Katie McDuffie is a final-year PharmD candidate at the High Point University Fred Wilson School of Pharmacy, and Angeles Morales Olivieri is a third-year PharmD candidate at the University of Florida College of Pharmacy, Orlando campus.
Navigating the OTC section can be daunting and confusing. There are plenty of bright boxes advertising to help with this and that. Coupons are punching out from the aisle, telling patients to buy five to get one free. Now imagine that same scenario, but you are an older adult: Your vision is blurry, your mobility is wobbly, and you just want to get something to help your headache. This task is something that many older adults deal with regularly. Older adults might not understand what a certain medication is for or how to take it, which can lead to other complications.
Over one-third of older adults report using OTC medications regularly,1 and usage generally increases with age. About 178,000 hospitalizations occur each year due to adverse drug events (ADEs) with OTC medications, and older adults are at an increased risk of having these major ADEs.2 Some of the most inappropriately used OTC medications are pain relievers (acetaminophen, NSAIDs), anticholinergic medications (diphenhydramine, oxybutynin), and PPIs (omeprazole, esomeprazole, and lansoprazole). While these medications may look appropriate to treat current symptoms, they may also cause more harm than good.
On average, older adult patients are taking four to eight medications at any given time.3 The reality is that most patients are on many medications for chronic diseases that they have been taking most of their lives, along with acute care therapies. These patients can also be taking dietary supplements to meet nutritional needs. In addition, they are taking OTC pain medications around the clock for pain management. It is crucial that pharmacists review these patients’ scripts to avoid patient harm and duplicate therapy.
Why older adults have an increased risk of ADEs
Older adults are at an increased risk of not following instructions listed on OTC products due to visual and/or cognitive impairment; they may also be used to taking a product a certain way and continue to take it the way they always used to. Multiple OTC products are combination products with varying generic medications. Because of this, the patient might be doubling up on a medication and not even know it. Older adults also have differences in metabolism and clearance of medications, which can also lead to toxicities and other ADEs.
Key counseling points
While older adults can benefit from OTC products, it is best practice to consult their physician and/or pharmacist before making any changes to their regimen. Some key counseling points and things to consider about the most inappropriately used medications are that NSAIDs can increase the risk of bleeding, increase BP, and should be used cautiously with kidney disease. It is crucial to inform older adults about the maximum dose of acetaminophen and how all usage of acetaminophen products throughout the day should be included in the maximum daily dose.
Anticholinergics are also a big concern for this population because they can lead to constipation, urinary retention, and blurred vision, which can lead to delirium or psychosis. All anticholinergic medications the older adult is on should be monitored to avoid these dangerous outcomes. PPIs can help with heartburn but should be trialed for discontinuation after 8 weeks due to the risk of osteoporosis, pneumonia, C. diff infections, and vitamin B12 deficiency.
Be proactive
As a future pharmacist, this is an area of need that you can excel in, no matter the practice setting. In the community setting, pharmacists can ensure that older adults are getting the proper medication for their condition, along with proper counseling. In the hospital, pharmacists can ensure a proper medical history is taken and teach the patient on discharge about the proper usage of all their medications, including OTC medications.
By being proactive, pharmacists can play an important role in promoting the safe and effective use of OTC medications in older adults. We are both passionate about older adult medication safety, a commitment shaped by our past volunteering and research experiences.
I (Katie) volunteered with a senior medication project serving at-risk patients in the High Point community, where I saw firsthand the importance of educating and advocating for older adults about safe medication use. And I (Angeles) have also contributed to this area by researching the most harmful OTC medications for older adults, and currently serve as a regional student leader for the American Society of Consultant Pharmacists.
You can play a key role as well.