Pharmacists are in a better position than GPs to notice any physical and mental decline  

Many older people have specific care needs and health requirements. But they must still be treated as individuals, explains Victoria Goldman

According to the latest figures from the Office for National Statistics, there are now 11.4 million people aged 65 or over in the UK. The over-65s are a highly diverse age group, with over 40 years’ life experience between the youngest and oldest ends of the spectrum. They vary significantly in their health, mobility and social needs.

Some over-65s work out in a gym regularly, whereas others have poor mobility. Some have multiple chronic health problems, while others may have none. More than a million over-65s are still in employment, having put off retirement.

Pharmacist Reena Barai, who owns SG Barai Pharmacy in Sutton, says that 65 is still relatively young when it comes to health. “When we all talk about older people, we really mean the over-75s or even the over-80s these days, although some people in these age groups are still fit and healthy too,” she says. “When dealing with older customers, we need to make sure we offer the same services that we would offer to any customer, but cater for any specific needs that may arise.”

Targeted advice

According to Age UK, 60 per cent of older people in the UK experience age discrimination on a daily basis. And 53 per cent of adults agree that once you reach very old age, people tend to treat you as a child.

Tom Gentry, policy advisor on health and care at Age UK, says it’s important not to make judgements or assumptions about older customers. “Pharmacists can’t make a complete assessment of every customer, but should keep an open mind, as developmental age can be a poor indicator of someone’s health,” he says. “Cognitive decline, for example, could be dementia but may also indicate a mild or temporary problem. Don’t assume that customers can’t do things for themselves, as many older people live independently for years.”

Ms Barai stresses that patience is important. “Younger people often get frustrated with older people,” she says. “But remember that just because people are older, this doesn’t mean they are any less intelligent. It’s important not to be condescending and to target communications at the right level. You may need to speak louder or more slowly, but think about how you would like to be treated.”

According to the British Geriatrics Society, only around 10 per cent of the over-65s are frail, but this rises to between 25 and 50 per cent of the over-85s. Frailty is a distinctive health state related to ageing in which the body gradually loses its in-built reserves. The signs are varied, but include unintentional weight loss, reduced muscle strength, loss of hearing or low mood.

“Frailty can come on very quickly, within months or even weeks in some people, so it’s important to be aware of the signs,” says Ms Barai. “Pharmacists are in a better position than GPs to notice any physical and mental decline, because they get to know their customers through regular contact.”

The concept of frailty is used to signpost services that are known to deliver better health for older people. But research commissioned by Age UK and the British Geriatrics Society, published in July 2015, revealed that using the medical term ‘frailty’ can provoke a strongly negative reaction from older people, because of its associations with loss of independence and end of life.

Dr Adam Gordon, spokesperson for the British Geriatrics Society, says: “If the patients we are seeking to help are put off by the very use of the word ‘frail’, then perhaps we’ll need to reconsider how we refer to such initiatives.”

Pharmacy services

It’s important to check that older customers are able to access services such as MURs. “Some older people are proficient in using the internet, for example, and are able to order prescriptions online with ease,” says Ms Barai. “But some don’t have access to this technology or find it difficult to deal with everything electronically. There are also older people who struggle to come into the pharmacy to collect their prescriptions or take part in an MUR.”

In May 2015, the Centre for Pharmacy Postgraduate Education (CPPE) launched a ‘Supporting older people’ learning campaign to get pharmacists thinking about how they can support older people. Karen Wragg, regional manager south central at the CPPE, says independent pharmacists may need to assess the training they provide for their delivery drivers, who may be the only contact some isolated older people have on a weekly basis.

“Another key area to focus on is transfer of care between settings,” she says. “By forging better relationships with pharmacy teams in local hospitals, community pharmacy teams can develop services locally to ensure that errors are minimised as people move to and from secondary care.”

An estimated four million older people in the UK have a limiting chronic illness, and pharmacies are an important place for older people to obtain health products and advice. “There are many pharmacy products that can be targeted at older customers,” says Ms Barai. “For example, pharmacies should stock incontinence ranges, such as TENA, and be aware of the different products available, from pads and pants to bed mats,” she says. “Some customers will benefit from disability aids – products to help with eating, drinking and grabbing items at home.”

Targeting products

Some of the topics on which older people need assistance may seem obvious, such as osteoporosis, joint health, falls prevention and dementia. But others may be considered more suitable for younger customers, even though they are still relevant to this age group. Topical analgesics, for example, can have a dual purpose – to ease aches and pains associated with arthritis, but also to manage acute sports injuries. They range from ibuprofen gels and rubefacient creams to heating and cooling patches. New Voltarol 140mg Medicated Plaster provides another topical option for pharmacists to recommend, as it’s a pharmacy-only patch containing the anti-inflammatory ingredient diclofenac.

In April, Nuffield Health revealed that the over-65s are the UK’s most frequent gym users, highlighting the increasing importance of good health and fitness to the older generation. Gym usage peaks at age 72, at eight visits per month.

“Many people are continuing to exercise and play sport into their 80s and beyond,” says Elvy Mardjono, senior product manager for Deep Relief Pain Relief Gel. “Even more enjoy walking the dog, gardening or spending time on crafts and hobbies. When customers want something to ease pain, pharmacy staff have a chance to discuss a range of pain-relieving options and highlight the benefits of topical analgesics for suitable customers.”

As we head towards winter, pharmacies need to watch out for cold and flu complications in older customers. This year’s national winter health campaign – Stay Well This Winter – focuses on people with long-term conditions, the over-65s, carers, pregnant woman and parents of the under-fives.

Last year, Office for National Statistics figures showed 18,300 excess winter deaths last year from cold-related illnesses, such as heart attacks and strokes. Most of these deaths were in older people, with 15,900 in the over-65s. According to Jan Batten, a British Lung Foundation respiratory nurse specialist, it’s important to remind eligible customers to have their flu and pneumonia jabs.

Lung Cancer Awareness Month takes place every November. Pharmacists play an important role in raising awareness, especially when customers are buying cough medicines. “When advising on a cough, pharmacists should ask how long they’ve had a cough, if it’s dry or producing, and whether they are experiencing any other symptoms,” says Ms Batten. “They should also ask whether the person has any other conditions such as chronic obstructive pulmonary disease (COPD) or another respiratory condition. All of this should help the pharmacist assess whether they should be referred to their GP.”