HOUSTON (AP) — Former President George H.W. Bush remained in guarded condition overnight in the intensive care unit at a Houston hospital after a day marked by “a series of setbacks including persistent fever,” according to his spokesman.

In a brief email Wednesday, Jim McGrath, Bush’s spokesman in Houston, said the 88-year-old former leader had been admitted Sunday to the ICU at Methodist Hospital. McGrath said Bush, the oldest living former U.S. president, was alert and talking to medical staff, adding that doctors are cautiously optimistic about his treatment.

No other details were released about his medical condition, but McGrath said Bush is surrounded by family.

Bush has been hospitalized since Nov. 23, when he was admitted for a lingering cough related to bronchitis after having been in and out of the hospital for complications related to the illness.

Earlier Wednesday, McGrath said, a fever that kept Bush in the hospital over Christmas had gotten worse and that doctors had put him on a liquids-only diet.

“It’s an elevated fever, so it’s actually gone up in the last day or two,” McGrath told The Associated Press. “It’s a stubborn fever that won’t go away.”

But he said the cough that initially brought Bush to the hospital has improved.

Bush was visited on Christmas by his wife, Barbara, his son, Neil, and Neil’s wife.

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