Currently costing the UK more than £26 billion a year, dementia is arguably the biggest health challenge this country faces. What role can pharmacy play to help?

According to the Alzheimer’s Society, there are 850,000 dementia sufferers in the UK at the moment, each of whom incurs average annual costs of over £32,000. Perhaps surprisingly, a relatively small proportion of this money – well under 20 per cent – is spent on healthcare, the remainder going on social care (both publicly and privately funded) and other costs including unpaid care. As breathtaking as these figures are, projections on the amount dementia is likely to cost in the not-so-distant future are overwhelming.

Independent health charity The King’s Fund estimates that the financial cost of the condition in England alone will rise to £34 billion by 2026. And it is worth noting that while one million people in the UK are predicted to have dementia by 2025, by 2050, this is likely to have doubled. While the maths is certainly doable, the prospect, in terms of both money and the wellbeing of the population at large, is almost unthinkable.

NICE guidance

It’s little wonder that guidance has recently been published on steps that can be taken to delay or prevent the onset of dementia as well as disability and frailty in later life. The document, published by the National Institute for Health and Care Excellence (NICE), makes no bones that these problems are sometimes determined by factors that can’t be altered, such as genetics or injury. But it also spells out clearly the fact that people can do much to reduce their risk by putting into place relatively simple changes in behaviour, namely:

• Stopping smoking
• Being more active
• Reducing alcohol consumption
• Improving diet
• Maintaining a healthy weight, and losing weight if necessary.

None of these changes should be news for pharmacy teams, since all are steps that are well recognised as having a wide range of health benefits. Awareness raising is another recommendation made in the NICE guidance and Gavin Terry, policy manager at the Alzheimer’s Society, is of the opinion that pharmacy teams are perfectly situated to assist in this.

“People who are concerned that they or a loved one have some memory loss may not go to their GP, perhaps out of embarrassment, and would prefer to seek help from somewhere that is less formal but still a healthcare environment, such as a pharmacy.” Having leaflets such as the charity’s Worried About Your Memory? booklet on display can be helpful prompts for conversations that individuals may not want to broach themselves, he suggests.

Spotting the signs

Early diagnosis is crucial, stresses Gavin: “One of our campaigns is called ‘Right to Know’ and is about people with dementia getting it diagnosed as early as possible so they can get the information and support they need to deal with the condition and plan for the future. Pharmacists and their staff Having some knowledge of dementia means they can encourage people who may be experiencing symptoms to take that important next step of going to the GP.”

But how can the moments of forgetfulness that everyone goes through every now and then be distinguished from memory lapses that may indicate something more serious? Gavin says that the key is to look for progression and impact.

So, for example, while everybody forgets every now and then whether they paid a particular bill, someone with dementia is likely to struggle with the process of paying the bill in the first place. An individual going to see, say, a friend they have visited in the past might pause to remember the way but would ultimately recall it, whereas a dementia sufferer would quickly become disorientated and be unable to follow any directions that had been provided.

Similarly, everyone forgets the odd word they are trying to remember, but it doesn’t impact on the flow of conversation, which compares starkly to a dementia patient who is likely to forget and misuse several words and repeat themselves several times during an exchange. While it goes without saying that there is a need to be nonjudgemental and empathetic when talking to a customer who is concerned that their memory, or that of a loved one, is deteriorating (becoming a Dementia Friend can make a huge difference in this respect), it is also important to be aware of other conditions that can present in a similar way, such as:

• Depression, although the onset of symptoms is likely to be more rapid
• Thyroid problems, as the metabolism running too fast or slow can cause confusion and sluggishness respectively
• Dehydration, particularly in older people, can lead to drowsiness and confusion, and is more likely to occur in hot weather, during bouts of diarrhoea or vomiting, and in those taking diuretic medication
• Acute delirium, which can be the result of a chest or urinary infection, particularly in older people, or alcohol withdrawal. Onset of symptoms is usually fast (hours or days) and the patient is likely to be more confused and disorientated as the day progresses, and may become aggressive or irritable as a result
• An adverse drug reaction. Common culprits include painkillers (more commonly opioids, but also some NSAIDs), older antidepressants, antipsychotics, benzodiazepines (e.g. temazepam), antiepileptics, some antibiotics, corticosteroids, some cardiac drugs including beta-blockers, digoxin and ACE inhibitors, and any drug with anticholinergic activity, such as H2-receptor antagonists.

Don’t give up

For individuals who have been diagnosed with dementia, there can be a tendency to give up, but this is a mistake, says Gavin. “Many of the steps that have been recommended in the NICE guidelines on delaying or preventing the onset of dementia apply equally to people who have already been diagnosed because they can help them stay better for longer,” he says. “This means that not only are they better able to plan for the future, but also means they are likely to be able to stay in their own homes and remain independent for longer than they would do otherwise.”

Again, this is an area that pharmacy support staff can easily become involved in. One of the key points to highlight is the importance of exercising the brain as well as the body. This doesn’t necessarily mean using ‘brain training’ software and apps – though there is evidence that these can be beneficial – as more subtle adjustments can be equally valuable.

For example:

• Playing strategy games such as chess and bridge
• Doing word and number puzzles (e.g. crosswords and Sudoku)
• Reading newspapers, magazines and books
• Learning new things – from a foreign language course to attempting to cook a previously untried recipe
• Taking a different walking route rather than the same one every day
• Undertaking a project that involves planning. For example, making a quilt or redesigning part of the house or garden.

Pharmacy staff can also suggest modifications that can help compensate for any lapse in memory. This includes anything from general tips, such as keeping belongings organised by having designated places for important objects such as keys and glasses and using a calendar to keep track of appointments, to more specialised advice such as suggesting devices that can help with medication adherence.

Exercising the brain by playing strategy games such as chess can be valuable for people with dementia

Further resources

• The NICE guidance, entitled Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset, can be found here. While reading such publications may seem daunting, it is worth bearing in mind the fact that the organisation has worked hard over recent years to make its documents easier to read and understand
• Information about the Alzheimer’s Society’s ‘Right To Know’ campaign, including a link to download or order the Worried About Your Memory? booklet, is available here
• Details of the Dementia Friends initiative, set up by the Alzheimer’s Society to transform the way the nation thinks, acts and talks about the condition, can be found here.

One million people in the UK are predicted to have dementia by 2025. By 2050, this is likely to have doubled