often stirs up a lifetime of memories, both good and bad. Think about your move as a fresh start. Tip #1 Start early. Don’t wait until the last minute to start making decisions about what to bring with you. It will seem less rushed if the hard decisions are made when you have time to think and contemplate. Know where you are moving? Great! Get the floor plan and think about how much space you will have and what will fit. Especially when it comes to memorabilia, start well in advance of the move, if possible. Sort, edit and archive the photos, important family documents and other meaningful items. You can find some nice archival boxes and products to use. Here is one type I like: http://www.dickblick.com/products/blick-archival-storage-boxes/ Tip #2 Evaluate what you have. Be ruthless. Whether it’s clothes, knick knacks or furniture, this is the time to decide what you can live without and what you truly value. Ask: Do I love this enough to bring it with me? Does this make me feel good when I see this or use this? Does this item remind me of joyful times? Tip #3 Organize! I usually suggest creating a notebook with various pages or sections that you can add to as you go along. Headings could be: Donate, Sell, Give to Family, Bring to New Space, etc. Go room by room and list each large item. If you are using your furniture right now but know that you will not be moving the green couch and the maple table, add those to the “Donate” list or the “Give to Family” list. Ask family and friends what they may like before you decide about donations. Maybe someone close to you can really use that couch or table. Tip #4 Enlist help. You can’t do it alone so don’t even try. Find good friends, family members or professionals to work with you. Host a coffee and dessert party or a wine and appetizer night to divide up the photos or knick knacks you would like to share with friends and family members before you start packing up. Tip #5 Simplify your daily life. Remember your mantra is “I can live more fully with less stuff weighing me down!” Too much stuff around you causes stress and creates more anxiety. Less stuff equals fewer items to keep clean and organized. .Your move can be the road to finding peace of mind. Cindy Levitt (click here) holds a Master of Education from DePaul University and a Bachelor of Arts in Psychology from Washington University. Peace by piece professional organizing and design offers on-site residential and business organizing, speaking and teaching, coaching, consultation, relocation and moving services, staging and redesign services. Cindy also works with seniors to organize and archive photographs and a lifetime of memorabilia. After moving from her home of 29 years to a smaller space, Cindy understands how difficult it is to make those tough decisions on what to keep and what to let go. Visit her web site.
As a caregiver for an older adult you cannot prevent a medical emergency, but you can prepare for one. Even if you are a distance caregiver, you will find that you can have your elderly parent help in preparing an "emergency kit" just in case. As a provider of geriatric care management services, I help families with whom I work to customize their preparations to the particular health needs of the loved ones. For starters, both a caregiver and an older adult should have what I refer to as the "grab and go list." Should there be an emergency, both of you should have a list which may include the following information or photocopies of important documents:
- identification like a social security card, passport or drivers license
- health insurance cards, both Medicare and any secondary carrier
- recent medical summaries or immunization records
- a list of current records or prescriptions
- a list of important contacts with phone numbers
- veterinary records if your loved one has a pet
- wills, advanced directives or powers of attorney
Because the emergency may not be medical, but instead may be a natural disaster, it is a good idea to have the grab and go kit in a waterproof container and/or fireproof safe. For the same reason, if you are a distance caregiver, it is a good idea to also have on hand the names and phone numbers of neighbors or friends who could be called to check on your loved one. If you have not met these individuals, use your next trip to see your loved one as an opportunity to also introduce yourself to these friends or neighbors. It will make any later, long distance communication a lot easier. Again, thinking about a natural disaster, help your loved one devise a home escape plan should they have to leave home quickly. And have at least two escape plans should the reason for escape be the sort of disaster that can damage the structure of a home, like a tornado, hurricane or earthquake. Help your loved one also to have a plan for sheltering in place for emergencies like a tornado or hurricane. Especially in the case of the latter, you should also have a set aside cache of fresh water, dry goods, a flashlight, battery-operated radio, whistle and crowbar in the event the emergency lasts for more than a day. For more details about specific responses to natural disasters, go to the FEMA web resource (http://www.ready.gov/). For more advice on preparing for - and facing - medical emergencies, this is a good resource (http://emergency.tufts.edu/guide/medical-emergency/). 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. We provide geriatric care management services to those in metropolitan Chicago. Please email your questions to ccbishop@creativecasemanagement.com.
If you are a caregiver to an older loved one, I'll bet that one thing you probably watch closely is their behavior or demeanor. Do they remember important facts from yesterday or are they tracking what is said in a conversation? In an age when most people worry about dementia more than mortality itself, everyone is rightfully vigilant for signs of an slip in cognitive function. But what about when the caregiver cannot be there to watch? Our caregiver clients often refer to our geriatric care managers as their eyes and ears. Let me share with you two real life examples of memory issues, but when things were really not what they may have appeared to be after all. And a geriatric care manager's eyes and ears could make the difference.
1. The Dementia that was an Infection. It started like this. The distance caregiver gets the phone call that the mother was found on the floor of her apartment in an independent living facility. She seems confused and has difficulty with word formation, all signs of classic post-stroke confusion or even dementia. The patient is rushed to the nearest hospital and initial tests rule out stroke. So, perhaps it is dementia? What would you do? A care manager on the scene likely would start with dementia as a consideration, but dementia typically is not a sudden onset predicament. It progresses over time...often a long time. A care manager would ask the medical providers if they have run blood and urine tests? Have the providers done a full body check. Why? to rule out any toxic exposure or an elevated white cell count. In this case, the tests found the woman had an infection that went systemic and dramatically and quickly affected the woman' mental abilities. So, this turns out to be delirium. The principal difference between dementia and delirium is that the latter is more sudden and often transient. Antibiotics within a matter of days brought her back to normal..
2. The Renal Failure that Wasn't. This one starts with the caregivers in an independent living center noticing that the man seems very tired and does not track what is going on very well. Delirium? A care manager suggests a trip to the physician's office for a blood test. The test shows renal function that is at virtually zero. No urine is being produced. None. The physician pronounces renal failure and ships the gentleman to the hospital for dialysis, but what does the nephrologist do? The patient is put on an IV drip and quickly given a large quantity of normal saline solution, and kidney function begins to return. Within three days of the start of this rehydration kidney function is returned to near normal. In this case, the patient was a sparse water drinker, and when the condition worsened, the body's response was to turn off the thirst sensation resulting in real dehydration and renal failure. With the renal issue resolved, the care manager enlists a caregiver who will help the gentleman keep to his medication schedule AND drink four cups of water in the presence of the caregiver each day. Both of these examples came from distance caregivers, siblings whose older parent lived in another state. Both of these cases also represent one reason that a care manager can be engaged before a crisis. In both cases, had there been a trained professional routinely just "dropping by" to be the eyes and ears for the adult children of the older parent, the infection might have been caught earlier and the renal issues may have been avoided. Geriatric care managers often get the call in an emergency, and they can make a difference in how well the older adult recovers from the emergency. But if you are a distance caregiver to an older adult, you should also consider having a GCM be the eyes and ears present when you cannot be. You might just find that having a sister in Chicago is a great addition to the family. 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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