Title: SIPA2: Improving the Pharmaceutical Care of Older People with Sensory Impairment
Funder: Dunhill Medical Trust

Abstract: Older people are: affected disproportionately by sensory impairment (SI); hearing, visual and dual; more likely to use polypharmacy (> 4 medicines); and to live alone. Older people with SI (OPwSI) are at high risk of iatrogenic harm and therapeutic failure with inappropriate medication use. SIPA1 demonstrated difficulties with medicines management throughout the medication journey (ordering, obtaining, storage and administration). SIPA2 will develop solutions to address these difficulties. 1. Technology Review To identify existing technology to optimise the pharmaceutical care of OPwSI. The review comprises: a literature review; a market search for assistive technology; and engagement with professional stakeholders (occupational therapists, community pharmacy personnel), to identify existing solutions/technologies to support OPwSI with medicine management. 2. Co-production of service and product specifications To understand/capture business, systems, service/user requirements from different stakeholder viewpoints. Design: Qualitative research and mapping, direct observation (body cameras) Participants*: OPwSI (N=<​15), care providers (N=<​15). (*NB: SIPA2 will be undertaken in Scotland to minimise the research costs. We are confident that Scotland-derived data will be generalisable to OPwSI across the UK.) Methods Service Specification Interviews and design-workshop-based qualitative capture will be undertaken of existing barriers and opportunities in medicine management from a variety of stakeholders. Direct observation of the medicine journey will be documented using body cameras worn by OPwSI. Images, text and spoken word will be thematically analysed and insights will mapped to user/professional journeys; and barriers and enablers mapped to these journeys. An annotated process map of the full medicine journey will capture multiple stakeholder viewpoints/needs and identify trigger points for design focus (e.g. user capabilities, service needs, etc). Product Specification The qualitative data and insight/process maps will be translated into functional requirements (features, look and feel, behaviours of the device/service) of digital and non-digital solutions and also non-functional requirements (usability, accessibility, feasibility, cost). This phase will include co-creation workshops with OPwSI where sound- and touch-based communication methods will be brain-/body-stormed and evaluated in terms of practical (clear, intelligible) and hedonic (pleasant/preferable) qualities. These will inform how technological solutions should convey information to and create meaningful interaction for OPwSI with varying levels/types of SI. The output will be an annotated (categorised and prioritised) requirements specification document that designers/developers could use to prototype/develop full working solutions. 3. Co-production of an educational resource for health and social care providers To develop educational resources informed by SIPA2 results.

Lay abstract: Many older people use multiple medicines and the more medicines a person uses, the greater the likelihood of them having a medicine-related problem. In addition, many older people develop sight and/or hearing loss (hereafter referred to as sensory impairment) due to their age and struggle to identify individual medicines because they are unable to read labels and/or information sheets, or they use their medicines incorrectly because they have been unable to hear information provided about their medicines by community pharmacy personnel. The challenges of older age, multiple medicines and sensory loss are further compounded for many individuals because they live alone with no support. This combination of circumstances means that older people are at increased risk of inappropriate medicine use which could result in failing to derive full benefit from their medicines e.g. missed doses, and/or, suffering harm from their medicines e.g. unintentional overdose. There has been minimal research undertaken of these challenges and the development of solutions to address them. This project, called SIPA2, builds upon earlier research undertaken by some of the applicants, which explored the challenges older people experience with their medicines, and pharmacy personnel’s training on the pharmaceutical care needs of older people with sight and/or hearing loss. The project comprises three components: 1. Product Review: A review of existing technology e.g. devices, which are or could be used by older people with sight and/or hearing loss, to promote the safe and effective use of medicines. This review will include searching electronic databases for relevant products and conducting surveys of occupational therapists and pharmacists to identify what they currently use to help older people with sight and/or hearing loss. It will also identify gaps in the market. 2. Service and Product Specification: A group of individuals, including older people with sensory impairment, and representatives from relevant organisations, will use recognised methods (workshops and interviews) to work together to derive specifications of desirable characteristics for new products (what is looks like, how it functions) which older people with sensory impairment could use easily to assist their safe and effective use of medicines. 3. Development of Educational Materials for Health and Social Care Providers The results will be used to create educational materials for health and social care providers involved with medicines management of older people with sensory impairment, to improve their knowledge of their needs and available solutions to help support these needs effectively.

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE