1. Medication management tools for the home based elderly Nicole Percival

2. Medication & The Elderly Seniors are major consumers of prescription medications, receiving 30% of written Rx’s per year (Wendt, 1998) As people age the number of medications prescribed increases (Winland-Brown &Vallante, 2000): -Typical Adult: 2.87 meds/day -Typical Senior: 7-10 meds; 13 different meds per year

3. Medication Management Problems Medication mismanagement in the elderly is due to a complex interaction of a variety of factors.

4. Factors Influencing Medication Compliance  The primary barrier to medication non-compliance is the patient’s perception of the medication regime.  The presence of one or more of several motivational factors will also influence medication compliance and successful medication management, resulting in sub- optimal adherence (Blonde, 2000; Nugent et al., 2007; Wendt, 1998).

5. Factors Influencing Medication Compliance  Motivational factors (Blonde, 2000; Nugent et al., 2007; Wendt, 1998)  Failure to understand a treatment routine  Side effects  Financial barriers/Cost of medication  Lack of social support  Amount of lifestyle disruption  Perceived effectiveness of medication  Forgetfulness

6. Manifestations of Medication Mismanagement  Polypharmacy leading to confusion over doses and schedules  Taking the incorrect dosages  Taking the wrong medication  Taking medication at the wrong time  Failure to fill prescriptions  Forgetting (50% of filled prescriptions are never taken)  Discontinuing medication prematurely  (Nugent et al., 2007; Wendt, 1998; Windland-Brown & Vallante, 2000).

7. Consequences of Medication Mismanagement The elderly are particularly vulnerable to medication mismanagement and the resulting adverse consequences (MacLaughlin et al., 2005).  ~ 50% of the elderly mismanage their medication, with estimates ranging from 26- 59%  High number of health conditions  Higher medication use than any other population

8. Consequences of Medication Mismanagement  Adverse side effects, deterioration of health and multiple other effects that may result in an increase in medical visits, admission into nursing homes or the hospital or even death (MacLaughlin et al., 2005; Windland-Brown & Vallante, 2000).  ~125,000 deaths per year in the U.S.  23% of nursing home admissions  28% of hospital admissions  Over 10% of all emergency room visits involving the elderly are due to medication non-adherence, polypharmacy and inter-drug interactions

9. Techniques for Improving Medication Management (MacLaughlin et al., 2005; Windland-Brown & Vallante, 2000)  Better communication between provider (G.P. & Pharmacy) and patient  Education on medication doses and scheduling  Home visits for monitoring mediation use  Mechanical aids (charts, written instructions)  Individualize timing of meds to patient’s sched  Colour coded pill bottles matched with weekly pill tray  Large, readable directions  Non-child resistant cap for easy opening

10. Existing Medication Management Tools Pill holders Alarm based devices Monitoring devices Mobile services Context aware devices

11. Existing Medication Management Tools  Pill holders

12. Existing Medication Management Tools  Automatic pill dispenser

13. Existing Medication Management Tools  Alarm based devices

14. Existing Medication Management Tools  Monitoring devices  Mobile Services

15. Existing Medication Management Tools  Context aware devices

16. Medication Management Tools – Design Considerations  Devices need to be cost effective and portable  Medication compliance is improved if device communicates with all stakeholders, not just the patient (Nugent et al., 2007)  G.P., Pharmacist, and Formal/Informal Caregivers

17. Medication Management Tools – Design Considerations  Context Awareness  Ubiquitous computing may provide a more valuable medication management system as it can support, intervene, monitor and manage the patient’s medication use  Considers patients on individual basis and makes recommendations or alteration to improve compliance  Flexibility to supports dynamic personal social context in an intelligent and proactive manner  (Agarawala, Greenberg, & Ho, 2004; Nugent et al., 2007)

18. Medication Management Tools – Design Considerations  Need devices designed with the potential to interact with other technologies and services in a dynamic and flexible way (Nugent et al., 2007)  Devices that interact with ubiquitous computing environments such as smart homes in supporting overall health management  Internet based services  Mobile medical devices  Personal physiological monitors

19. Medication Management Tools – Existing Technological Capabilities  Infrastructures are being developed to facilitate the communication of medication and condition related information to all stakeholders, which allows for the development of holistic health care models supported by technology (Nugent et al., 2007)

20. Conclusion Medication management amongst the elderly remains an important and understudied issue. Although many tools have been developed to improve medication adherence, however there remains a lack of large scaled randomized controlled studied to determine definitively which method is superior. What is known is that any successful medication management device should take into account several components, including context awareness, an alarm, the ability to notify a third party if medication is missed and interoperability with other devices.

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