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Older people and lots of pharmacy

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The rotation I am currently undertaking is Older People. I have so far realised that this involves elderly people with multiple conditions and even more medication. It is a very ‘pharmacy’ area and I feel like this is the rotation where I have used most of my university knowledge so far as I am faced with thromboembolism, cardiovascular diseases, renal impairment, diabetes, epilepsy and even end stage cancer.

 

So, to start, young elderly people are aged 60-74, elderly are aged 75-84 and very elderly are 85 and over. From my research, I have learned that, at the moment, 17% of people in the UK are over 65 years old, and by 2050 it is expected that this will increase by 25%. From my last LPET study day (the subject being public health), we were made aware that the average life expectancy in the UK is around 80 years for women and 75 years for men. Also, around three quarters of people over 75 have at least one long term condition and almost two-thirds of general and acute hospital beds are used by people over 65.

 

One of the main issues surrounding older people is falls. Elderly people are usually on multiple medications, which do not help; being on four or more medications impose a greater risk of falling. Another risk factor, particularly within a mental health hospital, is psychotropic medication, especially tricyclic antidepressents, antipsychotics and benzodiazepines as these can cause side effects such as sedation, drowsiness, dizziness, hypotension etc. There are numerous other reasons which can increase the risk of falls such as alcohol, visual impairment, hearing impairment, cognitive impairment, postural hypotension and even a previous fall.

 

There are many interventions pharmacists can make to decrease a patient’s risk of falling. Firstly, hip pads can be worn as secondary prevention to minimise the impact of falling and, in effect, prevent hip fractures. Dose reduction of benzodiazepines can be considered as it has been found that the risk of falls is still reduced if the dose is lowered because the risk is dose dependent. Postural hypotension is identified when there is a drop in systolic blood pressure of less than 20mmHg and diastolic pressure of less than 10mmHg. Screening for this by measuring blood pressure can hopefully prevent future falls. Colecalciferol has been shown to reduce falls by more than 20% so this can be considered as a supplement to high risk patients too. Furthermore, there should be frequent medication reviews to ensure all of the patient’s medication is necessary with the aim to stop any medication that isn’t. Lastly, if a patient is depressed, perhaps SSRIs should be considered as opposed to tricyclic antidepressants as they have a favourable side effect profile.

 

However, it should not be forgotten that the patient should be treated as a whole and all of their medical conditions need to be taken into account along with their past medication history. It is not always easy to switch a drug a patient is taking (e.g. tricyclic antidepressiant to SSRI) as they may be stabilised on a particular medication, or they may have tried multiple other drugs and no other ones have been effective. A patient may also need to take every medication they have been prescribed with there being no way of stopping any. This just shows that a pharmacist needs to take everything into account!

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