ABSTRACT As a person grows older, the chances of having various ailments increases. As illnesses increase, physical and psychological changes happen too. New introductions such as medicines, treatments and lifestyle changes are also a part of growing old. Dependency on medications and constrains due to illness can make everyday life de motivating and discouraging. The patient might adhere to medicines over a short period of time, but what happens when it is for a life time. How can design interventions help patients adhere to long term medication schedules? This project tries to understand the need for design and technology intervention to help patients adhere to their medication schedule. The project aims towards making long term bulk medication easier to comply with. The project explores opportunities ranging from connectivity between people to organization skills of a patient. How can activities like taking medicines and visiting doctors, be a beacon for ‘‘getting better’’ rather than, ‘‘ a downward spiral in illness’’. Seamlessly integrating and accepting these medicines into their lives is the path undertaken in this project. Communication media for this project include visual communication, sensors and mobile interface. Project Blog: http://diplomaprojecthealthcare.wordpress.com/.
understanding the
EELDERLY EL L
EVOLVED PROJECT OUTLOOK What are the areas of opportunity in medication management where design can intervene? What are the problems that the elderly in particular face in medication management?
The world’s population is growing older, leading us into uncharted demographic waters. There will be higher absolute numbers of elderly people, a larger share of elderly, longer healthy life expectancies, and relatively fewer numbers of working-age people. There are alarmist views – both popular and serious – in circulation regarding what these changes might mean for business and economic performance. But the effects of population aging are not straightforward to predict. Population aging does raise some formidable and fundamentally new challenges, but they are not insurmountable. These changes also bring some new opportunities, because people have longer, healthier lives, resulting in extended working years, and different capacities and needs. The key is adaptation on all levels: individual, organizational, and societal.
How can we enhance the medical adherence interactions to make them more intuitive and engaging?
To understand the elderly audience better, brainstorming on different facets of their life was done. This helped create a better picture of their lifestyle. Exploring these facets provide fodder for thought and made it easier to think and design for the elderly.
TIME LINE
The brainstorming inputs were categorized to relationships and sub groups. Registration
Jan Scope of Project
Feb
Mar
Apr
May
June
July
POPULATION SHARE
1990
2030
LIFE EXPECTANCY
65 years 67 years
Medical Non-adherence & Elderly Coming back to the main aim of this project, research through reading and user interviews was done on how the elderly perceive medications. The research also dwells upon what leads to non compliance to medication by elderly.
Secondary Research
Wire framing and prototype building
Analysis Primary Research Analysis
Concept Generation And validation
User Evaluation
An estimated 33 to 50% of patients do not adhere to their medication regimens as prescribed. In a study aimed at adherence in the elderly population, it was demonstrated that when prescribed stating therapy, there was only 40% compliance. Also, the highest rate of non-adherence tends to occur within the first few months of therapy. Explanations include the sudden added financial burden of a new prescription or the appearance of side effects soon after initiation. The elderly also face additional problems such as loneliness, detachment, sudden void, dependence on medication, and the diminishing motivation to get well. This can be further fuelled by lack of care and attention from the family. As the person ages his health problems and medications can increase. This turmoil between knowing that the medicines are meant to improve health and feeling a sense of dependency on the medicine can lead to additional non adherence.
Medical Condition Example: Asymptomatic chronic disease (lack of physical cues); mental health disorders (E.g., depression)
Health System
Patient disabilities Example: Physical impairments (e.g., vision problems or impaired dexterity); cognitive impairment; psychological/behavioral; age
Therapy
Example: Complexity of regimen; Example: Poor quality of provider-patient side effects relationship; poor communication; lack of access to health care; lack of continuity of care
Socioeconomic Example: Low literacy; higher medication costs; poor social support
AS LISTED BY WHO
CATEGORIES OF MEDICAL NON ADHERENCE
Medication non adherence may occur at different points in a patient’s decision-making process. It may occur at the start of therapy if a patient receives the initial prescription but does not fill it (primary non adherence), or it may occur after therapy has started if the patient fails to follow the instructions or fails to refill the prescription (secondary non adherence).
Primary Non Adherence Falling Ill
Visiting Doctor Revisiting medicines
Secondary Non Adherence Get Prescription
Purchasing medicines
Bringing medicines home
Organizing medicines
Taking medicines
MASLOW’S HEIRARCHY OF NEEDS
HIGHER LEVELS OF NEEDS
SELF-ACTUALIZATION AESTHETIC
On the basis of the understanding gain on the elderly, a heirarchy of needs was defined.
FRIENDSHIP motivation PRAISE AID CAPABILITY ubiquitous computing
emotional connect to product familiar way of using it Applaud capability
Maslow’s heirarchy of needs allows segregating the needs of the elderly from a medication management solution. The most fundamental and basic four layers of the pyramid contain what Maslow called "deficiency needs" or "d-needs": esteem, friendship and love, security, and physical needs.
positivity
COGNITIVE
Instant replies
look exciting
analogies
simple behaviour- easy to understand Updated immediately Learn more about illness
ESTEEM/ RESPECT
Customize/ give some controls to the user Empathize
If these "deficiency needs" are not met – with the exception of the most fundamental (physiological) need – there may not be a physical indication, but the individual will feel anxious and tense. Maslow's theory suggests that the most basic level of needs must be met before the individual will strongly desire (or focus motivation upon) the secondary or higher level needs.
LOVE AND BELONGINGNESS
BASIC NEEDS
PHYSIOLOGICAL
connectivity
Connected with family
caregiver family friends fellow ill persons
Cope with chaning lifestyle Share responsibility
Group motivation
Human connection
‘You’re not alone’
Gel into everyday schedule
SAFETY
patient
see the importance of taking meds AID not CONTROL
SECONDARY NEEDS
s rs s oll olou R tric h ce li d e i c o p go ian d c GYO cen bran leg ran russ san VIB con
Information on medicines
Not lead him to change too much Gel into everyday schedule Less time consuming
Side effects info
Over/under medication prevention Effects of medicine
Least effort/one time effort Arrange, time & schedule
invisible till required
ELIMINATE ANXIETY
snooze patterns
involvement leads to adjustable plans sense of responsibilty
involve in planning med schedule
alarm patterns
alarm ringtone
gel into current life
EASE ACCEPTANCE OF ILLNESS/CHANGE overlay new activities on old lifestyle
ADJUSTABLE SCHEDULING
REMINDERS
adaptable UI
colour/ large toffee/ dissolving packet
mobile wallpaper reflects condition
test change in hearing using apps
visible only when required
visually depict elderly health (remotely)
ABSTRACTION painting reflects adherence
COGNITIVE
friendly alarms to atract less attention
product designing ‘universal design’
medicine dose packets look attractive
visually appealing, interesting and adjustable
alarm format- sound/visual/ touch
ambience reflects health enhance features according to person
needs to look homely, gel into home
multi platform sounds which are familiar ALARMS visual and sound ques customize alarmas
Transparency COMMUNICATION
expired meds adherence report to pharmacist
Common platform for feedback from many doctors show benefits of taking medicines
quiz leads to alerts related to illness side effects communicated through info
not over doing it
medicine wise information and additional info
DOCTOR PATIENT INTERFACE
reflection of well being
POSITIVITY
chart out how NOT taking meds will lead to additional costs
emergency appointment for doctor
modular boxes
connected to eachother and cloud/hub locater for the boxes identify medicine through colour/shape/name -camera enabled automated -text recognition ubiquitous -colour recog identification - QRcode/bar code reader
connect with fellow ill people
FAMILY
old photos memories
instagram duo
facebook duo
ication of info
defect alert on each function show how machine/app will ease a particular task ACCEPTANCE OF MACHINE
communicate daily statistics but still remind to call
use analogy of ‘companion’ for each activity
check on refill scheduling
GAMIFY
form should be friendly
FRIENDSdiscuss about health (TAG TEAM) problems evaluate eachother’s health
tackle together
can help in seeing the need of investing in the solution
print booklet on use vioce guided procedures
connected to artifacts of their time questionaaire for daily reports
tips/ dosage specifications
Redefine
refill date
provide basic info on med INFORMATION ON MEDICINES
learning curve needs to be reduced
connected to artifacts of their time simple activities to check health
side effects
PRESCRIPTION
controlled commun
connectivity with well wishers twitter duo
name
simple app to show cost reflection
remind them to connect with elderly
media sharing
purpose (how its going to help) timing of medicine
controlled dependence
dual player games
source in info
one stop look on meds taken
consequences and unforseen additional treatment costs
options for alternative treatments from doc
easily accessible from diff platforms
app design
chart of meds taken
show cost chart updated daily
COST
Connect with more people with similar problems COMMUNITY
wearable computing -wristband -pendant -’reflection of health progress’
move dose groups around pill counter to check number of pills left/taken
history of effects/ med taken for future reference
record appointment
ORGANIZING MEDICINES
list of options given by the doctor
activity mapping
show progress charts
record instructions and tips given during appointment for future reference
one step to upload medicine from strips to boxes/machine
easy to move around the house
list/quiz on side effects and illnedd infographic on appointment details
targets to be acheived till next appointment
side effect monitoring
cost implications
regulated videos/ reading material according to severity of illness
phone book access to all functions old functions ques relate to new functions
SELF EVALUATION self evaluate adherence repeated symptoms lead to booking appointment
How to encourage if the medicines don’t help?
CATEGORIES OF INSIGHTS AND OPPORTUNITIES FOR INTERVENTION
I took that medicine for cholesterol for five months, I Still had to upgrade to a new one. What is the point? DISCLAIMER
mode of encouragement
COMMUNITY
responsible for eachother
comfort level social circle
support system
sharing of information
inspired by fellow ill people
embed adherence into environment
abstract communication
instant reflection of action
remote connectivity
emergency help
communicate data to cloud swallowing meds
10KL
10KL
10KL
10KL
10K
10K
*
T:90DF SH
T:90DF SH
*
* 40AK
home
100m 1Y
g
* 40AK
INDIVIDUAL
easy access to internet ease of use many interactions at one time
proof of intake 100m 1Y
g
organising meds
I also have developed concepts for all the levels. My design solution approach to this problem is that no one level of solution can solve the issue of medical non adherence. A combined effort of two or more of these layers will help in tackling the issue.
real time access
ease of access to digital ďŹ les
DIGITAL
attention
dynamic environment
surroundings reflect state of health
ENVIRONMENT
fellowship
arranging pills ďŹ lling medicines in box
These solutions are all coupled with mobile apps. These digital and physical interactions together complete each solution. While user tesing I will be showing paper prototype mobile screens and some interfaces on Processing. I hope to make one complete UI design out of all of them.