Module 215 - Care for the elderly
Well informed pharmacy staff can offer valuable advice to older customers by being alert to common health problems, says Francesca Robinson
Helping older customers with health issues
In this article you will learn about: ● Health problems that affect older people
● How you can advise older customers about eye problems, hearing difficulties and the need to eat a healthy, balanced diet
● How poor sleep can affect an older person's health
● Why you should check whether older people are taking their medicines correctly
People are living longer, so the care needs of the elderly are increasing. As a group, older people are now the biggest users of healthcare services, and they have always been important pharmacy customers. Pharmacy, which is so accessible for older people, has a key role to play in helping them stay healthy, active and independent for as long as possible.
Well informed counter assistants can offer valuable care and advice to the elderly by being alert to common health problems that might affect their quality of life. Providing information about eye or hearing difficulties, for example, may mean a problem is spotted earlier than it might be.
Directing customers or their carers to local charities or services that provide additional support could make all the difference to an elderly person's health and wellbeing. A professional, friendly and caring manner will encourage older customers to open up about their concerns and may be a lifeline if they are feeling unwell, worried, lonely or vulnerable.
Eyesight changes are part of the ageing process and most people will need to wear glasses or contact lenses by the time they are 65 years old. People who are 60 years old or over are entitled to a free NHS eye test every two years and one every year after their 70th birthday. Near-sightedness or myopia is when people see objects more clearly when they are close to the eye, while distant objects appear blurred.
Long-sightedness, also known as hyperopia, affects a person's ability to see objects close to them. Both can be rectified by wearing glasses or contact lenses. An eye test is also a vital check of the health of the eyes to spot common eye problems caused by ageing including:
● Glaucoma: an increase in pressure in the eye that leads to damage of the optic nerve, which connects the eye to the brain. Left untreated, glaucoma causes tunnel vision and, ultimately, blindness. However, if detected early enough, these complications can usually be avoided by treatment with eye drops. ● Cataracts: caused by a gradual clouding of the eye's lens. A relatively simple operation can improve and sometimes even restore sight. ● Macular degeneration: This is a disease of the retina, the nerve tissue lining the back of the eye. There are two types of macular degeneration: the dry form, which gets worse slowly and the wet form, which worsens very quickly and needs to be seen as an emergency in hospital for prompt treatment.
Customers should be encouraged to go for regular examinations because good eye health is important for getting the best out of life. Poor eyesight can affect balance and co-ordination, leading to falls, or prevent an older person from driving, causing loss of independence. They could also lose simple pleasures such as reading or watching television.
Hearing loss is a common problem that often develops with age. About seven out of 10 people with hearing impairment are aged over 70 years and most people over 80 have some hearing impairment. The cause is the gradual loss of fine hair cells in the cochlea, the auditory portion of the inner ear, which occurs naturally with age.
Signs of hearing loss include: ● difficulty hearing other people clearly ● asking people to repeat themselves ● listening to the radio or watching television with the volume turned up high ● feeling tired or stressed from having to concentrate closely while listening.
Customers who are worried about their hearing can be advised to visit the Action on Hearing Loss website or contact the helpline for a hearing test. This can be conducted online or over the phone.
Another type of hearing loss is when sounds are unable to pass from the outer ear to the inner ear. This may simply be the result of a blockage such as earwax. Earwax is a material produced by sebaceous glands inside the ear. It cleans, lubricates and protects the lining of the ear by trapping dirt and repelling water. Over-the-counter ear drops can be recommended to soften and loosen the earwax and may help it to work its way out naturally. If this treatment does not work after a couple of weeks, the customer may need to visit their GP to have their ears irrigated. This involves using a pressurised flow of water to remove the build-up of earwax.
Patients should be advised not to attempt to dislodge the earwax by putting objects in their ears, such as cotton buds. This may damage the ear canal or eardrum, and could result in earwax becoming lodged in the ear canal.
Problems taking medicines
As people age, they are much more likely to be prescribed more than one kind of medication, and many older patients take three or more. The problems caused by ageing can make it particularly difficult for the elderly to take their medicines correctly. For example: ● Memory problems put older people at risk of forgetting to take their medication or schedule doses at the right time during the day ● Eyesight problems make reading labels and leaflets on prescriptions and over-the-counter products difficult ● If they are hard of hearing, they may not be able to clearly hear instructions from healthcare professionals ● Dexterity problems, for example stiff, arthritic fingers, make it difficult for to open bottles, break tablets or handle medicines such as eye drops ● Swallowing difficulties make it hard to swallow capsules or tablets ● Older people are more at risk of not taking their medicines correctly if they live alone.
Counter assistants should be alert to these factors and can help by asking open questions about how the customer is getting on with taking their medications. They should offer a friendly and sympathetic ear and allow the customer plenty of time to raise concerns they may have about their medication or any other health issues that the pharmacy might be able to help with.
Easy strategies could include finding out if their medication could be packaged in a way that makes it more easily accessible. This could include non-child-resistant caps for example, but stress that such containers should be kept safely out of the reach and sight of children who live in or visit the home. You could recommend pill organisers to help the customer track whether they have taken their tablets. It may be helpful for the customer to link their medication routine to something they do every day, such as brushing their teeth, or to use a checklist.
As people age, their sleep patterns tend to change. It is common for older people to find it harder to fall asleep than younger people and wake up more often in the night. In general, the elderly need 30 to 60 minutes less sleep than younger people and a healthy 70-year-old may wake up three or four times during the night. This is because older people sleep more lightly and spend less time in deep sleep. This may make them feel deprived of sleep, but it is seldom a health concern.
Counter assistants should stress the importance of good sleep hygiene. Good quality sleep can bring health benefits, such as reducing the risk of depression, lowering inflammation, relieving stress and improving heart health. Sleep hygiene advice includes: ● Reduce caffeine intake ● Do not smoke or drink alcohol in the six hours before bedtime ● Do not have a meal just before retiring ● Get plenty of exercise and avoid napping during the day ● Ensure the bedroom is a quiet, relaxing place to sleep – not too warm, cold or noisy and it should have good curtains to keep it dark ● Go to bed only when feeling tired and sleepy, and keep regular habits and routines related to sleep.
A balanced, healthy diet is essential for helping older people to maintain their health and vitality. However, there may be many reasons why older people do not eat properly and may even lead to them suffering from malnutrition.
Loss of teeth and ill-fitting dentures can make chewing uncomfortable, and a reduced sense of smell or taste may make food seem bland and unappetising. Reduced saliva production may make the mouth dry, increasing swallowing difficulty and this could result in them eating low-fibre foods, leading to constipation.
Elderly people who live alone may not bother to cook for themselves and a lack of exercise reduces the metabolic rate and appetite. Mobility problems or an inability to drive may make it difficult to get to the shops to buy food. Dexterity problems may make it hard to hold utensils to eat with. Financial problems may deter them from buying nutritious food.
Older people who look pale or particularly thin may not be eating properly. A vitamin supplement may help to boost an inadequate diet and a laxative will help if the customer is suffering from constipation.
Tactfully try to offer advice on healthy eating and the benefits of getting plenty of exercise. Signpost customers to the local Meals on Wheels Service. Obesity is as much of a problem as not eating enough, as it puts strain on the heart and the patient at risk of diabetes. Counter assistants could refer customers to a weight loss clinic if the pharmacy runs one, or direct them to a local slimming club.
● Caring for your eyes, a guide for older people by Age UK
● The charity Action on Hearing Loss offers advice and runs hearing tests online, via a mobile app or by phone.
● Age UK offers advice on healthy ageing on its website or via its free telephone helpline 0800 169656
● The "What Does Age UK do in Your Area?" postcode checker on Age UK's home page provides links to help and support in local areas
● The "Eat Well Over 60" article on the NHS Choices website
● The government's Get Meals at Home (Meals on Wheels) website can direct you to services provided in your area
Refer to the pharmacist if...
● a customer with hearing loss complains of pain, discharge, blocked ears, a sudden deterioration in their hearing or has developed tinnitus (noises in the ears or head)
● you think the customer is taking medicines that sometimes interfere with sleep (eg diuretics, some antidepressants, steroids, beta-blockers, some slimming tablets, painkillers containing caffeine and some cold remedies containing pseudoephedrine)
● you think an older person is not taking their medicines correctly – they may benefit from a medicines use review
● the elderly person has not had a flu jab.
Your next steps
● Check your communication skills by asking a colleague to assess you and give feedback on the way you talk to older customers ● Study articles on health and wellbeing for older people on the Age UK site at ageuk.org.uk ● Find out what services in your area you can direct older people to for further help. Contact your local council, Social Services and Age UK