Hospital at Home, Bringing the Hospital to the Home

The hospital can be a dangerous place, especially for older patients. Decades ago, I met a physician named Dr. Bruce Leff. He asked the question: Can we bring the hospital to the home? There’s a reason he asked that question. He has a great explanation.

I say it over and over again: There's no one more important than the caregiver in the daily life of a frail person.

Warmest Aloha,

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Managing Diabetes Better in Older Patients – What does that mean?

Diabetes is one of the most common conditions managed by doctors. Diabetes results in increased risk for cardiovascular, kidney, eye diseases, infections, and amputations. Is Diabetes well managed in older adults? From a geriatrician’s perspective, management could be much better. The reason why might be unexpected. Many older adults are over treated, not under treated, with serious consequences.

I hear you: Listening with your heart

Alyson Kuhn is co-author of the book I hear you: Talking and listening to people with Alzheimers. In a previous post Alyson said: “My goal was always to help my mother feel in charge.” In it, Alyson talks about learning to “kuhncierge” to care for her mom.

In this post, Alyson talks about communications. It is the most overlooked and neglected aspect of caring for people with dementia. For some caregivers, communicating is intuitive; for others, it’s like learning a foreign language. It’s a skill we can all polish—and apply to everyone we care about. Alyson provides three practical pointers.

I say it over and over again: There's no one more important than the caregiver in the daily life of a frail person.
Warmest Aloha,

“I hear you” by Jane Mahakian, PhD and Alyson Kuhn
is available at,,
and through your local bookseller

I’m not sure I should go back on hospice. What do you think?

Most of my patients who passed away received hospice care at home. Hospice provides the best care possible at end of life. The hospice team focuses on physical, emotional, social, and spiritual wellbeing. Comfort and dignity are provided to both the patient and loved ones.

I am a strong advocate for hospice care. But, for many patients the choice to enroll in hospice is a difficult one. A recent patient told me why she dropped out of hospice:

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My goal was always to help my mother feel in charge

My friend Alyson Kuhn is co-author of the book I Hear You, about talking and listening to people with Alzheimer’s.  Alyson and her co-author, gerontologist Jane Mahakian, provide great insights about how to avoid “talking down” to someone living with dementia.
There is no greater gift to a person than conversing with love and respect. In today's video, Alyson presents a “social solution” to entice her mother to eat lunch.

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Rest and Revel

Dr. Warren Wong

The Holidays are almost over. After a challenging and exhausting year, I am pausing to rest. I hope you do too.

Just recently I reconnected with a friend from high school Alyson Kuhn. She is co-author of a wonderful book I Hear You. Alyson and her co-author, gerontologist Jane Mahakian, provide insights on conversing with a person with Alzheimer’s. We thought it would be great to interview Alyson and wanted to get a post out before Christmas. We decided, however, to take a bit more time and not rush at the end of a long year.

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A Special Relationship Between the Older Adult and the Caregiver

In a previous post, my friend Shannon talked about gracefully and thankfully accepting a caregiver at a certain stage in life.  Today’s post is Part 2 of our discussion. Shannon talks about the relationship “rules” that both the caregiver and the client need to keep in mind to make the relationship a strong one.

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What is Causing this Person’s Weight Loss?

In my last post I talked about a patient who had some bleeding in her brain. That was the obvious diagnosis. However, I'm frustrated because an important diagnosis was missed. It was immediately obvious that she was severely underweight. I looked through her chart carefully. Her weight had gone from 89 pounds to 74 pounds in a little bit over a year. No one had mentioned this.

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Why did my patient have a Subdural Hematoma?

Last week I was busy taking care of some patients. I reviewed the chart on a patient who recently had some falls and bleeding in the brain. She had a “subdural hematoma”. What is a Subdural Hematoma? Subdural hematoma is a medical term for bleeding between the brain and the skull. The bleeding can be a small or large amount and is easily seen on CT scan of the brain. The bleeding is due to bursting of veins on the surface of the brain. This is usually related to an injury to the head although […]

AARP “Saved my Life!!”

Did you know that November is National Family Caregivers Month? AARP Hawaii definitely knows and puts a tremendous amount of effort into a series of activities throughout the entire month. The AARP champion behind the scenes is Jackie Boland. A caregiver told her that AARP “saved my life!!”. In this short video Jackie tells that story, talks about “the Art of Caregiving”, “Sky Blossom” and Amy Goyer:

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