Although adults over 65 only make up 13 percent of the US population, they account for 34 percent of all prescription use and 30 percent of OTC medication use in the United States. Among older adults between 75 and 85, a 2008 study estimated that 47 percent were regular users of OTC medications. While much research has been done on prescription medication among older adults, much less is known about older adults’ behavior surrounding OTC drugs. In order to address this, the Gerontological Association of America and the Consumer Healthcare Products Association recently held a summit for experts to survey available research on OTC drug use by older adults and create an agenda for future study.
These experts noted that surprisingly little is known about how older adults select OTC medications, how the medications are actually used, and how users decide when to begin and stop using them. Little is also known about how involved physicians and family members are in older adults’ behaviors surrounding OTC medication use.
Prior research on prescription medicine has shown that older adults are two to seven times more likely to have an adverse drug reaction than younger adults, and that 62 percent of all emergency room visits for adverse drug reactions are by older adults. While OTC drugs are judged by the FDA as being safe and effective for use without a prescription, risks still remain associated with the misuse of these drugs. These risks can include unintentional overdosing or dangerous drug-drug interactions. Of the 81 percent of older adults using prescription medications, 46 percent are also simultaneously using OTC medications, which suggests potential risk for an adverse reaction. The 2008 study estimates that 4 percent of older adults’ medication regimes could include a potentially major drug-drug interaction, and that half of those potentially dangerous interactions could involve OTC medications.
Since a common feature of OTC drug use is self-diagnosis of a medical condition that might not require a doctor’s visit, the health literacy of OTC drug users becomes an important concern. It is encouraging that 80 percent of Americans report following community pharmacists’ recommendations for purchasing OTC medications. However, community pharmacists report that many of the OTC drug-related problems that they identify are a result of patients attempting to self-medicate when a visit to a physician would be more appropriate. In light of this, there is significant interest in what shapes OTC consumer behavior, such as in which instances older adults choose to consult or not consult with pharmacists or physicians, as well as the influence of factors like advertising and recommendations from family members or other sources. In particular, the effects of direct-to-consumer marketing and the Internet are in need of greater study.
What has been shown in a 2003 study is that older adults have lower health literacy scores than younger adults. Compared to 36 percent of adults overall, 59 percent of individuals over 65 were deemed to have basic or below basic health literacy. Another study estimated that one in five primary care patients lacked the skills required to manage everyday tasks relevant for health care decisions. Those older adults with less than high school education, racial/ethnic minorities, and individuals with multiple morbidities were identified as at greatest risk for low health literacy. Another complicating factor is research suggesting that physicians, registered nurses, and pharmacists cannot easily identify such at-risk patients. As the experts note, this poses a challenge for presenting health information in ways that enable older adults to make appropriate health-related decisions. They also note a need for understanding how older adults process health information and their symptoms in order to overcome such barriers. The report also notes the importance of caregivers having sufficient health literacy to properly manage the medications of a care recipient.
Research has also shown that “common sense” ideas about health and medications that are not in accord with medical recommendations can often interfere with proper drug usage. For example, some patients will stop taking medications when they feel better despite the potential need to continue drug usage for a period following the alleviation of symptoms, and some chronic conditions may require medication use even when acute symptoms are not present.
The report identified six main areas in which health literacy is important for OTC drug use: symptom recognition, appropriate self-management, knowledge of active ingredients, appropriate dosing, attention to drug warnings, and understanding when to stop use. Importance of these areas is made clear from the findings from a 2012 study showing that 24 percent of adults took more than the recommended dose of an OTC drug, 33 percent did not follow the recommended timing for taking a drug, and 46 percent used more than one product with the same active ingredient.
Further complicating matters is that while 86 percent of patients believe their physicians are aware of their OTC medications, only 46 percent report OTC medications to their physicians. This suggests that in addition to a need for greater health literacy and effective communication of important factors surrounding OTC drug use, there is also a need for effective interventions designed to encourage greater communication between health care providers and patients about their OTC medication use.
Lastly, this group noted the promise of technology for assisting with appropriate OTC medication management and usage by older adults. On the side of the health care provider, they note the need to incorporate OTC medication information in electronic medical records. On the side of the patient or caregiver, they note the potential impact of technology to provide reminders, monitoring, and education to assist with proper usage of OTC medications. However, research will be needed to evaluate the effectiveness of such technological interventions for older adults.
In light of all of the above, the panel suggested that further research into OTC drug use should become a greater health policy priority. From the perspective of the senior living industry, the current findings presented by this group suggest a need for greater attention to OTC drug use among older adults. Both health literacy and recommended OTC drug regimen adherence are issues that can be addressed and improved by service providers to older adults.
Albert SM, Bix L, Bridgeman MM, et al. Promoting safe and effective use of OTC medications: CHPA-GSA National Summit. The Gerontologist (2014); 54: 909–918.