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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
Mrs. BB is an 82-year-old female living at home. She has mild cognitive impairment (MCI) and limited mobility. Her office blood pressure is 162/71. Should she be treated for hypertension? If yes, what would her blood pressure (BP) target be?
Mr. Home is a 76-year-old man with a history of hypertension, osteoarthritis, Type 2 diabetes mellitus and dyslipidemia. He presented with worsening leg edema over the last six months. He was recently prescribed a diuretic to manage symptoms but has not been compliant due to frequent voids that interrupt daytime activities. He does not endorse symptoms of dyspnea or orthopnea.
Mrs. J. is a 97-year-old woman with a new diagnosis of dementia. She has been admitted to a long-term care (LTC) facility due to her frailty and functional decline at home. Prior to her decline in health and function, she was very active. Her past medical history is significant for osteoarthritis, hypertension and atrial fibrillation. On admission to the LTC facility, her issues were restlessness and agitation resulting in multiple hospital admissions.
Mrs. Jones, an 86-year-old patient of yours, recently learned one of her medications is an acid-reducing pill. Currently, she takes several medications and wants the acid pill reviewed. She has a history of COPD, hypertension, type 2 diabetes mellitus and osteoarthritis of the knees.
Ida is a 75-year-old woman living independently in a rented apartment. In the last three months, her family has noticed some cognitive impairment as well as frequent falls. They have also reported that Ida is inconsistent with taking her medication; she spends the majority of the day sleeping so likely has been sleeping through her medication administration time. In the past, Ida has been known to hoard her narcotics instead of taking them as scheduled. Ida’s medical history includes insomnia, right knee osteoarthritis, chronic pain syndrome, depression and anxiety, urinary incontinence and constipation.
You are responsible for the medical care of Cecelia, an 84-year-old female residing in a long-term care (LTC) facility. Cecelia is a non-smoker who does not drink. She has moderate dementia with a Cognitive Performance Scale score of 3 but no behavioral issues, such as wandering. She has no known family or personal history of fractures, nor conditions that could lead to secondary osteoporosis.
Amira, 72, is a patient with a documented history of dementia (likely Alzheimer’s-related) who has been living with her daughter. Over the five years since her initial diagnosis and follow-up, her dementia appears to have progressed to an advanced stage. As Amira is illiterate, formal cognitive testing could not be performed using the Mini-Mental State Examination or the Montreal Cognitive Assessment screen.
Mrs. Poly is a 78-year-old woman who resides in a seniors' retirement home. Her past medical history is significant for hypertension; type 2 diabetes; dyslipidemia; coronary artery disease with previous NSTEMI; gastritis; hypothyroidism; chronic knee pain and insomnia.
JR is a 92-year-old woman who lives at a long-term care (LTC) facility. She complains of not feeling well for the last two days with some lower abdominal discomfort. She has no burning on voiding, but her urine is cloudy and has a strong odor. She has also had recent falls. Her vitals were within normal limits. Her comorbidities include mild-to-moderate stage dementia, hypertension, atrial fibrillation on anticoagulant therapy, osteoarthritis and coronary artery disease.
John is a 78-year-old man who has experienced chronic low-back pain for several years, with gradual worsening over time. He has a history of degenerative disc disease and moderate lumbar spinal stenosis. There is no indication for surgical intervention. His history includes mild cognitive impairment, hypertension, diabetes mellitus type 2, mild chronic renal impairment and falls.
Phyllis, a 78-year-old woman with mild COPD comes to your office for a routine disease-monitoring visit. During the consultation, she tells you that she has been experiencing severe urinary urgency for many months and has had several accidents on the way to the washroom over the last few weeks. She hadn’t mentioned this before as she was embarrassed and thought it normal for older women. Her close friend suggested she mention it to you.
Mildred is a generally healthy 85-year-old female. She has a history of osteoporosis and when she developed hypertension in her 60s she was placed on a statin.