Advice needed - 91 year old dad is suddenly exhausted and has no appetite

[Anonymous]

Hi. I’d really appreciate any advice. My dad is 91 and in good health for his age (he has a history of stroke and intestinal blockages, but otherwise active and healthy). Over the past three days his appetite has declined (he’ll eat a few bites of something and he’s just not hungry anymore). We don’t believe he has a blockage or narrowing because he’s not nauseated, he’s had bowels movements, passed gas etc. He’s also exhausted. It was difficult for him to get up stairs and get in bed, difficult to get dressed, etc.

His GP is on vacation this week. My mom has to work and so I’m taking the day off to go be with him. He doesn’t want to go to the doctor (he has no fever, no pain, just wants to rest and not eat).

Any advice for us? Any idea what might be going on? He was hospitalized a few months ago for an infection after and endoscopy and he hated the hospital. He will definitely refuse to go, and I don’t want to call an ambulance if I can avoid it.

[Anonymous]

I’d get him into the doc right away, as much as he doesn’t like it. The elderly can manifest things from as simple as a UTI, to as complex as a stroke, very differently than younger adults do.

His appetite and weakness may be related if he is dehydrated, as the elderly can become very dehydrated in a short amount of time.

Tbh, with a history of stoke, I’d be inclined to get him in sooner rather than later.

[Anonymous]

Anonymous wrote:I’d get him into the doc right away, as much as he doesn’t like it. The elderly can manifest things from as simple as a UTI, to as complex as a stroke, very differently than younger adults do.

His appetite and weakness may be related if he is dehydrated, as the elderly can become very dehydrated in a short amount of time.

Tbh, with a history of stoke, I’d be inclined to get him in sooner rather than later.

Thank you. Actually he just woke up and my mom took his temp and he does have a low grade fever....

His gp office is open (they have a PA) so I’m going to take him there I think. It’ll be difficult bc he’s so tired and I’m wondering if I should call an ambulance instead? I don’t want to waste resources, but maybe this merits an ambulance?

[Anonymous]

What does HE want? I know it's hard to think about but do you really want to get down the road where he will be put through painful procedures and end up dying in the hospital vs. comfortably at home? We've had this conversation with my father who is a similar age and been through some health crises. He is adamant that he will not go back to the hospital. He will be happy if a simple infection leads to a quick end. He would be so angry with us if we called an ambulance and forced him to the hospital. Doing so would be all our our needs, not his.

You need to have the end-of-life conversation with your father and respect his wishes.

[Anonymous]

If you feel you cannot safely transport him, call an ambulance. Generally I don't say go.to.the ED with something like this because the ED is a cesspool of germs that you don't want to expose him to.

An ambulance won't take him to his GP.

[Anonymous]

Thanks PPS. I have talked to him about end of life - he doesn’t want extraordinary measures but if it’s just an infection that can be treated and he is otherwise active and healthy, he wants to live. I’m going to drive him to the GP to see the PA and am really hoping he can go home on antibiotics and not have to go to hospital. It’s such a nightmare (Inova Fairfax - when he was admitted a few months ago for an infection we spent 12 hours waiting for a bed, he Spent the entire time on a guerney in the hallway in the ER it was so crowded).

[Anonymous]

Anonymous wrote:What does HE want? I know it's hard to think about but do you really want to get down the road where he will be put through painful procedures and end up dying in the hospital vs. comfortably at home? We've had this conversation with my father who is a similar age and been through some health crises. He is adamant that he will not go back to the hospital. He will be happy if a simple infection leads to a quick end. He would be so angry with us if we called an ambulance and forced him to the hospital. Doing so would be all our our needs, not his.

You need to have the end-of-life conversation with your father and respect his wishes.

I definitely respect this. If he refuses to go to hospital today I definitely will not make him. Thank you.

[Anonymous]

Take him to a good ER. Have them run tests but don’t keep him there long , especially overnight, if possible. Do tests, let them give him an IV with nutrients and fluids and then go home.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I’d get him into the doc right away, as much as he doesn’t like it. The elderly can manifest things from as simple as a UTI, to as complex as a stroke, very differently than younger adults do.

His appetite and weakness may be related if he is dehydrated, as the elderly can become very dehydrated in a short amount of time.

Tbh, with a history of stoke, I’d be inclined to get him in sooner rather than later.

Thank you. Actually he just woke up and my mom took his temp and he does have a low grade fever....

His gp office is open (they have a PA) so I’m going to take him there I think. It’ll be difficult bc he’s so tired and I’m wondering if I should call an ambulance instead? I don’t want to waste resources, but maybe this merits an ambulance?

A PA is not at all qualified to diagnose your dad and odds are he/she will call an ambulance for your dad.
Has he been checked for prostate cancer? At his age and with those symptoms it’s a possibility.

[Anonymous]

Off topic I realize, but your mother has to work? How old is she?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I’d get him into the doc right away, as much as he doesn’t like it. The elderly can manifest things from as simple as a UTI, to as complex as a stroke, very differently than younger adults do.

His appetite and weakness may be related if he is dehydrated, as the elderly can become very dehydrated in a short amount of time.

Tbh, with a history of stoke, I’d be inclined to get him in sooner rather than later.

Thank you. Actually he just woke up and my mom took his temp and he does have a low grade fever....

His gp office is open (they have a PA) so I’m going to take him there I think. It’ll be difficult bc he’s so tired and I’m wondering if I should call an ambulance instead? I don’t want to waste resources, but maybe this merits an ambulance?

A PA is not at all qualified to diagnose your dad and odds are he/she will call an ambulance for your dad.
Has he been checked for prostate cancer? At his age and with those symptoms it’s a possibility.

The ER at this point is a good option. Believe me at this age he could worsen quickly, become very ill at home and be rushed to the hospital. If it gets to that point the odds are greater that he won’t make it out of the hospital. Explain to dad that you’re just going for tests and then you’re coming home.

[Anonymous]

Anonymous wrote:Off topic I realize, but your mother has to work? How old is she?

She’s 84 - she’s a (beloved!) art teacher. She doesn’t ever want to cancel classes on her students, but I think today she’s going to cancel and reschedule. She’s incredibly active and youthful (makes me feel like a lazy bum most days!).

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I’d get him into the doc right away, as much as he doesn’t like it. The elderly can manifest things from as simple as a UTI, to as complex as a stroke, very differently than younger adults do.

His appetite and weakness may be related if he is dehydrated, as the elderly can become very dehydrated in a short amount of time.

Tbh, with a history of stoke, I’d be inclined to get him in sooner rather than later.

Thank you. Actually he just woke up and my mom took his temp and he does have a low grade fever....

His gp office is open (they have a PA) so I’m going to take him there I think. It’ll be difficult bc he’s so tired and I’m wondering if I should call an ambulance instead? I don’t want to waste resources, but maybe this merits an ambulance?

A PA is not at all qualified to diagnose your dad and odds are he/she will call an ambulance for your dad.
Has he been checked for prostate cancer? At his age and with those symptoms it’s a possibility.

He was treated (successfully) for prostate cancer over 10 years ago (brachytherapy and radiology) and he got checked every 6 months for five years Post treaty,went. Do you think it could be a recurrence?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I’d get him into the doc right away, as much as he doesn’t like it. The elderly can manifest things from as simple as a UTI, to as complex as a stroke, very differently than younger adults do.

His appetite and weakness may be related if he is dehydrated, as the elderly can become very dehydrated in a short amount of time.

Tbh, with a history of stoke, I’d be inclined to get him in sooner rather than later.

Thank you. Actually he just woke up and my mom took his temp and he does have a low grade fever....

His gp office is open (they have a PA) so I’m going to take him there I think. It’ll be difficult bc he’s so tired and I’m wondering if I should call an ambulance instead? I don’t want to waste resources, but maybe this merits an ambulance?

A PA is not at all qualified to diagnose your dad and odds are he/she will call an ambulance for your dad.
Has he been checked for prostate cancer? At his age and with those symptoms it’s a possibility.

Post therapy. Sorry, autocorrect.

He was treated (successfully) for prostate cancer over 10 years ago (brachytherapy and radiology) and he got checked every 6 months for five years Post treaty,went. Do you think it could be a recurrence?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I’d get him into the doc right away, as much as he doesn’t like it. The elderly can manifest things from as simple as a UTI, to as complex as a stroke, very differently than younger adults do.

His appetite and weakness may be related if he is dehydrated, as the elderly can become very dehydrated in a short amount of time.

Tbh, with a history of stoke, I’d be inclined to get him in sooner rather than later.

Thank you. Actually he just woke up and my mom took his temp and he does have a low grade fever....

His gp office is open (they have a PA) so I’m going to take him there I think. It’ll be difficult bc he’s so tired and I’m wondering if I should call an ambulance instead? I don’t want to waste resources, but maybe this merits an ambulance?

A PA is not at all qualified to diagnose your dad and odds are he/she will call an ambulance for your dad.
Has he been checked for prostate cancer? At his age and with those symptoms it’s a possibility.

A PA cam most certainly check for the usual suspects. UTI is exceedingly common in the elderly, as are low level respiratory infections that cause issues. They can check for hydration status. They can also do a very basic neurological and cardiac exam. They can do a quick review of any medications and determine if they may be the cause. Based on their findings, yes, a transfer to hospital may be needed, but it’s also important that the father feel comfortable, and avoiding sitting for hours in the ER is probably not going to do that.