RESNA 26th International Annual Confence
We are developing a prototype of a medication reminding system that provides reminders based on the context of its user. The prototype will determine where a user is within the home, provide reminders in that location, determine whether the medication was successfully taken, and call for external assistance if the person does not comply. We will present our initial prototype and preliminary efficacy data.
Non-compliance and improper usage of medication is a common problem among older adults due to decreased cognition associated with the natural aging process and other disabilities such as dementia. Examples of non-compliance and improper usage include not taking medication at the required time, or as prescribed [1].
Several techniques and interventions have been used to help increase medication adherence including social support, education about the impact of adherence, improved design of medication labels and instructions, and various prospective reminding devices. However, medication non-compliance still remains one of the primary reasons for the hospitalization of older adults, accounting for approximately 20 percent of elderly hospital admissions for acute care [1].
Reminding devices range from low-tech solutions, such as plastic boxes divided into sections labeled by times and day, to electronic devices that have various levels of sophistication. The simplest of the electronic devices are timers on medication container caps that are reset for the same interval every time the cap is opened. The more complex are systems that dispense the drugs at the correct time and sound an alarm if the drugs are not taken within a given length of time. The user is required to push a button on the device to indicate when the medication has been taken successfully [2]. Providing this manual feedback may be achievable for a "healthier" user, but most likely is not acceptable for a user with poor memory, or impairments in planning and execution functions, to complete.
Existing automated reminding systems are sometimes ineffective because they do not take into consideration the user's context when making decisions regarding how and when to provide reminders. For example, often a medication device is located in a user's bathroom. If the person is in the kitchen when the alarm on the device is sounded, the person most likely will not hear the reminder rendering the device ineffective. This lack of "intelligence" may also result in unnecessary prompts to be provided and frustration and further confusion on the part of the user.
Context can be defined as any information that can be used to characterize the situation of a person, place, or object. This information may include the location, identity, and state of people, groups and computational and physical objects. Context can be used to interpret explicit acts, making communication, such as reminders, much more efficient and naturally fitting with a user's activities [3]. The use of this type of information and other context-aware design principles has rapidly been emerging is several fields including robotics, mobile computing devices, online help systems, web browsing technologies, and more recently, supportive environments and smart homes.
We are applying context-aware design principles to the design of a new medication reminding system. The system will be able to determine user-specific information and characteristics in order to provide reminders that are more appropriate for that particular person's preferences and habits.
At this stage of our design, we will begin by incorporating simple examples of contextual information into our prototype:
Three modules will be developed: 1) A main control unit; 2) An indoor positioning and reminding system; and 3) A medication uptake sensor module.
At a specified time prior to medication, the system will determine the location of the person within the house by reading wireless outputs from the motion sensors located in each room. The main control unit will then process these inputs to determine an appropriate reminder to be played or action to be carried out. The reminder, which will be a pre-recorded verbal prompt digitally stored by the main control unit, will be played via a speaker installed in the room in which the person is located. Once the required reminder has been issued, the medication uptake module will then monitor whether the person takes the medication. If it is detected that the person has not taken the medication after a set period of time, the system will re-assess the person's location and another reminder will be issued in the required location. If the medication is not taken after a certain number of reminders, the main control unit will activate its automatic emergency contact function in order to notify a family member, doctor, or neighbour that the person has not complied.
At this stage of our development we are not concerned with the dispensing of the medication. As there are numerous dispensing devices already available on the market, we are focusing solely on the reminding system. Subsequent development phases will include incorporating our new technology into an existing dispensing unit, or developing our own if we feel this is more appropriate.
Preliminary testing of the system will be conducted in the Dr. Tong Louie Living Laboratory at Simon Fraser University. This facility simulates a home environment in order to conduct realistic usability testing of new technologies and products.
The required hardware components of the new device will be set-up in the laboratory's home environment mock-up. For example, the position sensing and reminding hardware will be installed in the bathroom, living room, and kitchen, while the main control unit and medication will be set-up in the bedroom. Actual patients will not be used at this stage of our development due to the inherent risks associated with medication usage. We will focus primarily on the efficacy of the system functions.
Once the efficacy of this first prototype has been established, we will incorporate more sophisticated functions. For example, we will further develop our position sensing system to detect and relate locations with actions and actions with tasks or routines. In this way, changes to a user's routine may be detected and handled by the device so that medication adherence may be maintained even if the user's preferences and/or normal routine changes. For example, if the user decides to go for a walk ten minutes before it is time for medication, the system will be able to recognize the pattern of activities leading up to this event--e.g. walking towards the front door, putting on a coat, etc., and will then provide the medication reminder before the person leaves the house. Another example is the system will be able to detect if the person has eaten before taking the medication as required by the prescription. A variation of this type of tracking system is currently being developed as part of our intelligent supportive environments/smart homes research.
We expect to have our first prototype developed by April, 2003, and preliminary efficacy data by June, 2003. The next stage of work will commence by September, 2003.
This research project is supported by a research grant from the Canadian Foundation for Innovation.
Alex Mihailidis, Ph.D.
P.Eng.
Gerontology Research Centre, Simon Fraser University
515 West Hastings Street,
Vancouver, British Columbia, V6B 5K3
Tel: (604) 291-5180
Email: amihaili@sfu.ca