Pharmacists as pastoral carers in cognitive decline

The pastoral care role of the community pharmacist means we can still provide positive guidance even when medications will be generally ineffective.

Pharmacists working in classic community pharmacies have a close trust-based relationship with many of their patients.

We notice changes on a week-by-week basis and often have time for a chat about life events. Consequently, when patients confi­de that their brain isn’t what it used to be, this opens an avenue which may be ultimately constructive, both on individual and population levels.

With the evidence mounting for positive outcomes of comprehensive lifestyle and diet interventions in brain, as well as overall health, we need to be able to pass this knowledge, and with it, a degree of hope, to our patients.

I fi­nd asking about ‘brain fog’ often elicits a startled but joyful response. Phrasing it in this way makes it a genuine concern but without any of the negative connotations of impending doom and dementia. Further discussion then leads to actions that can be taken.

Naturally, a full physical and mental assessment with comprehensive blood tests at their managing health practitioner would be a fi­rst step, along with resources (books in particular) regarding positive diet and lifestyle approaches. The evidence at present suggests that the most effective approach is multi-faceted, with the quality of diet, exercise and sleep being major players.

This is the advice I would provide (as well as a referral to a dementia prevention practitioner) to a patient concerned about their brain function but who has been assessed as still ‘normal’ by their GP.

‘Firstly, there is something you can do right now. Start with sorting out your environment. Live a life that is based around being active (sweat with effort daily!) and as much as possible, outdoors, keeping a circadian rhythm going and not surrounding yourself with more chemical insults than necessary. Then get your dietary intake in order. Cut back on processed food, alcohol and sugar.’

‘Get blood tests done and get all your readings in the best possible range. Sort out your dental health, your mental health, your hormones and any tendency towards diabetes.’

‘Sleep properly. If you are snoring or have sleep apnoea, this needs to be dealt with promptly. Get onto a sleep clinic as soon as you can. Practise sleep hygiene.’

Being knowledgeable about the current interventions and research is both exciting for me and life-enhancing for those patients who are quietly convinced they are on a downward trajectory.

In brain health, single-molecule medication is not going to be a major player, at least in the near future.

Providing a sensible path for cognitive improvement empowers our patients to take control themselves and actively engage with their own health outcomes.

Pharmacists are often the only healthcare professional many patients will see regularly, or sometimes, at all. I recognise that remuneration is important, and certainly the system is imperfect when it comes to value-based funding, but for me it’s the positive and frequent changes we facilitate in our patients’ health and wellbeing that make it a joy to work in pharmacy.

Carolyn Glazier MPS was PSA’s joint winner of the Intern Pharmacist of the Year for 2017. She works at Gerald Burns Pharmacy, WA, winner of the Professional Innovation category of the Guild Pharmacy of the Year Awards delivered at APP18.

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