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

Involving the Family Caregiver in Optimized Prescribing

Lisa, an 83-year-old woman, lives with her husband, Mike, in a seniors’ apartment. Mike contacts your clinic as Lisa’s blood glucose has been uncontrolled, she is agitated during respite and she is experiencing diarrhea. How does one involve family caregivers to optimize prescribing?

Optimal management of dementia: a practical approach

Mr. Philips is 82 years old. He is presenting with a two-year history of gradual decline in cognition, which is affecting his daily function including missing bills and forgetting to take his medications. In primary care settings, more than half of dementia cases are missed and when recognized they are often undertreated. Patients living with dementia are projected to place an increasing burden on the health care system. Optimal management of dementia may help alleviate some of this.

Factoring in Frailty

Anne is 82 years’ old. She visits her physician to discuss her health concerns of low energy, confusion, and feeling shaky and dizzy. Her husband manages the housework and finances while home care provides her with bath assist and medication management. Anne has Type 2 diabetes, hypertension, dyslipidemia and urinary incontinence. Her medications include metformin, gliclazide, sitagliptin, hydrochlorothiazide, ramipril, rosuvastatin, lansoprazole and mirabegron. How do we address Anne’s complex health issues, balancing her frailty and targets of therapy?

Appropriate use of antipsychotics in dementia

Cecilia Moore is a 65-year-old woman diagnosed four years ago with early onset Alzheimer’s disease. Cecilia moved to designated supportive living four months ago because her husband could no longer manage her symptoms at home. Cecilia is experiencing insomnia, anxiety and visual hallucinations. In the facility where she currently resides, she is fearful of the caregivers and will fight, bite and kick when they try to help her with her personal care, which has resulted in some staff injuries. When is it appropriate to use antipsychotics for the behavioral and psychological symptoms of dementia?

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.

Is it therapeutic failure or is she forgetting to take her pills?

Mrs. Home is 75-year-old. She lives alone in a seniors’ independent living apartment and has had three emergency room visits in the last six months for hyperglycemia and poor blood pressure control. She currently takes 11 different medications and admits to forgetting to take her pills sometimes. How would you approach helping her with medication adherence?

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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