ELDERLY CARE


foods should be rich in fibre, starch, iron, calcium, folic acid, vitamins and minerals[8]


. In order to encourage healthy eating, patients should:


1. have balanced and a variety of healthy ingredients


2. have regular meals 3. have their five a day (mostly vegetables as fruit contains a lot of sugar).


4. Eat starchy, complex carbohydrates at every meal


5. Eat protein daily 6. Keep hydrated


beside changing the diet, other creative and innovative ways of addressing malnutrition are[9]


:


faLL IntErvEntIon Pharmacists can help to reduce the incidence of falls related to medicines by identifying patients who are at risk of falling and help them optimise their medicines. medicines optimisation looks at how patients use medicines over time. It can involve stopping some medicines as well as starting others, and considers opportunities for lifestyle changes and non-medical therapies to reduce the need for medicines[6]


.


nIcE recommends that all older people with recurrent falls or assessed at increased risk of falling should be considered for multifactorial intervention[7]


. this would include:


strength and balance training, home hazard assessment and intervention, vision assessment and referral and a medication review with modification or withdrawal of some medicines[7]


.


SUPPortIng IndEPEndEnt LIvIng older people are reluctant to accept advice on how to prevent falls, for a number of reasons. first, they think the information is only relevant to people much older and more frail than them. they also feel confident in their mobility and do not want to be labelled as ‘old’ or ‘frail’.


rather than focusing on the risk of falls, it is better to talk to an older person about the benefits of improving strength and balance, staying active and maintaining


40 - PharmacY In focUS


mobility and independence. People are more receptive to the advice provided only if they can choose the activities and advice that will suit their specific needs, abilities and lifestyles.


the community pharmacy team can support independent living in several ways, including giving advice and information to older people and their families on healthy living and maintaining well-being, recommending exercises, signposting to other services, such as sight and hearing, and signposting to practical and social support groups such as agenI.


Information can be provided through leaflets and posters about suitable local exercise classes and online resources however, muscle strengthening and balance programmes should be individually prescribed and monitored by a trained professional. the information provided should also be available in languages other than English. Social care and support services available to elderly patients include the provision of equipment, community support and activities, day centres, home adaptation and home help, residential care and occupational therapists.


nUtrItIonaL chaLLEngES In thE ELdErLY It is good to promote a nutrition strategy for the elderly and frail, especially those in long-term care. table 2 shows the barriers to eating well in elderly patients.


• Lunch clubs and community cafés - these clubs and community cafes are sometimes tailored to the needs of specific groups, for example: carers, people with dementia and those who are housebound • community gardening - focuses on the importance of growing their own food • home shopping services - more relevant to housebound elderly • cooking classes - again, tailored to the needs of specific groups, for example: widowed men and older people with special needs • food co-ops - these are often linked to healthy eating initiatives within local communities, and address both poverty and access issues. • Linked offerings - include linking food-based services with practical support in the home, or linking learning about food preparation to other skills such as computer literacy skills •


rISK factor Poverty Psychosocial factors


rEfErEncES 1. Up and about or falling Short? - a report of the findings of a mapping of Services for falls Prevention in older People [Internet]. gov.scot. 2017 [cited 20 January 2017]. available from: http://www.gov.scot/Publications/2012/05/697 9/3 1. Interim Impact report [Internet]. 1st ed. belfast: health and Social care board; 2016 [cited 11 June 2017]. available from: http://www.hscboard.hscni.net/download/PUbL IcatIonS/icps/more_about_icps/publications/ic p-impact-report-aug-2016.pdf 1. Polypharmacy guidance march 2015 [Internet]. Sign.ac.uk. 2015 [cited 20 January 2017]. available from: http://www.sign.ac.uk/ 1. Polypharmacy guidance [Internet]. nhS Scotland. 2012 [cited 20 January 2017]. available from: http://www.central.knowledge.scot.nhs.uk/upl oad/Polypharmacy%20full%20guidance%20v2 .pdf 1. traffic Light System (tLS) – medicines management [Internet]. medicinesmanagement.doncasterccg.nhs.uk. 2017 [cited 21 January 2017]. available from: http://medicinesmanagement.doncasterccg.nhs .uk/traffic-light-system/ 1. newsletter Supplement: medicines optimisation [Internet]. 1st ed. belfast: health and Social care board; 2015 [cited 11 June 2017]. available from: http://niformulary.hscni.net/Prescribingnewslett ers/Pdf/nImm_2015/nImm_newslettervol6Sup plementno2_Sept15.pdf 1. falls in older people: assessing risk and prevention | 1-recommendations | guidance and guidelines | nIcE [Internet]. nice.org.uk. 2013 [cited 20 January 2017]. available from: https://www.nice.org.uk/guidance/cg161/chapt er/1-recommendations#preventing-falls-in- older-people-2 1. healthy eating and drinking for older people | nidirect [Internet]. nidirect. 2017 [cited 11 June 2017]. available from: https://www.nidirect.gov.uk/articles/healthy- eating-and-drinking-older-people 1. Wood r,bain m. the health and Well-being of older People in Scotland - Insights from national data [Internet]. 1st ed. Edinburgh: nhS Scotland; 2001 [cited 20 January 2017]. available from: http://www.scot.nhs.uk/


ExamPLE


• Inability to access good food • Inability to afford good food


• Isolation/loneliness • anxiety • confusion • depression


mobility • Poor mobility • dementia • bereavement • disability


• Poor transport links • difficulty accessing local shops


functional constraints


• Inability to prepare food • Poor dental/oral health • Sensory disability • difficulty using food containers • difficulty reading food label


tabLE 2: barrIErS to EatIng WELL


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