Cold weather can exacerbate conditions for people living with illnesses such as heart disease, lung disease, asthma and other underlying health problems. In addition, a drop in temperature to below 12°C, plus common winter illnesses such as coughs, colds, flu and norovirus, can have an impact on the health of vulnerable people. These can lead to a spike in hospital admissions when early intervention and advice from pharmacy could often prevent people's symptoms from worsening.
"With the winter a hazardous season for all ages, now's the time to start identifying which of your customers are the most vulnerable," says Numark information services pharmacist Hilary Cunningham. "Community pharmacy is extremely well placed to spot when there is a problem with elderly or infirm people and many counter assistants instinctively do this by mentally making a note of who they have and haven't seen. You can formalise this by making notes of when you expect to see certain customers so that you can make enquiries if they don't show."
So which groups need more care in winter and what can you do to help?
Winter can be a time when older people find themselves more isolated, with weather conditions making them less able to get to GP appointments or to the shops. Age UK spokeswoman Anne-Marie Doohan says: "As we get older our bodies respond differently to the cold and this can leave us more vulnerable in cold weather. "As pharmacies are a good point of contact for older people in the community, they provide a vital role in talking to the person, finding out their needs and helping to signpost relevant, free information and local services."
People aged 65 years and over and those with long-term health conditions are particularly at risk of flu. Those individuals most in need will be invited to receive flu vaccinations at their local NHS provider but, for those who are not eligible, private pharmacy flu vaccination programmes are a useful, low-cost alternative. Now is the time to promote your flu vaccination programme, whether NHS or private, which should include raising awareness among GPs so they can direct patients accordingly.
Patients with chronic obstructive pulmonary disease (COPD) need to take extra precautions during cold weather to avoid symptoms worsening. The British Lung Foundation recommends patients stay indoors as much as possible to keep warm and that they try to stay as active as possible to generate heat. You could also advise any of your customers with COPD to get a seasonal flu jab.
Cold weather can have a serious impact on the 5.4 million people with asthma in the UK. According to Asthma UK, three quarters of sufferers say that cold air is a trigger for their symptoms and 90 per cent believe having a cold or flu makes their asthma considerably worse – so again, recommending a flu jab is helpful.
People whose asthma is well controlled are more likely to be able to withstand the winter months. Asthma UK recommends advising your customers with asthma to take one or two puffs of their reliever inhaler before going outside if they know that cold air triggers their asthma. They should also wrap up well and wear a scarf over their nose and mouth when going outside, as this helps to warm up the air before they breathe it in.
With 7 million disabled people in the UK and more than a million needing equipment to help them live independently in the community, this is another important vulnerable group to be mindful of when the temperature falls.
Less able or mobile people find it even harder to get out and about in winter. Ms Cunningham advises: "You should register customers for delivery and collection services and, as well as medicines, consider delivering any toiletry items that they may need. "As well as providing a service, this will build loyalty to your pharmacy. In my experience, delivery drivers are very alert to signs – such as post building up, curtains being closed and bins left out – that could indicate a problem with a vulnerable customer," she says.
Some pregnant women pick up every virus that is going round and can be even more vulnerable to infections in winter. As well as encouraging them to eat a balanced diet and wrap up warm, it's worth reminding them that not all medicines they might usually take for winter ailments are suitable when they're expecting.
For example, if they get a tummy bug they should avoid anti-diarrhoea medicines and some rehydration salts, and to drink ginger tea or lemon and water instead. For pain relief, paracetamol is the only painkiller suitable for use in pregnancy, but you can recommend other products such as heat patches.
Supporting vulnerable groups during winter not only benefits patients, but also encourages repeat business and builds the reputation of your pharmacy in the community. However, as Ms Cunningham points out: "Pharmacists are an integral part of the NHS system, but not everyone is aware of the services they can provide."
Apart from helping vulnerable customers directly, dealing with winter ailments also gives you the perfect opportunity to enhance your relationships with other healthcare providers who can suggest that patients try their local community pharmacy for advice that could shorten the time they suffer from the effects of cold weather or even avoid them altogether.
For the past few winters, Paul Mellis of Oakwood Pharmacy in Loughton, Essex has been taking his flu vaccination service out of his pharmacy and into local businesses. One of the businesses Mr Mellis is visiting this year is a local technology company, where he is setting up a portable pharmacy in its medical room to offer vaccinations to its 70 staff. "I love to get out and about and meet people and it's a win-win situation that has demonstrated visible benefits to my business," he says. "The patients have it funded by their company and I get to spread the good word of pharmacy at the same time."Further information Age UK produces a number of useful information guides:
● Winter Wrapped Up – ageuk.org.uk/health-wellbeing/keeping-your-body-healthy/winter-wrapped-up. Pharmacies can order multiple copies from the Age UK advice line on 0800 169 6565 ● Healthy Eating – ageuk.org.uk/Documents/EN-GB/Information-guides/AgeUKIG38_healthy_eating_inf.pdf?dtrk=true ● As part of Age UK's Spread the Warmth campaign, it is working with local and national partners to help older people keep warm and well throughout the winter. The charity also offers free information to older people and their families all year round via its advice line.