Can a “smart” pillbox and regular nursing visits help fragile older adults stay healthier and remain in their own homes longer?
Karen Marek, a University of Wisconsin-Milwaukee nurse-researcher, will be studying that question over the next five years with the support of a $2.2 million grant she recently received from the National Institutes of Health.
The study will involve a total of 500 people, all over age 65, on Medicare and taking multiple medications, according to Marek, an associate professor of nursing. Three groups will be compared: A control group will have no nursing services and no requirement to use a pillbox of any sort; a second group will use traditional plastic seven-day pillboxes and have a nurse assess them weekly; the final group will use a “smart,” or computerized, pillbox and will also have a nurse assess them weekly.
This study will build on Marek’s previous research on the benefits of allowing elderly people to stay at home, if possible. A pilot study showed that the MD.2, or “smart” pillbox, helps memory-impaired patients take their medications on time. With many homebound patients on a dozen or more medications, medication management can be a major challenge, says Marek. Often, if the problems aren’t resolved, the elderly end up in nursing homes.
The MD.2 pillbox, which is about the size of a coffee-maker, not only dispenses medications, but has an audio feature that reminds patients when it’s time to take them. For patients with hearing loss, there’s also a flashing light. A text message notes any special instructions. The MD.2 is connected to a service center via the phone line. When a patient takes pills from the device, the MD.2 sends information to the service center, Marek explains. “And if a patient skips a scheduled medication, the staff notifies the nurse or a neighbor.”
However, notes Marek, the NIH study isn’t about only the “smart” pillbox. “This is not just providing technology. We are providing a nurse as well,” she says. “A frail elderly person on 10 medications needs monitoring.” In fact, she adds, all study participants will receive a pharmacy screen before starting in the study to make sure the multiple medications they are on are all appropriate, and not causing harmful interactions.
Marek notes that the pillbox plus nursing services would cost about $300 a month per patient, very inexpensive compared with the $7.2 billion Americans pay annually in avoidable nursing home care attributed to not taking medications properly.
Research shows that about 87,400 older adults a year move from homes to nursing facilities because they aren’t taking medications properly, a number that could skyrocket as baby boomers age.
Aurora Visiting Nurse Association of Wisconsin will recruit the participants, all of whom will have been discharged from their home health care services.
Marek’s previous research — while working as director of the homecare agency at the University of Missouri-Columbia’s Sinclair School of Nursing — compared two groups of frail older adults with similar health problems. She found that those who remained home with a nurse care coordinator were less depressed, more mobile and retained more memory function than those who were institutionalized. The NIH grant will allow Marek to take her research to the next level and provide both clinical and cost outcomes. “We want to be able to find out if we are using the money to get the best possible patient and medical outcomes.”
“Finding ways to help our elderly maintain their independence is critical,” said Wisconsin Senator Herb Kohl. “This important study will examine new ways that regular nursing visits and technology may help improve their health.”
“We’ll be able to see if people are healthier at the end of the study,” Marek said. “Did they avoid the ER? Did they avoid nursing home care? If so, it would be logical for Medicare to consider providing smart pillboxes and nursing services as a benefit.”
