Community pharmacy can play a pivotal role in supporting the elderly through the cold winter months as Jane Devenish, a pharmacist at Well, explains…
Winter often causes health problems or exacerbates existing long-term conditions. Pharmacists are in the ideal position to be able to offer clinical advice and various types of treatment to the elderly to support them with winter ailments. Such guidance can help to catch symptoms early, reducing the chance of fatalities, helping to relieve pressure on GP’s who are under additional strain at this time of year, and reducing the number of hospital admissions.
The elderly are at higher risk of contracting flu and many health complications that can occur consequently, such as pneumonia. If a patient is over 65, pharmacy teams can recommend getting one single flu vaccine in October to December. If elderly patients do get flu after having the vaccination, it’s likely to be milder and shorter-lived than it would have been if they had not had the vaccination. Pharmacy teams should take this opportunity to check if the patient has also had the pneumococcal vaccine, and if not, recommend they go to their GP for this.
Asthma can worsen in the winter, and can be life-threating to the elderly. Cold air can trigger asthma symptoms such as shortness of breath, wheezing, tightness in the chest and difficulty speaking. Pharmacy teams can monitor their elderly customers for these symptoms, and provide advice on how to reduce these symptoms and what to do if they have an asthma attack – they can work together on creating an ‘Asthma Action Plan’. A fantastic resource to help with this can be found at www.asthma.org.uk
Pharmacy teams can recommend that patients avoid going outdoors on very cold and windy days and they be vigilant when taking regular medication. Most importantly, they should use their preventer inhaler regularly to avoid an attack, and keep their reliever inhalers close by just in case. Advise patients that if they have an asthma attack, they should take one to two puffs of the inhaler immediately, sit down and try to take slow breaths, then take two puffs of inhaler (one puff at a time) in every two minutes. They can take up to 10 puffs if the asthma attack does not subside.
Elderly patients with COPD often fair worse during the winter months but making sure that they have a rescue pack at home can be a massive help. Also, if you offer a delivery service it might also be worth reminding them of this being there in case they do need it.
The sickness bug Norovirus can occur all year around, although it is more prevalent in the winter months when the virus finds it easier to spread. The elderly are at a higher risk of getting Norovirus as their immune systems are weaker, and Norovirus can easily be transmitted in care homes through the passing of airborne particles or via person to person. If the elderly do fall ill with Norovirus, the greatest risk is dehydration. Pharmacy teams should advise patients to stay hydrated, and take rehydration sachets which are available in pharmacies.
Pharmacists should contact the GP if the patient has reduced urine output as this could indicate dehydration, or if they have a condition such as kidney disease where additional care is needed.
The cold weather increases blood pressure and puts more strain on the heart, increasing the risk of a cardiovascular event, particularly in the elderly. In colder climates, the body must work harder at maintaining a stable body temperature. To reduce the risk of elderly people having heart attacks, pharmacy teams should advise them to keep warm both indoors and outdoors, through layering up warm clothes and making sure their living environments are at the recommended temperature.
Raynaud’s and Chilblains
Raynaud’s and chilblains are more likely when it’s cold and can cause painful tingling and throbbing sensations usually on the fingers and toes. Chilblains can also be very itchy.
To prevent both conditions, elderly people should be advised to eat at least one hot meal a day, keep active, put gloves on when they go outside, wear layers for maximum insulation, and avoid getting wet, as this reduces the insulating effect of clothes. If they do get cold, avoid the temptation to warm up too fast by heating their hands on the radiator, for example, as this can cause chilblains or exacerbate existing ones.
To prevent chilblains, pharmacists can recommend keeping skin well moisturised so that it remains flexible, and can heal itself quickly. A warming moisturising cream like Balmosa can help too.
Patients need to be especially careful if chilblains break and become infected, or if they are diabetic. Diabetics may not be able to feel their feet and could have infected chilblains without realising it, so pharmacists can check the patient.
If elderly patients smoke, pharmacy teams should recommend that they engage with a smoking cessation service, as this can improve the symptoms of both Raynaud’s and chilblains.