2024/2025 Membership Renewal is now open!
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.
Ask us! Email your questions and suggestions to [email protected].
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 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
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.
“…a 71-year-old man turned over in bed onto his left side and experienced sudden onset of dizziness, described as if the bed was moving. Although lasting only 10-15 seconds, he became sweaty afterwards without nausea and vomiting…The intense vertigo resolved if he stayed still, but similar brief episodes recurred several times when he laid supine in the hospital.”
Ms. Haile is a 78-year-old woman presenting with mild fatigue and "brain fog" of three months' duration. She has a history of type 2 diabetes and hypothyroidism. She currently takes metformin 1,000 mg twice daily, and Synthroid 112 mcg daily. She denies any paresthesias, heartburn or change in bowel habit. She reports an adequate diet covering all of the food groups.
84-year-old Gladys has been hospitalized from home, where she lived independently, with delirium in the setting of a community-acquired pneumonia (COVID-19 negative). Further work-up revealed evidence of suspected underlying widely metastatic malignancy.
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. Current medications include amlodipine 5 mg daily; atorvastatin 20 mg daily; ECASA 81 mg daily; vitamin D 1000 units daily; calcium 500 mg daily; risedronate 35 mg weekly; levothyroxine 75 mcg daily; and zopiclone.
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.
Mrs. Grey is a 91-year-old woman who is a 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 this medication was discontinued. She is on no other medications. Mrs. Grey was usually pleasantly confused and easily redirected, but she gradually became resistant to assistance with her personal care, becoming angry and even throwing a shampoo bottle at a health care aide.
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.
Mrs. Green is a mildly frail, 85-year-old who had a ground-level fall. This is her second fall in 12 months. She reports her heart is racing. Her blood pressure is 135/70 without orthostatic changes. An ECG shows new atrial fibrillation (AF) with a heart rate of 120, and a beta-blocker is initiated for rate control. A Holter shows paroxysmal AF with the longest run lasting six hours.
Mrs. Williams is an 86-year-old woman admitted to hospital with a two-week history of dysuria, confusion, falls and functional decline. Her past medical history includes hypertension, diabetes, Alzheimer dementia and osteoporosis. Current medications include ramipril 5 mg daily, atorvastatin 40 mg daily, metformin 1,000 mg bid, calcium 500 mg daily and vitamin D 1,000 units IU.
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.