ORCATECH: Oregon Center for Aging and Technology

Medication Adherence in MCI and Normal Aging

Principal Investigator: Tamara Hayes
Affiliation: OHSU Department of Biomedical Engineering, Point of Care Lab
Funding Period: 2005-2006

Problem

More than 75% of people aged 65 and older take prescription medication, and on average they take 3 or more medications a day. More than 50% of these individuals are non-adherent to their medication regimen, which can have tremendous impact on their health. The financial cost of this medication mismanagement is also significant, since it leads to increased hospitalization and drug side-effects. We are exploring ways to combine medication adherence data and mobility data to identify patterns of behavior that lead to missed medication. This research includes the development of technology for automated tracking of medication adherence, and the development of algorithms to infer the activities and conditions that are associated with missing medications.

Objective

There are two main goals in this study. The first is to learn if very mild memory loss contributes to difficulties in following a medication regimen. The second goal is to understand if there are typical events (e.g. appointments outside the home or sleeping in) that increase the likelihood of missing medication doses.

Methods

Continuous in-home monitoring with wireless motion sensors and a medication tracking device for approximately 5 weeks.

Subjects

38 elderly subjects living independently in their own homes (17 from Holladay Park Plaza, 21 from Rogue Valley Manor)
Two groups based on age-adjusted scores on initial memory tests:

"Mild changes" group (slightly lower scores than the "no changes" group)
"No changes" group

The mean scores of both groups were well within the normal range, meaning we are looking at very mild memory loss

Results

We looked at 2 types of adherence: taking 2 pills a day as prescribed and taking those pills at specific times of day (1 hour before or 2 hours after a chosen time). In clinical studies of drug effectivness an 80% adherence rate is considered good and 66-81% compliance is typical for twice-daily regimens.

In our study we found that:

70% of all participants had "good adherence" to the regimen of taking a vitamin pill at 2 specific times during the day
Participants took 2 pills a day approximately 76% of the time
Adherence was better in the morning (77%) than in the evening (63%) for all participants
The "no changes" group was 4.5 times more likely to have good adherence (>80%) thank the "mild changes" group, indicating that even mild memory loss can affect medication adherence

Subjects reported the following reasons for non-adherence:

62.2% - I was busy doing something else when I was supposed to take it
59.5% - I wasn't home when I was supposed to take it
8.1% - I took it out of the pillbox but forgot to take it
2.7% - I was in a different room than the pillbox when I was supposed to take it
No one reported forgetting when to take the pill, forgetting to load the pillbox, not wanting to take the pill or not feeling well enough to take the pill as reasons for missing vitamins.

Conclusions + Next Steps

Mild cognitive changes can affect a person's ability to take their medication as prescribed.
In order to help people with mild cognitive changes take their medication more regularly it might be helpful to engineer a pillbox that has a reminding system, specifically one which can alert people about their pills even if they are not in the room with the pillbox.