Optimized Prescribing with Seniors


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.

Archived articles

The archive below includes the six most recent Optimized Prescribing with Seniors articles. For older issues, please contact the AMA web team at webmaster@albertadoctors.org

Care at the end of life: Management of “death rattle”

Dr. Sarah Burton-MacLeod discusses providing comfort at the end of life, with particular focus on the symptom management of death rattle.

Managing Delirium

Ms. Jones is 78 and presenting with a two-week history of fluctuating confusion with hallucinations. Her past medical history includes hypertension; dyslipidemia; coronary artery disease; osteoporosis; hypothyroidism; and insomnia.

Tackling polypharmacy by deprescribing: Active multidisciplinary collaboration

You are an attending physician providing medical care at a long-term care facility in Alberta. You have heard that the average number of medications per resident at your facility is well above the Alberta average. You would like to know how you should go about addressing the issue. How should a physician caring for the frail elderly in long-term care, and in the community, best go about tackling polypharmacy by deprescribing?

Case Study for Optimized Prescribing with Seniors: When Medication is Not the Answer

Mrs. Grey is a 91-year-old resident in a seniors’ lodge where she receives meals and assistance with bathing and dressing. She has a diagnosis of Alzheimer’s disease which was treated briefly with donepezil, but was discontinued. Recently she has has become more and more resistant to assistance with her personal care, becoming angry and even throwing objects at others. Is a change in medication needed or could Mrs. Grey's behavior change be related to the prolonged isolation during the COVID-19 pandemic?

Managing urinary incontinence

Jane Smith is 78 years old. She presents with a two-year history of gradually worsening urinary incontinence. She passes urine 10-12 times per day and twice overnight. She reports needing to rush to get to the washroom. She is often not able to make it in time and experiences incontinence several times daily as a result.

A practical approach to stopping medications

Mr. Jones is 89 with a four-month history of increasing confusion and recurrent falls. He is currently taking several medications, which is causing him to develop multiple medical problems. And as the number of medical problems increases, so does the number of medications that are prescribed.

OPS is for you: Send us your questions and suggestions

  • Is there a particular issue you would like to see addressed?
  • Do you see a scenario frequently and want to know an ideal, yet practical, approach to management?
  • Uncertain about the role of the "latest and greatest" new drug?

Ask us! Email your questions and suggestions to webmaster@albertadoctors.org.

OPS Physician Coordinator

Dr. Lesley Charles, OPS Physician CoordinatorDr. 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 an associate 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

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