Pharmacy U

Aging and cognitive decline – pharmacists play an important role in patients’ life changes


There is a new demographic reality that will have a direct and dramatic effect on pharmacists: Canada’s aging population.

By donalee Moulton

In numerical terms, the new reality looks like this, according to Employment and Social Development Canada. In 2011, an estimated five million Canadians were 65 years of age or older, but that number is expected to more than double in the next 25 years. By 2051, about one in four Canadians is expected to be 65 or over.

In practical terms, an aging population means more medications will need to be prescribed, more med checks will need to be performed, more consultations will be required, and more and more pharmacists will need to ensure they are meeting the needs of senior patients and their caregivers.

The first step is education, says Dr. Carlos Rojas-Fernandez, the Schlegel Research Chair in Geriatric Pharmacotherapy at the University of Waterloo. “Fundamentally, pharmacists need to have a better understanding of the aging process and diseases of the elderly.”

That understanding comes in small part from a pharmacist’s formal education and in large part by actively working to stay abreast of current research, thinking, and initiatives. “Knowledge is power,” stresses Mathilda Prinsloo, an independent consultant pharmacist at Senior Care Pharmacy Practice in the Winnipeg area. “It is crucial to have access to reputable resources for research and consulting purposes as well as peer networking groups to share experiences and expertise. The literature lacks data in older individuals with multiple co-morbidities, and appropriate management often relies on advice from experts in the field.”

Sharing that knowledge is essential, and pharmacists need to foster ongoing discussion with seniors and their caregivers. The logical place for that discussion to start is when a new prescription is filled or a med check is conducted. “Patients are often very pleased you would take the time. It reinforces that you are acting in the best interests of the patient,” says Neemet McDowell, a Certified Geriatric Pharmacist and president-elect of the Canadian Society of Consultant Pharmacists.

The value of consultations

During a consultation, the pharmacist can identify side effects, discuss compliance, and learn what other medications, prescription and over-the-counter, the patient may be taking. This is a unique and important role, says Prinsloo, a Certified Geriatric Pharmacist and Certified Diabetes Educator. “One of the main medication-related challenges for seniors is taking multiple medications including therapeutic supplements like calcium, vitamin D, and vitamin B12. Pharmacists in the majority of cases are the only health professionals who can simplify regimens, keep track of and help to improve adherence.”

She recommends that pharmacists provide each patient with a user-friendly personal medication list that includes over-the-counter medications. “Record pertinent information about medications, for example, the name, strength, dose, when to take or use, and the reason for taking on the list or make a chart for the patient to keep and carry.”

It is often the obvious that is overlooked in a consultation. For example, advises Rojas-Fernandez, “when counselling patients, ask if they can read the label. If you don’t ask, they will walk away often not being clear about what to do.”

Other considerations include ensuring patients can hear you clearly and they understand why they are being prescribed a particular medicine or advised to take a supplement. McDowell, a Safeway continuing care pharmacist in BC, suggests encouraging senior patients to bring along a caregiver, where appropriate, but never lose sight of who is at the heart of the discussion. “We need to ensure the resident or the patient is the focus,” she notes.

McDowell points out that often and inadvertently people talk down to older individuals. “When we talk in a patronizing voice, it’s called ‘elder speak,’ and it puts patients off. It can be a barrier to communication, especially for patients with dementia who may not understand what we are talking about but clearly pick up on the tone,” she says.

The groundwork for a comfortable discussion about uncomfortable issues starts with making information accessible. Dementia, which today affects 747,000 Canadians and by 2031 will affect 1.4 million men and women in this country, is one of those issues. “Having information about dementia visible sends a message to patients,” says Mary Schulz, director of education with the Alzheimer Society of Canada. “People are often reluctant to raise concerns about memory or other cognitive issues. Pharmacists are in an excellent position to normalize talking about these tough issues.”

Of course, pharmacists are not expected to be experts in every disease or serve as sole sources of information. Partners are essential. In the case of dementia, “ask if it would be okay for you to pass the patient’s name along to the Alzheimer Society. We’d be delighted to help,” says Schulz. “It’s about building relationships.”