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 […]
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.
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 […]
In a previous video, Ojay talked about how life changed for his parents. Over a number of years they moved from being hard working adult to becoming frail seniors. Over that time, Ojay became a full time caregiver. In this video, he talks about how his life has changed and about what has given him strength.
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.
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.
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? […]
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 […]
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 […]
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 […]