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Helping older people to manage their medicines

Studies have found that between 40 percent and 75 percent of older people do not take their medications at the right times or in the right amounts. The costs of poor adherence to medication (overdosing and under dosing) can be severe, both to the individual and in terms of potentially avoidable demand on health and social services. Adverse drug events and poor adherence are a common cause of hospitalisation in older people. The National Institute for Health and Clinical Evidence (NICE) estimated that in the UK in 2006/07 hospital admissions due to poor adherence cost the NHS between £36 and £196 million (NICE, 2009). The ability to adhere to medication is often a significant factor in decisions on whether an older person with chronic health conditions can continue to live independently. In 2005/06 Scottish local authorities spent an estimated £579 million (gross) on care homes (Sutherland Report, 2008).

The economic and health costs of older people’s poor adherence to medication are set to continue to rise. The Scottish population is ageing. Also, the rate of increase in life expectancy is greater than that of health life expectancy, meaning an increase in the period of ill-health in old age (currently around 10 years for women and around 7.5 years for men (ISD, 2009)). This period of ill-health in later life is frequently characterised by multiple health conditions, and as a result older people can have complicated medication regimes.

We intend to draw up a programme of research for the development of non-intrusive devices to simultaneously monitor and facilitate adherence to prescribed medication. Such devices would promote ageing in place and care in the community in line with Scottish and UK Government policies and strategies (as detailed, for example, in the UK Government’s ‘Building a Society for All Ages’, published July 2009). Support from the Scottish Crucible Project Fund would act as ‘pump-priming’ funds, enabling us to; build a network of collaborators; carry out supporting secondary research; and secure the funds required for the remainder of the programme.

The causes of and risk factors for non-adherence are not fully understood. Unintentional non-adherence can arise from capacity and resource limitations that prevent patients from following treatment recommendations, and may involve individual constraints (eg, memory, dexterity, difficulty using some medication types, etc) and aspects of their environments (eg, problems of accessing prescriptions, cost of medicines, competing demands, etc). Reasons for intentional non-adherence may include beliefs, attitudes and expectations that influence patients’ motivation to begin and persist with regimens, for example about treatment efficacy or the likelihood of undesirable side-effects. Our programme will focus on devices to identify and prevent unintentional non-adherence.

Existing devices assisting adherence generally consist of boxes or carousels with sub-divided compartments for days of the week and times of day. Such devices have a number of weaknesses. They are not suitable for all types of medication and can only be used for tablets and capsules. They do not provide access to information on the medications being dispensed in line with current medicines labelling regulations. They provide limited information on whether medicines have been taken, and whether they have been taken in the correct dosage at the correct time. Devices developed as part of our research programme will address these issues, building on and extending the use of technologies developed in the context of lifestyle monitoring and telecare applications.

Funding body: 
Royal Society of Edinburgh
1 October 2009 to 30 September 2010
Project members: 
Project Status: