Four decades ago, I finished my training in internal medicine. My first real life “job” was working at On Lok in San Francisco Chinatown. On Lok focuses on providing healthcare to frail older patients. There is an emphasis on home and community-based services. Daycare services and medical transport are included. On Lok was the original site of the Program of All-Inclusive Care for the Elderly (PACE). The above picture was taken at On Lok. I’m sitting with a 100-year-old patient. She would always walk up to me, show me her watch, and ask me what […]
Category Archives: Dr. Warren
Will we all become frail as we age?
Almost half of the people born in 1940 are still alive today. They are over 80 years old. For people who were born in 1950 or later, more than 70% are expected to live past the age of 80. What will life be like for these people? Is 80 the new 70? Or will living longer mean an extended period of weakness and frailty? It is true that frailty can be delayed. However, it is more controversial whether this has happened. Some people will live with extended periods of frailty. Why do some people become […]
Frailty – A Major Turning Point in Life
“I recently went to my 50th reunion. A bunch of old people showed up. They looked like the grandparents of the people I knew in high school. It was freaky. The school athletes are now anything but athletes. They looked overweight and out of shape. Some even had problems walking.” Have you ever been to a high school reunion? Everyone is roughly the same age, but some people seem to “age” sooner and more rapidly than others. As the years go by, some of these classmates will become frail while others will not. Will we […]
I don’t think I can do this-Teepa responds
Warmest Aloha,
PS: I say it over and over again: There's no one more important than the caregiver in the daily life of a frail person.
Who is Teepa? The Story behind Positive Approach to Care®
Warmest Aloha,
PS: I say it over and over again: There's no one more important than the caregiver in the daily life of a frail person.
After a Fall-Handle with Care
Finding a frail older person on the floor is stressful and chaotic. In this post, I provide some guidelines about what to do after a fall. Manage falls carefully. There can be major injury even if pain is not severe. Falls can also be due to a new medical problem. The most important points are: Step by Step Care After a Fall Call 911immediately for emergencies. Even for non-emergencies, do a 5-minute assessment before moving the person. Move the person into a sitting position if she/he appears stable. Provide follow-up care. Prevent future falls. Be […]
Don’t worry, Mrs Wong, I’m getting a hold of your son now
I’m on a mission to have my mother use a medical alert device. It won’t be easy, but she needs one. Firstly, she has had several falls. The single highest predictor of a fall in an older adult is a history of a fall in the previous year. Secondly, she didn’t pass the Timed Up and Go (TUG) Assessment. Lastly, she is home alone for many hours a day. If she falls at home, she could be on the floor for hours. Some people are good candidates for a “wearable” medical alert device, some people […]
She was falling too often. We made the difficult decision to put her in a nursing home.
The last several posts have been about fall prevention strategies. However, there are seniors who continue to fall frequently despite interventions. Some individuals are unstable as soon as they stand up and start walking. Other “frequent fallers” have dementia, poor judgement, and impaired impulse control. An accident can happen as soon as you’re not watching. Frequent falls can result in the decision to put a person into a nursing home. But nursing homes have limited success in reducing falls. Nursing home strategies include health assessments, medication review, exercise programs, and environmental improvements. However, falls continue […]