UNDERSTANDING OVER-THE-COUNTER MEDICATION USE AND DECISION-MAKING AMONG COMMUNITY-DWELLING US OLDER ADULTS: A MIXED-METHODS APPROACH

Introduction Older adults are regular consumers of over-the-counter (OTC) medications. OTC medications are generally considered safe, and convenient to use without requiring a prescription. However, the safety of an OTC medication and the final health outcome depends in part upon consumers’ perceptions, beliefs, and their decision-making about OTC medication use. The main objectives of this study were: 1) to examine the prevalence and characteristics of OTC medication use among community-dwelling US older adults (65 years and older), 2) to explore older adults’ knowledge, attitudes, beliefs and experiences about OTC medications, and 3) to elicit the OTC medication decision-making process in this population. Methods Data from the National Social Life, Health, and Aging Project (NSHAP) wave 2 was utilized to examine the prevalence and characteristics of OTC medication use in a nationally representative sample (N=2,637) of community-dwelling US older adults (65 years and older). OTC medication use was characterized based on sociodemographic, intrapersonal, interpersonal, organizational, and community-level factors. Further, a mixed-methods study was conducted in two senior-living communities in Richmond, VA. The qualitative phase of this mixed-methods study used focus group methodology to explore the knowledge, attitude, beliefs, and experiences about OTC medications, and the OTC medication decision-making process in a sample (N=80) of older adults using the criterion sampling strategy of purposeful sampling. Results from the qualitative phase informed the development of a semi-structured questionnaire, which was used to collect data in the quantitative phase of the mixed-methods study. The quantitative phase used in-person interviews to quantify attitudes, beliefs, preferences, and practices associated with the OTC medication use and decision-making process in a different convenient sample (N=88) of older adults within the same settings. Results NSHAP Study: The majority of participants were women (54%), whites (82%), and with an education greater than high school (57%). Study findings indicate a high weighted prevalence (76%) of OTC medication use in a nationally representative sample of older adults. Among older adult men, education (p value=0.0038), race (p value=0.0003) and comorbidity (p value =\u3c0.0001) significantly and independently predicted the OTC medication use. Older adult men who were whites had greater odds of using OTC medication than other races. Older adult men with higher than high school education were 1.54 times more likely (95% CI: 1.15-2.06) to use OTC medications than their counterparts. It was observed that with every unit increase in the number of co-morbid conditions, OTC medication use decreases by 26% (OR: 0.74, 95% CI: 0.65-0.84) among older adult men. Among older adult women, education (p value=0.0244), race (p value=0.0048), smoking (p value=0.0494), and social participation (p value=0.0341) showed a significant and independent association with OTC medication use. Older adult women who were whites and non-smokers had greater odds of using OTC medication than their counterparts. Older adult women with higher than high school education were 1.36 times more likely (95% CI: 1.04-1.79) to use OTC medications than their counterparts. It was observed that with every unit increase in the social participation, OTC medication use increases by 15% (OR: 1.15, 95% CI: 1.01-1.31) among older adult women. Qualitative Study: The majority of the sample were women (63%), whites (54%), and with an education greater than high school (60%). The study indicated that the OTC medications are generally considered very safe and effective for treating minor/routine symptoms by older adults. Brand version OTC medications were generally favored over generics by this sample of US older adults. There were found two types of decision-making scenarios following after the older adults make sense of their symptoms: 1) treatment decision-making and 2) purchase decision-making. The treatment decision-making comes with two approaches: 1) a decision to treat their symptoms by themselves (self-recommended) or 2) a decision to ask and/or follow physician’s recommendation (physician-recommended). Each of these treatment approaches may lead to the other depending on the person’s financial and healthcare resources, severity of the symptoms, experiences with the medication (past or current), and relationship with the physician. While purchasing OTC medication from the store, the majority of consumers first explore information on the drug-label, ask a pharmacist, compare various options (generic or brand), compare prices/deals, and make a final purchase decision favoring the maximum and fast relief, followed by the lower cost, and easy to swallow dosage forms. Quantitative study: The majority of the sample was women (55%), blacks (61%), and with an education less than or equal to high school (55%). Analgesics were the most (76%) prevalent OTC therapeutic category, and aspirin was the most (65%) prevalent OTC medication. A greater (82%) proportion of the participants reported self-recommended OTC medication use (self-medication with OTC medications) rather than physician-recommended use. A high (41%) prevalence of inappropriate use of OTC medications was observed in this sample of older adults. Most participants considered OTC medications very safe or safe (80%) and very effective or effective (80%) to use. The majority (79%) of participants felt very satisfied, and 16% felt satisfied with their OTC medication use. Brand name OTC medications were considered more safe and effective compared to generic versions. The pharmacy was the most (93%) commonly reported purchase location to buy an OTC medication. Physicians were the most (90%) commonly reported information source about OTC medications. Conclusions Older adults feel positive and satisfied with their OTC medication use, in general. Considering the self-reported high use, inappropriate use, and experiences of facing side effects, education focused toward older adults should be encouraged to aid in safe and responsible OTC decision-making