Medication Adherence Study

 Improving Medication Adherence of Elderly through Monitoring and Intervention 

With the growth of the elderly population in Singapore, healthcare expenditure and prevalence of age-related illnesses are expected to increase. Non-adherence to medication among the elderly is a common issue that leads to adverse health complications, particularly among those with chronic conditions.

The use of technology is a cost-effective method to: (i) monitor medication adherence in the elderly; and (ii) detect anomalies or changes in the elderly’s medication consumption over time.  thus allowing for subsequent personalized intervention by their caregivers

As part of the SHINESeniors project, the team has built a prototype sensor-enabled medication box and a gateway that is placed in each of the elderly residences. The sensor-enabled box detects the time and frequency that the elderly uses it; medication intake is then inferred based on usage of the box. This information is sent in real-time via the 3G-enabled gateway, to the caregivers - who can then take appropriate interventions whenever necessary.

The above graph shows the intake timings of Elderly S016, 
who takes her medication very regularly, twice a day

Based on engagements with our stakeholders, who include both medical professionals and caregivers, it is hypothesized that medication adherence monitoring has varying benefits to different groups of elderly. In extreme cases whereby the elderly is diagnosed with chronic illnesses that require extremely regular medication intake, it is essential for the caregiver to be notified in real-time whenever the elderly misses a dosage. This also reduces manpower costs, as caregivers can reduce the number of visits to the elderly (if medication intake is normal). On the other hand, with long-time monitoring, changes in an elderly’s medication consumption may indicate impending health issues. Caregivers can then be notified to provide pre-emptive interventions when such anomalies in medication consumption behavior are detected.

Although there are existing sensor-enabled medication boxes in the market, these are typically expensive and existing literature has reviewed that these solutions are not widely adopted by the elderly. Our medication box solution is easily customizable according to each individual elderly's preferences (e.g. size of the box, the color of the box, packing habits, etc). Furthermore, most existing solutions require the elderly to repack their prescribed medication into daily doses. However, our survey results indicate that most elderly do not have the habit of packing their medication into daily or weekly doses.

    

We have currently deployed the medication boxes in 10 homes in Marine Terrace, as of March 2016. There are future plans to deploy 14 more medication boxes under the Community for All Ages (CFAA) @ Bedok program. 

Frequently Asked Questions (FAQs)

Q: How is the medication box beneficial?

Based on engagements with our stakeholders (who include medical professionals and caregivers), a medication box that can monitor medication consumption is important for different groups of elderly.

●        In the most extreme case, an elderly with certain types of the chronic illness might require very regular medication intake throughout the day. It is thus essential for the caregiver to be notified in real-time, whenever the elderly misses a dosage. This also reduces manpower cost, as the caregiver can reduce the number of visits to the elderly (if medication intake is normal).

●        With long-time tracking, we can also tell when an elderly's medication consumption habits change, which can indicate impending health issues. Caregivers can then be notified to provide pre-emptive interventions, whenever necessary. 

Q: What is unique about this medication box, as compared to other solutions on the market?

Our medication box is unique in the following ways:

●        Customizable according to individual elderly's preferences (e.g. size of the box, the color of the box, packing habits, etc). This is done by retrofitting off-the-shelf boxes with our sensors.

●        Minimizes changes in the elderly's medication habits. Most existing solutions require elderly to repack their medication into daily doses; however, survey results indicate that most elderly in Singapore do not pack their medication into daily or weekly doses.

●        Provides an end-to-end solution comprising the medication box, daily email reports to caregivers, real-time visualization of medication consumption of each elderly, and analytics. We will be adding SMS alerts for caregivers in the upcoming iteration of the medication box solution.

Q: What is the technology behind the medication box?

It is based on reed switch technology. When the medication box is opened, the reed switch sensor is activated. The sensor will then transmit data to the 3G-enabled gateway, which will then forward the data to our backend servers.

Q: Does the medication box require mains power?

The medication box runs on batteries and does not require mains power. In this first version of the prototype, the sensor battery can last for about 3 to 4 months (with a usage of about 3 times a day). We are currently working on an improved version that will allow the battery to last for up to a year.

However, the medication box requires a gateway, to transmit data to the server. The gateway has to be connected to main power and consumes less than SGD1 per month.

Q: What if an elderly opens the medication box, but does not consume the medication?

Currently, only image-based solutions (e.g. cameras) or ingestible sensors, are able to tell very accurately that the elderly has consumed the medication. However, most elderly are not comfortable with having cameras at home, and ingestible sensors are still quite costly. Hence, the next best solution is to have inferred medication adherence based on our sensing technology.

Q: Where can I buy the medication box?

Currently, our medication boxes are available only for our elderly who are living in Marine Parade and Bedok, and who wish to participate in our research study as part of the SHINESeniors project. We hope to be able to make the solution more widely available in the near future.

Q: What’s next?

We are working on miniaturizing the sensors, improving the battery life, as well as allowing for medication monitoring even when the elderly brings the medication out. We are also working very closely with caregivers and medical professionals, to quantify the effectiveness of medication monitoring and interventions. 

Last updated on 14 May 2019 .