Assessing the impact of cognitive impairment on the usability of an electronic medication delivery unit in an assisted living population

Abstract

Purpose To examine the relationship between cognitive status and the usability of an integrated medication delivery unit (MDU) in older adults who reside in an Assisted Living Facility (ALF). Methods Subjects were recruited from a single ALF in Pittsburgh, PA. Usability testing sessions required subjects to execute tasks essential to using EMMA® (Electronic Medication Management Assistant), a Class II Federal Drug Administration (FDA) approved integrated MDU. Video coding allowed for quantification of usability errors observed during the testing sessions. Each subject's cognitive status was assessed using the Mini Mental State Exam (MMSE®) with scores <24 indicating cognitive impairment. Functional status was assessed using the Lawton Instrumental Activities of Daily Living (IADL) questionnaire, and a global assessment of subjective usability was assessed by completing the System Usability Scale (SUS). Non-parametric statistics and correlation analysis were used to determine whether significant differences existed between cognitively impaired and non-impaired subjects. Results Nineteen subjects were recruited and completed the protocol. The subject pool was primarily white, female, 80+ and in possession of above average education. There was a significant relationship between MMSE® scores and the percentage of task success (z = −2.03, p = 0.04). Subjects with MMSE® scores of 24+ (no cognitive impairment) successfully completed an average of 69.0% of tasks vs. the 34.7% performance for those in the cognitively impaired group (<24). Six of the unimpaired group also succeeded at meeting the 85% (6 out of 7 correct) threshold, while none of the impaired group was able to. No subject with cognitive impairments (<24 MMSE®) completed more than 5/7 (71.4%) of their tasks. Two of the impaired subjects failed all of the tasks. Three of the MMSE®'s subsections (Date, Location and Spell ‘world’ backwards) were found to be significantly related (p < 0.05) to the percentage of task success. Tasks success rates were related with IADL scores (z = −3.826, p < 0.0001), and SUS scores (r = 0.467, p = 0.0429). Conclusions Medication delivery units like EMMA® have the potential to improve medication management by combining reminder systems with telemedical monitoring and control capabilities. However, subjects judged to be “cognitively impaired” (<24 MMSE®) scored a significantly smaller percentage of task success than the “unimpaired” (> = 24), suggesting that cognitive screening of patients prior to the use of EMMA® may be advisable. Further studies are needed to test the use of EMMA® amongst ALF residents without cognitive impairment to see if this technology can improve medication adherence.

A review of features and characteristics of smart medication adherence products

“…31 , 44 Some devices required medications to be loaded individually (e.g., Pria or Pillo), and others required blister cards (e.g., Emma or RxPense), pill packs (e.g., spencer or Karie) or cups (e.g., Philips) to be inserted into the device. 27 , 41 , 47 , 50 , 54 , 57 , 69…”

A systematic review of electronic assistive technology within supporting living environments for people with dementia

“…The prototype system was found to increase the person’s ability to wash their hands without the help of a caregiver. The EMMA® medication dispensing device was explored by Ligons et al (2014). The findings indicated that the system was not user-friendly for people living with dementia and no individual successfully completed all the tasks.…”

“…Interestingly, the importance of keeping the data secure to uphold the privacy of the tenant or resident received little attention in the literature. It is also important to note that not all the interventions were successful in a population living with dementia (Ligons et al, 2014) or with all the users (Peak & Cheston, 2002). One study outlined the positive outcome for care when technology was removed from the care setting and replaced by reeducating staff (Bressler et al, 2011).…”

A Prospective Study of Usability and Workload of Electronic Medication Adherence Products by Older Adults, Caregivers, and Health Care Providers

“…Major challenges with usability were identified, including a narrow medication loading slot; difficulty in reading the font; and difficulty in identifying, retrieving, and opening delivered medications. In a separate study, usability of medication adherence technology was found to be limited in persons with cognitive impairment [ 40 ]. In this study, Mini-Mental Status Examination (MMSE) scores were significantly correlated with the percentage of task success; noncognitively impaired individuals completed 69% of the tasks required to use an integrated medication unit, whereas cognitively impaired individuals were only successful at completing 34.7% of the tasks [ 40 ].…”

“…In a separate study, usability of medication adherence technology was found to be limited in persons with cognitive impairment [ 40 ]. In this study, Mini-Mental Status Examination (MMSE) scores were significantly correlated with the percentage of task success; noncognitively impaired individuals completed 69% of the tasks required to use an integrated medication unit, whereas cognitively impaired individuals were only successful at completing 34.7% of the tasks [ 40 ]. Similar issues with navigation, poor visibility, and lack of transparency have been identified in medication management apps available for use in smartphones [ 41 , 42 ].…”