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Many medicines considerably improve the quality of life of older people, but unfortunately older people are more susceptible to their adverse effects than younger adults. Being on multiple medications (prescribed and those bought from the chemist or health food store)…

Many medicines considerably improve the quality of life of older people, but unfortunately older people are more susceptible to their adverse effects than younger adults.

Being on multiple medications (prescribed and those bought from the chemist or health food store) increases the risk of errors (by patients and doctors) and drug interactions. Some medications, such as sleeping tablets, cause more problems than others.

Unfortunately a significant number of acute (unplanned) hospitalisations occur because of medication problems experienced by older people. Also older patients often become sicker in hospital because of medication problems.

Our practice works hard not only to uncover any medication problems, but also to prevent them.

This is a lot harder than most people would imagine! For example, do not assume all your health care professionals have an up-to-date list of what you are taking - as you know doctors other than your GP often prescribe medications. Medication regimes are often changed in hospital and unfortunately mix-ups occur when older people change their GPs or chemists.

Extreme care also needs to be taken with regard to medication mix-ups when older people move into a residential aged care facility especially if it is only for a short ‘holiday’.

Many of you will be advised by this practice to use a Webster (blister) pack type system. This is one of the safest system we know, for all of us. Do not rely on taking along a piece of paper with a list of medications written on it when you visit the doctor (any doctor), have to go to hospital or are going to a hostel or nursing home. Take all your medicines with you (even the ones bought over the counter), or better still, get a Webster pack and take that.

The risk to older people’s health and wellbeing is such that we cannot emphasise just how important good medication management is. If we haven’t told you to get a Webster pack, get one anyway and remind us that we should have told you about this system.

Always bring all your medicines to all our appointments - do not assume we know something has changed since we last saw you or that you will remember to tell us. Better still, bring that Webster pack!

We have a sample Webster pack at this practice and if we haven’t shown you what one looks like, ask to see it.

If you are from a residential aged care facility, tell the staff at the facility to give you your up to date medication chart to bring to all your appointments with us (and with everyone else). Unfortunately we cannot always rely on the accuracy of the medication chart so if possible also bring the medications (a Webster pack or the MPS sachets) .

If you forget to bring your Webster pack to the consultation we are able to quickly ask your pharmacist for an up to date medication list. We cannot do this if you do not have a webster pack

Providing you with written information about changes to medications to take back to your chemist or residential aged care facility is essential. Do not let us forget to do this. We send a copy of what we give you to your GP as well.

The last thing we want to happen to you is an emergency trip to hospital

Falling is not inevitable as we get older but it is a very common and worrying problem for many older people. Up to 1/3 of all older people living in their own homes fall at least once a year. Unfortunately…

Falling is not inevitable as we get older but it is a very common and worrying problem for many older people. Up to 1/3 of all older people living in their own homes fall at least once a year. Unfortunately almost 1/2 of older people living in residential aged care facilities fall at least once a year.

Fortunately the majority of falls do not result in serious injury nor is hospitalisation needed, but many older people understandably restrict their activities after a fall and there is often significant loss of quality of life.

Aiming for better understanding of the risk factors for falls in older people and attempting to modify these risk factors, are what geriatricians do all the time.

We know there are no simple answers. Single interventions such as more exercise or having rails etc at home are helpful but it is important to have what we call a multidisciplinary perspective.

Medical input can help-general practitioners and specialists such as geriatricians being involved. We look for poorly controlled chronic medical problems, new (acute) illnesses and medication problems.

Your GP will also know about access to physiotherapy and other services such as home modification, in your area.

If you have a fall let your GP know even if you think it was only a simple trip or stumble. Please also let us know. A phone call from you may result in an earlier appointment being recommended.

Memory loss can be due to a number of problems and unfortunately areas of the brain other than the memory areas are often affected as well. Memory loss is often noticed first by others close to older people and their…

Memory loss can be due to a number of problems and unfortunately areas of the brain other than the memory areas are often affected as well.

Memory loss is often noticed first by others close to older people and their help is often needed to work out what is wrong. Patient privacy and dignity have to come first, but bringing along a spouse, partner, close relative or someone else close to you to your appointments usually means it is easier to sort out what is wrong.

Everyone’s memory is affected by stress or worry and this is something doctors look for. Sometimes treatment for the stress or worry solves the problem.

Memory loss can be made worse by medications. So please bring all your medications to every appointment so any problems can be sorted out.

Memory problems (eg due to a dementia) affect a person’s everyday life (we talk about ‘activities of daily living’). So we often ask questions about what is happening at home.

It is also important to try and determine the duration of the problem - if you only forgot something yesterday or last week then there is usually little to worry about. But if the problem has been slowly getting worse over a number of months or years then it needs sorting out and if possible you will be offered treatment.

There are also many medical illnesses which make memory problems worse and these need sorting out as well.

Investigations recommended by this practice for memory loss (blood tests and brain scans) are recommended not only to help with the diagnosis but to also assist with sorting out coexisting medical conditions

There is not a ‘test’ that will give doctors all the answers about memory loss and its cause(s). Most of the answers come from the history that is given to us, aided by a physical examination, sometimes helped by blood tests and brain scans and backed up by a memory test (often the Mini Mental State Examination - the ‘MMSE’).

Once doctors determine there is memory loss, it is then necessary to work out the cause of this. In Australia here are only a few common causes of memory loss (dementia) and treatment can be offered for a number of these. True memory loss cannot yet be cured, but the symptoms and the effect the memory loss has on an older person can be treated.


We talk about treatment slowing down the progression of symptoms which means older people with memory problems can remain independent and active for longer than would be otherwise possible. Treatment also makes it easier for others caring for older people with memory problems.

The commonest causes of memory loss (dementia) seen in this practice are:

• Mixed Dementia-a combination of Alzheimer’s disease and hardening of the arteries (cerebrovascular disease or vascular dementia)
• Alzheimer’s disease (ATD or just AD)
• Lewy Body Disease (LBD)
• Vascular Dementia (VaD)
• Frontotemporal Dementia (FTD)

Do not despair if a diagnosis of dementia is made. We now urge people to seek treatment as soon as possible. We know what changes are occurring in the brain meaning in the future we will have even better treatments.

If it’s any consolation, if we all live long enough we will all get a dementia. And do not worry too much about passing it onto your children - for the commonest dementias the biggest risk factors are still age, age and age.

Medication for the treatment of Alzheimer's Disease became available in Australia in the late 1990s and in early 2001 became available via our subsidised pharmaceutical schemes (the PBS and RPBS). Prior to this treatment was only available via a private…

Medication for the treatment of Alzheimer's Disease became available in Australia in the late 1990s and in early 2001 became available via our subsidised pharmaceutical schemes (the PBS and RPBS). Prior to this treatment was only available via a private prescription and was costly

These medications, known as Cholinesterase Inhibitors, are still restricted in terms of having access to them via our subsidised schemes. In order to obtain ‘initial approval’ via the schemes all of the following criteria must be met:

1. A diagnosis of Alzheimer’s disease must be made
2. The diagnosis must be confirmed by a specialist/consultant physician or psychiatrist, and
3. The Alzheimer’s disease must be of mild to moderate severity-patients must score less than 25/30 and greater than 10/30 on MMSE.

In May 2002 other restrictions were placed on doctors by the PBS (Pharmaceutical Benefits Scheme) meaning it is not simply a matter of writing a prescription.

Some people may not easily fulfill the above criteria and there is the option of paying for the drug privately as everyone used to. However this option is not routinely recommended in this practice.

If the diagnosis is mild Alzheimer’s disease but people are scoring well on the MMSE (more than 24/30) there is the option of undergoing more specialised memory testing known as the ADAS Cog*. Initial approval for treatment via the subsidised schemes can then be obtained irrespective of the score achieved on the ADAS Cog.

This practice does not routinely advise patients to wait until their MMSE score has deteriorated enough for them to qualify for subsidised treatment. Although it is said it is never too late to start treatment (it’s always better late than never), the sooner patients start treatment the better they will be in the longer term.

Once subsidised treatment is started there are still hurdles to overcome in order to continue to receive the subsidised treatment (initial treatment is only subsidised for 6 months). There were further changes made by the PBS 3-4 years ago regarding this.

Currently in Australia within 6 months of starting treatment patients must demonstrate a 'clinically meaningful response'. Previously there had to be an improvement in memory test scores.

Now other aspects of a person's life such as mood, level of independence and quality of life have to be assessed. There is still a need to show 'cognitive' benefit so repeating the MMSE or ADAS Cog is usually required as well.

At the present time the PBS also requires patients and their carer's, relatives and significant others to contribute to the 'on treatment' assessment. This practice provides as much support as needed during this process.

This is why this practice asks you to return for regular review especially during the first 4-6 months. We are busy trying to get you well, keep you well, and make treatment decisions about which drug, what dose, and when to make changes. We are also busy asking your GP to keep a close eye on you as well and hoping we have all your other medications right.

Sometimes we have to do a lot of work before we can even offer you treatment. We also have to pick the right time to undertake the PBS required 'on treatment' assessments.

When these Cholinesterase Inhibitor drugs first became subsidised the PBS did not require further assessments once ‘ongoing approval’ after the first 6 months of treatment was obtained.

Currently however every six months there has to be a 'reassessment'. These 6 monthly reassessments are usually not too difficult but a prescription cannot be provided without them occurring. This practice now offers this service.

At every consultation enquiries are made about new (acute) illnesses, worsening of other chronic illnesses, medications and lifestyle changes, eg a move to a residential aged care facility or an unexpected trip to hospital. All of these can adversely affect memory loss so we are always looking for ways to improving your well being

If for some reason you are lost to us we always let your GP know this and sometimes we offer alternative options to your GP. We don’t give up too easily!

Further information about the medications available will be provided prior to them being offered.


*ADAS Cog testing is available at this practice. It is not considered by this practice as part of the usual physician consultation. There is therefore no reimbursement available via Medicare or Veterans Affairs. The fee includes a GST component.