ELDERLY CARE


WIth thE coSt of an agEIng PoPULatIon ExPEctEd to PUt a hUgE fInancIaL bUrdEn on thE nhS, PharmacISt chanEL JonES conSIdErS hoW commUnItY PharmacY can hELP to rELIEvE thE bUrdEn


ELdErLY PatIEntS In PharmacY


L


ife expectancy is increasing for both men and women, with current projections showing that


northern Ireland’s population will exceed two million people by 2034 [1]


at the same time, the population is ageing significantly, with a 24.7 per cent increase in those aged over 65 years projected by 2039[1]


.


however, the length of time people spend being sick is also rising, as the incidence of health problems increases with age, resulting in a growing proportion of the population living with long-standing illness, health problems and disability.


between april 2015 and march 2016, 53,206 frail older people (over 75) were admitted to hospital as an emergency.[2]


frailty in older people is


associated with: increased hospital admissions due to falls, confusion, loss of mobility and increased length of stay once admitted to hospital.[2]


PoLYPharmacY most people aged 65 years or older have two or more long-term conditions and the majority of people aged 75 years or older have three or more.[3]


the more long-term


conditions a person has, the more medicines they are prescribed. the term polypharmacy means ‘many medications’[3]


when a patient takes a large combination of medications.


38 - PharmacY In focUS .


Polypharmacy is driven by the growth of an ageing and frail population and is not necessarily a bad thing, especially when prescribed appropriately for complex or multiple conditions[5]


. for example, secondary


prevention of myocardial infarction often requires the use of four different classes of drugs (antiplatelets, statins, acE inhibitors and beta blockers).


however, polypharmacy can become problematic when multiple medicines are inappropriately prescribed, or where the intended benefit of the medication is not realised[4]


. With the increase in


medications, there is a proportional increase in adverse drug reactions, impaired medication adherence and quality of life for patient.


and is used to describe


faLLS as the population ages, falls - and the consequences of falls - are a major and growing concern for older people and health and social care providers. falls are the leading cause of accident-related death in older people and are a common problem amongst older people with long-term conditions. recurrent falls are associated with increased mortality and rates of hospitalisation, curtailment of daily living activities and higher rates of institutionalisation.


the physical impact of a fall would mean that the person has constant pain, distress, injury, loss of independence mortality. the psychological impact would include loss of confidence, anxiety and depression. the social effect would be isolation, restriction of activities and loss of independence.


Economically, there is an impact on the nhS - 400,000 people visit a&E following a fall; 20 per cent of falls require immediate medical care and ten per cent of the cases result in hip fracture.


twenty per cent of older people who sustain a hip fracture die within six months and approximately half will never be 'functional' walkers again.[1] to identify a person’s fall risk, nIcE guidance recommends a routine enquiry if they have fallen in the past year, observing the person for balance and gait deficits, and conducting a multifactorial falls risk assessment (multiple assessments assessing all of the risk factors associated with falls).


medication accounts for between ten and 20 per cent of falls, while polypharmacy accounts for 20 per cent. as the number of medications and classes of medication increase, the more likely the person is to have a fall. drugs that mainly have an effect on the brain and circulation are more


likely to cause a person to have a fall, and stopping these drugs can reduce falls. the higher the dose and the longer the duration of use will increase the risk of having a fall. a traffic light system has been developed to identify which drugs are more likely to cause falls[5]


.


Examples of red drugs are: benzodiazepines, sedating antidepressants, antipsychotics, thiazide diuretics, alpha blockers, beta blockers, opioid analgesics and alcohol. amber drugs include: loop diuretics, SSrIs and calcium channel blockers. Yellow drugs will include: antihistamines, acetylcholinesterase inhibitors, vestibular sedatives and anticholinergic drugs.


> coLoUr red rISK


high risk: can commonly cause falls alone or in combination


amber


moderate risk: can cause falls especially in combination


Yellow


Possibly causes falls, particularly in combination


green nIcE guidelines tabLE 1: traffIc LIght SYStEm


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