Alma’s Technology: A Look at Medication Adherence Technologies

Messages from Majd | February 20, 2013

CAST’s new video, , follows 83-year-old Alma Jones on her journey from home to hospital, to a rehabilitation center, and back home. In this second installment of our 12-part series on “Alma’s Technology,” CAST Executive Director Majd Alwan explores medication adherence technologies, one of the technology solutions that helped our fictitious video character live independently.

 

“I hate seeing my mom getting old. But I think what impresses me most about her aging is that she’s taking charge of it.”

These heartfelt words come from the daughter of Alma Jones, an 83-year-old woman who is on a journey from home to hospital, to rehabilitation center, and back home after suffering a stroke. Alma is the central character in CAST’s new video, called High-Tech Aging: Improving Lives Today

The video illustrates how a variety of technology solutions are putting Alma in charge of her aging and helping to put her daughter Susanne’s mind at ease.

One of the technology solutions featured in the video is a medication dispenser system that:

  • Reminds Alma when it’s time to take her medications.
  • Dispenses correct doses of that medication.
  • Alerts a caregiver if Alma fails to take a medication dose.
  • Tracks Alma’s adherence.
  • Sends a refill request when her medication is about to run out. 

In this 2nd installment of our 12-part series on “Alma’s Technologies,” I’d like to explore medication adherence technologies and how they can help older adults stay healthy and independent.

Medication Management: A Major Challenge for Older Adults

Medication management for older adults can be a complex undertaking. That’s because people over age 65 are more likely to:

  • Have multiple chronic conditions.
  • Visit multiple health care providers in multiple care setting. 
  • Take multiple prescriptions. 

According to a recent Report to Congress on aging services technologies written by CAST and NORC, a research organization at the University of Chicago, medication errors harm at least 1.5 million people each year. These errors cause a significant number of preventable adverse drug events (ADE) that can send older adults to the hospital or could result in their death.

Some ADEs occur when physicians and pharmacies make mistakes during the ordering, transcribing or dispensing of prescriptions. But other ADEs take place when consumers don’t take their medicines as prescribed. This is a serious problem for older adults. One meta-analysis cited in our report suggests that medication adherence rates are dangerously low—between 26% and 59%—among older adults age 65 and older.

Non-adherence can result in unfavorable health outcomes, preventable hospital and nursing home admissions, or the need for formal and informal services and supports. Poor medication adherence accounts for 10% of hospital admissions, according to our report. Patients who do not adhere to their medication regimens are 3 times less likely to have favorable health outcomes than those who follow prescription-related instructions.

The Role of Technology in Medication Adherence

The number of ADEs goes down when medication management improves. Fortunately, a number of technology solutions can help.

Alma took advantage of several of these solutions. She had an electronic health record that informed all of her health care providers about her current medications, allergies and health conditions. And she used a medication adherence system on a day-to-day basis. This type of device is designed to make sure that an older adult takes every medication that is prescribed, at the right time and in the right dosage. Medication systems come in many designs and vary in their complexity. They generally offer 3 levels of service:

  • A simple reminder: Some medication adherence systems give the user an audible or visual cue (or both) when it’s time to take a pill. However, it’s up to the user to follow through and actually take the pill. These systems usually work for simple medication regimens and schedules. Medication reminders can be as simple as a wrist-watch alarm or as complex as a programmable smartphone app. They are generally very portable, which means that older adults can incorporate them very easily into their daily routines.
  • Reminder plus dispenser: Some medication adherence systems combine a reminder with a dispensing mechanism that releases medication doses at times or intervals specified by the user. Some devices only dispense one medication at a time. Others can handle several medications that must be taken on different schedules. Generally, these dispensers are not portable and require electric or battery power.
  • Reminder, dispenser and monitor: The most advanced at-home medication systems remind the user to take medication, provide the pill, and record the date and time the user took the pill. Some devices use the Internet or a telephone line to report this information to a server that creates a medication adherence record and can alert a clinician and/or caregiver via e-mail or text messages. This communication helps professional and family caregivers track whether the older adult is taking medications properly. If problems occur, the caregivers can intervene before an ADE occurs. Some of these devices are portable, while others are larger.

In the CAST video, Alma had the third type of medication dispenser, which generated an electronic medications adherence record to let her doctors track how faithfully she took her medications. When Alma had a stroke and was hospitalized, the adherence record informed her care team at the hospital “what medications she took last, and when she took them.” Alma’s hospitalist stresses that the information “probably saved her life.”

Tips for Using Medication Reminder/Dispensers Most Effectively

When advising a consumer who is selecting a medication adherence system, keep several things in mind:

  • Number of medications and complexity of schedule: Make sure that the solution can accommodate all the user’s medications and scheduling requirements. Start by having the user’s physician review all medications to make sure that they are all necessary. In many cases, this step may lead to a reduction in the number of medications and/or the complexity of the medication regimen.
  • User’s needs and abilities: Consider the user’s needs. Does he/she have a simple medications regimen that warrants a simple reminding system? Or does he/she have a more complex medication regimen that warrants a dispensing function? How critical it is for the caregiver to know if the care recipient is non-adherent? 
  • Ease of use, programming and filling: Assess the ease of use of the device to ensure that the older adult will be able to use it on a regular basis. Can the person program and fill the device without assistance? Filling will usually involve packaging the medications as well as filling the device. Alternatively, can a family caregiver program and fill the device for the older adult? Or will the family need a professional caregiver to program and fill the device? 
  • Refilling and monitoring responsibility: Based on the ease of filling and programming, the user will need to determine who will be responsible for refilling the dispenser when the medications run out. Should the device have a refill request feature? If the device has a monitored medication adherence solution, consider who will be responsible for receiving the non-adherence alerts. What will the response protocol entail? 
  • Portability: Portability is necessary for active older adults who spend a lot of time outside their “home” or travel frequently. If portability is required, consider the average length of trips when evaluating the pill capacity of a portable medication dispenser. 

I recommend watching the full-version of the Alma video, and I would encourage you to check the medication adherence technologies section of CAST’s report on the State of Technology in Aging Services to find out relevant information and technologies.