Aging in Place MeetUp: Medication Management

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from: Longevity Explorers | Aging in Place Technology

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Discussion Summary

We met again at TechShop Mid Peninsula (June 2016), this time to discuss Medication Management & Older Adults. We had a nice crowd of about 25 people.

First, we had one five-minute presentation, by Bob Glicksman. Months ago Bob deployed two sensors in the living room of his aging mother's apartment. He did this intending to test a low cost system he developed with Jim Schrempp. His intent was to gather some real world data before installing more sensors. However, Bob has found that just these two sensors have provided him a wealth of information. He's been able to use the data to call his mother at times when her routine seemed unusual. These interventions got his mother back on track. He believes this kind of very simple remote sensing helps her to continue living independently. The group discussion was so lively that Richard let it run for 15 minutes. Bob is working on a written report that will eventually be up on this web site.

We then moved into a large circle to discuss the topic of the day, moderated by Jim and Richard. As a group we explored our experiences, learning, and thoughts on many aspects of Medication Management. We had an interesting conversation that lasted over an hour. As always, I'll add some bullet points below from my notes. Please add your thoughts in the comments below.

The problem space

  • There are three components to the overall problem: Alert / Dispense / Confirm. We see a continuum of solutions:  Apps - Reminder Devices - Pill Dispensers - Skilled Nursing, some address only one part of the problem. 
  • There are also two aspects to consider: inadvertent deviation from a dosing schedule and purposeful non-compliance. A person might chose to not take a medicine for many reasons: side effects, cost, perception.
  • The many different dosage regimens make it difficult to be accurate. Some to be taken with a meal, some before a meal, some a time after a meal.

Devices

  • There are commercial devices to help manage the dosing. Many consumer devices exist that have small pill compartments that are automatically opened at the correct time. But this begs the question, "who's filling up those devices?" Non-nurse home health care workers are often prohibited by their company from touching any medications. So these seem like good ideas, but it requires a caregiver to load them and program them.
  • Many of the dispensing devices are also unattractive. One of the reminder devices has a huge button on it; another one speaks (yells) at you. One person said, "the device is huge, it sits on the counter, it tells everyone who comes over that the person is old." Why can't these devices look like a toaster and hide their function? Of course, this is all part of the stigmatization of aging, but it is the reality we live with today.
  • Instead of buzzing or speaking, maybe a reminder device could play songs from the person's era. A different song for each reminder might make the experience more pleasant.
  • Someone mentioned a device under development that will scan a pill bottle, accept a load of pills, and then dispense them as appropriate. This seems like an expensive proposition for a home of one or two people.
  • The cost of non-compliance is high. Many older adult emergency room visits are due to medication compliance issues. This means the cost to a health insurance company is also high; perhaps the insurance companies are a source of funding for in-home devices that improve compliance.
  • Why don't people get a 10% discount on their health insurance if they adhere to their medication regimen? Like a car insurance safe driver discount. Or those new devices that plug into the car and monitor your driving to qualify for a discount.

Motivation

  • Why can't medications be in a more enjoyable form? Pills, pills, pills. Some very big pills. Vitamins currently come in gummy candy form. Adding medications to a pleasant to ingest form might increase compliance.
  • Gamification - Some solutions try to reward adherence. Some offer a store coupon for reporting 100% compliance. Some solutions let you compete with friends to remain on schedule - much like FitBit does.
  • Peers - Some solutions let you team up with one or more friends. If one doesn't take a medication on time, the others get a notification and can encourage the person.
  • A variation on the buddy system is to pair up several people. You only get a reward if your buddy is 100% compliant! Or everyone in the group pays some amount and the 100% compliant people split the pot at the end of the month.
  • Patients might not understand why they are taking certain pills. The doctor prescribed the medication but the person doesn't remember what the pill is for.
  • Perhaps a solution could be tailored to a specific outcome and have the person monitor this along with their pill taking. Imagine that a person taking cholesterol lowering medication is able to measure their blood cholesterol level every day. The solution could show them the strong correlation to encourage them to keep taking it. Maybe a drug to reduce dizziness could have a simple test of balance that a person could do and report on. Again, the correlation between dosing and outcome could provide motivation.

It is always hard in these articles to capture all the rich discussion that went on. The points above are a poor substitute for being there. Luckily for you, the reader, we did an audio recording of this session and you may listen to it here.

Once again, thanks to Walt and Voler Systems for providing the pizza and drinks.

 

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Medication management