More and more middle-aged women in the UK have the responsibility of caring for multiple family members and for many, their health is suffering as a result. What can pharmacy teams do to help?

The combination of an ageing population and people starting families later in life is resulting in the rise of a group of people with ‘sandwich caring’ responsibilities. And research shows that it is middle-aged women who are more likely to face the pressure of having to simultaneously shoulder the responsibility for both young and old family members.

The number of middle-aged (50-64) female carers has risen by 13 per cent to 1.2 million in the last 10 years, according to a Carers UK study. They also found that women aged 40-60 are four times more likely than men to have given up work due to multiple caring responsibilities, resulting in financial hardship. Other recent research by the Centre for Longitudinal Studies shows that this is becoming one of the hardest pressed generations and these demands are having an impact on carers’ health, wellbeing and employment.

This study found that nearly a fifth of the 17,000 55-year-old participants spend 10 or more hours a week caring for grandchildren, parents or both. These people were considerably less likely to rate their health as ‘excellent’ or ‘very good’ compared to those who had few caring responsibilities. Similarly, they were less likely to say that they often felt full of energy, that their lives were full of opportunity, or that the future looked good.

Julia Ellis, development manager (primary care and community reach) at the Carers Trust, says: “There are very strong links between caring and ill-health. Carers, particularly women, tend to put their own needs on the back burner, such as attending health screening appointments, until things get really serious.”

She says it is well documented that high levels of depression and anxiety are common among sandwich carers, particularly those who have had to give up work because of their caring responsibilities. This group of women are less likely to go to a doctor when they have early symptoms of diseases like cancer and they may also suffer physical injuries from incorrect moving and handling of disabled relatives.

Julia explains: “Our research shows that generally, in terms of health impact, carers are twice as likely themselves to become permanently sick or disabled. One study found that 51 per cent of carers had a physical injury and 52 per cent were being treated for a stress-related illness.

“Carers feel isolated and say they don’t have much of a life outside caring. Very few carers know that help is available and very few identify with the word carer. It’s not something people readily adopt as a label and identity.”

But Julia says the local pharmacy is ideally placed to identify these female sandwich carers and can provide them with an indispensable, informed and approachable source of advice and support.

How pharmacy teams can help

Flu jabs

In the 2014-15 flu campaign, only 174,522 out of 5,430,000 carers were vaccinated at a GP practice, yet all carers are entitled to a free flu jab. Now the new pharmacy flu vaccination service is enabling carers to have a free NHS flu vaccination at their local pharmacy and it is an opportunity for pharmacy teams to help identify this group of customers who may be missing out.

Pharmacy staff can explain to women sandwich carers that they would particularly benefit from this service as flu is more likely to be brought into the home by their children and then passed on to the people they are caring for.

The Carers Trust has developed a script for a 60-second pharmacy flu chat to help pharmacy teams discreetly ask if someone might be a carer and explain why they might benefit from having a flu jab. This guidance can be found here.

Health checks

Heart disease

Health checks, including blood pressure, cholesterol, and blood sugar tests, will help women who may be neglecting their own heart health to identify any problems early and take steps to improve their health. A Carers Trust project in Salford, where nurses went out into the community offering health checks to carers, identified an unusually high number of people with undiagnosed high blood pressure and diabetes.

According to the British Heart Foundation there are over 900,000 women in the UK living with coronary heart disease. Coronary heart disease kills nearly three times more women than breast cancer. “Suggesting that a carer has their blood pressure taken while waiting for a prescription in the pharmacy could be a lifesaver,” suggests Julia.

Lung cancer

Women in the 40-60 age group may be at risk of lung cancer, the second most common cancer in the UK. Since 1975, rates of lung cancer in the UK have risen by 73 per cent in women, but have fallen by 47 per cent in men, according to Cancer Research UK. Lung cancer rates in women are now 41 per 100,000, almost doubling from 23 per 100,000 in 1975.

The explanation lies in contrasting trends in smoking habits: while the number of male smokers has been falling since the 1950s, women did not start to give up until the 1970s. Pharmacy teams can signpost smokers to the pharmacy’s smoking cessation service or to an NHS smoking cessation service.

Breast and cervical cancer

Each year around 50,000 women in the UK are diagnosed with breast cancer and 2,800 with cervical cancer. If both diseases are diagnosed at an early stage there is a good chance of preventing them spreading to other parts of the body.

It is well known that women carers don’t make time to look after themselves and often fail to attend health screening appointments such as smear tests. Pharmacy staff can play a role in advising women of the importance of attending these.

Signposting

The Carers Trust recently ran a Carer Friendly Pharmacy Scheme pilot which successfully encouraged pharmacy staff to identify carers and refer them to their local carer’s organisations for help and support. They also alerted their local GP surgery so that their medical records could be tagged.

Carers can be easily spotted as they are likely to be regular visitors to the pharmacy collecting prescriptions and managing medication for other people. “This is great for customer relationships because you are showing women carers that you are a resource for them in their local community and they will report back and tell other people,” says Julia. “You’re actually making a difference to people you see on a regular basis who are struggling.

“You can see that these women are tired, that they’re worried, that they think about dashing back home because they can’t leave the person in the room for very long and just making that small difference sometimes can be quite life changing for the carer.”

Yvette Oliver, manager of Newland Community Pharmacy, Hull, which participated in the Carer Friendly Pharmacy project, adds: “This group of middle-aged female sandwich carers are quite hard to identify because on the surface they often appear to be coping and they are usually rushing as well because they have so much to do so do not have time to stand and talk. But the pharmacy can still display leaflets offering help to carers, which might catch their eye.”

And Sami Hanna, owner of the Lobley Hill Pharmacy, Newcastle upon Tyne, who also participated in the Carer Friendly Pharmacy project, says the carers they identified were often at breaking point and very much in need of assistance: “We always offer these group of women a flu jab or a health check and put them in touch with the Carers Association if they need more support. It’s very rewarding to be able to help them”.

 Carers are twice as likely themselves to become permanently sick or disabled