A Patient with Delirium. Don’t Say: “You’re Confused!”

Dr. Inouye has been discussing delirium. By coincidence I recently cared for a patient with acute and distressing delirium. Sue is an 80-year-old woman who has mild Alzheimer’s Disease. Recently she fell and fractured a small bone in her hand. She was seen in the emergency room and a cast was put on. She was given a narcotic, hydrocodone, to relieve the pain. That night, at 1:30 in the morning, she walked over to her neighbor’s house in her nightgown. Her husband was sleeping next to her but didn’t wake up. The neighbors brought her […]

Delirium, prevention and long-term outcomes

For more than 30 years, Dr. Sharon K. Inouye has dedicated herself to the identification and prevention of delirium in the hospital. She created the Confusion Assessment Method (CAM), the most widely used method for identification of delirium worldwide. In her last video, Dr. Inouye described the features of delirium. She now discusses preventative strategies and long-term outcomes.

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Dr. Sharon K. Inouye explains delirium in older patients

Acute confusion is extremely common in hospitalized older adults. One third of general medical patients who are 70 years of age or older have delirium. For more than 30 years, Dr. Sharon K. Inouye has dedicated herself to the identification and prevention of delirium in the hospital. She created the Confusion Assessment Method (CAM), the most widely used method for identification of delirium worldwide. In addition, she is the champion of the Hospital Elder Life Program (HELP). In this video, Dr. Inouye explains delirium.

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Loss of Appetite: A Fifth Vital Sign

My mother was discharged from the hospital yesterday. She was treated for a serious urine infection. Now she won’t eat. She says she’s not hungry. I’ve checked her vital signs. They all seem ok. Should I be worried? Yes, this is something to be concerned about. In previous posts we discussed the four classic vital signs. They are heart rate, blood pressure, temperature, and respiratory rate. However, normal vital signs do not tell the whole story. Appetite is an important “fifth vital sign” in frail older adults. If this patient doesn’t eat, she will become […]

Respiratory Rate: What is Normal in Older Adults?

The four vital signs are taken at routine clinic visits. In previous posts, I’ve discussed blood pressure, heart rate and temperature. Respiratory rate is the 4th classic vital sign. Respiratory rate is the number of breaths that a person takes in a minute. The normal rate of breathing varies with age. Babies and children breath faster than adults. As we age, our lung capacity starts to decrease, and the respiratory rate goes up slightly. The normal range for an older adult is a respiratory rate of 14-20 at rest.

The Life of a Caregiver: Ojay

I wanted feedback on GeriatricswithAloha.com. A caregiver named Ojay provided that. In the process, I immediately felt that caregivers like Ojay, and patients like his parents,  are the reason I’m working on GeriatricswithAloha. This is the first of a two part video about Ojay. This video talks about how he came to be a caregiver and his daily routine. It was a privilege to get a glimpse of his life.

Hypertension | What is a good blood pressure for an elderly patient? (Part 2)

My Dad has lived with us for two years ever since Mom died. He’s 87 now and has become more and more disabled due to recurrent strokes. Is there a better way to control his hypertension? He’s on 3 medicines and his blood pressure is still over 160. His doctor is suggesting another medicine. I’m very worried because he needs help walking. His pressure drops below 95 when he stands up. He gets dizzy and he falls a lot. I think it’s because of his meds. What is the best blood pressure for this person? […]

Hypertension | What is a good blood pressure for an elderly patient?

My Dad is 85 years old. He has had hypertension for decades, but it is getting harder to control. He’s on 2 medicines and his blood pressure is still over 160. His doctor is suggesting another medicine. Is that a good idea? We all know that hypertension is bad. How important is it to decrease the systolic pressure below 160 mm in a patient who is over 80 years old? This is the first of two articles about blood pressure. The first article discusses the benefits of treatment. The second article discusses a challenging and […]

Heart Rate in Frail Older Patients | Too slow, too fast, irregular, and just right

My Mom is 86 years old and “frail”. She has been in and out of the hospital for heart problems. I’ve been checking her oxygen levels, her blood pressure, and her heart rate. Her heart rate is usually around 55. Sometimes it dips as low as 48 then goes back up. That seems slow to me. Her PCP says that her slow heart rate is due to her medicines. Is her heart rate too slow? Is it making her weaker? Is she getting enough oxygen to her brain? In the above scenario, the patient’s heart […]