Fever in a Frail Older Patient | Always a Warning Sign

Tom is the main caregiver for his mom, Beth. He is worried that she’s sick. He calls the doctor: “Hi Doctor, I’m worried about my mom. She just doesn’t seem herself. She doesn’t want to get out of bed. She looks weak. She recognizes me but she isn’t talking. She’s not eating either.” Does she have a fever? “I’m not sure, she feels kinda warm.” How do you know when a frail older person has become sick? In this and future posts I will talk about the importance of They are called “vital” signs for […]

3 Important No-no’s | Talking to a Person with Dementia /Alzheimer’s Disease

Dad has Alzheimer’s disease. You are a loyal daughter (Jill) who visits often and brings his favorite foods. On one visit, Dad has a big smile when he sees you. “Hi Mary” “Dad, I’m NOT Mary. (Mary is your older sister.)  What’s my name?” “Oh, gosh. Where’s Mary?” “Dad, I’m Jill!! Why do you always ask about Mary? Are you trying to get on my nerves?”

What’s the Most Likely Outcome in Your Case?

Mom Has Been Misplacing Things Your 84-year-old mother has Alzheimer’s disease. She has always tended to be anxious. Now that she has Alzheimer’s disease, the anxiety is much worse. She has been misplacing things such as her glasses and medicines. This happens frequently and she quickly becomes upset. She will claim that somebody took them. The hired caregiver becomes so fed up with the constant accusations that she leaves. “I didn’t want her here anyway,” says Mom. “She kept stealing my things!” The caregiver is gone but things continue to disappear: “Where did you put […]

Agitation – A Clear Description Leads to the Best Action Plan

A nurse working at night in the hospital calls the doctor asking for help: “I have a patient, Mrs Jones. She’s very agitated. Can you order some Imagine being the doctor in the above situation. The request can have multiple outcomes. The night doctor does not know the patient well. In addition, the doctor is busy and does not want more phone calls about the patient. In the worst-case scenario, a high dose of the medicine is ordered. The patient subsequently becomes over sedated and the next day she chokes on her food leading to […]

She Doesn’t Want to Do Anything? Is that Depression? Maybe Not

“Mom used to enjoy shopping, seeing friends, and going out to eat. After she was diagnosed with mild Alzheimer’s Disease, she’s changed. Now she just wants to stay at home and sit there.” It’s logical to think that a person with Alzheimer’s Disease might be depressed. After all, isn’t it a depressing disease? Depression IS commonly seen in Alzheimer’s Disease and other types of dementia. Loss of interest is a key feature. However, there is another possibility that is frequently overlooked. That person may have apathy, a loss of interest in doing things. Let’s take […]

Is Mom in the Hospital? Remember the 8 Ds

Dr. Warren Wong

The hospital is a hard place for older patients. In a previous post, I described three awful things that happen too often. I was frequently asked to help care for frail older patients in the hospital. Based on these experiences, I came up with 8D's.

When you have an older loved one in the hospital, think of these 8 Ds:

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Mom’s Hospitalized – Time to Cross our Fingers

In our last post, Dr. Bruce Leff talked about Hospital at Home. When someone becomes acutely ill or injured, hospital care is needed to treat the problem.  But hospitalization causes its own problems.  One of Dr. Leff’s patients described the hospital as a “crappy hotel.” I’ll describe three things that make the hospital feel like a crappy hotel.1. Who’s in charge? 3 different doctors in 2 days???When a patient is hospitalized at night, the nighttime doctor examines the patient and writes the orders. The next morning, the doctor goes home. Another provider assumes care. However, […]

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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