The number of people with dementia is on the rise, creating opportunities for pharmacy to help both sufferers and carers

The rapid rise in the number of people affected by dementia has caused everyone from healthcare professionals to the public and politicians to stand up and take notice. Dementia affects over 800,000 people in the UK, but is predicted to top a million by 2021 and two million by 2050. The burden on society is substantial; the condition costs the economy £23.6 billion per annum and this is predicted to rise to £59.4 billion by 2050. The burden on families is considerable too, with 670,000 family members currently caring for people with dementia.

Recent analysis suggests that by 2017, there will no longer be sufficient numbers of informal carers for dementia sufferers, creating increasing pressure on an overburdened NHS and social care network. At last December’s G8 Summit there was a commitment to take global action to improve the quality of life for people with dementia and their carers, and to increase research funding for a cure or diseasemodifying therapy by 2025.

Building on this, Alzheimer’s Research UK launched the Defeat Dementia campaign in June to raise £100 million for research over the next five years. Although some treatments are available for dementia, they only have a moderate effect for a limited time. It is estimated that if a treatment was found by 2020 that could delay dementia onset by five years, there would be 36 per cent fewer people with dementia by 2030 and almost 400,000 fewer carers needed. This would result in a cost saving of £14 billion.

Every nation in the UK has a dementia strategy, and pharmacy can play an increasing role. English Pharmacy Board member Deborah Evans says: “Dementia is a growing issue. Pharmacy is at the heart of the community and is the touchpoint for many people who are ageing and likely to develop dementia. Pharmacy has a community responsibility as well as a patient care responsibility and can help identify people with dementia as well as support them and their carers.”

Dementia symptoms

Dementia is not a single condition but a set of symptoms that includes memory loss, mood changes and difficulty communicating and reasoning. Symptoms worsen over time, but this can vary by person depending on the underlying cause, their overall health and their personal circumstances.

Although dementia is more common in people that are older, it is not a natural consequence of ageing but is due to diseases of the brain (see box right). Around pick up on changes,” says Pippa Scrimshaw, specialist pharmacy technician, domiciliary medicines management, at Cambridgeshire Community Services NHS Trust.

“Pharmacy staff can see changes in routines and the behaviour of regular customers, if they start to look unkempt or if they are confused. Also if they repeatedly forget to collect their medicines, start asking for medications every day or have blister packs that are brought back full. It all leads towards behaviour change that may be part of dementia.”

Deborah believes that pharmacy staff can be the eyes of the community, seeing what is going on and bringing it to the attention of the pharmacist. “We can help spot the regulars who come in and who are not themselves, with behaviour that is out of character, or who are more aggressive, more confused or coming in more.”

She adds that Healthy Living Pharmacies have health champions on the counter and can be a great target for focusing on dementia. “They are already proactive in the health of their community, but other pharmacies can also do a great job in dementia.”

The signs and symptoms pharmacy staff should watch out for include:

• Struggling to remember recent events, but easily recalling things from the past
• Finding it hard to follow conversations or TV programmes
• Forgetting the names of friends or everyday objects
• Forgetting themselves and losing the thread of what they were saying lProblems with thinking and reasoning
• Confusion, even when in a familiar environment
• A reduced ability to talk, read or write
• Other people noticing their forgetfulness
• Feeling angry, depressed or anxious about their forgetfulness. 

Although customers who present with some of these symptoms may not have dementia, Pippa recommends that concerns are raised: “If we can get them to see their GP sooner, we can make a difference.”

We have a duty of care to help people and, because we see patients frequently, we can pick up on changes

Dementia-friendly pharmacies Once a dementia diagnosis has been made, pharmacy teams can pro-actively help sufferers and their carers.

To encourage pharmacy staff to become more engaged and have a greater understanding of the challenges being faced, the Dementia Friends (DF) initiative from the Alzheimer’s Society can help. These are people with the ‘know-how’ to help those with dementia feel understood and included in their community. The Royal Pharmaceutical Society (RPS) is committed to helping the Alzheimer’s Society reach its target of having one million DFs by 2015, with RPS staff being trained as DFs, the English Pharmacy Board encouraging all of those who work in pharmacy to become DFs, and Local Practice Forums in Wales running a number of DF events.

Tom Branning, a locum pharmacist from Brecon, says: “Everyone’s experience with dementia is different. The important thing is that every patient is respected, understood and supported. Becoming a Dementia Friend has put me in a better position to support and help patients with this condition.”

Deborah is another DF: “A big bit is about focusing on what it is like to have dementia and being more sensitive and tolerant of the patient and their needs. If you saw someone having difficulty crossing the road or struggling to get money out of their purse, it is about reaching out to help them.”

Already a number of pharmacies have signed up. Day Lewis, for example, have at least two DFs in every pharmacy. By watching a short video or attending a 45-minute face-to-face training session, you too can become a DF. “The whole pharmacy team could watch the video one lunchtime and then you have a dementia-friendly pharmacy,” recommends Deborah.

Medicines and more

Heidi Wright, RPS policy and practice lead for England, adds that pharmacy staff also play a role in ensuring there is appropriate prescribing of medicines. “Care homes generally have a significant proportion of residents with dementia and these are a particular cohort of patients where pharmacy can make a contribution to improving the quality of care.”

Deborah says pharmacy staff can also help with other issues, such as considering whether a mobility aid may be of value, advising on overall health and nutrition and ensuring there is enough support for those using incontinence products. Engaging with other healthcare professionals and local authority services is also important. “Admiral Nurses are specialist dementia nurses within the NHS. Find out who your local nurse is and speak with them,” she advises. “Also contact local authorities to find out the process for social care support for things such as home adaptations.”

In general, adds Pippa: “Pharmacy teams are observant, caring and can make a difference. Patients tell us things they may not be telling other people.”

Medicines advice

Specialist pharmacy technician Pippa Scrimshaw offers the following medicines management advice for people with dementia:

• Offer tablets in blister packs and consider electronic tablet dispensers to remind patients to take the correct medication
• Advise patients to use calendars, diaries or a Medicines Administration Record to tick when the medication is taken
• Have the pharmacist talk to the GP about simplifying medication to reduce the number of times patients have to take their tablets per day
• Offer delivery services
• Keep tablets near the cereal box or bread bin to act as a reminder for morning medication
• Set reminders for taking medicines on mobile phones, if the patient has one

Signposting

• Admiral Nurses Helpline: 0845 257 9406 Email: direct@dementiauk.org
• Alzheimer’s Society
• Carer’s UK
• Dementia UK