In June 2020, around 4.2 million people in Australia (or 16 per cent of the population) were aged 65 and over. About 80 per cent of these people had one or more chronic conditions, and 51 per cent had two or more.
A large percentage of those visiting pharmacies are within this age group. They will be receiving prescription medication and will need support from the pharmacy.
Chronic conditions diagnosed in older Australians (65-plus) include:
- Arthritis.
- Asthma.
- Back pain.
- Cancer.
- Cardiovascular disease.
- Chronic obstructive pulmonary disease.
- Diabetes.
- Mental health and behavioural issues.
- Osteoporosis.
- Kidney disease.
Mental health and behavioural issues, while typically associated with anxiety, depression, bipolar disorder, schizophrenia and others, also include dementia.
Dementia is the term used to describe the symptoms of a large group of illnesses that cause a progressive decline in a person’s functioning. It’s a broad term used to describe a loss of memory, intellect, rationality, social skills and physical functioning.
The many types of dementia include Alzheimer’s disease, vascular dementia, frontotemporal dementia and Lewy body disease. According to Dementia Australia, dementia can affect anyone, but it’s more common after the age of 65.1
- Dementia is the second leading cause of death of all Australians2 and provisional data is showing that dementia will likely soon be the leading cause of death.3
- Dementia is the leading cause of death for women.2
- More than 400,000 Australians are estimated to be living with dementia in 2023. Without a medical breakthrough, the number of people with dementia is expected to increase to more than 800,000 by 2058.2
- More than 28,650 people In Australia are estimated to have younger onset dementia in 2023, with this figure expected to rise to more than 42,400 people by 2058. This can include people in their 30s, 40s and 50s.2
- More than 1.5 million people in Australia are estimated to be involved in the care of someone living with dementia in 2023.4
- Two in three people with dementia are thought to be living in the community.2
- 68.1 per cent of aged care residents have moderate to severe cognitive impairment.5
Ageing, genetics and family history are immutable, but scientific research suggests that changing certain health and lifestyle habits may make a big difference in reducing or delaying the risk of developing dementia.1
Although there are no curative treatments available yet for dementia, increasing evidence points to the significant potential benefits of targeted strategies for its prevention. Recent studies suggest that up to 40 per cent of dementia cases could be prevented or delayed.
Pharmacy assistants should recognise and help customers who visit the pharmacy to prevent this condition by reducing the risks of developing it.
WHO recommendations
Here, we present a guide to 12 recommendations for reducing the risk of cognitive decline, released by the World Health Organisation.6
- Be physically active
During exercise, blood flow and nerve connections increase in the brain, which stimulates ‘happy’ chemicals such as endorphins and serotonin.
As a result, there are:
- Reduced depression and anxiety symptoms.
- Improved mood.
- Clarity of thought and attention.
- Increased productivity.
- Improved memory.
- Better sleep quality
- Reduction in risk of serious illnesses, including diabetes, cancer, heart disease and dementia.
Exercise also often brings opportunities to socialise, reducing feelings of loneliness and isolation.
- Stop smoking
For decades, pharmacies have provided products and support to customers who want to reduce or quit smoking.
Nicotine replacement therapy (NRT) includes patches, gum, lozenges, inhalers and mouth spray. The aim of NRT products is to replace some of the nicotine from cigarettes without the harmful chemicals found in tobacco smoke, thus reducing withdrawal symptoms, such as cravings and anxiety.
There are non-nicotine medications that are also effective in helping smokers to quit. These are available only on prescription via the GP.
- Eat a balanced diet, such as the Mediterranean diet
A balanced diet should include a variety of foods, including vegetables, fruit, whole grains, low-fat dairy products and lean protein foods.
Foods with high saturated fat and cholesterol should be limited. Some fat is essential for health, but not all fats are good. Intake of fats that are bad for heart health should be reduced, such as butter, solid shortening and fatty cuts of meat.
Intake of refined sugars should be reduced. Often found in processed foods, refined sugars contain calories but lack vitamins, minerals and fibre.
Foods with high sodium should be limited, and less salt should be used in cooking food. As an alternative, spices or herbs should be used to season food.
As dementia progresses, loss of appetite and weight loss may become concerns. Dietary supplements between meals can be suggested to add calories.
To prevent dehydration, fluid intake should be encouraged, with small cups of water or other liquids throughout the day or foods with high water content, such as fruit, soups, milkshakes and smoothies.
Can taking vitamin and mineral supplements help prevent dementia?
B vitamin supplements. Taking B vitamin supplements probably has little or no effect on overall cognitive function at any time point within five years and may have no effect at five to 10 years.
Antioxidant vitamins: ß‐carotene, vitamin C or vitamin E. The results are mixed, but long-term supplementation with antioxidant vitamins may be the most promising area for future research. There is low-certainty evidence of benefit in overall cognitive function with long-term supplementation with ß‐carotene (after a mean of 18 years of treatment) and with vitamin C (after five to 10 years), but an antioxidant vitamin combination or vitamin E, alone or with selenium, may have no effect.
Selenium. Selenium alone, taken for around five years, may have no effect on the incidence of dementia.
Zinc and copper supplementation. Moderate-certainty evidence suggests that this has little or no effect on overall cognitive function, or the incidence of cognitive impairment, after five to 10 years.
Complex supplements. Combinations of B vitamins, antioxidant vitamins, and minerals may have little or no effect on cognitive function after around 8.5 years of taking them.
Omega 3 polyunsaturated fatty acids (fish oils). There is no direct evidence of the effect of omega-3 supplements on the number of people being diagnosed with dementia.
VMS for people with mild cognitive impairment. A Cochrane Review into the effects of vitamin and mineral supplementation on cognitive function in people with mild cognitive impairment (MCI) has found that the evidence is very limited. Only B vitamins have been assessed in more than one clinical trial. Taking B vitamins for six months to two years probably results in little or no difference in memory, thinking skills or quality of life.
The reviewers conclude: “At the moment, it’s not possible to identify any supplements which can reduce the risk of people with MCI developing dementia or which can effectively treat their symptoms.”7
- Drink alcohol in moderation
The Australian Alcohol Guidelines8 recommend that healthy adults should drink no more than 10 standard drinks in a week and no more than four standard drinks on any one day.
- Practise cognitive training
Customers should be encouraged to exercise their minds like their bodies.
Some activities that have also been associated with reduced dementia risk as part of a mentally active lifestyle are:
- Reading.
- Listening to the radio.
- Visiting museums.
- Taking a course.
- Learning a new language.
- Playing musical instruments.
- Artistic and other hobbies.
- Participation in leisure activities such as sports, hobbies, dancing, gardening, groups, cultural activities and conversation.
- Board games.
- Crosswords.
- Sudoku and other puzzles.
- Be socially active
Many of the activities involved in cognitive training also involve social interaction and physical activity. Recent research suggests that combining mental, social and physical components in leisure activities offers the greatest benefit in terms of reducing dementia risk.1
- Look after your weight
Maintaining a healthy weight with diet and exercise helps with brain cognition.
- Manage any hypertension
- Manage any diabetes
- Manage any cholesterol
- Manage depression
These are all chronic illnesses, and maintaining control of these conditions will reduce the chance of dementia developing as a side effect of these not being well managed.
Hypertension, diabetes and high cholesterol levels can contribute to heart attack and stroke, both of which can cause a reduction in cognition and further restrict lifestyle and quality of life.
- Look after your hearing and manage hearing loss
Studies have shown that hearing loss can increase the risk of developing dementia by up to five times. The greater the hearing loss, the greater the risk. A decline in memory and thinking capabilities happens up to 40 per cent faster in those with hearing loss compared with those without.9
Regular hearing tests can identify hearing loss. People with hearing loss can be more susceptible to social isolation, which can increase the risk of developing dementia. Adequate hearing ensures that people are able to stay connected with the environment, family and friends around them.
The pharmacy assistant’s role
As always, pharmacy assistants are the frontline in good customer care, and apart from these ways to help prevent dementia, PAs are available to customers and carers to give advice and support. This support may be in relation to dose administration aids (either to use at home or packed at the pharmacy), home medical supplies and equipment, incontinence supplies, mobility aids and many other pharmacy supplies and services.
References:
- dementia.org.au/
- Australian Institute of Health and Welfare. ‘Dementia in Australia’, AIHW, Australian Government. [Accessed 20/1/23].
- Australian Institute of Health and Welfare.
- Based on Dementia Australia’s analysis of the following: ‘2020 Aged Care Workforce Census Report’ (Department of Health and Aged Care), page 6 (2020); ‘Dementia in Australia’ (Australian Institute of Health and Welfare (2022).
- AIHW suggests that more than half of all aged care residents have dementia: Australian Institute of Health and Welfare (2022) Dementia in Australia, AIHW, Australian Government, accessed 20 January 2020
- World Health Organisation. ‘Risk reduction of cognitive decline and dementia’, 2020.
See also: Livingston G, Huntley J, Sommerlad A, et al. ‘Dementia prevention, intervention, and care: 2020 report of the Lancet Commission’. <itals>The Lancet<itals>, 2020. - cochrane.org/news/preventing-dementia-do-vitamin-and-mineral-supplements-have-role
- Australian Guidelines to Reduce Health Risks from Alcohol (NHMRC 2020).
- Lin FR, Albert M. ‘Hearing loss and dementia – Who’s listening?’, Aging Ment Health, 2014 Aug; 18 (6): 671–673 [viewed 2 July 2019]
Written by Sue Holzberger.
This feature was originally published in the August issue of RPA magazine.
