INITIATIVE
MEDICINES OPTIMISATION IN THE ELDERLY: BACK TO BASICS
A RECENT ‘THINK TANK’ LOOKED AT MEDICINES OPTIMISATION IN OLDER PEOPLE IN NI. HERE, DEIRDRE MCCLOSKEY, PROJECT DEVELOPMENT MANAGER AT MID AND EAST ANTRIM AGEWELL PARTNERSHIP (MEAAP), ASKS ‘ARE COMMUNITY PHARMACISTS
ASKING THE RIGHT QUESTIONS?’ At the Think Tank, which was attended by 50 people representing hospital and community pharmacy, Local Commissioning Groups, GPs, the Department of Health, MEAAP and the Health & Social Care Board, it was very clear that, as the Chief Pharmaceutical Officer, Dr Mark Timoney, said, we have both a moral and ethical obligation to our increasing population of older people to optimise their medicines and to focus on their healthcare journey.
On the day, pharmacists from various settings, including care homes, intermediate care and the acute setting presented on their innovative work and new services, and it was clear that there’s some fantastic work currently being done in this area.
I would bring the whole issue down a step further and look at the need to establish older people’s needs on a holistic basis and consider issues such as health literacy: an area in which I firmly believe that you, as a community pharmacist, have an incredibly vital role to play.
All healthcare professionals need to continually challenge themselves
44 - PHARMACY IN FOCUS
to ensure that, when giving advice and dispensing medication, an older person is ‘health literate’, ie, that they have the ability to read, understand and act on the health information given.
Yet, recent research carried out in Scotland and the south of Ireland showed that:
• One in five Irish people are not fully confident that they understand the information they receive from their healthcare professionals
• Only 43 per cent of people admitted that they would only sometimes ask their healthcare professional to clarify the information if they did not understand something they had said
• One in ten people have taken the wrong dose of medication because they didn’t understand the instructions
Due to your community setting, you are probably the healthcare professionals most in contact with patients and are therefore in a prime position to ensure that older people are both aware of what, why and
how they are to take their own specific medication.
At MEAAP, we work with older people in our community on a daily basis - especially those who are particularly vulnerable, isolated and lonely – through initiatives such as our Good Morning project. As such, we are aware of some general points regarding medication for this particular demograph:
• The printed labels on the boxes are too small to read and the instructions inside the pill boxes are even smaller
• Multiple prescriptions are often written on different slips. These are often then made up at different times and it is easy to leave the pharmacy without all of the necessary items
• Transport problems – not all pharmacies deliver prescriptions
• While the prescription may have the name of the medication, the ailment for which it was prescribed is usually not indicated and therefore it can become a sweetie style lottery as to what table an older person may select
• Older people often hold on to old medication, which may have expired, or they may be taking it, unable to remember the ailment for which it was prescribed
• Opening tablet bottles/cough bottles can often become too difficult for many older people
• Domiciliary Care Workers who support older people to remain at home often arrive at irregular times, and will only give the tablets which have been made up as part of a blister pack, so there is no mechanism to manage breakthrough pain
• When tablets are prescribed and administered, little time is
taken to explain when the tablets should be actually taken and with/ without food. This is all written on the label, which in many cases is too small for older people to read. Could a tablet timetable be developed, in large writing, so that every time a new prescription is added they know what tablet to take/when/with or without food and what ailment it is for?
I believe that there is a great opportunity for the community pharmacist to ensure that older people get the right prescription at the right time, with support from a range of medical and wellbeing providers.
Very often, it’s simply a matter of asking the right questions. Is the patient able to get the lids off the bottles OK? Are they eating enough food to cope with the medication they’re taking? Even simple steps, such as writing the patient’s ailment on the label, can be extremely effective in ensuring both compliance and efficacy.
On an even wider scale, you as a community pharmacist know that tablets are not the ‘be all and end all’ in tackling an illness. MEEAP has recently been trying to secure funding for an Involving Many to Prescribe Alternative Care Together (IMPACT) programme, whereby we would have a community-based worker, working alongside an older person GP, nurse and pharmacist to look at developing and supporting a personal health and wellbeing plan tackling these more ‘social’ care-related issues and promoting self care.
This is a co-design based model that has already been embraced by many of you, who understand that you can go that extra mile in ensuring that an older person fully understands the information they have been given each time they visit your pharmacy. •
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