Designing Packaging for the Elderly

Over 597 million people in the world – 8.2 percent of the population – are 65 or over (1). In the UK the proportion is 17.3 percent, and in the EU it is 18.2 percent.

Ageing is not as debilitating as it was in our parents’ or grandparents’ day, but it still brings with it a unique set of problems – and it is not necessary to be a student of gerontology to appreciate the impediments of age. We have known about the issues faced by the elderly for years. Shakespeare knew – consider his monologue describing the Seven Ages of Man from the play As You Like It.

For the purposes of this article, obvious impediments that come to mind are:

• Impaired eyesight. According to the Royal National Institute for the Blind (RNIB), there are 11 million people in the UK with low vision.
• Reduced manual dexterity and manual strength, including pinch strength.
• Fingertip friction rapidly degenerates after the age of 65. I often say to colleagues that if they dab their fingertips, in talc the resultant loss of friction resembles that of a 65 year old. Try it. 

These are generally (or should be) easy to deal with, when it comes to medical packaging. Large clear fonts and graphics are beneficial for those with impaired vision. Large tabs on packaging like blister packs can help compensate for the loss of fingertip strength and friction. And suitable polymer specification can deal with the lack of pinch strength.

Less obvious and capable of remedy is the fear that many elderly people have of  getting it wrong or looking stupid; the fear of not being able to open simple packaging, or being unable to make a supposedly simple inhaler work – never mind the more complex drug delivery systems that are also now on the market.

A lot of drug packaging is difficult for elderly people to handle or open – and it shouldn’t be. Despite everything we know about the pains of the elderly, why are fonts often too small to read and tabs too short to grip? I’ve seen so many packaging designs for ordinary solid or liquid medicines that are just counter-intuitive, and inhaler packaging that doesn’t even mention the ten priming actions necessary to actuate the pump. Packaging is a minefield that can easily destroy the confidence of the already unsure – and damage health.

Medicine packaging that is difficult to open leads to poor patient compliance.  And poor compliance prolongs diseases, selects for resistant bacteria and generally drags down the health of the population. Lack of compliance also destroys brand value. When medicines seem not to work, users blame those medicines rather than their own lack of compliance (and patients today are only too happy to talk about bad experiences with medicine to others and online).

Testing for ease of opening by older adults has been with us for some time. All child resistant packaging has to achieve a 90 percent success when tested by a panel of 100 adults aged 50-70 years. This is all set out in ISO 8317 (Child-resistant packaging – Requirements and testing procedures for reclosable packages) and EN14375 (Child-resistant non-reclosable packaging for pharmaceutical products. Requirements and testing) standards, to which child resistant packaging must adhere. But the panel age group of 50-70 years is unsatisfactory because it doesn’t reflect the population. And standard packaging is not really tested for openability at all.

In the standards writing community, BSI, CEN and ISO, we have worked hard to create standards that can help the whole supply chain create more elderly friendly packaging. From 2005, work began in parallel between CEN in Europe and ISO in Japan. It culminated in a CEN technical specification in 2011 and finally an ISO standard: ISO 17480, Packaging – Accessible design – Ease of opening. Published in 2015, ISO 17480 is a comprehensive and helpful document that includes a panel test with a realistic sample age range of 65-80 years, taking into account user’s context of use, opening strength, dexterity and cognition. It also deals with the equally important aspect of reclosing, and includes designer’s and conformance checklists.

What have we failed to do thus far? Quite simply, although it has been available for more than two years there has not been adequate take-up of ISO 17480. This is despite the fact that compliance with the standard will give a competitive advantage and brand protection and maintenance in one quick step, as well as (incidentally) provide a better service and product to elderly people, who are a substantial part of pharma’s customer base.