Sense and Sensibility

For the elderly, sensory impairment (visual, auditory or both) and loss of cognitive function affect medicine adherence and increase the risk of morbidity and mortality. Coupled with their increased likelihood of polypharmacy and increased risk of harmful drug events (when compared with younger patients), it is beyond question that the needs of this vulnerable patient group need to be considered. 

Sensory impairment is a common long-term condition of the elderly, but the rapid surge in prevalence of visual and auditory impairment we’ve seen in recent times has been driven by our ageing populations. Globally, it is estimated that 285 million people have impaired vision and 82 percent of people who are blind are aged 50 or over. Pharmaceutical packaging is often inaccessible to people in this demographic; they have difficulty in reading the labelling provided thus preventing them from identifying medications, accessing relevant instructions and  reading expiry dates. 

The provision of Braille instructions does little for the majority of older adult patients with visual impairment as very few of these individuals are Braille-proficient. For the small percentage of Braille-readers who interact with this type of  pharmaceutical packaging, labelling is often placed over Braille information, preventing access to information essential for the appropriate storage and administration of their medicines and preventing patients from attaining comparable levels of knowledge and understanding as their sighted counterparts.

As a knock-on effect of poor interactions with healthcare providers, elderly patients often administer their medications incorrectly (missing doses or administering the wrong dose of medicine entirely), leading to suboptimal therapeutic responses, uncontrolled disease states and patient harm. To help alleviate the growing economic burden on healthcare services, comprehensive training about the issues faced by older adult patients makes sense. Now, more than  ever before, patients have access to non-medical prescribers who should be encouraged to raise their awareness of this patient population’s needs and consider them when prescribing and undertaking medical review.

However, most crucial to the issue at hand is how deeply pharma is willing to involve itself in patient issues.Pharmaceutical companies should engage more closely with patients to co-design packaging. Patient-centricity is a long overdue step in encouraging patient adherence and unless pharma is willing to work with end-users of their products, they won’t be able to properly cater to their patients’ needs.

It should be noted however, that engaging with patients in a meaningful way can be difficult. Collaboration between pharma and health services could provide a means to facilitate the insightful dialogue with patients the industry needs.

By its nature, the pharma industry is hugely innovative; it now needs to apply its innovative approaches to ensure that its products achieve their desired therapeutic effects with minimal harm in this at-risk population. There is considerable scope to explore and develop assistive technology to support older people who have sensory impairment and are receiving polypharmacy. Existing technology includes reading machines, which use optical character recognition, automated prompts (e.g. sounds, vibrations) and digital recorders could be used to assist with medication administration, none are available that have been developed with older people with sensory impairment and polypharmacy in mind.  Some optical readers cannot ‘read’ text which is printed over Braille.   There is substantial scope for innovation with packaging, including replacing written information in an audible format e.g. using integrated speakers.  

If manufacturers addressed the unique challenges faced by these patients, they would have the potential to enhance the user-friendliness of their products and throw the “one size fits all” approach to product development to the wayside.