Medication management: Recognizing anticholinergic effects

College of Physicians and Surgeons of Alberta Messenger, Optimized Prescribing with Seniors Leave a Comment

Myrtle is an 87-year-old female with hypertension, urinary urgency and a mild dementia syndrome. She lives with her daughter and manages with her support. She is taking hydrochlorothiazide, amlodipine, ASA, tolterodine LA, and mirtazapine for sleep. Myrtle recently slipped on the stairs and twisted her back. Because of the pain, she started taking acetaminophen/methocarbamol. Her daughter brings her in because …

Tackling GERD (common and atypical symptoms) in older patients

College of Physicians and Surgeons of Alberta Messenger, Optimized Prescribing with Seniors Leave a Comment

George, a 78 year old male, comes in to your office for an initial visit as his previous physician has retired. His chronic medical issues are managed and stable, but he has been having increasing heartburn. He takes an antacid as needed but is not finding this to be sufficient. Issue: What does the evidence say about investigation and management …

HgA1c targets and use of agents for diabetes in older adults

College of Physicians and Surgeons of Alberta Optimized Prescribing with Seniors Leave a Comment

 By: Diana L. Turner, Msc, MD, CCFP, FCFP, Care of the Elderly | Associate Clinical Professor, Department of Family Medicine | University of Calgary Case: An 82-year-old patient with longstanding type 2 diabetes mellitus (T2DM); multiple comorbidities (hypertension, dyslipidemia, severe degenerative osteoarthritis, GERD, gout and COPD); and self-managed polypharmacy, including insulin. His office visit was triggered by his stressed spouse, …

Medication reviews in long-term care and supportive living: a physician’s perspective

College of Physicians and Surgeons of Alberta Optimized Prescribing with Seniors Leave a Comment

Issue: What does the evidence say about the risks posed to patient safety in residential care homes as a result of medication errors and adverse drug events? Bottom Line: The single greatest risk to patient safety in residential care homes is medication use: specifically medication errors and adverse drug events.1  Evidence: A recent prospective study identified two thirds of LTC …