Nonprescription Drug Use Research Articles

Drug Utilization in the Old Old and How it Relates to Self‐Perceived Health and All‐Cause Mortality: Results from the Bronx Aging Study

To characterize medication use in a "well" very old population and relate the quantity and type of medication use to 10-year mortality. A longitudinal, 10-year, follow-up study involving 488 healthy, community-dwelling volunteers aged 75 to 85 years. The subjects underwent a detailed baseline evaluation and annual assessments that included comprehensive physical exams, laboratory and diagnostic tests, and related interviews. Prescription and nonprescription drug use was determined by self report, confirmation through hospital records, and reports by subjects and significant others. At study baseline, the mean number of prescription and nonprescription medications used was 2.3 and 1.5, respectively. Female subjects (n = 315), those older than 80 years, or those who reported themselves to be in fair or poor health on initial health self-report were found to show significantly increased use of prescription medications. The most commonly used classes of medications were cardiovascular drugs and analgesics. Subjects who were consuming a greater number of prescription and nonprescription medications did not have higher mortality rates. After correcting for differences in cardiovascular health status between users and nonusers, only digoxin approached significance as an independent predictor of death (P < .08). This study confirmed that medication use in an ambulatory, old old population is not excessive. The oldest subjects in the cohort consumed more medications than did the younger subjects. Women used more prescription drugs than men. Increased medication use was associated with worse ratings on health self report. Medication use alone, however, was not a predictor of 10-year mortality in this population. Questions are raised about the inappropriate prescription of digoxin in older subjects.

Drug use in an elderly Chinese population: prevalence and associated factors.

This study examined the pattern of drug use in an elderly population aged 70 years and over, and the factors associated with drug use. The study population was selected by stratified random sampling of all registered recipients of Old Age and Disability Allowance in Hong Kong. 997 men and 1,035 women were interviewed as part of a survey on physical, functional, mental health and social status of the elderly in Hong Kong. 71% of the sample took drugs, the prevalence being higher in women. The most common drugs taken were antihypertensives, skin preparations, vitamins and minerals, other cardiovascular drugs, antacids or H2 antagonists, and non-steroidal anti-inflammatory analgesics (all over 10%). Overall, 66% were using medications that were unlabelled. Factors associated with drug use that were examined included socioeconomic factors, educational level, physical health, cognitive function, depressive symptoms, functional ability, life satisfaction, and living arrangements. Multivariate analysis using forward stepwise logistic regression showed that the use of prescription drugs was associated with the presence of chronic disease, poor self-perceived health and being female. Use of > 5 drugs was associated with similar factors: presence of chronic disease, being female, and residence in institutions. The factors for use of non-prescription drugs were different: living in the community, presence of joint pain restricting activities, dissatisfaction with living arrangements, and age. Reducing the number of unlabelled drugs, restricting access to non-prescription drugs, improving access to doctors and patient education all might well be important measures in improving the therapeutic needs of this elderly population.

Shifting Gears: The Toll of Shifting in New Zealand Manufacturing

Shiftwork has increased dramatically in recent years, mainly due to the expansion of service industries and extended hours of operation. Manufacturing, targeted for decline, is still a dominant shiftwork employer, particularly in a move to leverage physical plant and meet variable demand levels. This productivity comes at often dramatic human costs. A 12-year longitudinal study of New Zealand process manufacturers was undertaken to document shift patterns and establish their impact on organisational performance and employee well-being. This paper reports the results of questionnaire and interview data relating shiftwork and shift patterns to health and well-being. The historical domination of the eight-hour, reverse rotating shift is noted, and linked to increased sleep disorders, digestive problems, and use of prescription and non-prescription drugs. Disruption to family and social life were also reported. These adverse effects are heightened by lack of training and support and moderate to heavy utilisation of overtime. The author suggests shiftwork reforms to address some of these issues.

Demographic and Health Locus of Control Influences on Nonprescription Drug Information Use Expectations

The present study observed that older consumers indicated increased performance risk-based nonprescription drug information use expectations. These consumers were more interested in using product ingredient, side-effect, physician, and pharmacist information when making nonprescription drug decisions. Younger consumer were more interest in using pain relief, strength, brand name, price, friend, family, television ad, magazine ad, technical publication, and general news media information. Compared lo older consumers, younger consumers preferred information which was not specifically designed to reduce performance risk related to nonprescription drug decisions. Additional analyses indicated that, compared lo younger consumers, older consumers indicated lower nonprescription drug category knowledge and greater nonprescription drug use. These results, combined with the older group's preference for certain woes of performance risk-based nonprescription drug information, indicate that increased efforts to provi...

An In‐Home Preventive Assessment Program for Independent Older Adults: A Randomized Controlled Trial

To evaluate the effectiveness of in-home geriatric assessments as a means of providing preventive health care and improving health and functional status of community-living elderly veterans. Randomized controlled trial with 1-year follow-up. Home visits performed in a suburb of Los Angeles. Community-living veterans 70 years and older not currently receiving health care at the Sepulveda VA Medical Center (n = 131 intervention; 123 controls). A home visit by a physician's assistant or nurse, to screen for medical, functional and psychosocial problems, followed by a letter describing findings and recommendations, and follow-up visits by trained volunteers at 4-month intervals for 1 year. Controls received only telephone interviews at 4-month intervals to collect outcome data. Compliance with recommendations was studied for the intervention group. Outcome comparisons between the two groups included: mortality, medication usage, functional status, immunization rates, and nursing home and hospital utilization. A mean of four new or suboptimally treated problems was identified for intervention subjects. Subjects complied with 76% of recommendations to see a physician or initiate a specific health practice. At 12-month follow-up, intervention subjects had significantly increased their immunization rates (P < 0.001) and had a significantly increased likelihood of having a primary care physician (P < 0.05). Twelve-month functional status (IADL) scores were significantly higher for intervention subjects than for controls; intervention subjects maintained their functional status, while controls experienced significant decline during the follow-up year (P < 0.05). Non-prescription drug use increased significantly among controls, but not among intervention subjects (P < 0.05). A brief geriatric screening assessment performed in the home can detect unrecognized and treatable problems, even among relatively healthy older adults. The use of trained volunteers is a feasible strategy for providing health education and follow-up contacts. These results support the concept that preventive gerontological approaches can help maintain important aspects of health and function.

Ten-year change in the use of medical drugs among the elderly—a longitudinal study and cohort comparison

Longitudinal changes and cohort differences from 1979 to 1989 in the use of prescribed and non-prescribed medical drugs were examined and the connections of drug use to various background variables were analysed in the framework of the Tampere Longitudinal Study of Ageing. In the longitudinal study random samples of men and women born in 1900–09 and 1910–19 (738 persons) were interviewed in 1979 and the survivors (62%) were interviewed again in 1989. In the cohort comparison the 60–69-year-olds studied in 1979 (364 persons) were compared with the 60–69-year-olds in 1989 (395 persons). In the longitudinal setting the number of prescribed drugs increased. In 1989 2 or 3 in 10 persons used at least five prescribed drugs simultaneously. In the cohort comparison there were no differences in the number of prescribed drugs between the two groups of 60–69-year-olds. Use was connected with multimorbidity and poor self-rated health. Both the longitudinal comparison in the group born in 1910–19 and the cohort comparison revealed a significant increase in the use of non-prescribed drugs. The use of analgesics was connected with sex, occupational class, self-rated health and feelings of loneliness. In the use of vitamins, no connection was found with health variables, but they were mostly used by white-collar employees and women. However, when all these variables were controlled for, both analgesics and, in particular, vitamins were used more in 1989 than in 1979. The results suggest that the increase in the use of non-prescribed drugs is mainly due to social and historical factors, by changes both in drug policies, health culture and health behaviour of elderly persons.

Effects of menstrual phase on intake of nicotine, caffeine, and alcohol and nonprescribed drugs in women with late luteal phase dysphoric disorder

To investigate the possibility that cigarette smoking and other drug use are affected by menstrual phase in smokers with Late Luteal Phase Dysphoric Disorder (LLPDD), we examined daily diaries rating menstrual symptomatology, smoking, alcohol and nonprescription drug use, and caffeine intake in nine female smokers meeting criteria for LLPDD. Menstrual symptomatology peaked during the premenstrual phase. Smoking, alcohol, and nonprescription drug intake were increased during menses; caffeine intake was unaffected by phase. No systematic intrasubject correlation between symptomatology and smoking was detected. It was concluded that in women with LLPDD, smoking and alcohol and nonprescription drug intake appear to vary as a function of menstrual phase. The lack of intrasubject correlations between symptomatology and intake, and the failure of peak intake to coincide with peak symptomatology, however, indicate that these effects cannot be explained simply as "self-medication" of acute episodes of dysphoric mood.

Prescription and nonprescription drug use among black and white community-residing elderly.

To examine and compare concomitants of prescription and nonprescription drug use of Black and White community-dwelling elderly. Information on prescription and nonprescription drug use, demographic and health characteristics, and use of health services was obtained from a probability-based sample of Black (n = 2152) and White (n = 1821) community-resident elderly in the Piedmont area of North Carolina. Descriptive statistics were calculated. Linear regression, in which sample weights and design effects were taken into account, was used for the final models. For prescription drug use, 37% and 32% of the variance was explained for Whites and Blacks, respectively (6% and 5% for nonprescription drugs). Health status and use of medical services were the strongest predictors of prescription drug use for both races (with Medigap insurance also important for Whites and Medicaid important for Blacks). Demographic characteristics and self-assessed health were significant factors in the use of nonprescription drugs. Race independently predicted use of both types of drugs but explained only a small proportion of the variance. Health status and use of health services are importantly related to prescription drug use. Non-prescription drug use is difficult to explain.

Mental and Physical Health of Homeless Persons Who Use Emergency Shelters in Vancouver

Homelessness is often associated with deinstitutionalization of chronic mentally ill people, but estimates of the number of mentally ill people in the homeless population vary. The purpose of the study was to determine the extent of psychiatric problems among the users of shelters for homeless persons in Vancouver, British Columbia. In addition, the study documented the demographic and physical health characteristics of shelter residents. Researchers surveyed 124 emergency shelter users about their self-reported physical and mental health status and assessed their mental health status using the Brief Psychiatric Rating Scale (BPRS). Shelter users in Vancouver were predominantly a young, male, single mobile population. About half reported a current physical health problem, 44 percent reported use of nonprescribed drugs, and 69 percent reported use of alcohol. Nineteen percent reported a current mental or emotional problem, with schizophrenia and bipolar disorder the most common diagnoses reported. BPRS scores indicated that depression, anxiety, and tension were common problems. Although the number of individuals with mental illness in the population surveyed was lower than in similar populations in the United States, the presence of mentally ill people in Vancouver shelters suggests that shelters should address mental health issues as well as provide services to ensure residents' basic survival.

Medication use patterns in HIV-positive patients.

Patients with HIV infection or AIDS often receive several medications for treatment or prevention of their primary disease and/or associated complications. The objective of this study was to document patterns of drug use in an HIV-positive, outpatient population. Data were collected via one-on-one interviews with 26 HIV-positive patients; prescription and non-prescription drug use, adverse drug reactions and drug allergies were recorded. Anti-retroviral therapy was received by over 90 % of the patients. Over 90% of patients were on anti-infective agents, commonly cotrimoxazole or dapsone, while 27% received acyclovir. At least 70% of patients used three or more prescription medications concurrently. Every patient reported self-medicating with at least one over-the-counter (OTC) product and over half used three or more OTC products concurrently. Adverse reactions, mainly attributable to zidovudine, were reported by over 80% of patients. Non-compliance was a common drug-related issue; over 70% of patients omitted drug doses. In conclusion, the use of multiple medications in the ambulatory HIV-positive patients presents the health care team with potential drug-related problems that may ultimately affect the efficacy and toxicity of therapy. Thus pharmacists may play an active role in the provision of direct care to these patients.

Use of prescription and non-prescription drugs in pregnancy

We analyzed use of therapeutic drugs during pregnancy by 2752 mothers of infants without major congenital malformations. During pregnancy, 68% of the women used at least one prescription or non-prescription drug. Drug use in pregnancy was significantly more common for women who were white, older, married, better educated, of higher income and occupational status, receiving private prenatal care and not living in urban areas. Number of maternal illnesses, higher socioeconomic status, white race, multiparity and use of recreational drugs explained 26% of reported drug use. The mean number of drugs reported (1.2) underestimates total drug exposure due to exclusion of some drug categories including multivitamins and illicit drugs. Since the majority of women giving birth to normal infants report use of at least one pharmacologic agent during pregnancy, attribution of adverse outcome to drug use in an individual case is rarely justified.

Self‐Medication: A survey of nonprescription drug use

AbstractA sample of adults (n = 148) which reflected age, gender, and race characteristics of the 1980 U.S. Census was surveyed on the incidence of obtaining over the counter (OTC) drugs during the previous year and the nature of the drugs used. Most (78%) reported obtaining OTC drugs, and of 15 categories, headache or pain remedies, cold or flu remedies, and vitamins were most frequently (&gt;50%) reported as used. No gender or race effects were found for obtaining OTC drugs or for the nature of OTC drugs used. Identified patterns of OTC drug use were related to previous research and have implications for drug development, health care, and marketing concerns. © 1993 Wiley‐Liss, Inc.

Prescription and nonprescription drug use among black and white community-residing elderly.

Prescription and nonprescription drug use among black and white community-residing elderly.

The consequences of a change in formulation of methadone prescribed in a drug clinic.

Methadone mixture DTF (1mg in 1ml) is a safe non-injectable alternative to methadone tablets (5mg). It also allows for a more gradual detoxification from opiate dependence. For these reasons it was decided to 'rationalise' our prescribing so that methadone in mixture form only would be dispensed. At the beginning of 1989, 66 opiate-dependent patients were receiving methadone tablets, 61 the methadone mixture. We report the consequences of instituting a policy change which was clearly very unpopular with patients. Of the 66 patients receiving methadone tablets prior to the change to mixture, 53 were represcribed tablets by the end of the 3-month follow-up period. In many cases this was because of an intense resistance to the change over, physical complications of methadone mixture occurred in very few. We were able to observe a decline in social stability and an increased use of non-prescribed drugs in some patients who changed to methadone mixture. More far-reaching consequences of the change included an increase in chemist break-ins, an increase in the street value of methadone tablets and greater hostility and threatening behaviour towards staff. These changes reflect psychological rather than pharmacological or pharmacokinetic effects.

Use of medications by persons 65 and over: data from the established populations for epidemiologic studies of the elderly.

Data were analyzed from household interviews of four population-based cohorts comprising the Established Populations for Epidemiologic Studies of the Elderly to estimate the prevalence of prescription and nonprescription medication use among community-living elderly and to examine sociodemographic and health factors related to medication use. Prescription drugs were used by 60-68% of men and 68-78% of women. Nonprescription drugs were used by 52-68% of men and 64-76% of women. Use of prescription medications generally increased with age although use of nonprescription drugs was not associated with age. Men and women who smoked or used alcohol in the preceding year frequently took medications. Those who reported more depressive symptoms, impairments in physical functioning, hospitalizations, and had poorer self-perceived health status were most likely to take medications. However, 10-29% of respondents with fair or poor self-perceived health took no prescription medications, and 3-13% took neither prescription nor nonprescription medications. While further research appears warranted into potential overmedication of elders, particularly those with many depressive symptoms, these data suggest that studies of potential underuse among elders with poor health are equally important.

Multiple medication use in the elderly

To document the extent of polypharmacy or multiple medication use in the elderly. Cross-sectional examination of an age cohort of a community. Community-based study in Dubbo, NSW, in 1988-1989. All non-institutionalised residents aged 60 years and over, numbering 1237 men and 1568 women. Assessment of use of prescription and non-prescription drugs, recent hospitalisation, years of education, psychosocial variables. 18% of men and 25% of women were currently using three or more classes of prescription drugs. The corresponding values for two or more classes of non-prescription drugs were 29% and 44%. Of those who were using multiple prescription drugs 56% of men and 76% of women were also using multiple non-prescription drugs. In a multiple logistic model, the following possible predictors of multiple drug use were included: hospitalisation in the last six months, age, sex, depression, life satisfaction and education. Multiple prescription drug use was significantly predicted by recent hospitalisation (odds ratio [OR] = 2.40; 95% confidence interval [CI], 1.63-3.56), increasing age (e.g. 70-79 years versus 60-69 years; OR = 2.54; CI, 1.97-3.25), female sex (OR = 1.59; CI, 1.25-2.01) and increasing depression (e.g. highest tertile of depression scale versus lowest; OR = 2.52; CI, 1.84-3.42). Multiple non-prescription drug use was significantly predicted by female sex (OR = 2.38; CI, 1.95-2.92) and increasing depression (OR = 2.77; CI, 2.16-3.56). For prescription items, non-prescription items, and both categories in combination levels of use 20% above the population average have been documented. Polypharmacy in the elderly population appears to be predicted by recent hospitalisation, increasing age, female sex and increasing depression. There is potential for drug-drug interaction to occur, but the findings suggest target areas for preventive action.

Pharmacoepidemiology and Military Medical Automation: Opportunity for Excellence

Fielding of the Composite Health Care System (CHCS) brings an unparalleled opportunity for medical research. This sophisticated automated medical record system promises pharmacoepidemiologic research of a quality and quantity never before possible. Pharmacoepidemiology provides answers about the validity of beneficial and adverse drug events and aids in individualizing drug therapy. When CHCS eventually encompasses an estimated 9.1 million patients at 166 military hospitals and 588 clinics around the world, it will provide a database capable of supporting sophisticated automated research. In addition to the unprecedented size of this resource, advantages of pharmacoepidemiology performed with the CHCS database include integration of inpatient and outpatient care records, the completeness of prescription and medical records, and the wide socioeconomic spectrum covered in a defined population. Limitations and potential biases of such a database include separate drug formularies at each medical treatment facility, only limited information about nonprescription drug use and single-dose drug orders in clinics, and the mobility of military service members and their families. Pharmacoepidemiology is a tool that will benefit individual members of the military family, as well as advancing the sciences of pharmacy and medicine. Using the CHCS database for this form of research is in the best tradition of military medical research.

HIV-Related Sexual Behaviors of College Students

A follow-up study explored the prevalence of behavioral risk factors for HIV infection in a population of college students. Two hundred forty-three single students ranging in age from 17 to 24 years who identified themselves as heterosexual completed questionnaires related to planned and unplanned sexual intercourse and such other factors as alcohol and nonprescription drug use that might increase the risk of HIV infection. Forty-seven percent of the men and 57% of the women stated that they had had sexual intercourse from 1 to 5 times primarily because they were intoxicated, a phenomenon that increased with age until only 19% of those over 21 had never had sex because of intoxication. Seventeen percent of the sexually active men and 21% of the women said that they had used condoms. Nineteen percent of the men and 33% of the women acknowledged consenting to sexual intercourse because they felt awkward in refusing. The dangerous interaction between alcohol use and high-risk sexual activities suggested that college HIV prevention efforts should make the connection between the two risk factors explicit.

Medications with dental significance: usage in a nursing home population

The institutionalized elderly use more drugs per capita than do other segments of the population and are more likely than other population groups to have adverse drug reactions. Many of these drugs could affect oral health or dental treatment. This paper provides data on the frequency with which a population of nursing home residents took medications with possible oral effects. Information regarding prescription and nonprescription drug use was obtained from nursing home records of 481 subjects. Nine medication effect categories of possible significance in dentistry were established. Dentists treating institutionalized patients must be knowledgeable about patient drug use because 94% of this institutionalized population were taking medications that could alter oral health or dental treatment.

Chapter 15 Drug allergy and Hymenoptera sensitivity

Adverse reactions to drugs (ADRs) represent the majority of illnesses due to physician intervention. Surveys of hospitalized (medical) patients yield an ADR prevalence of 6% to 15%. ADRs are complicated by the frequent use of nonprescription drugs and by multiple drug prescribing. Allergic drug reactions probably account for only 6% to 10% of all ADRs. Allergy to drugs may affect 5% of the population; 15% categorize themselves as drug allergic. ADR may be characterized as predictable (80%) or unpredictable. Predictable reactions include (1) overdose or toxicity, (2) side effect, (3) secondary or indirect effects, and (4) drug interactions. The most serious ADRs are toxic. Side effects represent the most frequent ADR and may be unavoidable at pharmacologic doses. Delayed side effects include carcinogenicity and teratogenicity. Secondary/indirect effects include consequences of the pharmacologic action of the drug that are not universal. Drug interactions are common due to frequent prescribing of multiple drugs. Unpredictable ADRs include (1) intolerance (lowered threshold to normal pharmacologic actions), (2) idiosyncrasy (a qualitatively unusual, nonimmunologic reaction to normal pharmacologic doses in susceptible individuals; these may be genetically determined defects, such as hemolytic anemia associated with G6PD/primaquine), (3) pseudoallergic reactions (similar clinical manifestations and often similar pathogenic mechanisms to allergic reactions), and (4) allergic reactions (reaction between a drug and antibodies or sensitized T cells). For a drug to be immunogenic, it must either be a complete antigen (insulin or foreign antiserum) or, more commonly, a hapten-protein complex. All usual immunologic mechanisms may be seen in ADRs. Drugs may produce pseudoallergic reactions that often use a nonimmunologic mechanism to activate common inflammatory pathways.