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

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?

Medical cannabis and the older adult

Mary Brown is 82 years' old. She comes in for routine monitoring of her heart failure and diabetes and reports that she has been having pain in her feet that interferes with her ability to sleep at night. Her granddaughter has suggested that cannabis as an ideal treatment.

Blood pressure management and dementia prevention: Is lower better?

Elaine is a 78-year-old woman with hypertension and is on multiple medications. She is concerned about memory changes and has read that well-controlled blood pressure will protect her from dementia.

Promoting Diagnostic Stewardship: Ensuring clinically relevant microbiology results

An 80-year-old afebrile, hemodynamically stable woman is seen in the emergency for acute onset confusion. She has not been eating or drinking well for the last few weeks. She is dehydrated, has a long-term indwelling catheter in situ and her urine is cloudy and foul-smelling. Her physician sends a urine specimen for culture to rule out infection but the relevant clinical information has not been provided on the microbiology requisition.

Managing dizziness in the elderly

Ms Abawi is 85 years' old with long standing history of dizziness. She presents with worsening dizziness post fall three months ago. Brain imaging post fall showed small vessel ischemic changes with no acute abnormalities. Her past medical history is significant for GERD, hypertension, osteoarthritis, osteoporosis, type 2 diabetes mellitus and depression. She is concerned about ongoing dizziness, poor balance and decreasing mobility.

Managing apathy in Alzheimer’s type dementia

Mr. AP is 78 years' old with a diagnosis of Alzheimer’s-type dementia. He is relatively healthy but requires reminders and cueing for tasks around the home, including for grooming and dressing. His wife has been coping with her caregiving role but is becoming increasingly frustrated as she notes he will sit around all day, not helping with chores or wanting to do any of the activities he used to enjoy. When assessed by his family physician, Mr. AP describes no depressed mood or feelings of hopelessness.

Management of osteoporosis: fracture prevention

Ms Y is 72 years' old with a history of hypertension, osteoarthritis and well controlled GERD. Her current medications are Ramipril, hydrochlorothiazide and pantoprazole. Your EMR reminds you that she has not been screened for osteoporosis. This article focuses on post-menopausal osteoporosis and follows the related Toward Optimized Practice guidelines.

Subclinical hypothyroidism: a brief review and suggested treatment approach

Meredith is 90 years’ old and is experiencing mild fatigue, slight cold intolerance and reduced ability to lose weight. Her symptoms are non-specific. Meredith’s laboratory results indicate slightly elevated thyroid stimulating hormone (TSH) levels with a normal free T4. You’ve diagnosed her with subclinical hypothyroidism. What would your approach be?

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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