Innovative technological intervention to improve clinical outcomes and medication adherence in elderly patients

Abstract

As the population ages, the proportion of elderly patients who live alone with chronic diseases, multi-morbidity and with a lack of family support is expanding. These patients may experience difficulty in adhering to prescribed medications. IT solutions are capable of providing assistance to elderly people who wish to live independently in their own homes for as long as possible. The present thesis focuses on three areas: (i) helping elderly patients who live alone to live safely in their own homes, (ii) helping elderly patients who live alone to manage their medicines and (iii) helping to overcome loneliness in elderly patients who live alone. The experimental aspects of the thesis commences with a retrospective study which was conducted to evaluate the healthcare utilisation of elderly patients enrolled in a telecare service (Telecare NI) provided in the five healthcare trusts across N. Ireland (NI). Data were collected relating to pre- and post-installation of the service over a period of six years (between 2010 and 2016). This service used a range of detectors and monitoring equipment to enable remote monitoring of the activity and safety of elderly patients in their own homes. The study found a significant (PO.OS) increase in health service utilisation (non-elective hospital admissions, period of hospital stay, outpatient clinic visits and emergency room visits) post-installation of the telecare service. Two aspects of care not addressed by telecare or indeed telehealth programmes in N. Ireland at present is assistance with medication adherence and dealing with loneliness. A potential solution to these challenges is currently under development within the research team, i.e. a virtual pet platform for loading on to a mobile phone or a computer tablet. As an integral aspect of the research, a systematic review was conducted to determine the evidence base to date on the application of a virtual pet within the healthcare field. The final review included a total of eleven studies which examined the use of a virtual pet platform in changing health behaviours. None of the included studies explored the use of a virtual pet platform to assist patients with medication adherence management to date. The thesis goes on to provide details of the ongoing development of a novel ‘Medication Adherence Companion’ (MAC) platform utilising a virtual pet dog, for use in mobile phones and tablet computer devices, primarily for elderly people. The virtual pet dog platform has the potential to provide companionship and work as a medication assistant to remind patients about their daily medication schedule. Furthermore, it can connect the patient to his/her GP or healthcare provider if required. A study was undertaken to test the robustness of the software and the functions of the main features of the prototype amongst members of the development team. All participants agreed that the software was relatively robust but required further work and that the platform would be easy to use by elderly patients. Lastly, a qualitative study, which included a total of seven focus groups, was conducted to explore views of older people (>65 years old) who lived alone on the use of the medication adherence companion (MAC) to assist with medication management and loneliness. Although not unanimous, the overall views of the focus group participants were positive with general support for ongoing, further development of the MAC platform. It can be concluded that elderly patients are willing to embrace IT solutions and that there is scope for platforms to assist with medication management and dealing with loneliness. Such developments have the potential to help address challenges encountered by the increasing numbers of elderly patients who live alone.