Sadik Al Hassan, a pharmacist at Well, considers how important community pharmacies are to our senior citizens…


With around 1.2 million people visiting a community pharmacy in UK every day we have access to a very large patient population. Over half of all the prescriptions we dispense in pharmacy are for people over 65 years of age, with those over 75 years old likely to be on four or more medicines at a time.

Our elderly patients are generally divided into three categories; 65 to 74 years often referred to as the ‘young elderly’, 75 to 84 years referred to as ‘elderly’ and 85 years plus termed ‘very elderly.’
During the winter months the elderly and very elderly are at increased risk of negative health outcomes but with our regular contact with these patient groups, we are in an ideal position to help manage their health and wellbeing.

The biggest risks for these groups during winter are usually hypothermia and falls. Hypothermia is a dangerous drop in body temperature and affects the elderly who are inactive as well as those who do not eat well.
The early signs to look out for in your patients are shivering, slurred speech, fast breathing, tiredness, cold/pale skin and confusion.
If any of these symptoms are present call an ambulance for immediate treatment. Pharmacists can help prevent this by ensuring elderly patients keep warm and keep active to keep well.

There many commonly prescribed medications that can increase the risk of falls in the elderly. During winter any elderly patients who take antipsychotics, Parkinson’s treatments, antidepressants, antiepileptic, diuretics, high blood pressure medication, painkillers and antihistamines could benefit from a Medication Use Review.
A review helps to educate patients about their medicines and enables the pharmacist to review any treatment needs around osteoporosis risk.
Practical advice that pharmacy teams could give to this patient group to reduce the risk of falls includes:

• Removing clutter throughout the home.
• Choosing appropriate footwear to remain steady and stable.
• Having good lighting throughout the home.
• Using non-slip mats and rugs.

Coughs and colds
Advice on managing colds in the elderly includes:

• Encourage the patient to wash their hands often, stay well hydrated and eat a balanced diet.
• When recommending OTC medication in the elderly extra care must be taken due to existing conditions, medication and kidney function, so ensure you take a full medical history.
• Counsel on when to use Rescue Packs in COPD/asthma patients and make sure they have them in winter months.
• Refer on if the patient exhibits any of these symptoms: high fever, shortness of breath, wheezing, pain (sinus, ear) and sputum that is foul smelling or contains blood.

The following common conditions that affect the elderly and very elderly can be exacerbated during the winter months:

• Patients with dementia may struggle to adjust to the colder weather and monitoring their regular medication provides pharmacy teams with a good prompt to make contact to check on their wellbeing.
• In diabetics, the winter usually means an increase in blood sugar and reduced control of their condition associated with serious infections like influenza. A recommendation of an increase in regular exercise could help to increase insulin sensitivity during the winter months. Diabetics should regularly test if using insulin in case their requirements decrease. Poor peripheral sensation in diabetics can increase the chances of hypothermia not being detected, so staying warm is very important.
• In Parkinson’s patients the increase in protein associated with winter eating (e.g. Turkey at Christmas) has been shown to reduce absorption of Levodopa so pharmacists should advise that medication containing Levodopa should be taken 60 minutes before food.
• Arthritic conditions are often reported by patients as worsening during periods of cold weather but the reason for this is still largely unknown. One theory to explain worsening arthritis in the winter states that the increased air pressure leads to increase pain in joints. However, a more likely option is that cold temperature signals sent by nerve fibres cause an amplification effect of existing pain signals. Reduced activity can lead to a worsening of the condition so it is important to advice patients to remain active during the winter months and a conversation around a joint supplement could benefit them too.
• More Elderly Patients die from Coronary Heart Disease in the winter than any other season of the year. It is thought that the body’s own clotting control process, haemostasis, might be responsible specifically involving an increase in von Willebrand Factor, D-Dimer and tissue plasminogen activator clotting factors. Cold weather also increases the heart rate and blood pressure putting more strain on the heart.

Patients with chronic heart disease, COPD and diabetes are at greater risk from colds, influenza and pneumonia so it’s vital that this group have the influenza vaccination.
Patients over 65 years of age qualify for a free vaccine under the seasonal influenza vaccination advanced service that was confirmed for this year in the Department of Health’s annual flu letter.
The advanced service can be operated by a trained pharmacist in any pharmacy in England with a consultation room suitable for MURs. The PSNC and LPCs can offer support to land a vaccination service in your pharmacy so that your elderly patients can benefit from this when they need it most.