Using technology to improve medication adherence in older Australians
When 84-year-old Margaret from Bendigo says her morning tablet routine has gone "a bit haywire", the pharmacist behind the counter hears a story playing out in living rooms from Launceston to Cairns. More than one in five Australians are now aged 60 or over, and this cohort takes a disproportionate share of the medicines dispensed every year. Adherence rates for chronic disease sit between 50 and 70 per cent in most published research, and the picture in Australia is broadly similar.
Community pharmacists see the consequences of missed doses and confused regimens every working day. Webster-paks, MedsCheck consultations, and Home Medicines Reviews are tried and tested responses, but a quiet digital shift is happening alongside them. Smart blister packs, reminder apps, and connected devices are moving from novelty items into everyday pharmacy practice.
This article looks at how technology is being used to support older Australians to take their medicines as intended, what the policy environment looks like under the Seventh Community Pharmacy Agreement, and where the practical pitfalls lie for pharmacists, family carers, and the older people themselves.
The focus is on people living in their own homes, as well as residents in aged care facilities, and on the role pharmacists can play in choosing and supporting the right digital tools for each individual.
Why adherence gets harder with age
Polypharmacy is the rule rather than the exception for older Australians. A person managing heart failure, type 2 diabetes, osteoporosis, and a bit of arthritis can easily end up on eight or more regular medicines, plus a few "when required" items for breakthrough symptoms. The Therapeutic Goods Administration reminds clinicians that the risk of interactions and adverse effects climbs steeply once a person is on five or more medicines, which is a common threshold for an HMR referral.
Cognitive change, vision loss, arthritis in the hands, and the simple fatigue of feeling unwell all make the daily choreography of remembering, opening, and swallowing medicines harder. Carers, often a partner in their seventies or eighties, may be juggling their own medication burden. The PBS safety net helps with cost, but it does not solve the question of whether the right tablet is in the mouth at the right time.
There is also a quiet emotional layer. A daughter in Sydney described her father's refusal to use a dosette box as a small act of independence he was not ready to give up. That kind of sentiment is something a thoughtful pharmacist can pick up on and work with, rather than against.
The digital toolkit pharmacists are reaching for
A range of relatively affordable technologies now sits alongside the Webster-pak on pharmacy shelves. Some are designed specifically for medicines management, while others are everyday consumer products that have been adapted for the purpose.
Tools that are gaining traction include:
- Smart tablet dispensers with locked cartridges that release the correct dose at a set time and alert a caregiver if a dose is missed
- Electronic blister cards with printed circuitry that records when a tablet has been pushed through
- Smartphone apps such as Medisafe and MyTherapy that send reminders, track refills, and produce adherence reports
- Voice assistants like Google Home or Alexa, which can be programmed to call out medication times without the user needing to look at or touch a screen
The shift is partly cultural. Phones are no longer the preserve of the young, and research from the Australian Digital Inclusion Index shows that everyday internet use among Australians aged 65 and over has climbed steadily over the past five years. That makes it realistic to introduce app-based tools, provided the design is simple and the training is patient. Pharmacists interested in building their own library of practical resources can browse the writing at johnathanlaird.com, which gathers reflections on community pharmacy practice from a working pharmacist in the field.
Apps, reminders, and the smartphone generation
Medication reminder apps have come a long way from the basic alarm clocks of a decade ago. The leading products now handle multiple medicines, link to a chosen pharmacy for refill alerts, and let a family member or community nurse view a shared adherence timeline. For older Australians who are comfortable with a smartphone, these apps can be transformative, particularly when there is someone in the family willing to set them up and check in regularly.
For those who are not comfortable with a phone, the same logic can be applied through a smart speaker. A pharmacist in a regional Victorian town described how she programmed her own Google Nest device to remind her father to take his morning blood pressure tablet, and now keeps a small batch of pre-configured devices to sell to her older customers.
The conversation also needs to include complementary medicines, which are widely used by older Australians. A patient researching turmeric for joint pain may come across websites offering anti-inflammatory information about curcumin that sits outside the mainstream evidence base. Talking openly with patients about what they are reading online is a small but important part of supporting adherence, because a confused patient is less likely to follow the prescribed regimen.
Policy backing: 7CPA, HMR, and the eNRMC
Australia has a layered policy environment that supports pharmacists in doing this work. The Seventh Community Pharmacy Agreement funds professional programs such as MedsCheck and Diabetes MedsCheck, which allow a pharmacist to sit down with a patient and review their medicines, identify adherence problems, and propose solutions. Where a more detailed review is needed, a GP can refer the patient for a Home Medicines Review, with the pharmacist visiting the home and producing a written report.
For residents in aged care, the electronic National Residential Medication Chart has been a quiet revolution. Instead of paper charts that travel between the GP, the pharmacy, and the facility by fax, prescribers can now chart medicines digitally, and pharmacists can dispense directly from that electronic record. This reduces transcription errors and makes it easier to spot when a dose has been missed or doubled.
The My Health Record system gives pharmacists a view of the medicines a patient has been dispensed across different pharmacies, provided the patient has not opted out. For a person seeing multiple specialists and picking up scripts at different locations, this single view is a powerful adherence tool in its own right.
Wearables, smart speakers, and the data question
Beyond the dedicated adherence devices, a wider ecosystem of consumer technology is starting to play a role. Smart watches can detect falls, track heart rate, and remind the wearer to stand up and move, which indirectly supports the routine that includes medication. Smart speakers can read out a reminder, play a familiar tune to cue a dose, or even place a call to a designated contact if the person does not respond.
Pharmacists should think carefully about the following when recommending such tools:
- Privacy settings, especially when the device is connected to a family member's account
- Backup power and internet resilience, which can be fragile in rural and remote parts of the country
- Plain language instructions so the older person understands what the device is doing and why
- An exit plan if the technology fails or the person simply does not get on with it
Mental wellbeing is part of the adherence picture as well. Older adults managing chronic illness are at higher risk of depression and anxiety, and stigma can prevent them from speaking openly about how they are coping. Pharmacists interested in creating a more supportive conversation in the dispensary can find practical guidance on mental health stigma in pharmacy, with a dedicated post offering practical advice.
A side-by-side look at common adherence technologies
| Technology | Best suited for | Approximate cost | Main strength | Main limitation |
|---|---|---|---|---|
| Smart tablet dispenser with locked cartridge | Person living alone with cognitive impairment | $300-$800 plus ongoing cartridge refills | Removes the need to remember which tablet is which | Requires reliable power and a regular refill service |
| Electronic blister card | Person with a stable regimen and a family member checking in | $40-$120 per month of cards | Familiar blister format with an added digital layer | Less useful when the regimen changes frequently |
| Smartphone app | Tech-comfortable older adult with an engaged family | Free to $60 per year | Flexible and shareable with caregivers | Requires a smartphone and some setup support |
| Smart speaker reminders | Person uncomfortable with phones | $80-$200 one-off | Voice interface with no screen needed | Cannot confirm that a dose was actually taken |
| Pharmacist-led MedsCheck | Any patient on multiple medicines | Funded under the 7CPA | Human conversation and a tailored plan | One-off review, not continuous monitoring |
The right choice depends on the individual, the medicines involved, the home environment, and the support network. A device that works beautifully for a chatty 72-year-old in Brisbane may be entirely wrong for a 90-year-old with dementia in a Hobart aged care home. The best results tend to come from matching the tool to the person rather than the other way around, and from revisiting the decision at regular intervals as circumstances shift.
The right digital tool, offered at the right moment by a pharmacist who knows the patient, can quietly turn a struggling routine into a manageable one. For older Australians, the value of technology lies in the conversations it allows, the mistakes it prevents, and the dignity it preserves. If you are a pharmacist, an HMR is often the right place to start, and the Pharmacy Guild and the Pharmaceutical Society of Australia both publish practical guides on integrating digital adherence tools into everyday practice. If you are a family carer, your local community pharmacist is a ready source of unbiased advice and can help you trial a device before committing to a purchase. Drop into the pharmacy, bring a list of the medicines currently being taken, and ask what they would suggest for your situation.