Providing pharmacy services to patients and their carers living with dementia
As part of our ongoing series of articles focusing on equality, we highlight the provision of pharmacy services to patients and their carers living with dementia
As set out in our EDI strategy, we’re committed to tackling discrimination and reducing health inequalities, thinking about the nine legally protected characteristics as well as wider issues affecting patients, the public and the pharmacy sector in all of our work.
In this article, we look at how dementia can impact different groups and how pharmacy teams and services play an important role in this context. Dementia is an umbrella term for a range of over 200 subtypes of progressive conditions that affect the brain and the person’s ability to remember, think and speak. The most common types of dementia are Alzheimer’s disease, vascular dementia, and frontotemporal dementia. Dementia can affect a person at any age, but it is more common in people over the age of 65.
Dementia UK state that by 2025, it is estimated that over one million people in the UK will have a diagnosis of dementia – and almost all of us will know someone living with the condition.
More than 25,000 older black and minority ethnic (BME) people live with dementia in the UK, in part due to vascular risk factors such as hypertension often found in African-Caribbean and South Asian UK populations. Dementia rates are 22% higher among black people in the UK compared to white people.
People with a learning disability are at greater risk of developing dementia, especially young onset dementia (when dementia symptoms develop before the age of 65).
There are around 540,000 carers of people with dementia in England. It is estimated that one in three people will care for a person with dementia in their lifetime.
Thinking about these issues through an intersectional lens is also important – for example, studies have shown that caregivers may face different challenges and burdens due to other characteristics such as ethnicity or gender.
Standards for pharmacy professionals
Several of the standards for pharmacy professionals are especially relevant when providing services to patients with dementia and their carers:
- Standard 1 Pharmacy professionals must provide person-centred care
- Standard 2 Pharmacy professionals must work in partnership with others
- Standard 3 Pharmacy professionals must communicate effectively
Standards for registered pharmacies
When providing services to patients with dementia and their carers, pharmacy professionals should ensure that standards for registered pharmacies are being met at all times. Some key standards outlined below will be particularly important when providing services to patients with dementia.
- Standard 1.8 Vulnerable adults are safeguarded
- Standard 2.2 Staff have the appropriate skills, qualifications and competence for their role and the tasks they carry out, or are working under the supervision of another person while they are in training
- Standard 4.1 The pharmacy services provided are accessible to patients and the public
- Standard 4.2 Pharmacy services are managed and delivered safely and effectively
- Standard 4.3 Medicines and medical devices are: obtained from a reputable source; safe and fit for purpose; stored securely; safeguarded from unauthorized access; supplied to the patient safely; and disposed of safely and securely
In Scotland, Dementia SIGN guidance is expected to be published in August 2023.
As the pharmacy regulator, we have a responsibility to promote equality of access to safe and effective pharmacy services for all. Our equality guidance for pharmacies provides a dementia case study which outlines how pharmacy professionals can meet the requirement to protect the privacy, dignity and confidentiality of staff, patients and the public.
“Our Dementia Friends initiative – which is currently over three million people strong - is a vital network of support for people living with dementia. As customer facing staff, pharmacists have a critical role to play in caring for people living with dementia and there are several ways in which they can do so. This includes attending a dementia awareness session and becoming a Dementia Friend, to enhance their understanding of the condition, help spot the signs and symptoms of dementia in customers and, signpost customers to Alzheimer’s Society’s expert resources and information.”
There are a number of charities that pharmacy professionals, patients and carers can contact for further information and support relating to dementia and Alzheimer’s disease including Dementia UK, Alzheimer’s Society, Carers UK and Dementia Friends.
Pharmacy professionals could also signpost patients and carers to the NHS Dementia guide which provides further information relating to the signs and symptoms of dementia. Dementia UK also provides easy read Dementia information leaflets for patients with learning disabilities.
Pharmacies can register with the Dementia Friends’ charity to obtain charity information, action cards, badges, and training videos.
Dementia Action Week is Alzheimer's Society's biggest and longest running awareness campaign. Each year, they collaborate with individuals and organisations across the UK to encourage people to ‘act on dementia’.
See the further support section for links to all these organisations and initiatives.
GPhC knowledge hub
Example: Safeguarding vulnerable adults
A community pharmacy team contact their local general practice teams when they identify patients with concerning behaviour. Dementia trigger signs might include patients asking for food groceries, popping in every day for medication that is due to be dispensed on a specific day, losing tablets, getting angry/ frustrated or being more easily confused. General practitioners may less frequently assess those patients, and hence might not notice the gradual cognitive decline. General practice teams are usually appreciative of the onward referral and arrange an annual review.
During inspections our inspectors identified several dementia notable practice examples which can be found on our Knowledge hub, including:
- A pharmacist who developed a checklist of topics to be considered in pharmacies to make them 'dementia friendly', initially for use in their own pharmacy, but believing that it could be useful for other pharmacies, a toolkit was developed for use in all pharmacies. The toolkit included training material for pharmacy staff, agencies to signpost patients to, and an audit to undertake in the pharmacy to assess its 'dementia friendliness'.
- A pharmacy team collaborated with their local medical centre to support patients showing early signs of dementia. On such occasions the pharmacy team members would share their concern with the team at the medical centre. This would trigger a visit to patients’ homes by the district nurse.
- A Scottish pharmacy supported dementia awareness week by obtaining packs from Age Scotland with useful resources for patients and carers.
- A pharmacy with several elderly patients with dementia and other age-related conditions developed services to meet their specific needs. All pharmacy staff members became ‘dementia friends’ by training to improve their understanding of the disease.
Patients with dementia and their carers may require assistance with their medicines.
The optimal method of supplying medicines is one that meets the person’s health and care needs, provides person-centred care with the ultimate aim of maintaining the persons independence wherever possible. Pharmacy professionals should make reasonable adjustments to help people with dementia take their medicines.
There are a variety of ways to promote people’s independence including reminder charts, winged bottle caps, large print labels, alarms (such as notifications on mobile phones), tablet splitters and support from carers.
Multi-compartment aids (MCAs) are another option, but they may not always simplify how people with dementia take their medicines. Choosing an option should be done in partnership with the patient, their carer if they have one, and other healthcare providers involved in the care of the patient.
Dementia Friends pharmacy registration page
NHS - About dementia
Dementia UK - learning disability & dementia leaflets
Dementia Action Week
Age UK – dementia webpage
NHS England - dementia webpage
Royal Pharmaceutical Society multi-compartment aid pharmacy guide