There are 10 million people in the UK aged over 65 years, and with this figure set to grow, it is increasingly important that pharmacy staff are equipped with the knowledge to help this group stay as healthy as possible

The pensioner population is on the rise. Government figures put the number of people over 65 years of age at 10 million, and this is expected to have nearly doubled by 2050. The main reasons for this are increased longevity, and also the ageing of the large number of people born during the post-war baby boom. However, although people are living longer, healthy life expectancy is not increasing at the same rate, and this is putting a strain on healthcare services.

In many cases, the earlier someone adopts a healthy lifestyle, the better, but it is also rarely too late to change bad habits. Pharmacy staff are ideally placed to offer advice in this area, as they deal with many older customers every day. Some of the topics on which people need assistance are obvious, such as bone health and dementia, whereas others may be thought of as being more suitable for a younger demographic, but are relevant nonetheless. So it is vital to keep your eyes and mind open, and deal with the person as a whole rather than pigeonholing someone into a group, or treating a set of symptoms in isolation.

Healthy body

Think of an older person, and you may think of someone sitting in a chair wearing slippers, or maybe walking with a stick, but these scenarios are a long way off for many. David Terrace, health and wellbeing programme manager for Age UK, says: “Our slogan is ‘love later life’ and people staying active is a huge part of that. Not only are there physical benefits in terms of the prevention and management of conditions such as heart disease and high blood pressure, but exercise also has a role in mental wellbeing, in terms of increasing social contact, reducing isolation and loneliness, lifting mood, and maintaining independence.”

What works for one person isn’t necessarily suitable for another, but a good starting point is the individual’s GP or local Age UK, both of whom should be able to provide details of exercise programmes in the area. These range from activities for the very fit and healthy such as football, sailing and biking, down to more sedate pursuits such as walking and tai chi. There are even chair-based exercises for those who struggle with their mobility or are worried about falling. David states: “It’s important to find something that suits someone’s individual needs, but with a risk assessment and appropriate training, anything is possible.”

Activity is also important in maintaining healthy bones. Julia Thomson, helpline nurse at the National Osteoporosis Society, explains: “Bone loss accelerates as people get older, so it is important to do exercise that involves the individual bearing their own weight.” But she adds: “It is important to be realistic. If someone is frail and unsteady, they shouldn’t push it, but instead make sure they stand up every hour so that they bear weight on their bones. Any form of exercise needs to be sustainable for it to be effective.”

Older people should also be advised to cut down on smoking and drinking alcohol, as both are enemies of bone health, she warns. Getting out and about has the added benefit of boosting levels of vitamin D, which is vital for strong bones, says Julia. “Vitamin D and calcium supplements have their place for those who don’t get outside, but can cause constipation, so explain that it is possible to get the equivalent from a pint of milk a day, which could be split across some breakfast cereal in the morning, a cheese sandwich at lunchtime, a dinner involving some kind of white or cheese sauce, and a few cups of milky coffee.”

A significant proportion of older people are on medication for osteoporosis, but not all take it reliably. Julia says: “If someone finds it difficult to remember their bisphosphonate tablet because it is weekly and not daily, suggest that they tie it in with a weekly task such as picking up the Sunday newspaper from the door mat or putting out the bins. These tablets also need to be taken correctly so that they are properly absorbed and do not cause too many side effects.”

Running through the patient information leaflet is a way of identifying inappropriate ways that drugs are being used, such as taking osteoporosis medication with breakfast, and reinforcing correct administration techniques, such as standing or sitting upright to take it with a full glass of water.

Staying active can help prevent and manage a number of physical conditions, and it also has a role in mental wellbeing

In many cases, the earlier someone adopts a healthy lifestyle, the better, but it is also rarely too late to change bad habits

Above the neck

Staying mentally active is as important as maintaining levels of physical activity, says Age UK’s David: “Staying in touch with the local community via neighbours, family, friends or a local club reduces isolation and loneliness, and prevents the downward spiral that can so easily happen and ends up with someone who feels like they simply can’t get out of the house.” Anything that breaks up the day-to-day routine is good, he says, whether that’s playing a board game with someone or doing puzzles such as Sudoku on a computer.

There are many schemes available to get older people out of the house, including lunch clubs, tea parties and befriending initiatives. If someone is reluctant to participate in what is on offer, David suggests gentle encouragement. For example, a family member or friend who normally does the shopping for an older person and drops it in could propose going to the supermarket together for a change, or even just sit with them and go through the newspaper to discuss the stories. “It’s about getting them to engage in something different,” he recommends.

While many older people will have regular GP appointments for a long-term condition or medication, it can be easy to overlook other areas of their health. Eyes are a prime example, and it is worth reminding the over 60s that they are entitled to an NHS-funded sight test every two years. This assesses both standard and peripheral vision, and looks for signs of other conditions, such as macular degeneration, glaucoma and cataracts. If picked up early, many of these can be well managed and further damage minimised.

Many older people find they have problems with their eyesight, despite getting the all clear at the optician. This may well be because 60-year-olds require three times the amount of light as a 20-year-old to see clearly, so provide advice on pulling curtains back as far as they can go, keeping windows clean, and having good lighting, particularly at the top and bottom of the stairs and for close work such as reading or sewing.

Problems with hearing affect a huge number of older people – the charity Action on Hearing Loss says that 1.3 million people in the UK wear a hearing aid, but four million would benefit from such a device – and there are certain signs to look out for that could indicate a problem. These include having to turn up the TV or radio volume more than in the past, asking people to repeat things they have said because they seem to be mumbling, missing the doorbell or telephone ringing or a name being called, or finding it difficult to have a conversation when there is background noise. The GP should be the first port of call, as they can conduct some simple tests and refer the patient for a hearing test if needed.

 

 

A friend indeed

A condition that is reaching the public consciousness like never before is dementia. There are around 800,000 people in the UK with the condition, but this figure is predicted to rise to over a million by 2021. George McNamara, head of policy and public affairs at the Alzheimer’s Society, says: “Dementia is a national challenge that goes far beyond health and social care, and the quality of life for many people with the condition is very poor.”

The sheer number of people who are affected by dementia has led to the Dementia Friends initiative. This involves people attending an information session or watching a short video online so they understand more about the condition and the little things that can be done to make a difference to sufferers. Many pharmacies now have a Dementia Friend among their staff, thanks to a current Centre for Pharmacy Postgraduate Education programme that includes an information session open to all support staff. Numerous people have built on their training to become Dementia Champions, which means they can then run information sessions so that others can become Dementia Friends.

Lloydspharmacy is taking the initiative one step further. Clare Kerr, head of external affairs, says: “This is a really important area that supports our customer base and we are encouraging as many colleagues as possible across the company to become Dementia Friends and Champions. We are not just thinking of this as a brief initiative, but rather as an ongoing, longer-term project, by building it into the induction of people coming into the business.”

The multiple is also hoping to work with the Alzheimer’s Society on strategic improvements that will help dementia patients in their everyday lives. As well as looking at how pharmacy services can be tailored for this patient group, Clare says: “We are looking at making the environment of our branches more dementia-friendly – for example, by having clearer signage and imagery and making sure the shop floor is clutter-free."