• Aging and Health: The Role of Self-Medication
• To Your Good Health: Advice for Older Adults about Medicines for Self-Care
• Nonprescription Medicines: Modern Medicines for Mature Americans
• What Every Woman Should Know: A Special Guide to Nonprescription Medicines for Midlife and Older Women

With the increase in medicines available OTC that used to be available only by prescription, more people than ever are self-medicating with OTCs to treat common health problems like coughs, colds and headaches.

Older adults use at least 25% of OTC medicines, even though they make up only 13% of the population. One reason for the more common use of OTCs among older adults is that many conditions for which OTC drugs are used, such as arthritis pain, insomnia and constipation, become more prevalent with advancing age.

As a nation, we have become more aware of the "Aging of America" and its implications for the use and costs of health care. At the same time, wellness programs and self-care have emerged as major components of health maintenance, especially for the older population.

Until recently, little information existed on the use of OTCs by older adults. New studies have revealed much about consumer health care practices and OTC medicine use. Although more remains to be learned, we now have some compelling information on the use of OTCs by people 65 and older.

This report summarizes our knowledge of the health and self-medication practices of older Americans. It also provides helpful information on how to safely and effectively use over-the-counter medicines.

The Health of Older Americans

One of every eight Americans, or almost 13% of the population, is age 65 or older. In 1998, this age group numbered 34.2 million persons.

Americans of all ages are expected to live longer today than they were a decade ago. Men who reach age 65 can expect to live another 15.5 years. Women reaching 65 can expect to live another 19.2 years. Advances in medical technology are in part responsible for this increase in life span.

Experts predict that the number of people over age 65 will more than double by 2030. In the coming years, those 85 and older will make up nearly 25% of the older population. (See chart, below.)

As the number of older persons and their average age increases, the public and health care professionals alike are changing their attitudes towards aging. Today older people are increasingly recognized as healthy, vibrant and active. In fact, less than one-quarter of Americans age 65 to 74 describe themselves as retired, and less than one-third of Americans age 75 and older classify themselves as retired.

The majority of older Americans consider themselves to be in good health. In a 1994 survey, 72% of persons age 65 and older rated their health as excellent or good. Only 28% rated their health as fair or poor.

When asked, most older adults said they do a good job of taking care of their own health.

Common problems for persons age 65 and older at the rate per 100 persons are:
Condition	Rate/100
Arthritis	50
High Blood Pressure	36
Heart Disease	32
Deaf/Hard of Hearing	29
Cataracts	17
Orthopedic Impairments	16
Sinusitis	15
Diabetes	10
Visual Impairmen	8
Profile of Older Americans: 1997, AARP

Hospitals, health maintenance organizations (HMOs), senior centers and social service agencies across the nation offer health educational programs. These programs are attended weekly by thousands of older Americans.

These positive attitudes about health occur despite the presence of long-term ailments among many older people. As a person ages, chronic conditionsÐsuch as arthritis, diabetes, and high blood pressureÐoccur more often than short-term health problems. Most older adults have at least one chronic health condition and many have multiple health conditions.

Older persons use health care services more than younger adults. Individuals age 65 and older often use almost twice as many health care services (physician visits, emergency room visits, hospitalizations) as younger persons. Older adults accounted for 38 percent of all hospital stays and 48 percent of all days of care in hospitals in 1995. The average length of a hospital stay was 6.9 days for older people, compared to 4.5 days for people under age 65. About 1.5 million elderly persons lived in nursing homes in 1995.

Despite these general statistics, health care professionals, as well as the lay public, have come to appreciate the great variation among older persons. No two persons age the same Ð physiologically, emotionally, or socially.

Medical researchers and physicians generally agree that health status and medicine use are determined more by physiological age than by chronological age.

The Economic Factor:

Costs and Benefits

The economic cost-effectiveness of self-medication with nonprescription medicines is especially important in these times of rising health care costs. This is particularly true for older Americans. Persons 65 and older accounted for more than one-third of the nation's total health care costs in 1995.

A recent study estimated that the availability of OTCs to treat 12 common health conditions saves consumers more than $20 billion each year compared with the costs to treat these same conditions by seeking medical attention and using prescription medications.

Self-medication helps reduce costs and when properly practiced often acts as a screening mechanism that sorts out everyday and self-treatable disorders from those requiring professional, medical care.

Nonprescription Medicine Use by Older Americans

No national agency routinely collects data on the use of nonprescription medicines by the age of consumer. Thus, to gather information about the use of OTC medicines by older persons, Consumer Healthcare Products Association (CHPA) sponsored a nationwide consumer survey in the early 1990s.

The study included questions about everyday health problems and use of nonprescription medicines. The objectives of the study were to discover the type of common, minor health problems (common cold, headaches, stomach upset) people experience and to learn what people do about these problems, if they use OTC medicines and with what results.

The study showed that:

• Older adults reported experiencing an average of five minor health problems during a two-week period.

• The most frequently reported everyday health problems of older people are arthritis, sleeping difficulties, muscle aches and pains, upset stomach, being overweight, headaches, colds, and bunions/corns/calluses.

• Twenty-eight percent of the time, older adults reported treating their everyday problems with OTC medicines.

• Older consumers using nonprescription medicines reported successful and safe use of these products when used as directed. Almost all older persons reported being satisfied with the performance of the nonprescription medicines they used.

In summary, the CHPA survey showed that older adults use nonprescription medicines responsibly and are satisfied with the results.

The New Era of Self-Medication

Advances in technology and more streamlined government review of OTC medicines allow today's consumers, including older adults, to be increasingly assured of the safety and effectiveness of modern nonprescription medicines. As a result, today we are in a new era of self-medication. This new era, coupled with a renewed interest in personal responsibility and greater consumer sophistication in health matters, leads to increased consumer access to OTC medicines that were previously available only by prescription.

This trend (prescription-to-OTC switch) empowers consumers. An increasingly self-reliant society needs and is more capable of using new OTC medicines; and the spiraling costs of health care demand it. Progress is apparent: more than 600 OTC products use ingredients or dosages available only by prescription 20 years ago. Many commonly used OTC medicines, such as certain pain relievers, vaginal antifungal preparations, stomach acid blockers and smoking cessation products, were only available by prescription less than a decade ago.

The OTC medicine industry, consumers, health professionals and government officials are working to provide more self-medication opportunities. This will continue to occur as science, technology and market experience assure safe and appropriate use of the products by consumers. Products that can help older Americans treat their special health needs also deserve particular attention.

The Value of Information and Independence

A major goal of most older adults is to remain independent. Health care professionals support measures that enable older persons to maintain their ability to function independently in their own environment. Likewise, older adults, the majority of whom are healthy, demand that the health care system provide not only sophisticated technology when they are in the hospital, but also sophisticated tools to help them stay well when they are home. OTC drugs are among these valuable resources.

Public demand for information naturally follows public interest in self-medication. However, consumers must stay informed and be responsible in their use of OTCs. Next to safe and effective medicines, consumer information is the most important element of self-medication.

Staying informed begins with reading the label. The importance of reading and understanding product labels is critical. The OTC label includes all the information needed for safe and effective use (such as ingredients, directions for use, warnings, etc.). It is important to read the product label every time you use an OTC product.

Another source of information is from health professionals. Health education programs for older adults frequently include information about how to use and store medicines properly and how to avoid drug interactions. Many hospitals, senior centers and HMOs offer "brown bag" medication screenings and invite seniors to bring their medicines for review by pharmacists or other health care professionals.

A Shared Responsibility

Many Americans find nonprescription medicines a familiar, convenient and inexpensive way of treating minor illnesses and injuries. They are valuable tools for independent self-reliance in health care.

No one knows your body as well as you. You are in a unique position to take charge of your health by learning as much as you can about your prescription and over-the-counter medicines.

Just because a drug is available without a prescription does not mean it is safe under every circumstance for everyone. Like all medicines, OTCs can cause side-effects and interact with other medicines, alcoholic beverages, or foods. These problems are more common in older people who often suffer from many illnesses and take several medicines. Take special care always read the OTC label anyway! The label will tell you if you should or should not take a particular OTC, or if you should talk to your doctor or pharmacist before taking the product.

Tips on Using OTC Medicines

Knowledge, common sense and a few simple tools will help you safely manage your medicines.

• Read the label every time you use any medicine. Look at the directions for use, warnings and drug interaction precautions sections on OTC products.
• Follow the directions carefully. Special instructions, such as "Take with a full glass of water or other liquid' or "Avoid alcoholic beverages" are given because they affect the way a medicine works. If you don't understand the directions, ask a doctor, pharmacist, or other health professional.
• Keep an up-to-date record of all medicines you take. Don't forget to include all nonprescription medicines, eye drops, vitamin supplements and any prescription shampoos or skin creams.
• Tell all health professionals you visit about all the medicines you are using, both prescription and nonprescription. Take your medication record with you on every visit, including visits to the dentist, pharmacist and any health care specialist.
• Check your medicine cabinet twice a year. Throw away any medicines that have past their expiration date, that are no longer in their original container or that you have been told to stop taking. Throw away old medicines by flushing them down the toilet.
• Store your medicines in a cool, dry place Ð not the bathroom.
• If you have questions, take your medicines to your doctor, pharmacist or other health professional and ask for help.

Acknowledgements

The development and distribution of this Special Report was supported by an educational grant from Consumer Healthcare Products Association (CHPA). The following individuals are responsible for this Special Report: Kathleen A Cameron, RPh, MPH, Program Officer, American Society of Consultant Pharmacists Foundation; Meg B. Grattan, Public Policy Associate for Policy Communications, CHPA; and Anne Werner, President and CEO, USHC. The complete bibliography is available upon request and on our web site at www.ushc-online.org. This report may be reproduced with appropriate credit to CHPA and USHC. Your comments are welcome and should be sent to: United Seniors Health Cooperative (USHC), 409 Third Street, SW, Suite 200, Washington, DC 20024. Phone No: 202-479-6973.

ENDNOTES

1. Schondelmeyer, Steven W., "Estimates of Nonprescription Drug and Supplies Expenditures by the Elderly: 1986 to 1991," PRIME Institute, University of Minnesota, Minneapolis, MN; 1992.

2. Coons, Johnson, Chandler, "Sources of Self-Treatment Information and Use of Home Remedies and OTC Medications Among Older Adults," Journal of Geriatric Drug Therapy, Vol. 7(1), 1992, p. 72.

3. American Association of Retired Persons, A Profile of Older Americans, 1994, Washington, D.C.

4. U.S. Department of Commerce, Bureau of the Census, Profiles of America's Elderly, No. 2. Washington, D.C.: July 1992.

5. American Association of Retired Persons, America's Changing Work Force -- Statistics in Brief. Washington, D.C.: 1993.

6. U.S. Department of Health and Human Services, National Center for Health Statistics, National Health Interview Survey, "Number of persons and percent distribution by respondent-assessed health status," Series 10, No. 190, Table 70, 1993.

7. U.S. Department of Commerce, Bureau of the Census, "A Demographic Portrait of America's Oldest Old." Washington, D.C.: 1992.

8. U.S. Department of Health and Human Services, National Center for Health Statistics, "Aging in the Eighties: Advance Data from Vital and Health Statistics," No. 115, DHHS Pub. No. 86-1250, 1986.

9. American Association of Retired Persons, A Profile of Older Americans, 1994, Washington, D.C.

10. U.S. Department of Health and Human Services, National Center for Health Statistics, National Health Interview Survey, "Number per person per year and number of physician contacts," Series 10, No. 190, Table 71, 1993.

11. American Association of Retired Persons, A Profile of Older Americans, 1994, Washington, D.C.

12. American Association of Retired Persons, A Profile of Older Americans, 1994, Washington, D.C.

13. U.S. Department of Commerce, Bureau of the Census, We the American...Elderly, Figure 10, page 6, Washington, D.C.: September 1993.

14. Heller Research Group and Consumer Healthcare Products Association, Self-Medication in the '90s: Practices and Perceptions. Washington, D.C.: 1992.

15. Waldo, Sonnefeld, McKusick and Arnett, "Health expenditures by age group, 1977 and 1987." Health Care Financing Review, Vol. 10, Number 4, Table 3: summer 1989.

16. Waldo, Sonnefeld, McKusick and Arnett, "Health expenditures by age group, 1977 and 1987." Health Care Financing Review, Vol. 10, Number 4, Table 3: summer 1989.

17. American Association of Retired Persons/Public Policy Institute and The Urban Institute, "Coming Up Short: Increasing Out-of-Pocket Health Spending by Older Americans." Washington, D.C.: April 1994.

18. U.S. Department of Labor, Bureau of Labor Statistics, "Average annual expenditures and characteristics." Consumer Expenditure Survey, 1994, Table 1300. Washington, D.C.: November 1994.

19. Nielsen North America; U.S. Department of Health and Human Services, Health Care Financing Administration, Pub. No. 03351, November 1995.

20. Nielsen North America, Schaumburg, IL: April 1995.

21. Consumer Healthcare Products Association; Pharmaceutical Research and Manufacturers of America: American Medical Association, 1993.

22. Consumer Healthcare Products Association, "Ingredients and Dosages Transferred from Rx-to-OTC Status." Washington, D.C.: July 1994.