MedGUIDE: ICT Integrated System for Coordinated Polypharmacy Management in Elders with Dementia

The main goals of the MedGUIDE project was to - improve the medication process for people in early stages of dementia - improve the quality of life and support an independent life for people in early stages of dementia by - providing an overview of daily activities for the person, such as patterns of sleeping, eating, toilet visits and activity indoors and outdoors. - give the person with early dementia reminders that it is time to take the medicine and if the medication is not taken, notify the healthcare professional or relatives The project was coordinated by ConnectedCare Services from the Netherlands. The project had partners from the Netherlands, Cyprus, Romania and Norway. Karde was the only partner from Norway. Karde's duties were related to system architecture, design, usability, testing and evaluation of the system, as well as dissemination of new knowledge from the project. For testing the system, Karde involved Vaksdal municipality. Vaksdal recruited users for two rounds of trial. The first round lasted 4 weeks, while the second round lasted 3 months. The reason for the second round being so long was that the MedGUIDE system should establish a basis for activity patterns over a 4-week period. The people who participated in the project should preferably live alone in their apartment. The daily activity pattern was mapped through movement sensors in the living room, hallway, kitchen and bathroom / toilet, bed sensor that told how long the person was in bed, door sensors on the refrigerator door that would give an indication of food intake and the outside door that would tell how long the person had been out of their apartment. The overview of the daily activity pattern was made available to formal and informal (often relatives) caregivers as well as doctors and pharmacists after the person had given consent. A polypharmacy module was developed for proactive detection of drug-related problems. The module was designed to detect adverse side effects and drug interactions on the basis of significantly altered patient activity patterns. For major changes from baseline, more than 30%, a pharmacist or physician would have to qualify if the changes could be due to unfortunate combinations of medications. It is appropriate to note that in Norway, doctors receive warnings if they prescribe medication that interacts poorly. They are also told about possible side effects of the medication. Then the doctor must consider whether there are alternatives, and if not, decide whether she should still prescribe the medicine. It is conceivable that the alternative, namely, not to prescribe medicine, is inferior. The MedGUIDE system consists of three main components: 1. web application for primary user 2. web application for support staff (health care professionals, relatives and doctors and pharmacists) 3. polypharmacy module that detects nonconformities in activity pattern for primary user and suggests that this may be due to adverse interactions or side effects of medication primary user takes The primary user web application was set up on a tablet. The tablet always showed the MedGUIDE app. It was not possible to get out of the app without tapping a special pattern on the tablet. The most important features were reminders to take medicine, confirmations that the medication was taken, opportunity to report discomfort and mood, as well as get a simple presentation on dementia and possible remedies for forgetfulness. The support staff application provided an overview of activity patterns for each day, details of the activities, notification function for communication with primary users, overview of the care network and information about dementia. The polypharmacy module had a function where support staff could post the medication plan for each patient. The GP or pharmacist could post known side effects and interactions for the medication. The app analysed activity patterns and recorded non-conformities. In case of major non-compliance, a doctor or pharmacist should qualify if the non-compliance could be due to medication. The results of the trials were based on several rounds of interviews with primary users, support staff (both formal and next of kin) as well as pharmacists and primary physicians who were particularly interested in the polypharmacy module. The users answered in validated forms. In general, all users thought that the MedGUIDE system could be a useful tool. Relatives liked the activity overview; it gave a good insight into the daily life of the users. The test rounds were too short for the polypharmacy module to generate particularly interesting results. For all users, the medication was reasonably unchanged during the period the tests lasted, and therefore there was no deviation in the activity pattern attributable to medication. However, the doctors and pharmacists who participated in the study believed that the polypharmacy module could provide useful input.

Achieved outcomes 1. web application for primary user 2. web application for support staff (health care professionals, relatives and doctors and pharmacists) 3. polypharmacy module that detects non-conformities in activity pattern for primary user and suggests that this may be due to adverse interactions or side effects of medication primary user takes Impacts For municipalities and companies working with assistive technologies we have obtained: - increased knowledge about potential with sensor technology in general for monitoring of elders living alone. - Knowledge about how sensor data may contribute to better polypharmacy medication for elders. - new knowledge about a large number of pitfalls and shortcomings of the use of technology in elderly care

The challenges addressed are: 1. Medical professionals have difficulties assessing and distinguishing the medication side effects in care of the frail elders with early dementia with a multifactorial pallet of symptoms belonging to dementia. 2. Pharmacists have difficulties to monitor, evaluate and review medication use of these patients. 3. These patients have difficulties in adhering to the medication regime which impacts their well-being. The MedGUIDE system will provide following ICT services: 1. Activity and Polypharmacy Monitoring Service for holistic monitoring and integration of distributed self-reports (from the elderly patients and/or the network of caregivers) and IoT data sources describing the elder's activity of daily life, habits, medication intake and adherence to medication therapy. 2. Assessment Service leveraging on big data analytics to establish the baseline functional activities of each patient, and to detect events that represent changes, either sudden or gradual, in their activity routines which may signal progression of symptoms, well-being decline or side effects of medication. 3. Dementia Care and Polypharmacy Management Service enacting personalised and coordinated guidance, motivation and support among types of system end users interested in dementia and associated polypharmacy care using specific dashboard interfaces and polypharmacy knowledge ontology. The MedGUIDE system will provide a closed control feedback loop which will be essential for lowering the communication gap between professional - caregiver - patient with dementia, helping the care providers not to overestimate the achievement of medication, detect adverse effects, and to adjust the medication intervention in correlation with dementia progression. This will allow for providing 24/7, personalised and non-intrusive support and medication guidance to the elders and their care-givers.