Pharmacists in academia: Developing evidence-based solutions to promote the safe and effective use of medicines by older people with sensory impairment

Professor Margaret (Mags) Watson is Professor of Health Services Research and Pharmacy Practice at Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde. She is also the Founder/Director of Watson Research and Training Ltd. She posts on X via @MagsWatson1.

I am a health services researcher and pharmacist with 30 years of experience in academic research related to the safe and effective use of medicines. I lead a research programme about medicines and older people with sensory impairment (hearing and/or visual). My research adopts evidence and theory-based methods to identify challenges and develop solutions.

Older age, multi-morbidity and polypharmacy often go hand-in-hand. The loss of sensory function, specifically visual and/or hearing ability, often occurs with the ageing process and is associated with higher rates of co-morbid conditions including heart disease and stroke¹. Older people in general are more susceptible to medicine-related harm and for those with sensory impairment, the risk of iatrogenic disease is even greater.

By 2035, one in five people in the UK will have hearing impairment or loss, over 900,000 of whom will be severely or profoundly deaf. More than 50% of adults with hearing impairment are over 70 years of age². Globally, hearing impairment and loss disorders are projected to be one of the top 10 causes of disease burden in high/middle income countries³.

Visual impairment/loss affects around 1.9 million people in the UK and people aged 60-73 have around double the risk of bilateral impairment or loss compared with individuals aged 40-49. Individuals with visual impairment or loss are also more likely to live alone.

Imagine being 70+ years of age, living alone with impaired vision and hearing, with over 10 medicines to be used daily, including high risk items such as insulin. Consider the complexities of managing this regimen, especially how to:

• know when to order new supplies – how to assess how much solution remains in a bottle or vial
• order new supplies – what if telephone ordering is the only mode permitted but the extent of hearing loss is such that telephone communication is ineffective and/or inaccurate?
• navigate the journey to collect medicines if a delivery service is unavailable and visual loss prohibits driving or other methods of independent travel
• sort through medicine supplies to identify which is which, whether everything is correct and what changes have been made due to different manufacturers’ products being used remember which medicine(s) to use at specific times
• measure the dose(s) accurately

and so on.

The above is an example of the lived experience of one of our research study participants. Despite the magnitude of people affected, the medicine-related needs of older people with sensory impairment (“OPwSI”) have received little attention or recognition⁴. Until now.

I lead a research programme to develop evidence- and theory-based solutions to the medicine-related challenges experienced by OPwSI. I combine my knowledge and experience of health services research with my training and experience as a pharmacist, and work with multidisciplinary teams to address the substantial burden experienced by OPwSI in relation to their medicines.

The SIPA 1 and 2 (Sensory Impairment and Pharmaceutical cAre) projects identified many and multiple challenges throughout the ‘medicine journey’⁵:prescribing consultation; ordering, obtaining, storing and administering the medicine(s); and medicine disposal. This research involves collaboration with pharmacists, doctors, nurses, patients, the public, occupational therapists, psychologists, digital specialists, third sector organisations, designers, architects, engineers, social scientists, sociologists etc. The list is (almost) endless.

So what have we achieved? We know the challenges and now are starting to develop solutions. In 2023, we launched a free massive open online course⁶ to raise awareness of the medicine-related challenges of OPwSI. We are currently co-producing a searchable website that identifies and matches assistive technologies to medicine-related needs. Three of my PhD students are working within the programme: one is exploring whether and how prescribers modify their practice when prescribing for OPwSI and what resources and initiatives are needed to support more person-centred prescribing for these patient populations; another is co-producing a digital assessment tool for OPwSI and their medicines; and the third is exploring how OPwSI navigate from home to healthcare environments and within hospital settings, and what improvements are needed.

There is still much to be done, and my membership of the British Geriatrics Society and international networks will help to contribute to further improvements.

NB: The SIPA 1 and 2 studies were funded by the Chief Scientist Office (Scotland) and Dunhill Medical Trust, respectively. The PhD student cohort is also funded by Dunhill Medical Trust.

References:

1. Crews JE, Campbell VA. Vision impairment and hearing loss among community-dwelling older Americans: implications for health and functioning. Am J Public Health. 2004 May;94(5):823-9. doi: 10.2105/ajph.94.5.823.
2. https://www.actiononhearingloss.org.uk/your-hearing/about-deafness-and-hearing-loss/statistics.aspx (accessed 24/09)
3. https://www.who.int/news-room/fact-sheets/detail/deafness-and-hearing-loss#:~:text=Overview,affected%20by%20disabling%20hearing%20loss (accessed 24/09)
4. Killick K, et al (last author Watson MC). A scoping review of the pharmaceutical care needs of people with sensory impairment. Int J Pharm Pract. 2018 Oct;26(5):380-386. doi: 10.1111/ijpp.12456
5. Fuzesi P, et al (last author Watson MC). The burden of managing medicines for older people with sensory impairment: an ethnographic-informed study. Gerontology and Geriatric Medicine, 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11100380/
6. https://www.futurelearn.com/courses/supporting-medicine-use-by-older-people-with-sensory-impairment (accessed 24/09)