Section
Description
Page Number
1
Rationale of Crisis
1.1 Greater medical non-adherence among elderly with no caregivers
1.2 Importance of medical adherence and impact of medical non-adherence
2
Analysis of Crisis (reasons)
2.1 Non-medical adherence in elderly
2.1.1 Effects of cognitive decline and role of polypharmacy
2.1.2 Problems that may arise during taking of medicine
3
Current measure
3.1 Evaluative criteria for measure needed
3.2 Current measure: Pillbox
3.2.1 Process of sorting medicine into pillbox by elderly
3.2.2 Fault in packaging of medication
3.3 Evaluation of current measure
3.4 Rationale for new measure
1000 words limit
4
Case study
4.1 Lack of manpower in parcel delivery industry
4.2 Solution(s) adopted to tackle the problem
4.3 Similarities between medical non-adherence in the elderly and lack of manpower in mail industry
4.4 Differences between medical non-adherence in the elderly and lack of manpower in mail industry
4.5 Modifications to the differences
1000 words limit
5
Idea Generation
5.1 Idea (how it works)
5.2 How the idea reduces the medication non-adherence rate in the elderly
5.3 Limitations of idea
Section 1.1.1 Greater medical non-adherence among elderly with no caregivers
(https://link.springer.com/article/10.3275/8475)
APA FORMAT:
Foebel, A.D., Hirdes, J.P. & Heckman, G.A. (2012) Caregiver status affects medication adherence among older home care clients with heart failure. Volume 24, Issue 6, pp 718–721.
Retrieved from https://link.springer.com/article/10.3275/8475#citeas
From article: Foebel, A.D., Hirdes, J.P. & Heckman, G.A. Aging Clin Exp Res (2012) 24: 718. https://doi.org/10.3275/8475
According to the Aging Clinical and Experimental Research, not receiving help from caregivers increases medical non-adherence among the elderly. Caregivers reduce the impacts of cognitive decline on the elderly by reminding them to follow their medical regimen, hence reducing the impact of medical non-adherence. As such, it can be inferred that elderly without caregivers are more medically non-adherent than those with caregivers.
Our project aims to benefit the elderly without caregivers by enabling them to have a more effective medication process.
Section 1.2 Importance of medical adherence and impact of medical non-adherence
Type of Drugs for common chronic diseases that the elderly suffer from
Medication Prescription
Effects of not following prescription
Anticoagulant for diseases such as atrial fibrillation
Timing
Dosage
Delaying or taking 2 tablets at once may cause increased risk of bleeding
Taken twice daily;12 hours gap required.
If dosage is missed, can be retaken up to 6 hours prior to next dose
Only one tablet should be taken at once
Pyridostigmine
Twice daily
Must not skip prescribed dosage
Increase the risk of symptoms such as muscle weakness
Figure 1: Importance of medical adherence and adverse effects of not doing so
As shown in figure 1, it is clear that not adhering to their prescription will not only reduce their recovery rate but also cause detrimental effects. As a result, it can be concluded that medical adherence is imperative and thus is crucial to improving adherence among struggling elderly. https://products.boehringer-ingelheim.com/pradaxa/surgery-and-emergencies/overdose-with-pradaxa/
Avoiding Pitfalls With Time-Critical Meds – Therapeutic Research Center
From article: Technician Tutorial, Med Administration: Timing is Everything. Pharmacist’s Letter/Pharmacy Technician’s Letter. June 2018.
Section 2.1.1 Cognitive decline and polypharmacy decreases medical adherence in elderly
Polypharmacy and decline in cognitive ability of the elderly were identified as the main causes for non-medical adherence in the elderly.
In general, amount of medication consumed increases with age due to the natural increase in the number of diseases.
The use of multiple medications, known as polypharmacy, generally refers to the consumption of five or more prescribed drugs per day.
The increase in the number of medicine adds to the strenuous nature of sorting medicine appropriately according to the prescription. This process is more difficult for the elderly due to greater cognitive decline than other age groups.
Cognitive decline is the reduced ability in processing information. Processing ability is defined by how much the brain can remember, and connect different pieces of information more efficiently and effectively.
Processing ability is needed to remember the time intervals at which each specific type of medicine should be taken at. As shown in figure 2, an elderly suffering from polypharmacy will have to remember the different time intervals for each of the 5 kinds of medication.
Figure 2: Different medications and timings to be eaten at
Section 2.1.2 Problems that may arise in the process of taking medication
Figure 3: Medication schedule in 24 hours (with reference to medications from fig. 2)
Figure 4: Mandatory prescription stickers on medications by hospitals or clinics
Elderly will have to consolidate the different medications to be taken in 24 hours like in figure 3. However, as they are incapable of connecting different pieces of information efficiently and effectively due to cognitive decline, the elderly are unable to categorise the different medications with similar time intervals together.
Elderly are unable to remember which medicine to take at a specific timing. This is because the medications consumed by the elderly may be taken at different time intervals, as shown in figure 2, on top of cognitive decline.
Elderly are unable to remember whether he has already consumed the required dosage of a specific medication or not. This requires the elderly to count and note down the number of pills in the packet after the previous consumption. Currently, not many of them are doing so.
A 1994 study of adults and seniors found more self-administration medication errors with 9 vs. 12 or 14 point font and Courier vs. Helvetica fonts. This shows that in order to ensure medical adherence in the elderly, a minimum of 12 point font is needed. However, as indicated in figure 4, both fonts on the packaging are below 12 point font.
Elderly with poor eyesight will have a hard time reading these small words, and hence read the instructions wrongly. For example, elderly might read the number 3 as 5 and take 5 times a day instead of 3.
Only English instructions are given, resulting in a language barrier. According to the Organisation for Economic Co-operation and Development (OECD), it can be inferred that most elderly in Singapore are English illiterate, with older adults, particularly 55-65 year olds, attaining some of the lowest scores in literacy among all participating countries. Hence, elderly will not understand the instructions and interpret them wrongly is no one translates for them.
The problems mentioned above decreases medical adherence in elderly.
Section 3.1 Evaluative Criteria for measure
To tackle the problem of medical non-adherence among the elderly, measures should follow specific criterion to effectively reduce or eliminate medical non-adherence.
Such criterion includes:
Measures should ease the involvement of having to use one’s cognitive ability by helping them to classify the medications according to:
Name of the medicine
The timing to be consumed at
Measure should help tackle their memory decline by reminding them to eat their medicine
Sustainable design with low maintenance so that the elderly would no need to worry about the working status of the measure
Section 3.2 Current measure
One of the measure available now is the usage of a pillbox.
Figure 5: Image of pillbox as current measure and its functions
Section 3.2.1 Process of sorting medicine into pillbox by elderly
Steps taken by elderly
Problems that may arise in the process of sorting
Implications
Read the prescription label
As explained in section 2.1.2, point 4, the issue of a small font is still present when the elderly are sorting out their medication into their pillbox.
As explained in section 2.1.2, point 5, the issue of language barrier is still present when the elderly are sorting out their medication into their pillbox.
Appropriately plan out the timings at which they are supposed to consume every one of their medicines at
╳
╳
Plan the quantity of medicine they are supposed to take at the specific times
╳
╳
Put them in the pillbox accordingly
Only 3 sub-compartments in a day in the pillbox. The compartments not enough as some medicine needs to be taken every 4 hours.
At least 4 compartments will be needed in 24 hours. Using this pillbox, time critical medicine will not be taken on time, leading to dire consequences on the elderly’s health.
* ╳ represents no significant problems / implications
(https://www.straitstimes.com/singapore/english-most-common-home-language-in-singapore-bilingualism-also-up-government-survey)
APA FORMAT: Pearl, L. (2016) English most common home language in Singapore, bilingualism also up: Government survey. Retrieved from: https://www.straitstimes.com/singapore/english-most-common-home-language-in-singapore-bilingualism-also-up-government-survey
Section 3.3 Evaluation of current measure
Pros of current measure:
With low maintenance required and straightforward usage of the pillbox, the elderly will be more receptive towards using the product. In addition, in-built alarm that reminds user to take medication at the allocated timings (morning, noon, and night) helps tackle the issue of poor memory commonly experienced by elderly. The elderly can also check if they have yet to consume the required dosage needed for that day by checking if that particular section of the pillbox is filled.
Cons of current measure :
As explained in Sections 3.2.1 and 3.2.2, the issue of small fonts on packaging and language barrier still remain. In addition, there is an insufficient number of sub-compartments on the pillbox. However, this device only helps the elderly during the consumption process by reminding the elderly when to consume medication. The device does not help the elderly with the process of sorting the medication according to timing and quantity.
Word Count as of 8 oct 4:09PM: 1037
Japan Yamato:
https://www.nippon.com/en/currents/d00321/
https://asia.nikkei.com/Business/Japan-s-parcel-shippers-forced-to-revise-unprofitable-strategy
https://www.csmonitor.com/1982/0809/080940.html
FedEx:
https://about.van.fedex.com/our-story/history-timeline/history/
UPS:
https://money.howstuffworks.com/ups1.htm
Crisis to company : Financial aspect / reputation ( Fall in sales after the xmas thingy )
Used to be manual now automated bc when it was manual it was full of errors (until like crisis liddat)
2012 : UPS implemented the wearable barcode system
https://www.cnbc.com/2018/05/14/ups-shares-to-rise-on-automation-and-pricing-bank-of-america.html
Section 4.1: Lack of accuracy in mail industry
https://postalmuseum.si.edu/americasmailingindustry/United-States-Postal-Service.html
https://postalmuseum.si.edu/americasmailingindustry/United-States-Postal-Service.html
Section 4.2 Impact of lack of manpower on the company
Section 5.1: Idea Generation
Figure 6: Proposed Idea
Parts (with reference to figure 6):
Section A is a machine with 8 compartments. Each compartment is a cylindrical tube labelled from number 1 to 8 and has a small tube attached to the bottom of each one.
Section B is attached at the bottom of section A. It is a pill box with 24 compartments, one for each hour for a total of 24 hours. Each compartment contains all the medications to be eaten for that hour.
Section A has a barcode scanner and an automated dispensing cabinet. Every prescribed medicine has a barcode on the prescription label.
How it works:
First, the barcode of prescribed medicine has to be scanned. The barcode reader will be able to identify the type of medicine, the dosage and the time intervals at which they must be administered to elderly, and store this information.
Elderly will then have to press the compartment number which the medicine is going to be poured into.
Machine will match the information scanned to that compartment number and start sorting process.
Elderly to input the start time of which the first dosage of medicine is going to be administered at. For example, if the start time is 8 A.M., the first dosage of every type of medicine is going to be dispensed at 8 A.M.
Based on the time intervals and dosage of each medicine, each compartment in section A will be rotated and the medication in it will be sort into all the timings that it has to be taken at, through a tube. Section A operates on a rotator mechanism while the pillbox at the bottom is fixed. For example, compartment 1 is section A contains Dabigatran, which needs to be taken every 12 hours. So, section A will rotate till the tube of compartment A reaches the “8 A.M.” compartment in section B and drop the pill into it. Next, the tube will then be rotated to the “8 P.M.” compartment and drop another pill down again. The mechanism to how one pill is dropped at a time is with reference to https://www.youtube.com/watch?v=9evqJGrDaVw. If 2 pills are to be dropped at once, the mechanism will be repeated twice.
This process repeats until all the medications to be taken in 24 hours is sorted out.
A lighting and alarm mechanism attached to each compartment in section B
lights up and rings at that certain hour to remind elderly to eat their medications.
Thus, elderly will only have to eat all the medication that is in that compartment at that timing.
Each compartment in section B is also detachable and portable.
Section 5.2: How the idea reduces the medication non-adherence rate in the elderly
It helps to plan and sort all prescribed type of medications for the elderly, removing the need to plan out their medication schedule, thus reducing the chances of medication non-adherence since the need to employ elderly’s declined cognitive ability is minimised.
The issue of small fonts on packaging and language barrier is solved since the barcode scanner reads and stores the information on the prescription label.
Number of compartments in the pillbox increased, allowing for more flexibility in the planning the medication schedule and chances of not adhering to time-critical medications is reduced. Time-critical medications are medications with that have to be taken on time or 30 minutes before/after prescribed timing, if not there will be severe negative impacts on health.
Section 5.3: Limitations of idea
Have to go through another process of sorting after 24 hours
Bulky, making it difficult to carry the whole machine overseas when needed