The government’s plan for dementia care includes identifying and supporting more people with the condition by harnessing the expertise of those working with older people in the community. So how can community pharmacy help, asks P3?

Dementia places a huge burden on people with the disease, as well as on their relatives, carers and society as a whole – a problem that will increase as the world’s population ages. This year, the number of people living with dementia worldwide is estimated to be 47 million, reaching 135 million in 2050, according to UK Secretary of State for Health Jeremy Hunt, in his recent progress report on the Global Action Against Dementia initiative.

The condition is a key focus for health services and social care. In February this year, the Prime Minister launched the government’s five-year vision for the future of dementia care, support and research – following on from the current Prime Minister’s Challenge on Dementia, launched in 2012 – which aims to boost dementia research, train more health and care staff, follow up timely diagnosis with greater access to help, advice and support for people with dementia and their carers, increase public awareness and create more dementia-friendly public and private organisations and communities.

Raising awareness

One such initiative is the ‘Dementia Friends’ programme, run by the Alzheimer’s Society and Public Health England (funded the UK Cabinet Office and Department of Health). So far, more than one million people in England have become Dementia Friends, with a new target set to educate an additional three million by 2020.

The Royal Pharmaceutical Society supports the campaign and its Local Practice Forum leads have become Dementia Champions in order to train other RPS members as Dementia Friends. Heidi Wright, practice and policy lead for England at the RPS, says: ‘850,000 people in the UK have dementia and so it is vital that all of us – healthcare professionals and the public – play our part to help. Dementia Friends helps pharmacists who interact daily with dementia patients, can aid the early detection of the condition and is also a way for pharmacists to raise public awareness of dementia.’

Numark member Sally Porter is a locality-lead pharmacist at Doncaster Clinical Commissioning Group and owns Abbey Pharmacy in Rotherham with her husband. All the staff at the pharmacy are Dementia Friends and Sally has recently also trained as a Dementia Champion so she can deliver Dementia Friends information sessions to the public within the community that their pharmacy serves. 

She says: ‘I work at NHS Doncaster CCG three days a week and dementia is one of their priorities. They’ve got a Dementia Friends Champion within the CCG and had allowed staff to attend Dementia Friends info sessions in work time. I’d been to one and thought the material was very good and felt inspired by the concept and that my employer had allowed me to go, so felt motivated to do the same for our staff. 

‘We developed an action plan and are now members of the Rotherham Dementia Action Alliance (RDAA). The LPC is working with public health and the RDAA to consider how community pharmacy can support people with dementia. For me, one of the key points is knowing how to interact with and support people with dementia, still giving them respect. If lots of people learn a little more, our
communities can be more understanding and we can help people to live well with dementia.’

Boots has also taken up the dementia challenge, training up 65 Dementia Champions and more than 10,000 Dementia Friends, including staff working in its pharmacies, Boots Hearingcare, delivery drivers and care home teams. 

Hilary Cunningham, Numark information pharmacist and another Dementia Friend, says that it’s often small actions that make the most difference: ‘Staff can be vigilant to watch for deterioration in a patient’s condition, such as coming into the pharmacy or being seen out inappropriately dressed for the weather or still wearing their slippers or night clothes,’ she says.

‘Delivery drivers are also ideally placed to identify possible problems or a reduced ability to cope with living independently within the patient’s home.’

Social acceptance

Pharmacy also has a role to play in lifting the stigma surrounding dementia; something that Day Lewis is working towards by offering Dementia Drop-in Centres at some of its pharmacies in Exeter, Torquay, Paignton (and soon St Austell) in association with Purple Angel, a group that
specialises in raising awareness of dementia. 

Rosie McDermott, Day Lewis’ regional manager for the South West, says: ‘Our pharmacy close to Torbay has a significant number of elderly patients. As a team, we became increasingly concerned about the effects of dementia and understand that with early identification and active support, disease progression can slowed and lifestyles enhanced.

With this in mind, we decided to look at bringing dementia into the pharmacy so that patients and carers would feel far more comfortable discussing the condition. In fact, removing the stigma associated with dementia is one of our main aims. Importantly, this initiative is all about raising the awareness of dementia and getting people talking about the condition.’

Local surgeries are also enthused about the service. ‘Historically, the GPs were nervous about dementia services because they were concerned about other healthcare professionals diagnosing dementia,’ says McDermott, ‘but now they have seen the service up and running and understand that it is there for people to obtain help, support and advice, they are actively signposting people to the pharmacy. Another benefit of building stronger links with the local GP surgeries means that we are now seeing other patients being referred to us for conditions other than dementia.’

Helpful technology

Pharmacy staff can also advise people how best to help friends and relatives with dementia. ‘Many of us are concerned about elderly parents living on their own and especially those with dementia,’ says Norman Niven, pharmacist and pioneer of tele-enabled monitored dosage systems at Protomed, who has recently set up Protelhealth, a company that creates opportunities for leading-edge health technology to help more people live independently in their own homes.

‘The technology now exists to help people with dementia live independently for longer in their own homes. There are sensors and alarms that can protect them – smoke, carbon monoxide, gas, flood and heat detectors. These can be connected easily to relatives’ devices or to professional monitoring services. Personal safety and wellbeing can be improved with GPS safety devices, movement sensors, fall detectors and nuisance call screening. Pharmacists are in the perfect position to facilitate access to these products as they are health care professionals but also have commercial interests.’

Rowlands Pharmacy and South West Yorkshire Partnership NHS Foundation Trust are also trialling a medicines delivery system that enables live, remote monitoring and management of patient adherence, instantly alerting the patient, carer, clinician or pharmacist if medicines are not taken as prescribed – another way that people with dementia could remain living in the familiar environment of their own home for as long as possible.

Ian Pearce, pharmacist and managing director of Protomed, the company behind the Biodose medicines delivery system, says: ‘The issue of medicines adherence for people living with dementia is obvious; patients can accidentally overdose, miss a dose or stop treatment altogether, without their GP – or anyone else – knowing.

Patients with dementia require appropriate support to allow them to handle often complex medication regimes safely; be that additional support from staff or monitored dosage systems where medication is pre-measured for the care home resident.’

Home care is key

One in four patients in acute hospital beds has dementia, with an estimated financial cost of dementia to the UK of £26 billion per annum. According to Deirdre Doogan, spokesperson for policy and communications at Pharmacy Voice – which sits on the Prime Minister’s Champion Group on Maintaining Personal Wellbeing for People Living With Dementia – keeping patients out of hospital is paramount.

She says: ‘Pharmacy teams are perfectly placed to work with people living with dementia and their families, offering bespoke solutions to medicine management problems, depending on individual circumstances and medication. Pharmacy teams can also help to educate carers and family members in how to best handle someone suffering from dementia, including how to take medicines effectively. This allows more care to be provided at home, keeping patients out of hospital wherever possible.

As well as a strong national plan, it is important that local pharmacy teams are empowered to collaborate with other community care providers, allowing them to undertake innovative projects in their local area, she says.