The Burden of Managing Medicines for Older People With Sensory Impairment: An Ethnographic-Informed Study.

Background: Older age is associated with increased prevalence of sensory impairment and use of medicines. Objectives: To explore the daily "medicine journey" of older people with sensory impairment. Methods: The study used ethnographic-informed methods (using audio-, photo- and video-recordings, diary notes and semi-structured interviews with researchers) and involved community-dwelling adults (aged > 65) in Scotland, with visual and/or hearing impairment and using >4 medicines. Data analysis used the constant comparative method. Results: Fourteen older people with sensory impairment participated and used a mean of 11.0 (SD 5.0) medicines (range 5-22). Participants reported difficulties with medicine ordering, obtaining, storage, administration and disposal. They used elaborate strategies to manage their medicines including bespoke storage systems, fixed routines, simple aids, communication, and assistive technologies. Conclusion: Older people with sensory impairment experience substantial burden, challenges and risk with medicines management. Tailored medicine regimens and assistive technologies could provide greater support to older people with sensory impairment.

Assistive technologies and strategies to support the medication management of individuals with hearing and/or visual impairment: A scoping review.

BACKGROUND: Individuals with sensory impairment (visual and/or hearing) experience health inequalities and increased the risk of medication-related iatrogenic disease compared with the general population. Assistive technologies and tailored strategies could support medication management for individuals with sensory impairment to reduce harm and increase the likelihood of therapeutic benefit. OBJECTIVE: This scoping review identified assistive technologies and strategies to support medication management of/for people with hearing and/or visual impairment. METHODS: Standard scoping review methodology was used to identify studies that evaluated technologies or strategies designed to support people with sensory impairment with independent medicine management. Electronic databases were searched (MEDLINE, Embase, CINAHL, ACM, Cochrane) from inception to 18/07/22. Independent duplicate screening, selection, and data extraction were undertaken. RESULTS: Of 1231 publications identified, 18 were included, reporting 17 studies, 16 of which evaluated technologies to assist people with visual impairment and one study to assist people with hearing impairment. The range of technologies and devices included: applications for android phones (n = 6); eyedrop-assistance devices (n = 5); audio-prescription labelling/reading systems (n = 2); touch-to-speech devices (n = 2); continuous glucose monitoring system (n = 1); magnifying technology (n = 1). Ten studies tested early-stage prototypes. Most participants could operate the technologies effectively and deemed them to be useful. CONCLUSIONS: Despite the increasing number of medicine-related assistive technologies, there has been limited empirical evaluation of their effectiveness for supporting individuals with sensory impairment. Prototypes appear to be useful for people with visual or hearing impairment, however wider 'real-life' testing is needed to confirm the benefits of these technologies.

Quantification of single use plastics waste generated in clinical dental practice and hospital settings.

OBJECTIVES: To quantify (by number and mass) single use plastic waste generated from the provision of oral healthcare in primary and secondary care clinical dental settings in the UK. METHODS: An observational study of four dental practices and the clinics of a UK undergraduate dental teaching hospital was conducted. A range of routine common procedures were observed by trained and calibrated observers; these were: Examinations, endodontics, periodontics, direct placement restorations, fixed and removable prosthodontics and oral surgery. The PPE items used before and during the COVID-19 pandemic were also included. RESULTS: Routine 'surgery set up' generic items present a significant proportion of SUP plastic waste as these are used in every instance of patient treatment. An average of twenty-one (n = 21) SUP plastic waste items are used for every procedure with a mean mass of 354 g per procedure (including set up and clean up). The use of PPE increased from 14 items (pre-COVID -19) to 19 items during the pandemic. SUP items are constructed from a single plastic or from multiple plastics forming compound structures (heteropolymers); with an approximate 50:50 distribution. CONCLUSIONS: The dental profession, at the point of care, uses a high volume of single use plastic that becomes clinical waste. The use of personal protective equipment (PPE) significantly increased during the COVID 19 pandemic and this accounts for the single greatest contribution of single use plastic, as this is used for every clinical procedure. CLINICAL SIGNIFICANCE: Manufacturers, distributors and oral healthcare providers have an opportunity to consider and implement approaches that include effective waste management with reduction, recovery and recycling at its core, towards transforming oral healthcare to a circular plastics economy.