Research database

This Research Database has been developed by HCPC Europe to create an overview of the available research in the field of patient-friendly and adherence packaging. The database is for all members of HCPC Europe. Members can register as a user to get access to the database. Is your organisation not a member yet? Then please register your organisation as a member or contact our Executive Director Ger Standhardt for more information.

Problems of geriatric patients with managing drug containers

The purpose of the study was to measure the prevalence of difficulties in elderly inpatients in opening a range of common commercial drug packagings, in breaking a bar-scored tablet, and in reading medication instructions. Sixty-seven patients (female: 47; male: 20, mean age: 81.6 +/- 6.1) who reported that they had managed their medication independently before hospital admission, underwent a comprehensive geriatric assessment. They were also asked to remove tablets and drops from various commercial drug packagings and a “dosett”, to break a tablet, and to read medication instructions enclosed in the packings. Only 21 patients (31%) were able to perform all tasks. Thirty-one patients (46.3%) failed in opening the “push and turn” bottle and 44 patients (65.7%) were unable to open the flip-top container. There were significant differences (p < 0.05) in age, cognitive capacity, handgrip, and manual dexterity between the patients who were able to perform all tasks, and those who were not able to do so. Many of the common medication packagings impede a reliable management of drugs by elderly patients.

Dispensing eye drops from flexible plastic dropper bottles. Part III: Comparison between volunteers and elderly patients

The delivery of drops from flexible plastic dropper bottles by ten healthy volunteers was compared to that by six elderly patients aged 50 years or older. During the dispensing of the drops the air pressure inside the bottle, the weight of the drops and the time necessary to dispense a drop were registered. The influence of the flexibility of the dropper bottle and the design of the dropper tip was investigated. In general, the drop delivery data of the elderly patients were comparable to those of the healthy volunteers. However, the patients squeezed the dropper bottles fitted with a special design dropper tip less strongly as the volunteers, resulting in a lower air pressure difference, but a higher drop weight. For one subject, a patient with severe arthritis, dispensing drops from this special design dropper tip was at the limit of the capability to squeeze. Overall, the stiffness of the dropper bottle had no significant effect on the delivery of drops by the volunteers or the patients. On the other hand, the smaller the inner aperture diameter of the dropper tip, the larger the air pressure difference created inside the bottle and the longer the dispensing time.

Determinants of eye drop size

Ophthalmic solutions are available for multidose or single-dose administration in a wide variety of glass and plastic dropper bottles which deliver drops with a volume between 25 and 70 μl. From a biopharmaceutical and economic point of view, however, smaller volumes of 5 to 15 μl should be instilled. In this review, the technical, pharmaceutical, and therapeutic aspects of eye drop formation and delivery are presented. The different types of containers are described and the determinants of eye drop size are discussed, such as the design and physical characteristics of the dropper tip and bottle, the physico-chemical properties of the solution, and the manner in which the patient dispenses the drops. Preferred and alternative instillation techniques and aids to facilitate the administration of eye drops by elderly patients are described.

The impact of innovative packaging on adherence and treatment outcomes in elderly patients with hypertension

This study compares compliance rates of an antihypertensive drug administered to some elderly patients in a bottle and others in a blister. The results of this study continue to prove the point that calendarized blister packaging can provide increases in patient adherence. In the OSU research, 88 adults, all 65+ years of age, were included in the study. All had blood pressure readings of at least 140/90. Forty-eight participants received Prinivil in blister packs with compliance-prompting features. These partipants constituted the study group. Forty received Prinivil in traditional pharmacy vials and composed the control group. The patients were tracked for 12 months.
Over these months, the percent of on-time refills of the control group was only 66.1%, while the study group’s percent of on-time refills was 80.4%. Dramatic improvements in blood pressure were also measured in the study group. The change in DBP of the control group was -17% and SBP was -40%. For the study group , DBP was -50% and SBP was – 57%. The conclusions drawn by the researchers: “Patients in the study group had better adherence as
measured by: 1) Significantly more likely to refill prescriptions on time; and 2) Medication possession ratios significantly higher for study group (MRP = “proportion of days a patient has medication available to be taken”) and At 12 months, a significantly greater proportion of patients in the study group had lower diastolic blood pressure (compared to baseline) than patients in the control group.

Can elderly people take their medicine?

This study used performance tests to assess the cognitive, visual and physical abilities related to taking medicines in the elderly population.

The study population consisted of the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD II), a nationally representative interview survey. SWEOLD II is a random sample of all community-based and institutionalized persons aged 77+ in Sweden. Five tests related to medication management were administered in the direct interviews (n = 492): hand function (opening bottle), vision (reading label), and medication competence (comprehension and calculation).

Results showed that 9.4% could not read instructions on a medicine container and 14.6% had difficulty opening a plastic flip-top medicine bottle. The three cognitive tests related to taking medicine resulted in 30.7, 47.4 and 20.1% errors. Combining all the tests revealed that 66.3% of the sample had at least one limitation of capacity related to taking medicine. There were no significant gender differences. Among those people who did not pass all the tests, 31.8% lived alone with no home-help.

Taking medicines is a complex task and a large proportion of the Swedish elderly population has cognitive, visual or physical limitations that may hinder their ability to take medicines accurately. Awareness of these limitations is essential to concordance.

The difficulty of opening medicine containers in old age: A population-based study

Objectives: To investigate elderly people’s ability to open medicine containers, and how this ability correlates to some common disorders that may cause functional or cognitive impairment.

Methods: Cross-sectional study of older people age 81 years and older, from the second follow-up (1994–1996) of the Kungsholmen project, a population based study of very old people in an urban area of Stockholm, Sweden. Six hundred and four persons (mean age 86.7 years) were tested for their ability to open three types of medicine containers. The disorders studied were rheumatoid arthritis, stroke, Parkinson’s disease, cognitive impairment (measured by mini-mental state examination, MMSE) and impaired vision.

Results: We found that 14% were unable to open a screw cap bottle, 32% a bottle with a snap lid, and 10% a blister pack. Female gender, higher age, living in an institution, Parkinson’s disease, rheumatoid arthritis, cognitive impairment and impaired vision were all associated with a decreased ability to open the containers. Less than half of the elderly people who were unable to open one or more of the containers received help with their medication. Among those living in their own homes only 27% received help.

Conclusion: Older peoples’ ability to open medicine containers is impaired by several conditions affecting physical and cognitive functioning. Many elderly people who are unable to open medicine containers do not receive help with their medication, particularly those living in their own homes.


Self-application of single-use eyedrop containers in an elderly population: comparisons with standard eyedrop bottle and with younger patients

Purpose: To test whether patients aged ≥80 years can safely and successfully apply eyedrops from a single‐use eyedrop container without support, and to compare the results with those of younger patients using single‐use containers and older patients using standard eyedrop bottles.

Methods: Patients aged ≥80 years who had no physical or mental conditions hindering self‐application of eyedrops and actually did so because of glaucoma or dry eyes were included consecutively in the study group (n=44) in order to perform self‐application of eyedrops from single‐use eyedrop containers. Patients were observed meticulously by two investigators, who documented practical problems during the procedure in a checklist. In control group A (n=22), glaucoma or sicca patients aged between 50 and 65 years applied drops from single‐use eyedrop containers; in control group B (n=28), glaucoma or sicca patients aged ≥80 years used a traditional eyedrop bottle.

Results: Successful application of the drops into the conjunctival sac was achieved by 57% in the study group (95% and 89% in control groups A and B, respectively). Scratching of the eyedrop container along the conjunctiva or cornea was observed in 68% of the study group (41% and 61% in control groups A and B, respectively). Frequency of problems during opening and self‐application of single‐use eyedrop containers in the study group showed an inverse correlation to visual acuity in the better eye and previous experience with this kind of eyedrop container.

Conclusion: Older patients have massive problems in self‐administering eyedrops from single‐use containers. Factors influencing the success of self‐application may include the patient’s previous experience with this kind of eyedrop container and the patient’s visual acuity.

Impact of medication packaging on adherence and treatment outcomes in older ambulatory patients

Objective: To evaluate medication adherence and treatment outcomes in elderly outpatients using daily-dose blister packaging (Pill Calendar) compared with medications packaged in bottles of loose tablets.

Design: Randomized controlled trial.

Setting: Ambulatory care clinics at Ohio State University Medical Center, Columbus; University of Arizona Health Science Center, Tucson; and Riverside Methodist Hospital Family Medicine Clinic, Columbus, Ohio, from July 1, 2002, to December 31, 2004.

Patients: 85 individuals 65 years of age or older being treated with lisinopril for hypertension.

Intervention: Patients were randomly assigned to receive lisinopril in either daily-dose blister packaging (Pill Calendar) or traditional bottles of loose tablets.

Main outcome measures: Adherence was assessed by prescription refill regularity and medication possession ratio (MPR). Treatment outcome and use of medical services were assessed by medical record review of blood pressure and morbidity associated with poorly controlled hypertension.

Results: Patients receiving lisinopril in the daily-dose blister packaging (Pill Calendar) refilled their prescriptions on time more often (P = 0.01), had higher MPRs (P = 0.04), and had lower diastolic blood pressure (P = 0.01) than patients who had their medications packaged in traditional bottles of loose tablets.

Conclusion: Providing medications in a package that identifies the day each dose is intended to be taken and provides information on proper self-administration can improve treatment regimen adherence and treatment outcomes in elderly patients.


How wide do you want the jar?: The effect on diameter for ease of opening for wide-mouth closures

The ease with which a container can be accessed or its ‘openability’ is becoming more of an issue for manufacturers and consumers as the average age of the population increases. Ageing brings with it a range of issues including a loss of strength and reduced dexterity. This paper aimed to look at the relationship between diameter, torque and age for standard consumer closures using a torque‐measuring device.

The results of the investigation show that larger‐diameter jars (85 mm) require much higher opening forces than smaller ones (75 mm and below). Smaller jars require lower opening torques, although the force required to open many jars is still higher than many elderly people are able to generate.

Carpe diem, Carpe ampulla: A numerical model as an aid to the design of child-resistant closures


► Numerical modelling of a complex hand task is feasible.

► Higher stresses occur for smaller hand sizes.

► Simple geometry changes can be made to increase comfort.

The population of most developed countries is ageing. Despite continuing medical advances, ageing brings with it a host of issues, not least a loss in strength and dexterity. One major area of concern is the ability of elderly consumers to access packaged goods such as food and medicines. In previous studies, the authors developed a numerical model of a human hand that was used to investigate the effect of physical dimensions and choice of grip on joint stresses to aid the understanding between physical effort, ability and discomfort. This previous work was supported by ethnographic studies and led to recommendations for packaging design.

In this paper, a small ethnographic study is undertaken which identifies the grip types used to access to a product that is known to cause particular difficulties for the elderly, the “squeeze and turn” child-resistant closure or CRC, commonly used on medicines and cleaning products. One of the grip types used was chosen to be modelled using the numerical model developed in previous studies by the author. Model geometry and loading were adapted to simulate the “squeeze and turn” nature of the initial opening for closures of this type. A series of studies were then undertaken using different hand geometries; an average male hand, an average female hand and a fifth percentile female hand.

The prediction from the model here is that female users with smaller hands will experience more discomfort when accessing squeeze and turn CRC’s and that the turn process whilst maintaining the squeeze is problematic.