Pharmacists can play a very crucial role in caring for patients diagnosed with Alzheimer’s and dementia Ria Westerman (pharmacist at Medipost Pharmacy) said in an interview with Pharmacy Magazine.
“It is very important to understand that dementia is a syndrome, or group of conditions, impacting memory and cognitive functioning, whereas Alzheimer’s disease is classified as a specific condition and is the leading cause of dementia,” she said. “The World Health Organization estimates that 50 million people around the world are living with dementia, which is a major cause of disability and dependency among senior citizens.
“Signs of dementia may include difficulties with memory or finding the right words, sudden mood changes, restlessness, and the individual repeating themselves, amongst others. The effects of dementia tend to get progressively worse over time. In the case of Alzheimer’s disease, this may be described in seven different stages,” Westerman explained:
- STAGE 1: No Impairment. During this stage, Alzheimer's is not detectable, and no memory problems or other symptoms of dementia are evident.
- STAGE 2: Very mild decline.
- STAGE 3: Mild decline.
- STAGE 4: Moderate decline.
- STAGE 5: Moderately severe decline.
- STAGE 6: Severe decline.
- STAGE 7: Very severe decline.
“The pharmacist tends to only interact with the patient directly in the first two stages, and the patient will need to be assisted to take their medicine by a family member or caretaker. From stage three onwards, the person sadly requires a caretaker to handle their medicine for them. For this reason, the pharmacist will usually interact with the patient’s spouse or family member, or a carer who handles the prescriptions on their behalf from stage three onwards,” said Westerman. “Their caretaker becomes responsible for administering their medicine in the correct doses, as prescribed by their treating doctor. This becomes necessary for safety because the person may forget to take their medicine or may accidentally overdose by mistakenly taking their medicine multiple times in a day.
“Unfortunately, there is no medicine available to prevent, cure, or stop Alzheimer’s disease or most other forms of dementia,” said Westerman. “The role of the medicine is to help stabilise the patient so they can enjoy the best possible lifestyle for as long as possible. The desired stabilising effects of treatment may in turn also help the person to interact better with others, which can assist in reducing pressure on their support network.
DISPENSING MEDICINE TO PATIENTS
“Pharmacists should always be particularly calm, kind, and patient with dementia patients,” said Westerman. “Aware of how dementia or Alzheimer’s disease can impact a person’s behaviour and perceptions, we need to be particularly conscious of the fact that deviations from their usual routine – such as a trip to the pharmacy – can be a physical and emotional challenge for them.
“It is also important to be alert for any signs the person may require help, and subtly offer additional assistance if needed. The patient should not be made to feel any different due to their condition, so it is important that any extra assistance is not over-expressed.
“Listening to the patient very carefully is crucial to gauging the emotional state they are in. Dementia patients often have sudden mood changes and may become distressed if they are asked too many questions, or the questions are asked too quickly. If the patient is clearly having difficulty and is accompanied by a family member for assistance, the pharmacist may obtain the required information from them.
“In the case of our Medipost Walk-In Pharmacy in Gezina, for instance, while the pharmacist is dispensing the patient’s medicine, he or she will make a point of reassuring the patient that they are briefly stepping away from the counter and will return shortly,” explained Westerman. “This may help to reduce confusion while the pharmacist is dispensing the medication. Also, if the patient must sign for receiving their medicine, the pharmacist should place the sanitised pen properly in their hand and indicate exactly where they need to sign.
“Explain any directions or dosage information clearly, making sure the patient understands as far as possible, and show them where the directions are on the medicine container for future reference. If a close family member is accompanying the patient, make sure they listen as the family member or caretaker is often the person giving the patient their medicine. But keep in mind that a pharmacist can only inform or educate the family of the patient’s concerns if they are living together, not if the patient lives in a residential care facility.
“The three medications most commonly used for the treatment of Alzheimer’s Disease are cholinesterase inhibitors. These are Donepezil, which may be prescribed for any stage of Alzheimer’s disease, Galantamine and Rivastigmine, which both may be prescribed to treat mild to moderate Alzheimer's disease,” said Westerman.
“There are other medicines that may enhance memory, mood stabilisers, tranquillisers, and others that may be used in combination with cholinesterase inhibitors according to the symptoms and wellbeing of the patient. These medicines are only available with a valid prescription from a physician.
“Some limited studies have suggested there could potentially be benefits associated with certain non-prescription medicines and vitamin supplements, however not all of these are available in South Africa,” she concluded.