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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.
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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
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. His past medical history includes hypertension, dyslipidemia, STEMI, LBBB, anxiety, depression, insomnia and benign prostatic hyperplasia.
Anne is 82 years’ old. She visits her physician to discuss her health concerns of low energy, confusion, and feeling shaky and dizzy. Anne has been slowing down and uses a walker now. 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.
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. Her husband reported that, while home Cecilia was not sleeping at night, she would wander around the house mumbling to herself and would see things that were not there.
Mr. Jones is 89 and presenting with a four-month history of increasing confusion and recurrent falls. His past medical history includes Alzheimer’s dementia, benign prostatic hypertrophy, atrial fibrillation, insomnia, hypertension, anxiety and depression.
Mrs. Home is a 75-year-old retired teacher who lives alone in a seniors’ independent living apartment. She’s had three emergency room visits in the last six months for hyperglycemia and poor blood pressure control. Her past medical history is significant for type 2 diabetes, hypertension, previous stroke, chronic kidney disease, coronary artery disease and osteoarthritis.
Mary Brown is an 82-year-old female who comes in for routine monitoring of her heart failure and diabetes. She reports she has been having pain in her feet that interferes with her ability to sleep at night. Her granddaughter has suggested that cannabis would be an ideal treatment and she is asking for your opinion.
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.
An 80-year-old afebrile, hemodynamically stable woman is seen in the emergency department for acute onset confusion. She has not been eating or drinking well for the last few weeks. On examination, she is dehydrated. She has a long-term indwelling catheter in situ and her urine is cloudy and foul smelling.
Ms Abawi is an 85-year-old woman 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.
Mr. AP is a 78-year-old retired high school teacher with a diagnosis of Alzheimer’s-type dementia. He resides with his wife who serves as his primary caregiver. Mr. AP is relatively healthy but requires reminders and cueing for tasks around the home, including sometimes for grooming and dressing. His wife has been coping with her caregiving role but is becoming increasingly frustrated by his lack of “get up and go.”
Ms Y is a 72 year old woman with a history of hypertension, osteoarthritis and well controlled Gastroesophageal reflux disease (GERD). She presents for a periodic health maintenance visit and seems generally well. Her current medications are Ramipril, hydrochlorothiazide and pantoprazole. Your EMR reminds you that she has not been screened for osteoporosis.
Your patient, 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?