Changes in Prescription and Over-the-Counter Medication and Dietary Supplement Use Among Older Adults in the United States, 2005 vs 2011

Prerana Patel, Mercer University College of Pharmacy

According to the Centers for Disease Control and Prevention (CDC), physicians prescribed 2.3 billion prescriptions in 2012 from physician office visits and another 329.2 million from hospital outpatient visits.  Of those, the most frequently prescribed medications were analgesics, antihyperlipidemic agents, antidepressants, and antidiabetic agents from the combined visits. The CDC also reports that 48.7% of people used at least one prescription drug in the past 30 days while another 10.7% used five or more prescription drugs in the same time period. [1]

Title: Changes in Prescription and Over-the-Counter Medication and Dietary Supplement Use Among Older Adults in the United States, 2005 vs 2011 [2]
Design Descriptive analyses; N = 4,557
Objective To characterize changes in the prevalence of medication use, including concurrent use of prescription and over-the-counter medications and dietary supplements, and to quantify the frequency and types of potential major drug-drug interactions
Study Groups Adults aged 62 to 85 in 2005 – 2006 (n = 2,351); 2010 – 2011 (n = 2,206)
Methods In-home interviews with direct medication inspection were conducted in 2005-2006 and again in 2010-2011.
Duration Analysis ran from March to November 2015
Primary Outcome Measure Population estimates of the prevalence of medication use (in aggregate and by therapeutic class), concurrent use, and major drug-drug interactions
Baseline Characteristics   2005 – 2006

(n = 2,351)

2010 – 2011

(n = 2,206)

p – value
Mean age, years 70.9 71.4  
Females, n (%) 53 51.6  
Use of at least one prescription medication, n (%) 84.1 87.7 0.003
Concurrent use of at least five prescription medications, n (%) 30.6 35.8 0.02
Use of over-the-counter medications, n (%) 44.4 37.9 <0.001
Use of dietary supplements, n (%) 51.8 63.7 <0.001
Use of statins, n (%) 33.8 46.2 <0.05
Use of antiplatelets, n (%) 32.8 43.0 <0.05
Use of omega-3 fish oil, n (%) 4.7 18.6 <0.05
Risk for potential major drug – drug interaction, n (%) 8.4 15.1 <0.001
Results   Estimated Prevalence, %

(95% CI)

 
  2005 – 2006

(n = 2351)

2010 – 2011

(n = 2206)

p –value
Antihyperlipidemics 37.3 (34.6 – 40.1) 50.1 (47.1 – 53.0) <0.001
Statins 33.8

(31.3 – 36.4)

46.2

(43.3 – 49.2)

<0.001
Antihypertensives 60.9

(58.3 – 63.6)

65.1

(62.3 – 67.9)

<0.001
Angiotension-converting enzyme inhibitors 24.5

(22.7 – 26.4)

30.4

(27.5 – 33.4)

<0.001
Diuretics 27.4

(24.9 – 30.1)

29.5

(26.5 – 32.8)

0.22
Beta-blockers 27.1

(24.9 – 29.5)

31.2

(29.0 – 33.4)

0.03
Coagulation modifiers 36.9

(34.1 – 39.8)

47.6

(45.2 – 50.1)

<0.001
Antiplatelets 32.8

(29.9 – 35.8)

43.0

(40.6 – 45.6)

<0.001
Analgesics 44.3

(41.7 – 47.2)

54.1

(51.3 – 57.0)

<0.001
Salicylates 30.3

(27.5 – 33.3)

40.4

(37.8 – 43.0)

<0.001
Over-the-counter medication (OTC)
Aspirin 30.2

(27.4 – 33.1)

40.2

(37.7 – 42.8)

<0.001
Dietary supplements
Multivitamins/minerals 29.0

(25.5 – 32.6)

34.9

(32.2 – 37.7)

0.03
Calcium 18.9

(17.0 – 21.0)

24.1

(22.0 – 26.5)

0.009
Interactions
Prescription – prescription 2.5 (1.9 – 3.3) 6.3 (5.2 – 7.7) <0.001
Prescription – nonprescription 5.7 (4.7 – 6.9) 9.4 (7.9 – 11.2) 0.002
Nonprescription – nonprescription 0.9 (0.6 – 1.3) 2.2 (1.5 – 3.3) 0.001
Any major drug interactions 8.4 (7.2 – 9.8) 15.1

(13.2 – 17.1)

<0.001
≥ 2 major interactions 1.6 (1.0 – 2.5) 4.2 (3.1 – 5.6) 0.002
* The table only reflects those medication classes that were over 20% in estimated prevalence.
Adverse Events Common Adverse Events: N/A
Serious Adverse Events: N/A
Percentage that Discontinued due to Adverse Events: N/A
Study Author Conclusions The use of prescription medications and dietary supplements, and the concurrent use of interacting medications have increased since 2005, with 15% of older adults potentially at risk for a major drug-drug interaction.

 

With new drugs being approved daily by the Food and Drug Administration (FDA), it comes as no surprise that pharmacists have to be more informed about drug-drug interactions as well as potential side effects.  This article is novel in that it compares how the use of drugs has changed over the years with the focus being on the increased use of OTC and dietary products.  This information can help shape the way pharmacist counsel their patients.  Knowing that OTC and dietary supplement use is on the rise can lead a pharmacist to counsel about interactions and potential side effects.

References

[1] CDC. Drug-use-therapeutic. Available at: http://www.cdc.gov/nchs/fastats/drug-use-therapeutic.htm. Accessed January 20, 2016.

[2] Qato DM, Wilder J, Schumm LP, Gillet V, Alexander GC. Changes in Prescription and Over-the-Counter Medication and Dietary Supplement Use Among Older Adults in the United States, 2005 vs 2011. JAMA Intern Med. 2016;176(4):473-82.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s