The Pansophy Cohort: Multidisciplinary solutions to age-related challenges of pharmaceutical care

Older people are disproportionately affected by sensory impairment (SI) (hearing and/or visual) and more likely to use multiple medicines and to live alone. Pharmaceutical care aims to promote the safe and effective supply and use of medicines. Older people with SI (OPwSI) are at high risk of harm and therapeutic failure.

Healthcare settings, consultations and services need to support the complex needs of the growing number of older, community-dwelling citizens to facilitate their ability to live at home for as long as desired.

These Studentships present a novel opportunity to derive inter-disciplinary solutions, common challenges experienced by OPwSI and their pharmaceutical care. 1.

Person-centred consultations for OPwSI CIS (Lennon/Watson) Blended Care models (a mixture of human and technology enabled care) were being explored with varying success before the Covid19 pandemic. Many health and care consultations moved online and/or via telephone or video call for example.

For OPwSI, technologies used for consultations need to be accessible, usable and flexible to suit a wide a range of needs in order for them to improve the care delivery and management experience.

This PhD in Computer Information Science will be co-supervised by SIPBS and will involve a mixed methods study with OPwSI and how they currently access and experience consultations with their care givers e.g. pharmacists, general practitioners, specifically in relation to medicine management.

The aim is to identify future models of medicine management involving technologies that 'work' from both the service delivery point of view but also for the citizen’s needs and lifestyle.

The study will involve a ‘living lab’ and co-design methodology involving citizens (OPwSI) from the outset to design the research programme itself and to create digital (and other) stories to be used to derive user needs and requirements (Year 1 (Y1)) which will also inform policy and practice (and guidelines) around future technology-enabled models of consultations.

Y2 will involve co-design of a range of technology prototypes or ‘probes’ to be road tested 'in the lab' and 'in the field' (people’s homes) for accessibility and usability.

Y3 will involve combining human computer interaction paradigms with an implementation science framework to identify both existing and future barriers and opportunities for the use of technologies for medicine management at home that are inclusive for OPwSI. 2.

Exploration of Place: OPwSI and the Built Environment, Architecture (McElroy, Giardini, Watson) Following the COVID19 pandemic and the Hackett review of Grenfell, new restrictions and challenges will arise in building and urban design.

Cities need to change and adapt as will populations: things that we took for granted will no longer be possible or practical – from negotiating our highstreets, to inhabiting artificially conditioned spaces.

Whilst the existing infrastructure will be central to our new normal, it is no longer fit for purpose in terms of ease of navigation and social distancing, particularly for people with sensory impairment.

New and innovative ideas are needed to help us to adapt our existing infrastructure to make it resilient to future disruptors, including the large proportion of older people in society.

This proposal provides options that include navigating a healthcare and/or home environment, and the role of technology in assisting independent living, e.g. new ‘beacons’ for those with auditory impairment.

Much of the current research focus is on technological possibilities and not on the range and scope of environments in which these might be applied.

Bringing together Architecture (and Urban Design) and Biomedical Engineering significantly broadens and deepens the research possibilities.

This PhD will explore how OPwSI experience the built environment and how that experience could be improved and supported using simple, low-cost techniques.

This could involve how to support people in the navigation of spaces – as this is applicable to older people with a range of conditions such as sensory or cognitive impairment and mobility issues.

The RNIB currently supports a range of non-visual, electronic orientation aids to assist people with visual impairment to navigate indoor and outdoor spaces.

These range from smartphone technologies to smart canes, smart/3D maps, Bluetooth beacons and IoT (Internet of things)-enabled approaches that allow communication between various systems and technologies that can transfer data over a network without requiring any form of human or machine interactions [M1].

The work will build on research carried out by McElroy while based at the Building Research Establishment, to support elderly people with cognitive impairment, using a range of novel and conventional approaches, to enable them to live independently for as long as possible. 3.

Medicinal Product Design for OPwSI Biomedical Engineering (Giardini, Watson) Medication non-adherence is a growing public health concern, specific to the elderly population [G1].

Managing medication despite the physical limitations inevitable with age has been identified as one of the strategies for effective self-management of medication [G2].

Eye drop instillation is a notoriously difficult task for the older person [G3], yet essential for the management of common eye conditions, such as glaucoma.

This project will develop proof-of-concept packaging for simplified eye drop administration, optimised for simple and reliable delivery of metered eye drops without the need for fine motor skills. This PhD will be configured as a PhD in Biomedical Engineering, with co-supervision by the SIPBS.

The Department of Biomedical Engineering offers a solid context of established collaboration with NHS and the Scottish Government on the development of eye care solutions that range from novel devices, to telemedicine services, to more speculative topics. Y1 will involve a first implementation of a functional prototype.

Y2 will progress into an iterative refinement of the prototype in strict liaison with the appropriate patient and professional stakeholders.

Y3 will be dedicated to finalisation of the designs, determination of the limit performance, and generation of data to attract follow-on investment. 4.The Pharmaceutical Care of OPwSI SIPBS (Watson, Lennon) This PhD will use multi-stakeholder coproduction of evidence based (EB) guidelines for the assessment and management of the pharmaceutical care of OPwSI, and will test the feasibility of the guideline implementation into different healthcare settings.

This PhD in Health Services Research will be co-supervised by members of SAN and Futures. The PhD will involve mixed methods.

Y1 will involve the identification and synthesis of evidence to inform the guidelines and the establishment of a multi-disciplinary guideline development group.

In Y2, participatory methods, will be used to derive formalised consensus regarding the content and format of the guidelines. Y3 will involve a feasibility study to evaluate the guideline implementation into different healthcare settings.