The UK population is ageing rapidly, with the number of older people (defined by NICE as those aged 65 and over) making up nearly 18 per cent of the total, according to the Office for National Statistics. But living longer often goes hand in hand with poorer health, which is where pharmacy teams have a role to play. Helping older people stay healthy will not only improve their quality of life but also enable them to stay living in the community rather than ending up in secondary or social care.
A healthy lifestyle that includes regular exercise, a balanced diet and an active social life are all important factors in ageing well, and Marion Shoard – writer and lecturer on older people, and author of How to Handle Later Life – says it’s never too early to start. She says: “Research has shown an association between some of the most common and most disabling medical conditions of old age such as diabetes, dementia, osteoporosis and cardiovascular disease, and factors which individual older people can do something about – such as their diet and the extent to which they socialise with other people and engage in physical activity. So it is worth taking steps to reduce any known risk of developing [these] conditions, which are common but not an inevitable result of ageing.”
Following a healthy diet that includes the right balance of nutrients is also important for protecting long-term health, yet many people are still unsure of what that means. Dr Emma Derbyshire, nutritionist and advisor to the Health & Food Supplements Information Service, says this is where community pharmacy has a key advisory role, because if people feel they are not getting the nutrients they need through diet alone then multivitamin supplementation can help. “As Government surveys show that many people aged 50 and beyond are missing out on vital nutrients, a good multivitamin helps bridge dietary gaps and keeps our body fuelled as we age”, says Emma. “For example, calcium and vitamin D work together to help keep our bones strong; vitamin D which is low in many people’s diets, supports our immune functions; and calcium is involved in the transmission of nerve impulses. Vitamin C helps keep cells healthy and facilitates the absorption of iron, whilst iron is involved in the production of red blood cells and helps get oxygen around our bodies, along with riboflavin (vitamin B2) vitamins B6 and B12 and folic acid.”
Government studies also claim that around a quarter of adults in the UK admit to taking part in fewer than 30 minutes of physical activity a week, which can have far-reaching effects in later life. Staying active doesn’t just regulate body weight, as Marion explains: “Physical activity reduces the risk of developing many of the common ailments of later life, or of preventing them getting worse. Aerobic exercise significantly reduces the risk of developing cardiovascular disease and so the risk of strokes, heart attacks and vascular dementia (which results from many tiny strokes and is the second main cause of dementia after Alzheimer’s disease). “Flexibility enables us to retain a wide range of movement in our joints and muscles, as well as walk correctly, while strengthening our muscles enables us not only to climb hills and play badminton but also rise easily from a chair, reach up to shelves, and so remain independent of other people to help with daily activities.”
And maintaining physical activity in later life is important for other reasons too, according to Gopal Ladva, integrated care clinical pharmacist (older people) at Guy’s & St Thomas’ NHS Foundation Trust Community Services, and HCA and pharmacy technician training tutor at Inspire Middlesex College. “We know that older people are at risk of falls, and the problems that occur thereafter, but there is a stage before that which exercise can help mitigate, which many people are not aware of,” he says. “By staying active in older years you minimise your responses to stressors. For example, if someone has not been looking after their own health and develops an acute infection, that can cause a confusional state. This may lead to a fall, they have a fracture, have to be admitted into secondary care and will never recover back to baseline.” The solution is simple, according to Gopal: “Talk to your customers. Ask if they are doing 30 minutes of heart-rate-raising exercise five times a week and explain that increasing their stability means if they are faced by a stressor they are in a better place to deal with it, because being stronger physically, with good muscle mass and bone density, helps fight infection.”
Age UK’s Wellbeing in Later Life survey showed that one in 10 over-65s are regularly dancing and attending dance classes, which has been found to reduce the risk of falls and positively impact their mental and physical wellbeing. The charity says the reason for this could be because “dancing is a highly sociable activity [so] for many of these older dancers the opportunity to meet new friends is a major attraction of getting involved”, plus “research has found that just an hour of dancing a week lowers the chances of having a fall”. Dancing and other forms of physical activity also help to keep the brain in good working order. In addition to the physical benefits, Age UK’s Wellbeing Index found that participating in ‘creative activities’ of all kinds, including dancing, was the single most effective thing any older person could do to improve their sense of wellbeing.
Just as the body benefits from physical exercise, keeping the brain active can help keep us mentally healthy too. “Brain health is a real concern because our mental and emotional wellbeing shapes every moment of every day,” says Emma, “and the latest science and studies show there is a lot we can do – such as exercise and eating healthily – to maintain our emotional and intellectual brain power.” However, although some studies have suggested that keeping active and engaged with the world reduces the risks of dementia, Marion warns that: “While the greatest risk factor for dementia is age, which of course we cannot affect, the causes of dementia remain unclear.
It is important not to assume that keeping your mind active will stop you developing dementia. If you do lots of word puzzles, for instance, you will probably get better at doing puzzles, but you may still get dementia.” However, Marion adds: “A team of leading experts did identify a number of risk factors which in combination could account for 35 per cent of dementia and potentially could be modifi ed. In a review in The Lancet in 2017, they explained that these are: high blood pressure in midlife (age 45-65 years), obesity in midlife, physical inactivity, smoking, diabetes, depression in later life (over the age of 65), hearing loss, and social isolation.”
In fact, we now know that staying socially connected is a vital factor in keeping healthy in older age. “Socialising is important for longevity and can help to improve mood, increase feelings of wellbeing and help offset feelings of depression,” says Emma. This is important because, according to The Mental Health Foundation, older people are more vulnerable to mental health problems, with – it says – depression affecting around 22 per cent of men and 28 per cent of women aged 65 years and over.
Gopal sees the effects of loneliness first hand when he visits older people in their homes to help with medicines management. “Data suggests that a third of our elderly population will have social isolation issues – nearer half for those over 80,” he says. “We see this regularly, and how it leads to negative physical and mental outcomes – for example, the damage it causes is equivalent to having hypertension or smoking.” His solution is raising awareness, and signposting. He says: “Pharmacy staff can do a great deal to interact with their community, and need to be aware of initiatives to signpost people on to, such as Age UK events, befriending services, workshops, and health centres running classes for older people. Taking part in social activities like this helps keep people independent and reduces their risk of mental health problems, depression, and anxiety.”
Keeping socially connected, physically active and mentally healthy can also have the cumulative benefit of helping older people stay in the community rather than ending up in secondary or social care. Indeed, recent research in the British Medical Journal suggests that a concerted effort to provide support and opportunities for physical activity can help older adults maintain independence and lessen the costly burden of social care – which not only costs an average of £32,600 a year for a residential care placement, but may be required for decades if the person never returns to “baseline”, as Gopal mentions. “Moving to unfamiliar environments shows evidence of functional ability declining, plus people are vulnerable in secondary or social care, with an increased risk of falls and fractures, and anxiety,” adds Gopal.
On the other hand, independent living is not for everyone, and Marion says: “The benefits are not always clear-cut. In theory, you have greater choice if you are living in your own home and can decide how your days are organised, but it is no fun being at home, [if you are] unable to get out and about and cut off from other people. You might be happier in the company of other people and with the practical help you need available whenever you need it in a care home.”
With a little research and a good dose of empathy there is plenty of advice, services and signposting that community pharmacy teams can offer that will help older people keep their brain and body in good working order. Caroline Abrahams, charity director at Age UK, says: “Pharmacy staff can play an extremely important role in supporting older people’s health, not just by dispensing and providing advice on medicines but also by helping them to manage their health conditions and by being a friendly, expert ear for any concerns. By encouraging older people to focus on what they are able to do, rather than the things they cannot do, you can buoy up the self-confidence and resilience of your older customers, supporting them to stay well and get the most out of life.”
Because community pharmacies are much more accessible than GPs to many, Marion suggests staff can “help individuals monitor their own health through telehealth devices”, and “provide information on the importance of physical activity and about exercise classes and walking groups in their locality, as well as signposting people to social clubs and volunteering and other activities”.
Gopal says signposting to Age UK is “an absolute must”. He says: “They do a lot of work around keeping people independent, provide home assessments to identify issues, and have befriending services. Community pharmacies should also engage with local care networks, and even if you don’t attend the meetings yourself you should be able to signpost people towards the services they offer in your area.” Gopal’s advice – which holds true in so many community pharmacy interactions – is that “even if someone comes to us with problem A it is worth looking for problem B. Think holistically about the individual and ask WWHAM questions about their general health, as any warning signs or symptoms you identify could be really pivotal in protecting that. I tell students they are the frontline of healthcare so don’t ever take your role lightly. Even a couple of minutes of your time could make all the difference.”
Data suggests that a third of our elderly population will have social isolation issues – nearer half for those over 80