Mr. S is 81 years old, was diagnosed with dementia three years prior, and lives alone in a two-story
house. His daughter lives 45 minutes away and visits him at home a couple times per week after work to check in and drop off prepared dinners. Mr. S was well upon waking early this morning, but gradually felt more fatigued and decided to take a nap mid-morning. Later, he was too tired to go from his 2nd floor bedroom down to the kitchen to make his usual lunch. When his daughter arrived late afternoon, she found him still in bed. She had to assist him to walk downstairs and decided to bring him to the emergency department (ED) because he was feeling unusually weak and tired. In the ED, Mr. S’s vitals are normal, and he denies any chest pain, shortness of breath, or abdominal pain, and reports having no recent falls or injuries. His workup, including infectious sources, electrolytes, and ECG are all normal. However, Mr. S still reports feeling unwell and while he can get out of bed, he doesn’t want to get up or walk even 20 feet outside of his room. His daughter is concerned because this is unusual for him. The ED physician, Dr. F, is conflicted on whether to admit the patient for further monitoring and evaluation. Mr. S does not have any evidence of a serious illness that clearly requires treatment in the hospital, but Dr. F knows that older patients with weakness can have poor outcomes even with nonspecific presentations.