Optimized Prescribing with Seniors is a joint communication of the Alberta Medical Association and the College of Physicians & Surgeons of Alberta, these articles are written by physicians for physicians prescribing in the care of older patients.
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Dr. Lesley Charles, MBChB, CCFP, is a geriatric physician at the Grey Nuns Community Hospital. Her areas of clinical interest include dementia, delirium and treatment of osteoporosis. She obtained her medical education at the University of Edinburgh then completed her family medicine residence at the University of Alberta.
Dr. Charles is a professor with the Department of Family Medicine (Division of Care of the Elderly) at the University of Alberta. Her research interests include the Care of the Elderly Program; Decision-Making Capacity Assessment and Implementation and Sustainability Framework; Care of the Elderly Graduates Research; Developing and the Effects of Introducing Core Competencies; and Caregivers
Falls among older adults are a public health issue in Canada.
Alcohol use disorders (AUD) occur at all ages, and consequences of unhealthy drinking are often what lead to encounters with the health care system.
Behavioural and psychological symptoms of dementia (BPSD) can adversely affect quality of life and function.
Heart failure is frequently underdiagnosed, particularly in frail individuals with atypical presentations.
Heart failure is a significant health care issue in Canada, impacting more than 600,000 Canadians aged 40 and above.
Nocturia is common in the general population and increases in prevalence with increasing age.
Constipation is common in elderly patients for a variety of reasons and can present with overflow incontinence. How can constipation be recognized and managed effectively in this population?
George is 72 and a retired teacher. He has a 10-year history of Parkinson’s disease with motor fluctuations including end of dose wearing off, for which he receives pramipexole and entacapone; and peak dose dyskinesias (involuntary movements), for which he receives amantadine.
Mr. Howell is 81 and presenting with a six-month history of lightheadedness on standing up. His past medical history includes hypertension, dyslipidemia, diabetes, osteoporosis, diverticular disease and venous insufficiency.
Amanda is a 72-year-old retired teacher with an eight-year history of Parkinson’s disease (PD). Her past medical history includes hypertension, anxiety and type 2 diabetes mellitus (DM). She lives with her husband Ben in a bungalow and uses a walker for ambulation.
Mrs. Farley is an 84-year-old living in long-term care. She has a known major neurocognitive disorder secondary to Alzheimer’s Disease and has been on Donepezil 10mg daily for the past eight years. She needs cueing and assistance for most of her basic activities of daily living including washing, dressing and bathing. Her most recent Mini Mental State Examination score was 8/30. Her son would like to have her cholinesterase inhibitor (ChEI) discontinued to reduce pill burden.
Mrs. R is an 81-year-old widow who lives with her daughter and her family. She was referred to the geriatric outpatient clinic for assessment of cognition and mobility. She recently fell at home and has had pain in her back and legs since that time. The family also noticed recently that Mrs. R has been paying less attention to conversation during meals, becomes confused when asked questions, has been losing her glasses because she takes them off frequently and has been coughing frequently (which is new). She also describes new abdominal pain.