Hong Kong—Pictograms of simple instructions—such as “take by mouth,” “read the label,” or “take with food”—are helping older patients take their medications more safely.

A study in the journal Applied Ergonomics shows that including pictograms on written medication instructions helps improve adherence and avoid mishaps in patients age 65 years and older.

Background information in the article cites a CDC estimate that the cost of nonadherence to prescriptions, by taking the medicine at the wrong dose, time or frequency, is between $100 and $289 billion annually.

To address the problem, researchers from the City University of Hong Kong and colleagues used nine different pharmaceutical pictograms to help older people understand written medical information.

“Drugs are necessary to treat diseases and relieve symptoms; however, improper use of drugs can lead to serious consequences such as stomach bleeding and poisoning,” explained lead author, Annie Ng, PhD. “We wanted to see if supplementary pictograms could help older people understand how to take their medication safely.”

Participants, whose educational levels ranged from primary school to university level and who all had normal or corrected-to-normal vision, completed a medical-information comprehension task.

For the study, 50 participants ages 65 to 84 years were asked to read and understand the medical instructions printed on five different medications widely used in Hong Kong—aspirin, warfarin, cardiprin, atenolol, and gliclazide. While one group received the information using plain text, the other was provided with a range of pictograms in addition to the text.

Comprehension performance was associated with the number of pharmaceutical pictograms used—the more the pictograms, the higher the comprehension score, according to study authors. Results indicate, however, that participants with a lower education level demonstrated a poorer overall understanding of the medication information.

“Information on medicine labels can sometimes be confusing, especially if a patient has several medications to contend with. Including a few simple pictures on a medicine label helps older people to read and understand this information,” Ng pointed out. “This not only prevents accidental overdose, it relieves some of the pressure that our aging population is putting on the health service by avoiding preventable tragedies.”

She added that the study “focused on seniors but we believe this research could help a much wider demographic. People with vision problems or difficulties comprehending basic written information, for example, will be able to better understand their medication needs, which will help their health and support their independence.”

The United States Pharmacopeia (USP) Convention developed a set of 81 pharmaceutical pictograms as “standardized graphic images that help convey medication instructions, precautions and/or warnings to patients and consumers” in 2015, but the study emphasizes that no previous research has focused on the USP pharmaceutical pictograms for older people in the context of real medicine labels and drug-container boxes.
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