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

Reducing anticholinergic burden to improve safety

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.

Vertigo: Considerations for management in older adults

Although vertigo involves the perception of motion, older adults may not report it as motion but as unsteadiness and falling. What are the considerations in the management of vertigo in the older adult? This article will provide an overview.

Vitamin B12 deficiency and metformin

Vitamin B12 deficiency may be easily overlooked as it can present with a wide range of non-specific symptoms. A number of conditions and medications increase the risk of vitamin B12 deficiency and periodic screening in some individuals should be considered.

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

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?

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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