Medical and psychiatric history

The nature of the information required is no different from that in younger patients. However, of particular importance in the older population is past and present medication. Drugs taken at the prescribed dose, at a wrong dose (due to dementia), or drugs no longer intended to be taken and prescribed sometimes quite a long time ago but of which a residual supply remains are all potent causes of confusion and even frank delirium in old people. It is therefore good practice to ask to see where all medication is kept and to examine each pack or bottle to check that the amount left is approximately proportionate to that which one might expect given the date the drugs were dispensed. Since elderly people are frequently the victims of clinically injudicious polypharmacy, it is common to find a large quantity of current and prescription-expired drugs which the patient is taking on a random basis. To counter this problem proprietary boxes which dispense drugs in daily amounts, such as the Dosette or Nomad systems, are used and can more easily be checked for compliance or overdosing.

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