• Adopting a healthy lifestyle in middle age can double the chances of remaining healthy beyond 70 years
• Long-term medical conditions are more prevalent from mid-life
• Diseases caused by high blood pressure are estimated to cost the NHS over £2bn every year.
Adopting a healthier lifestyle in middle age doubles the chances of being healthy beyond 70 years of age, according to Public Health England. When launching the ‘One You’ campaign earlier this year, PHE said the aim was to encourage people in mid-life (defined as people aged 40-64 years) to take control of their health to enjoy the benefits now and in the future.
With around 40 per cent of deaths related to behaviour and with an annual spend of £11bn on treating illness caused by the effects of diet, inactivity, smoking and drinking alcohol, it is clear that making lifestyle changes in middle age can bring personal benefits while also reducing the burden on the NHS.
Within the past 10 years, the UK population aged 65 years and over has increased by 21 per cent to 11.6m people, while the population aged 85 years and over has increased by 31 per cent to 1.5m people. Life expectancy is now at record levels, and while female life expectancy (82.8 years) still exceeds that for males (79.1 years), the gap is closing. Long-term medical conditions (LTMCs) are more prevalent in older people and it is estimated that, with 15m people now living with LTMCs, an additional £5bn spend on health and social care may be needed by 2018.
Cardiovascular disease (CVD) is responsible for one-third of all deaths in the UK and includes peripheral arterial disease, coronary heart disease (angina; myocardial infarction) and stroke.
Around 20 per cent of people aged over 60 years have some form of peripheral arterial disease (the narrowing of the peripheral arteries in the lower limbs) caused by atherosclerosis (fatty plaques), which restrict blood flow to the muscles and other tissues. This leads to symptoms such as leg pain on walking as well as complications such as ulceration or gangrene (which can lead to amputation) and death.
The mortality rate for peripheral arterial disease is high, at around 50 per cent within five years and 70 per cent at 10 years. The incidence is highest in those who smoke, have diabetes and those with coronary artery disease. Smoking cessation significantly reduces the risk of claudication (blocking of the arteries), so much so that after one year of being smoke-free, the risk is the same as that for a non-smoker.
It is estimated that 90 per cent of people with peripheral arterial disease also have coronary heart disease (CHD), where the flow of blood to the heart is reduced by fatty deposits, which can cause the pain of angina or a heart attack.
Stroke, where the blood supply to the brain is blocked either by a blood clot or part of an atherosclerotic plaque that has broken free, is the third commonest cause of death in the UK and occurs mostly in those over 65 years of age. Complications as a result of stroke include problems with balance, pain, memory, speech and difficulty swallowing.
The QRISK CVD calculator estimates the risk of having a heart attack or stroke over the next 10 years and, among other variables, takes into account smoking status, diabetes, blood pressure, height and weight.
People who are overweight or who are inactive are more at risk of developing type 2 diabetes, as excess weight and inactivity can exacerbate insulin resistance. Obesity contributes to 80-85 per cent of the risk of developing the disease.
Initially, type 2 diabetes can be managed with lifestyle interventions, such as diet and physical activity. However, it is likely that medications, such as oral hypoglycaemics, or an insulin injection will be needed at some point. Complications include cardiovascular disease, and life expectancy can be reduced by an average of 10 years.
Chronic kidney disease (CKD) is an abnormality of kidney function or structure that lasts for three months or more. The risk of developing chronic kidney disease increases with age and there is overlap between CKD, diabetes and CVD. The reduced glomerular filtration rate (GFR) can result in complications such as renal disease, malnutrition, neuropathy and cardiovascular disease. It is estimated that chronic kidney disease is responsible for an extra 7,000 strokes and 12,000 myocardial infarctions a year.
Vascular dementia is caused by brain damage as a result of cerebrovascular disease such as a stroke, many small (unnoticed) strokes, or changes in small blood vessels. It is responsible for around 25 per cent of dementia cases and is often linked to underlying health conditions, such as hypertension and diabetes, as well as lifestyle factors like smoking and being overweight.
Alzheimer’s disease, which accounts for 50 per cent of cases of dementia, is a degenerative condition that results in changes to the brain structure and chemistry. While the cause of Alzheimer’s disease is unknown, drinking more than the recommended number of alcohol units per week is known to be a risk for dementia.
Hypertension (blood pressure that is at least 140/90mmHg) is a risk factor for CVD and CKD. Prevalence in England is estimated at 30 per cent, increasing to 70 per cent for people over 75 years.
The risk of stroke, myocardial infarction and peripheral vascular disease is two to three times greater in people with hypertension. However, stroke is the most important complication. The absolute risk should be calculated using the QRISK calculator described earlier, taking into account other risk factors.
According to a report from Public Health England, over 5m people are unaware they have high blood pressure and it is one of the biggest risk factors for premature death and disability in England. Diseases caused by high blood pressure are estimated to cost the NHS over £2bn every year.
All the diseases mentioned can be influenced by modifiable risk factors – so how can pharmacy get involved and help improve mid-life health?
Local or national health campaigns can be useful to kick start conversations with customers. Know Your Numbers! Week 2016, Blood Pressure UK’s flagship campaign, runs from September 12-18 this year, with the aim of encouraging people to have their blood pressure measured so they can take the steps needed to manage it and reduce their risk of stroke.
Blood Pressure UK is calling on healthcare professionals to join the campaign by hosting a ‘pressure station’ and encouraging people to have their blood pressure measured.
“Having your blood pressure checked is one of the biggest steps that people can take to reduce their risk of stroke and heart attack,” says Professor Graham MacGregor, chairman of Blood Pressure UK.
National No Smoking Day, Stoptober and New Year should be permanent fixtures on the pharmacy calendar as prime times for providing support and encouragement to people wanting to quit smoking and cut down on their alcohol consumption.
Pharmacy teams can also provide information and advice about eating healthily and losing weight safely by recommending sources of accurate and trusted information, such as the NHS Weight Loss Plan (a 12-week diet and exercise plan, as well as advising against alternative diets that may not be safe or help maintain a healthy weight.
The aim of the NHS Health Check programme is to reduce premature mortality and health inequalities in England by addressing the top seven preventable causes of ill health:
• High blood pressure
• Poor diet
• Physical inactivity
• Alcohol consumption.
The health checks, which comprise a vascular risk assessment, is available for anyone aged between 40 to 74 years. However, national uptake of the scheme (mainly in GP practices) has been below expectation at only 50 per cent (the target is 66 per cent).
In community pharmacy a risk assessment pathway indicates when to provide lifestyle advice, when to offer an intervention (e.g. smoking cessation) and when to refer to the GP.
A survey of 2,100 people by the Royal Society for Public Health showed that 78 per cent were comfortable having health checks in community pharmacies. While it is not known exactly how many pharmacies provide NHS health checks, the service has only been commissioned by around 30 bodies (mainly local authorities) throughout England.
“Much has been made recently regarding the strains on A&E departments and GP surgeries across the country,” says Shirley Cramer CBE, chief executive of the Royal Society for Public Health. “Pharmacies offer a fantastic opportunity to improve public health in a relaxed and informal setting within local communities while relieving the strain being placed on other healthcare services.
“There is a growing body of evidence showing community pharmacies are successful when it comes to delivering health improvement initiatives. Couple this with the fact that an estimated 95 per cent of people visit a pharmacy at least once a year and it becomes clear that utilising pharmacies to deliver commissioned services has the potential to be hugely beneficial in the battle against high levels of avoidable illness and premature mortality.”
Making lifestyle changes in middle age can bring personal benefits while also reducing the burden on the NHS
A number of other conditions are frequently associated with the approach of middle age and beyond.
This affects one in three women and one in four men over the age of 40. Pharmacy teams can provide advice about lifestyle changes (reducing caffeine intake; losing weight) as well as information on exercises (pelvic floor muscle training) and bladder training.
Advising people with bladder weakness about appropriate pads and pants in a confidential and understanding environment is helpful, says Donna Wilson, TENA training and brand manager. It is important to stress that purpose-made bladder weakness protection:
• Is available in a range of absorbency levels, designed to deal with varying levels of bladder weakness
• Is much more absorbent than regular sanitary protection
• Rapidly absorbs and moves moisture away from the body for a fresh, dry feeling
• Neutralises and controls odour
• Is designed to be discreet and non-intrusive
• Comes in a choice of different styles.
It is estimated that half of men aged 40-70 years have some degree of erectile dys-function. It is associated with diabetes, high blood pressure and high cholesterol.
While this can occur at any age, vaginal dryness is commoner around the menopause. Vaginal dryness can cause irritation, discomfort during sex and repeated urinary tract infections. In addition to providing advice about appropriate moisturisers and lubricants, pharmacy teams can provide reassurance and refer to the GP when required.
• Public Health England: One You website: nhs.uk/oneyou#SGYwup1JKOflpTby.97
• Public Health England: Health Matters: gov.uk/government/collections/health-matters-public-health-issues
• QRISK calculator: qrisk.org
• Blood Pressure UK. Know your numbers!: bloodpressureuk.org
• Know your limits: knowyourlimits.info
• The Eat Well guide: nhs.uk/Livewell/Goodfood/Pages/the-eatwell-guide.aspx