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.

The difficulties of old people taking drugs

There is considerable interest in the problems of the elderly taking drugs correctly and appropriately. A recent survey (Parkin et al. 1976) showed that these problems that have long been known in geriatric practice have now been noted by general physicians. This review was undertaken when an occupational therapist in a geriatric unit team noted that, although patients and their relatives were taught methods of dressing, toileting, shaving, bathing, eating, walking, transferring to a chair, wheelchair mobility and communication by the occupational therapist, physiotherapist and speech therapist, no advice or teaching was given concerning the accurate taking of the drugs prescribed. The results of a detailed investigation are reported elsewhere (Atkinson, Gibson & Andrews 1978). Repeatedly, patients ready for discharge were handed a batch of drugs by a nurse at the last possible moment, even while sitting by their luggage awaiting the ambulance. Following this, special attention was paid to problems such as intellectual impairment, loss of memory and confusion, poor sight, inability to handle containers, failure to take drugs and lack of patient-education. During ward rounds, particularly when a geriatric health visitor was present, attention was drawn to special topics such as the number of patients who inadvertently kill themselves and the numbers needing readmission due to failure to take drugs, overdosage or underdosage or mixing of drugs (Wade 1972). Ferguson Anderson’s comment (1974) that 7.15% of hospital admissions are due to drug reactions was also noted.

Child-resistant containers for the elderly?

With the introduction of child-resistant medication containers, the geriatric patient has suffered another setback in an already poor record of medication compliance. Most physicians, while applauding the remarkable decrease in child poisonings resulting from safety closure devices, are not aware of the burden that child-resistant medication containers has imposed on the elderly. Nor are they aware of methods to correct the problem. Elderly patients, however, are keenly aware of the problems of child-resistant medication containers but are ignorant about methods to overcome the difficulty in opening and closing them.

Adherence of elderly patients to treatment with pentoxifylline

A study of adherence to treatment was conducted by 179 general practitioners in elderly outpatients with geriatric cerebral symptomatology treated with pentoxifylline. The drug was provided in 2 different randomized packages, with or without memory‐aid stickers (also randomized). Compliance was assessed by pill count after 1 mo of treatment. Clinical evolution was assessed by a digit‐span test, and by filling in 9 “relative” visual analogue scales of aggravation—improvement. Side effects were recorded from patient complaints. Leftover drug was brought back by 83.1% of patients, and this proportion was influenced neither by packaging type nor memory‐aid stickers. Compliance was considered good (fewer than 30 tablets returned) in 62% of patients, and was not influenced by either packaging types or stickers. Peaks of pill count were evident at multiples of packaging units (10 or 40 according to type). Compliance was not related to age or sex, but was related to memory score. There was a correlation between compliance and clinical improvement, and a significant inverse correlation between the former and the frequency of side effects.

Poison prevention packaging act, 1970: A human factors standard

This paper, the first of two, gives an account of legislation and regulations made in the USA requiring hazardous pharmaceutical and other household products to be packaged in child-resistant containers. Human factors test procedures and standards, in terms of which child-resistance is defined, are described. An account is given of those hazardous substances which regulations in the USA require should be packed in child-resistant containers. The paper concludes with a description of the effects of the regulations and of child-resistant containers in reducing mortality and morbidity associated with the ingestion of poisonous substances, particularly aspirin, in the USA.

The second paper will briefly describe the effects of legislation made in England and Wales requiring certain pharmaceutical products to be packaged in child-resistant containers. It will also give an account of experiments, carried out in England and Sweden, describing the difficulties and inconvenience which the elderly and disabled experience when they attempt to use such containers.

An ergonomics evaluation of a reclosable pharmaceutical container with special reference to the elderly

The British Standard on reclosable child resistant medicine containers stales that adults should be able to open such containers but fails to consider the special problems of the elderly.

This study compared the ability of 100 elderly people to open a particular child resistant container (CRC) with their ability to open conventional drug containers. Information on drug taking and on contact with children under 5 years was also collected, and indicated that 62% of the subjects were taking prescribed tablets and, of these, 70% came into contact with children under 5 years.

The results showed that, without a demonstration, over 20% of attempts to open the CRCs resulted in failure and even after a demonstration 16 5% of attempts were unsuccessful. Taking the frequency of contact with children into account, it was concluded that the elderly come into contact with young children sufficiently often to justify their tablets being dispensed in CRCs. Consequently it was felt that the special problems of the elderly need consideration in the British Standard and in the design of child resistant containers.

Compliance with prescribed medication by elderly patients

Factors contributing to improper use of medication were examined in 40 patients aged 65 years or more who were in a home care program. They reported taking an average of 3.8 prescription medications and 1.2 nonprescription medications each. Pill counts showed that they were actually taking 57% of the prescribed medications; compliance decreased with the number of medications concurrently prescribed. Poor labelling instructions, difficulty opening childproof containers and misunderstanding of verbal instructions contributed to this problem. The patients tended to rely more on physicians than on pharmacists or visiting nurses for advice problems with medication.

Assessment of a new calendar pack—the ‘C-Pak’

Seventy-eight elderly patients in hospital were studied for up to four weeks to assess drug compliance. Forty patients received medication from individualized calendar packs (‘C-Pak’) and 38 received medication from standard bottles. There was no difference in compliance between the two groups, the percentage error for each group being 26%. This result suggests that C-Pak is unlikely to improve drug compliance in unselected elderly patients.

Testing child resistant packaging for access by infants and the elderly

Accidental poisoning of young children by household products and medicines remains a serious problem in many countries. Child resistant packaging, i.e. packages of which the opening and closing mechanisme requires manipulation and/or forces beyond the limits of children’s exertions, has been developed to counter this problem. It is important to standardise field trials of such packaging to ensure adequate protection for the population at risk (the inquisitive and ingenious youngsters), while permitting access by adults. Testing variables which were studied were the age boundaries of the child panel and of the adult panel. Tests were conducted on four types of child resistant reclosable containers; two of the push-and-turn type, two of the squeeze-and-turn type. Inclusion of children between 24 and 41 months old in the test panel did not significantly affect the proportion of subjects who were able to gain access to the containers. However, the inclusion of adults, in the age-range 60–75 yr, in the test was found to provide the best safeguard against overcomplex and difficult packaging coming on to the market. Any standardised tests need to take into account the finding that in a testing situation most of the children between 42 and 51 months do not use their teeth. In normal situations nevertheless, children of one-two years old, the age group in which most of the poisoning accidents happen, frequently resort to using their teeth when they are unable to open containers by hand.