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Frailty affects more than one in 10 people over 65 and community pharmacy is perfectly placed to deliver accessible help, writes Victoria Goldman

According to the British Geriatrics Society’s (BGS) report on proactive care for older people with frailty, published in October 2024, the number of people aged 65+ was estimated to be 31.8 per cent of the UK population in 2023 and is projected to increase to 36.7 per cent of the UK population by 2045. 

At age 65, people can expect to live on average around half of their remaining life expectancy in good health, with the likelihood of being disabled and/or experiencing multiple chronic and complex health conditions increasing with age.

Frailty affects more than one in 10 people over 65 and up to half of the population aged over 85.

In October, the BGS, supported by other organisations, also expressed grave concerns about the impact of the winter months on the health and wellbeing of older people.

The BGS called for the government to ensure that services for older people living with multiple long-term conditions take a coordinated and person-centred approach to reduce unnecessary investigations and medications. 

Caroline Abrahams CBE, Age UK charity director, says that pharmacists embedded in their communities are in a great position to provide tailored support to help older people stay as well as possible.

“Whether that’s encouraging someone to take part in regular exercise, eat a balanced diet or cut down on smoking and alcohol consumption,” she says.

“Some local pharmacists also play a key role in the rollout of the flu and Covid-19 vaccination programmes in preparation for winter.

"They can also help to identify and offer support to older people who are living with frailty, who are at risk of malnutrition or falling, or who may be socially isolated or lonely.”

Preventative care

Age UK’s ‘The State of Health and Care of Older People in 2024’ report in September 2024 stated that growth in the number of GPs isn’t keeping pace with the population growth of older people aged 75+, and the numbers of district nurses reduced by 17.5 percent between 2014 and 2023 – despite their important role in treating older people at home for potentially serious health problems such as pressure sores.

Two million people aged 65+ have unmet needs for care and support, needing help with essential everyday tasks such as bathing, eating and dressing, but don’t receive it.

As a result, many older people end up in hospital for something that could have been avoided with appropriate home care packages and regular GP check-ups, and this puts more pressure on the NHS and hospital system.

Community pharmacies have always been an important source of health advice for older people, especially those taking regular medication.

“Pharmacists can help with preventative care when it comes to winter-related illnesses,” says professor Claire Anderson, president of the Royal Pharmaceutical Society. 

“They can also provide accessible and tailored advice on nutrition, light exercise and lifestyle changes to help older people look after their health. Pharmacy closures impact older people by limiting access to essential medicines and care, especially for those with mobility issues.”

In April 2024, Healthwatch’s ‘Pharmacy: what people want’ report revealed that older people (82 per cent) are more likely than younger people (59 per cent) to obtain their medicines from a community pharmacy.

It’s therefore not surprising that pharmacy closures and medicine shortages are having a significant impact on the older generation.

Three in 10 people over 65 have experienced problems getting medicines in the last year because of shortages, compared with 15 per cent of those aged 18 to 24.

In addition, 66 per cent of people over 55 who had problems getting a medicine weren’t able to get it on the same day. 

“Evidence shows that too many pharmacies are closing and that poorer areas are the worst affected, increasing the inequality in healthcare provision,” says Abrahams.

“Pharmacies are important local resources, especially for older people living with health conditions, who often come to depend on them for advice and support.

"They are often more accessible than GP practices – and with our ageing population, we need more of them, not fewer. So the government must think hard and quickly about how to address the apparent decline in their numbers, particularly in places where they are needed the most.”

Medicines management

Polypharmacy is particularly common among older adults and can increase the risk of medication side-effects and interactions, along with frailty, disability, falls, hospitalisations and mortality.

Structured medication reviews can help to improve medicines use and therefore patient outcomes. 

However, according to Age UK, research shows that most people accessing NHS services don’t know what a structured medication review is, or what to expect when they are invited for one by their GP or pharmacist. 

According to members of the BGS Pharmacy Professionals Group – Louise Organista (advanced clinical pharmacist), Ðula Alićehajić-Bečić (consultant pharmacist, frailty) and Lindsey Fairbrother (community pharmacist) – without formal commissioning for structured medication reviews, pharmacists are having to highlight medication issues opportunistically.

“Patients may ring up to discuss a medication or a concern about an adverse effect, showing the valuable rapport older people have with their pharmacist,” they say.

“To improve the input and value community pharmacists can bring with respect to optimisation, it would be great to see the use of independent prescribing skills so pharmacists can be empowered and enabled to alter medication prescriptions themselves and complete structured medication reviews with shared decision making, without adding workload to the GP.”

Medicine shortages may provide an ideal opportunity to review a patient’s medication. Fairbrother gives a recent example of a stressed and frustrated patient ringing different pharmacies to locate stock of a less-commonly prescribed ACE inhibitor, trandolapril.

“The issue was resolved by asking the patient questions about why they were on this particular drug and empowering him to speak to his GP to trial a first-line drug of the same class which is widely stocked,” she says.

“This gentleman was taking 8 x 0.5mg tablets, which could have been avoided through more careful prescribing. In some cases, the community pharmacist may be in the better position to suggest alternatives to our GP colleagues, to help our patients access more readily available medications.”

Ongoing medicine supply problems may cause confusion among older customers if their medicines need to be changed suddenly. 

“Community pharmacy teams should ensure that patients are kept informed about this, as a change in size/shape/colour of a regular medication may cause distress to a patient who wasn’t expecting it,” say the BGS Pharmacy Professionals Group members.

“If a patient’s local pharmacy closes, older patients (who may not drive and depend on irregular public transport) will find it difficult to access the next available pharmacy.”

Health advice

According to a BGS roundtable July 2023 – ‘Transforming care for older people’, it’s important that older people receive appropriate support to make positive changes to their own health and wellbeing, especially to address modifiable risk factors such as obesity, smoking and high blood pressure.

Interventions could include exercise classes, smoking cessation or social activities provided locally by voluntary or leisure organisations. 

Age UK’s recent report suggests that GP practices, primary care and community services should offer coordinated support for people living with long-term conditions and/or frailty, with a preventative public health strategy that encourages and enables physical activity among older people and those with long-term health conditions. 

The BGS Pharmacy Professionals Group members say that community pharmacists could prompt lifestyle-related conversations when issuing a prescription, or even add a nutrition and movement checklist to the Discharge Medicines Service or New Medicine Service paperwork.

“Awareness of important aspects of an older person’s care and appropriate signposting form an integral part of community pharmacy’s role,” they say. 

“For example, reviewing incontinence products purchased and ensuring they align with the person’s needs; acting on requests for constipation medication with provision of advice on dietary changes and fluid intake and regular meds reviews; acting to address concerns over joint pain by provision of appropriate advice to optimise body weight and access to exercise support and appropriate pain relief; and ensuring skin health through the use of emollients.

"Patients should be encouraged to purchase their own vitamin D supplements, and vitamin B, folic acid and iron supplements can be useful for fatigue.

"Mobility aids can help patients to retain their independence and reduce the risk of falls and fractures.”

Support networks

Since community pharmacies are more likely to see older people regularly, they may notice changes in a customer’s health and wellbeing that may not be noticed via a phone call or occasional in-person consultation with a GP.

“The joint Royal Pharmaceutical Society and Marie Curie Daffodil Standards supports pharmacists in providing compassionate, patient-centred care, and helps them to recognise early signs of dementia and loneliness,” says Anderson.

“By building trust with patients, pharmacists can help patients address these issues and get the support they need.”

According to the RNID, 71.1 per cent of people over 70 in the UK experience hearing loss. As people get older, they may find it harder to hear high-pitch sounds, such as some voices, especially in noisy environments.

“Hearing loss, seen in older adults, arguably the most vulnerable of people with hearing impairments, can significantly affect their health by hindering communication, particularly in critical settings like pharmacies,” says Paul Harrison, audiology expert and medical content contributor at Hearing Aid UK.

“Misunderstanding medication instructions or failing to hear important information can lead to serious health risks and complications.

"From a practical and convenient point of view, pharmacies can support the older generation with in-house remedies that are easily administered at home, dexterity dependent.

"They usually have a good supply of essential products such as ear wax remedies and hearing aid batteries.”

According to the BGS Pharmacy Professionals Group members, community pharmacies are a social service in their own right and an invaluable resource for older people.

“The main advantage is ease of access – they take away the burden from other healthcare sectors and provide that personal touch which is often missing in the world of healthcare,” they say.

“Unfortunately, these pharmacy-patient relationships are being affected by pharmacy closures. Community pharmacists are the most accessible healthcare practitioners, and we should understand the importance of their services in provision of safe care for our older population.”