Smart Speakers Bring the Pharmacy Home for Older Adults

Thanks to a project at the Admiral at the Lake Continuing Care Retirement Community, Amazon’s Alexa-enabled Echo Dot smart speakers now reside in 100 of the facility’s independent-living apartments. Drs. Jennie Jarrett, UIC assistant professor of pharmacy, and Robert DiDomenico (UIC 1996), UIC associate professor of pharmacy practice, lead the university’s portion of the project. They will work to bring medication education into older adults’ homes through a podcast on the Dots, a companion live-presentation series, and potentially other applications, like medication reminders.

Through this partnership, DiDomenico said, the school hopes to show that technology can give older adults a sense of independence.

We want to “empower the residents to … have some measure of control over their health and their medications, which I think can sometimes be fleeting to them,” he said, “particularly when you start adding up not only the health conditions that they may have, but the medications that they have.”

Dr. Jennie Jarrett

Dr. Robert DiDomenico

Connecting with Amazon

The perhaps-surprising pairing of artificially intelligent gadgets with older adults first arose for reasons entirely unrelated to medicine: The Admiral saw an opportunity to help its residents decide what to eat — among other things. Specifically, the facility wanted to give its residents better access to information about programs at the Admiral, such as activities and restaurant menus, “largely for their own quality of life,” DiDomenico said.

However, a colleague of Jarrett and DiDomenico’s — Jewel Younge, clinical assistant professor at UIC — has links to the Admiral and saw a research opportunity. So, she got ahold of the two professors. “We got to talking,” DiDomenico said, “and we tried to put a little bit of a healthcare spin on it.”

The Admiral first put dots in100 residents’ apartments in December, with a second rollout of 50-100 occurring this spring. In all cases, the residents volunteered to take part.

Thanks to their contacts at Admiral, Jarrett and DiDomenico learned that residents have already found a medication application for their Dots — even before the UIC has launched its activities. “A lot of the older adults were, even without instructions, using the smart speakers s … for their medication reminders,” Jarrett said.

UIC’s healthcare content and functions for the speakers, including the planned podcasts, will come after upcoming focus sessions. But that medication-reminder angle will likely be a goal, DiDomenico said.

“It's certainly on our radar screen,” he said. “I do think that it’s a very simple way for the residents to in some way take control of their medication administration.”

Podcast fills information gap

The greatest healthcare application of the Dots, however, will likely come not as a reminder service but as an informational source, the researchers said.

Older adults face complex medication regimens, in which they take multiple medications. They also must deal with a sea of bad information, limited time with their healthcare providers and compounding issues like dementia. The Amazon project could address that information gap, DiDomenico said, helping pharmacy experts get medication education to older adults where they live.

“That’s, for us as providers, the biggest challenge that we face is actually getting eyes and ears inside their homes,” he said. “You have a finite period of time to interact with that patient when they’re in your clinic or when they’re in your pharmacy ... But the majority of what happens in control of their health happens inside their own home, and that's the black box for us.”

With the podcast, Jarrett and DiDomenico aim to illuminate that shadowy area, providing education “around both disease-state management but also problematic drugs within this population to help them manage their medications,” DiDomenico said.

The content will be on-demand, too, so residents can listen whenever they want — including when they may most need it, while taking their medications. The project will pair that content with live Q-and-A sessions at the Admiral presented by UIC Pharmacy professionals. The host of each podcast will visit the facility the week following their episode.

Unique medication challenges

This all aims to address the acute medication challenges older populations face. Most importantly, there’s the challenge of poly-medication: Older adults take an average of seven drugs, raising their risk of adverse events and medication errors.

“And we know that the older adults are particularly susceptible to that,” DiDomenico said, “not only because of, in some cases, their frailty, but [also] … the complexity of their medication regimen, their disease state and in some cases the issues with dementia.”

Further compounding the problem, these complex regimens don't come with extra information from doctors or pharmacists.

“Due to the complexity of their health problems, older adults need more time and interaction with their health care provider for a full understanding,” Jarrett said. “Yet … they still get the 15 minutes that every other patient gets.”

Meanwhile, older adults often receive too much information from bad sources — “from Google or Dr. Oz — or their family members, who speak from their own experiences,” Jarrett said. “They’re getting a lot of false information.

“So, a goal with this project is … to provide older adults with information in a personalized way that they may not be receiving,” she added. “It's giving them more time with a provider and quality information they can trust.”

Ideal partners

Amazon’s smart speakers made a logical choice as the technological aides to provide that information, Jarrett said. Many older adults have vision impairments, making screen-based devices like smartphones and tablets difficult to use. Those devices also “require tactile dexterity, and many [older adults] may not have as good of use of their hands as they once did,” she said.

“But if they can just talk to a device, it will be able to help them in a way that’s supportive of their stage in life,” Jarrett said.

In addition to that technology fit, the Admiral makes an ideal partner for UIC. Because the facility offers services ranging from independent living to 24-hour care, the college can study across that spectrum, DiDomenico said.

For its part, UIC’s medication expertise makes it an ideal partner, too. “We like to think of ourselves as one of the best [pharmacy] schools in the country,” DiDomenico said. “We are the experts when it comes to medications, and we think we should be the ones pushing the envelope and trying to improve medication use.”

Launch and expansion

In their next steps, the researchers will host a series of focus groups this spring to pinpoint what the residents could get from the Dots. The podcast will launch this summer.

Then, with good results, hopefully the project can expand — perhaps developing an Alexa Skill (app) to formalize the medication-reminder function. Beyond that, the researchers want to bring the Dots to more older adults at more facilities.

“If we’re able to show that this is effective and improves the quality of life for their residents, this … then becomes potentially scalable,” DiDomenico said. “That’s the hope — that if we’re able to show this on a smaller scale, this has some scalability.”

Learn more about Admiral at the Lake Continuing Care Retirement Community at admiral.kendal.org.