Once a patient reaches the age of 60, he/she is likely to suffer from common conditions and will seek medical assistance from their local pharmacist concerning the management and treatment of these conditions.
Osteoarthritis (OA) is a long-term chronic condition characterised by the deterioration of the cartilage in joints which results in bones rubbing together and creating stiffness, pain, and impaired movement, the World Health Organization explained. “The disease most commonly affects the joints in the knees, hands, feet, and spine and is relatively common in the shoulder and hip joints.” While OA commonly afflicts patients over the age of 60, it is also associated with “a variety of both modifiable and nonmodifiable risk factors, including obesity, lack of exercise, genetic predisposition, bone density, occupational injury, trauma, and gender”. Head of the Rheumatology Unit at The Alfred hospital and the Musculoskeletal Unit in the School of Public Health and Preventive Medicine at Monash University, Professor Flavia Cicuttini advised that maintaining a healthy weight, avoiding injuries to joints, and regular exercise to strengthen muscles around the joints, are all important for the prevention of osteoarthritis. “Muscle-strengthening exercises are very effective for reducing pain in osteoarthritis and anti-inflammatory creams have been shown to improve joint pain.” Prof Cicuttini advised that medications like paracetamol and anti-inflammatory tablets should only be used in the short term. The National Osteoporosis Foundation of South Africa (NOFSA) encouraged calcium and vitamin D supplementation. “Calcium is a major building block of bone tissue, which is important for preventing osteoporosis and bone disease. Vitamin D helps in assisting the absorption of calcium from food in your intestines, as well as for ensuring the correct renewal and mineralisation of bone tissue. It is therefore essential for the maintenance and development of bone.”
Urinary incontinence is a highly prevalent condition in patients over 60. According to the World Health Organization’s Integrated care for older people (ICOPE) guidelines, the common types of urinary incontinence in older people are stress incontinence and urge incontinence. “Stress incontinence is the involuntary leaking of urine during efforts or exertion, or while sneezing or coughing. Urge incontinence, or overactive bladder syndrome, involves a constellation of symptoms including frequency, urgency and leakage immediately preceded by urgency. Several chronic conditions and environmental factors increase the risk of urinary incontinence in older patients.” ICOPE guidelines include diabetes, Parkinson’s disease, dementia, stroke, prostatic cancer, chronic obstructive pulmonary disease (COPD), and arthritis as chronic diseases associated with urinary incontinence. Environmental factors can also play a role. The primary goal of urinary incontinence interventions is to improve continence by reducing the frequency of urinary incontinence episodes. Non-pharmacological interventions include pelvic floor muscle training (PFMT), bladder training and habit retraining, and timed or prompted voiding. Several medicines can help the bladder empty more fully during urination, while other drugs tighten muscles and can lessen leakage. “Some women find that using an oestrogen vaginal cream may help relieve stress or urge incontinence,” the National Institute on Aging explained. “A low dose of oestrogen cream is applied directly to the vaginal walls and urethral tissue.”
A chronic condition, gout is caused by the crystallisation of uric acid in and around the joints and soft tissues. “While gout is commonly considered to be a disease affecting men, this gender difference diminishes after the age of 65, likely due to hormonal influences,” Dr Priya Chowalloor et al. explained in Gout in the elderly (OA Elderly Medicine). “Untreated chronic gout is associated with significant morbidity. The most common musculoskeletal complications are acute pain, but joint destruction may result in functional impairment,” the authors advised. As is true for many painful conditions, Harvard Medical School recommended one of the nonsteroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, ibuprofen, or indomethacin as first-line treatment for a gout attack. “For people who can’t take NSAIDs, colchicine is an alternative. It’s been used for centuries specifically for gout. If neither an NSAID nor colchicine is an option, then gout attacks can be treated with an oral corticosteroid, such as prednisone, or with corticosteroid injections into the joints.”
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
COPD is a common, preventable, and treatable inflammatory lung disease that gets worse over time. In COPD in elderly patients (Journal of Gerontology and Geriatrics, Volume 64) Prof Giuseppe Paolisso, explained that “the prevalence of COPD is often directly related to the prevalence of tobacco smoking, although, in many countries, outdoor, occupational, and indoor air pollution are major COPD risk factors. Age is often listed as a risk factor for COPD.” With no cure, current treatments focus on managing symptoms or underlying conditions and improving the patient’s quality of life. According to non-profit academic healthcare organisation Cedars-Sinai, treatment approaches, including lifestyle changes, medication, rehabilitation, therapy, as well as surgery, vary depending on how severe the COPD is and what has caused it. “Inhaled medications are the cornerstone for COPD treatment and are typically administered by different types of devices including pressurised metered-dose inhalers, dry powder inhalers, and nebulisers,” reported Prof Paolisso. “Age-related pulmonary changes may negatively influence the delivery of inhaled medications to the small airways. Physical and cognitive impairment, which are common in elderly patients with COPD, cause difficulties in the use of handheld inhalers in the elderly.” As a result, he stressed that treatment with inhaled therapy should be customised for each older patient. “To achieve an optimal adherence to treatment, it is as important to train patients in the use of handheld inhalers and to check that patients are using them correctly on a regular basis as to choose appropriate drugs.”