OLDER PEOPLE


AS SCOTLAND’S AGEING POPULATION CONTINUES TO PRESENT HEALTHCARE PROFESSIONALS WITH AN INCREASING NUMBER OF AGE-RELATED ISSUES, CHANEL JONES CONSIDERS THE SITUATION FROM THE COMMUNITY PHARMACY PERSPECTIVE.


ELDERLY PATIENTS IN PHARMACY


By Chanel Jones


leading cause of accident-related death in older people and are a common problem amongst older people with long-term conditions, such as dementia. This is due to a number of risk factors such as: cognitive impairment, footwear, continence, medication, other health problems, visual problems, postural instability, mobility problems and/ or balance problems and syncope syndrome. Physical impact of a fall would mean that the person has: constant pain, distress, injury, loss of independence mortality. 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. Falls and fractures, in people aged 65 and over, account for over 18,000 unscheduled admissions and 390,500 bed days each year in Scotland[1]


. The


acute management of hip fracture alone costs NHS Scotland in excess of £73 million each year[1]


. 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


Scotland’s population will rise to 5.7 million by 2039 [1][2]


L


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


. At the same time,


the population is ageing significantly, with a 53 per cent increase in those aged over 65 years projected by 2039[2]


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[4]


. The


. 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. The Scottish Government’s implementation of the Reshaping Care for Older People (RCOP) agenda is designed to support and encourage older people to remain healthy active and independent in the community[3]


. POLYPHARMACY


Medication is the most commonly used medical intervention. Most


22 - SCOTTISH PHARMACIST


more long-term conditions a person has, the more medication they are prescribed. The term polypharmacy itself just means ‘many medications’[4] and has often been defined as when a patient takes a large combination of medications. Simply, polypharmacy is driven with the growth of an ageing and frail population. Polypharmacy is becoming increasingly common, and is not necessarily a bad, 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[5]


. With


the increase in medications, there is a proportional increase in adverse drug reactions, impaired medication adherence and quality of life for patient. This increases the clinical workload, thus requiring doctors, nurses and pharmacists to work coherently as a team[5]


. An example


of how polypharmacy can affect a patient’s quality of life is by causing them to have a fall.


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. Recurrent falls are associated with increased mortality, increased rates of hospitalisation, curtailment of daily living activities and higher rates of institutionalisation. Falls are the


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. There is good evidence that shows that stopping these drugs reduces falls. The higher the dose, the higher the risk of having a fall. The risk of having a fall is also increase with increasing duration of use. Sedatives, antipsychotics and sedating antidepressants cause drowsiness and slow reaction times, and some antidepressants and antipsychotics also cause postural hypotension. Maintaining consciousness and


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