Thesis for Beth Tomlinson

USE OF PRESCRIPTION AND NONPRESCRIPTION MEDICATIONS BY THE
ELDERLY POPULATION
A MASTER’S PROJECT
SUBMITTED TO THE GRADUATE FACULTY
OF THE CENTER FOR ADULT AND PROFESSIONAL STUDIES
AND THE GRADUATE SCHOOL
BETHEL UNIVERSITY
BY
BETH C. TOMLINSON
IN PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF
MASTER OF ARTS IN GERONTOLOGY
MAY 2010

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BETHEL UNIVERSITY
USE OF PRESCRIPTION AND NONPRESCRIPTION MEDICATIONS BY THE
ELDERLY POPULATION
BETH C. TOMLINSON
JUNE 15, 2010
Approved: , Practicum Advisor
ACCEPTED
Department Chairperson

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Acknowledgements
First of all, I want to thank God for the strength and guidance He has given me
throughout the past three years. My journey toward a Master’s degree began in August
of 2007 when I contacted Bethel University regarding the Gerontology program. I did
not know how difficult or how rewarding this time would be. Looking back, I can see
how I was led step-by-step through this process.
Secondly, I give thanks to my husband and very best friend, Wayne, who has
been loving and patient through the entire program. He keeps the house clean, makes
sure I have clean laundry, and cooks most of the meals. He is a blessing and I thank God
for him every day!
Next, I thank my children who have always encouraged me to continue my
education. In addition, each of my children has blessed me with a granddaughter. Laynie
and Leighla are the lights of my life. Without my family, I would be less joyful, but with
them cheering me on, I know such joy!
Finally, I am grateful to my cohort group, all of the wonderful instructors, and
especially Pam Zimmerman, who has been patient and supportive throughout my writing
process. In addition, I have been blessed to work with wonderful people who have
cheered me on and given me support as I have traveled on this journey.

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Abstract
The purpose of this study was to determine the awareness of prescription and
nonprescription drug use among the elderly. Helping people become attentive to their
use of medications could help them lead healthier and longer lives. In addition, the
purpose was to see if a group of elderly who live independently share similar opinions as
those found through review of scholarly sources. It is important for seniors to be aware
of medications being used, as well as any possible side effects or contraindications
among drugs. The health, well-being, and safety of seniors are a concern, especially if
medications are not being used as directed. Research showed that many elderly do not
ask questions regarding medication. Additionally, further examination recognized lack of
awareness by physicians concerning the drugs prescribed to elderly patients.
The project examined seniors who are self-sufficient and need no assistance
taking medications. After surveying 70 seniors, those elderly appear to be reasonably
aware of their medication use. On the other hand, literature showed that many elderly do
not know all of the medications that they consume (Hanlon, Fillenbaum, Ruby, Gray, &
Bohannon, 2001). Also, several elderly do not read the instructions included with their
medications, nor do they ask questions regarding possible side effects. In addition,
doctors are prescribing medications that may or may not help the elderly (Francis,
Barnett, & Denham, 2005). Oftentimes a patient will request a specific medication from
their physician. These requests are filled with high frequency.
Additional education on this topic is crucial to elderly who use prescription and
over-the-counter medications. Physicians and other health care professionals also need
further training regarding elderly and their medication consumption.

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Table of Contents
Acknowledgements………………………………………………………………………..3
Abstract…………………………………………………………………………………....4
Chapter I: Introduction…………………………………………………………………….8
Introduction………………………………………………………………..8
Focus of the project………………………………………………………10
Awareness of the issue…………………………………………………..11
What literature states….…………………………………………………13
Summary…………………………………………………………………14
Chapter II: Literature Review ........................................................................................... 15
Introduction……………………………………………………………....15
Use of herbal remedies…………………………………………………..15
Use of medication as pain management…………………………………18
Use of alternative methods………………………………………………19
Adverse reactions to drugs………………………………………………19
Unnecessary use of medications…………………………………………20
Labeling of medications…………………………………………………21
Medication errors………………………………………………………...24
Non-compliance with medication use……………………………….......25
Safety of prescription medications………………………………………26
Adverse affects on the elderly…………………………………………...27
Improving use of medications among older adults……………………...28
Perception of medication use……………………………………………29

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Differences of medication use in varying cultures………………………30
Drug costs among the elderly………………………………....................31
Summary of Literature Review…………………………………………..34
Chapter III: Methodology and Presentation of Data……………………………………..35
Importance of the issue…………………………………………………..35
Methods………………………………………………………………….35
Objectives………………………………………………………………..37
Results…………………………………………………………………...37
Table 1 - age of participants……………………………………..38
Table 2 - medication usage………………………………………39
Table 3 - additional answers to survey questions………………..40
Focus group results………………………………………………………41
Thoughts from health care professionals………………………………...43
Concluding thoughts…………………………………………………….45
Chapter IV: Conclusions……………………………………….......................................46
Review of the issue……………………………………………………...46
Limitations to research…………………………………………………..46
Comparing results to literature review…………………………………..47
Summary of findings…………………………………………………….47
Summary and conclusions……………………………………………….48
References……………………………………………………………………………….50
Appendix A - Consent form for Manager of facility……………………………………56
Appendix B - Survey…………………………………………………………………….57

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Appendix C - Consent form for participants……………………………………………..58
Appendix D - Questions for the focus group…………………………………………….59

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Chapter I: Introduction
Introduction
People over the age of 65 are the primary consumers of prescription and
nonprescription medication. As stated in the Merck Online Manual (2005), seniors have
a higher risk of negative reactions to drugs. This could be due to changes in metabolism
as we age. Additionally, the danger is raised if more than one medication is used (Merck
Manual editors, 2005). The issue regarding perception of the use of these medications is
a concern. Many elderly people do not view over-the-counter drugs as medicine;
additionally, some use herbal remedies without consulting their physicians regarding any
contraindications that could occur. As the population of people over the age of 65
continues to grow, this matter will become more concerning.
The focus of the research is to learn about the elderly person’s awareness of the
medications that they use. Helping people to be more attentive of their use of
medications could help them lead healthier and longer lives. Additional education will be
crucial to elderly who use prescription and nonprescription medication; also, those who
work with the elderly will need more instruction.
Prescription drugs are gradually being changed to nonprescription levels in the
United States as well as other industrial nations. Due to these changes, many powerful
medications that previously required a doctor’s authority can now be obtained without a
prescription. Consequently, physicians, nurses, and other health care providers are
becoming alarmed for the well-being of elderly patients who purchase these drugs.
Seniors are the main users of over-the-counter medications and are more apt to have
harmful consequences from using nonprescription drugs (Francis, Barnett, & Denham,
2005).

9
Seniors who live independently need to be alert to potentially dangerous side
effects from medications. Physicians often treat hypertension using prescription
medication that can cause dizziness. If the person taking the medication does not read the
information that tells about potential ill effects, she/he could suffer an injurious fall. In
addition to reading the information included with a prescription, the elderly need to be
aware of what over-the-counter medications could possibly interfere with their prescribed
drugs.
Furthermore, prescription medications to help with sleep can have some severe
side effects such as sleepwalking or eating while asleep. Several drug companies
advertise medications on television and suggest that people see their doctor about the
drug. The television commercial always states possible side effects, but the disclaimers
are spoken quickly and quietly and are not always heard. Because many elderly live
alone and spend hours watching television, they tend to think that they might need the
medications that are being advertised.
Consequently, the need for further education among medical personnel is crucial.
Our aging population is growing rapidly; therefore, more issues will arise that will need
attention regarding drug use. There will be a call for training on the topic of aging. In
fact, the need for this knowledge is already at hand. Additionally, education for seniors is
essential to help them understand what they are putting into their bodies.
In addition to over-the-counter medications that treat minor aches and pains or
cold symptoms, herbal remedies are becoming popular for healing ills. The government
has not approved these medications, and they potentially could do more harm than good.

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Manufacturers that produce nonprescription medicines use many of the same herbs found
in prescription medications. These herbs could be very strong in a non-diluted form.
In addition to perception of use, misuse of medications among the elderly is a
concern. Most likely, the misuse is unintentional due to lack of information and
education on the part of the person using the drug. Education and awareness regarding
this issue is extremely important and will become more so as the aging population
increases in number.
Focus of the project
To accomplish this study, the researcher will gather data from elderly who are
living independently. The researcher will distribute a survey regarding use of
prescription and nonprescription drugs. Residents of the facility will complete the
surveys anonymously. The researcher will give these surveys to residents living in an
independent living facility for people over the age of 55 located in Coon Rapids,
Minnesota. Because my mother was once a resident there, the staff and some of the
residents are familiar. While the surveys are completed, the researcher will conduct
focus groups with a few of the residents who are willing to discuss this issue. The
purpose of the focus groups is to ask residents to give further details about the answers on
the survey. This researcher felt that the seniors might be willing to share specifics
concerning use of medications that could not be stated on the survey.
In addition to survey responses and focus groups, the researcher will consult with
three geriatric nurses. One is Kathy Helm, who is the head nurse at an assisted living
facility in Coon Rapids, MN. The second is Becky Berglund, who has worked in several
senior facilities for over 20 years. Finally, Valerie Heintz works in southern MN in a
long term care facility. Each of these women gives unique insight regarding their

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observations of elderly and use of medicine. I will consult with them because I know of
their vast experience with the elderly which will provide good insight about this topic. I
will only ask each one about their thoughts regarding perception of use; I will not give
them any information concerning the seniors with which I worked.
Awareness of the issue
While observing my mother, I became aware and concerned about overuse and
misuse of prescription and nonprescription medications. My mother took at least 15
prescription medications as well as many over-the-counter medications. My mother
relayed that she did not read the information included with her prescriptions. This was
concerning because many of these drugs have some serious side effects as well as
possible contraindications when combined with over-the-counter drugs. The choice to
research perception of drug use in seniors stemmed from witnessing her habits.
Observing her apparent lack of knowledge about what she was using caused concern.
Rather than attempt to change eating habits or make lifestyle changes, she chose to take a
pill for every illness she had. In addition, many of the maladies from which she suffered
tended to be self-inflicted or psychosomatic. This lack of concern as to what affect all
these drugs could do to her caused desire to know more about medications and their
effects on the elderly.
I read all labels of any medication consumed. If side effects were mentioned, they
were carefully perused. Should there be concern regarding side effects, I will consult a
physician or pharmacist before taking the medication. Because of the experience with
overuse and misuse of medications with my mother, I attempt to be keenly aware when it
comes to what medications are consumed. Since I am so aware, I am able to list every
single drug I use; these include prescription as well as over-the-counter medications and

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vitamins. As consumers, we have every right to know what ill effects, if any, a
medication may have on us. Too many people completely trust their physicians when it
comes to medications they are told to take. Doctors tend to treat only the illness and may
not be inclined to care for the whole person.
The elderly tend to be trusting, especially regarding those who are caregivers.
Many elderly people who are living in this century have been taught not to question
anyone who is an expert in their field; they see doctors, nurses and other caregivers as
people with authority. Unfortunately, some people with those powers will take
advantage of that trust.
Another concern regarding misuse and perception of use stems from the fact that
many elderly are unable to afford their medications. As a result, people may not take
their prescriptions as recommended. Therefore, the illness that is being treated may not
improve or could become worse. The future of health care is currently under
examination; consequently, this problem could intensify in the next few years.
The study by Francis, et al (2005) showed that many elderly patients have adverse
reactions to medications. This is especially true when they combine over-the-counter
drugs with prescribed medications. Painkillers were the type of drugs used most
frequently, especially by women. This study revealed that patients do not always
disclose to their physician all of the medications that they are taking. Additionally, the
variable reactions by the elderly to medications often make it difficult for medical
personnel to diagnose the problem (Olivier, Bertrand, Tubery, Lauque, Montastruc, &
Lapeyre-Mestre, 2009).

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The reasons for misuse of prescription drugs among the elderly usually is not
because they are trying to abuse their medications but because of their lack of knowledge.
Doctors often do not treat the patient as a whole, but only attempt to treat the malady. If
the physician is not aware of other issues with the patient, he may prescribe a medication
that could be potentially hazardous to the patient’s health.
The lack of information and knowledge amongst the elderly is concerning. Not
only does misuse of medications cause health decline, it could also trigger the cost of
insurance and drugs to skyrocket. This is disquieting because most elderly people live on
incomes that are not subject to increases each year. If health care and the cost of
prescriptions rise too much, many elderly will not be able to afford to have health and
prescription drug coverage. According to a 2006 study done by the New England Journal
of Medicine, elderly covered by Medicare with a high deductible were more apt to suffer
adverse effects than those who had a plan that covered costs completely. In addition,
these underinsured seniors spent more time in emergency rooms and in hospitals than the
aged who had excellent coverage (Hsu, et al., 2006).
A great deal of research has been conducted regarding perception of drug use
among the elderly. There is still much more to be discovered and discussed concerning
this topic. The first of the baby boomers are now turning 65 and are eligible for
Medicare. If these people are not educated about the medications they are using, the cost
of their drug plans and health insurance could become prohibitive (Hsu, et al., 2006).
What literature states
The literature review will reveal more insight into the perception of the elderly
regarding drug use. It will show the need for more education among the elderly to help

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them be aware of their health and wellness needs. The topic will bring to light how older
people often do not pay attention to what kind of damage their medications may be doing
to their bodies; their only concern is treating their illness.
Additionally, we will discover that there is a need for further education for
doctors, nurses, pharmacists and others who work with the elderly. As people age, there
may be a need to adjust medication dosage. A less active lifestyle may mean that a
person needs more or less of a certain drug in order for that prescription to be effective.
On the other hand, if a person has become more active, an adjustment could also be in
order.
Finally, the issue to consider is seniors’ ability to afford medications. With the
controversy currently surrounding the health care reform issue, seniors will be keeping
close watch on the outcome. Many of our elderly who are covered by Medicare still have
enormous costs to consider, especially if they take several different prescription
medications.
Summary
The issue of perception concerning medication use is a worry. Scholars have
written articles showing how the lack of information can be detrimental for seniors. In
the next chapter, research from scholarly sources will show that my concern is justified.

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Chapter II: Literature Review
Introduction
The issues regarding the perception of medication use among people over the age
of 65 is not a new problem. Additionally, this topic is not unique to one particular
geographical area. Elderly around the world have difficulty determining which
medications are safe to take together with other drugs. Furthermore, the medical
community is in a quandary as to how to manage this problem.
Equally important is the use of herbal remedies taken simultaneously with
prescription and over-the-counter medications. The Food and Drug Administration does
not regulate herbal medications; therefore, they could be dangerous when used in
conjunction with some prescription or nonprescription drugs. Furthermore, some foods
can have adverse effects when eaten with certain prescription medicines. Finally, many
elderly people are unable to afford all of the prescriptions they are required to take. Even
though most people over the age of 65 have drug coverage under Medicare Part D or
another plan, oftentimes they fall short especially if they need more than one or two
prescription medications.
Use of herbal remedies
A study conducted in Sweden surveyed over 1,000 people concerning use of
herbal cures or use of food complements as therapy for their illness. Approximately 30
percent of the people surveyed used herbal preparations. Females tended to be more
frequent consumers than men. Additionally, older people were more likely to use these
remedies. Although women were the majority of users, those who have an emotional
disorder were more likely to use herbs and food to help improve their symptoms.

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Furthermore, the psychosomatic diseases were not necessarily diagnosed by a physician
but were self-identified (Stjernberg, Berglund, & Halling, 2006).
Moreover, an article published through Brown University spoke of doctors who
discussed herbal medication use with their psychiatric patients. Physicians examined the
following herbs: chamomile, garcinia, Ginkgo biloba, ginseng, kava kava, ephedra, St.
John’s wort, and valerian. Supposedly chamomile, garcinia, ginseng and valerian are
effective remedies to help one sleep; however this study found that this was not true; in
fact, these remedies could be harmful, especially to an older person. The remaining plant
remedies’ effectiveness – Ginkgo, kava kava, ephedra, and St. John’s wort – is still
uncertain. However, ginseng has benefitted some patients with memory loss. The results
were weighed against prescription drugs distributed by physicians to help patients who
may have dementia or Alzheimer’s disease. Kava kava has sometimes been successful in
treating anxiety; however, the use of this herb could cause liver damage. Ephedra was
taken off the market because it has been shown to be unsafe, especially when used in
conjunction with prescription drugs (Desai & Grossberg, 2003).
Equally important is a study conducted in Texas among elderly who live near the
Mexican border and travel to Mexico for herbal remedies. The researchers gave a
questionnaire to people over the age of 60 who spoke both English and Spanish. Over
100 people answered the questions. The study found adults over the age of 65 to be in
greater danger of adverse results than younger people from using herbs in addition to
their other medications (Loya, Gonzalez-Stuart, & Rivera, 2009).
Additionally, research conducted in a Canadian memory clinic revealed that
people over the age of 65 are more susceptible to adverse effects from herbal

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medications. These researchers concluded that they need more investigation into the
dependability of herbal remedies, especially when they are used along with prescription
or over-the-counter drugs. This study was at the forefront of recognizing the possible ill
effects of herbs when mixed with usual medications (Dergal, et al., 2002).
Furthermore, Nahin et al (2006) found that aggressive promotion of herbs as
medication has intensified in the ten years prior to this research. Because of this, health
care professionals are concerned about the possible harmful effects of herbal remedies
when used along with prescription drugs, especially in people over the age of 65. The
authors reiterated the fact that people over age 65 are the highest increasing portion of the
population. In addition, that segment of the populace uses the majority of prescribed
drugs. Equally important, harmful results from medications can have higher negative
results concerning the health and well-being of the elderly. Therefore, because many of
these herbal drugs are not approved by the government, elderly people should be very
cautious before using any of them (Nahin, Fitzpatrick, Williamson, Burke, DeKosky, &
Furberg, 2006).
Although many elderly take nonprescription and herbal medications, these drugs
can be harmful when used in conjunction with certain prescription therapies. Ginkgo
Biloba is a plant extract commonly used to improve memory loss. Tang et al (2008)
tested the dissolvability of Ginkgo Biloba when added to oils, agents that reduce surface
tension of liquids, and how they liquefy when spun quickly in different fluids. It was
found that this herb dissipates in many different kinds of isopropyl alcohols. The
conclusion was that an elderly person should consult their physician before using Ginkgo

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Biloba, especially if they are already using a medication to improve memory loss (Tang,
et al, 2008).
By comparison to herbal remedies used in the United States, Kogure et al (2004)
conducted an investigation of 21 elderly patients in Japan who used herbal remedies
extensively. All of the patients experienced limitations of some variation before the
study began. They used three different herbal remedies in this trial. They are EK-41,
also known and Hochu-ekki-to; EK-48, known as Juzen-taiho-to; and ED-98, also called
Ogi-kenchu-to. Only 21 elderly people participated in this particular study; however, the
results were quite significant. A majority of the patients had improvement in their
limitations after a three-month period of time. The researchers concluded that herbal
medicines can help improve some maladies in elderly patients, but it is essential that
these remedies are used under the care of a physician (Kogure, et al., 2004).
Use of medication as pain management
Because many people over the age of 65 have sleep difficulties, they are more
likely to use over-the-counter medications to help them get to sleep. Although this
problem affects over one-third of the population of adults in the United States, less than
10 percent of people consult their physician about the issue. By contrast, sleep problems
among the elderly occur in approximately 75 percent of this age group. The fear among
physicians is that there can be adverse side-effects from the use of over-the-counter sleep
aids when used in conjunction with some prescription medications, but especially drugs
that are used to treat psychological or psychosocial maladies (Sproule, et al, 1999).
Chronic pain is prevalent among the population of people over the age of 65.
Therefore, the use of prescription and nonprescription medications to manage pain is

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widespread. Pain can also be treated exclusive of medication use. Keeping physically
fit, resting, using hot or cold packs, and manipulation of joints can help reduce pain as
well. Additionally, the use of electrical stimulation of nerves can be an effective way to
reduce soreness (Blomqvist & Hallberg, 2002).
Use of alternative methods
Although the use of alternative methods is preferred to medications, most elderly
people choose to use drugs to manage their discomfort. However, according to
Blomqvist and Hallberg (2002), in spite of what is desired by older persons, nurses and
other home health care providers are encouraging the use of non-medicinal procedures to
deal with pain. In addition, when a sampling of elderly in Sweden were asked to be a
part of a study, it was found that they preferred alternative options in lieu of medications
to assist them with handling their aches and pains (Blomqvist & Hallberg, 2002).
Adverse reactions to drugs
It is a fact that people over the age of 65 comprise about 15 percent of the entire
population in industrialized countries. Additionally, they are consumers of over 30
percent of all prescription medications. Researchers and other medical personnel have
been attempting to evaluate various reactions to medications that occur in this population.
The most common undesirable side effect or reaction was problems with the blood. The
second most troublesome side effect was difficulty with metabolism, followed by trouble
with the nervous system and finally complications of the heart and lungs. The
medications studied that gave these reactions were painkillers, anti-inflammatory drugs,
tranquilizers, and medications that prevent blood clots. Most of the problems that caused
hospitalization were due to self-medicating by use of pain relieving drugs. Women were

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more likely than men to use these medications, and at least 20 percent of the time there
was no record of the drug in the patient’s medical file (Olivier, et al, 2009).
Additionally, in a survey conducted at the University of Massachusetts Medical
School, researchers found that giving free prescription samples to elderly patients was not
an effective method to regulate drug use. There is dispute as to whether or not this means
saves money for consumers and insurance companies. Researchers tend to believe that
this practice may increase the use of certain medications rather than help people discover
that generic pills can give the same results. The investigators believe that physicians
need to ask patients more in-depth questions before giving out free samples. This method
could help them learn more about need for certain drugs and could save money for both
patient and insurer (Tija, Briesacher, Soumerai, Ross-Degnan, & Gurwitz, 2008).
Moreover, Stockl, Le, Zhang and Harada (2010) conducted research with a cohort
of patients over the age of 65 who were possibly receiving the wrong medication to treat
their ailment. This was a retrospective study which used electronic pharmacy and
medical claim forms from elderly patients. Unfavorable outcomes of interest were
confusion or delusions from medications for blocking neurotransmitters. In addition,
some medications used to induce sleep caused dizziness, falls, and even some broken
bones. These adverse outcomes were based on the medication information contained in
the claim forms. Nevertheless, the conclusion was that if patients take medications as
directed, their risk of a negative response would be reduced (Stockl, et al., 2010).
Unnecessary use of medications
Oftentimes a physician will prescribe a drug for a condition that could be
controlled through diet and exercise. One example of this is treating hypertension with

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medications. According to Moynihan and Cassels (2005), a person over the age of 65
with blood pressure above 140/90 has about a 5 percent risk of having a heart attack
within 5 years. On the other hand, someone over the age of 65 with normal blood
pressure, i.e. 120/80 or below has approximately a 4 percent risk of angina in the same
period of time. Blood pressure higher than 140/90 is hypertension; therefore doctors will
generally prescribe a diuretic or other medication to help lower blood pressure.
However, these authors found that many physicians do not suggest that patients try an
alternative to medication to treat their hypertension (Moynihan & Cassels, 2005, pp. 83-
91).
Furthermore, Moynihan and Cassels’ (2005) research showed that many people
go to their doctor because of something they have seen on television with regard to a
medication to treat a certain illness. Unfortunately, some doctors simply give medication
to the patient because the person tells the physician that they are experiencing certain
symptoms. Moreover, people are using medications that may be unnecessary.
Regrettably, this behavior is helping drug companies to make more money and causing
the cost of prescription drugs to skyrocket (Moynihan & Cassels, 2005, pp. 119-120).
Labeling of medications
As noted in the introduction, many elderly people do not read the information that
is included with their medications. As reported by the National Institutes on Drug Abuse
(2003), the population of the United States contains almost 15 percent of people over the
age of 65. This portion of the population, however, uses over 30 percent of all
medications prescribed. Yet, studies done regarding the dangers or effectiveness of
medications usually do not include the elderly. Because this portion of the population is

22
at higher risk for harmful side effects, further research needs to be conducted (National
Institute on Drug Abuse, 2003).
Steinmetz, Coley and Pollock (2005) evaluated all people over the age of 65 who
were admitted to the University of Pittsburgh Medical Center during the year 2003.
During this period, the information enclosed with prescribed medicines was perused and
compared to what was listed in the most current edition of the Physician’s Desk
Reference (PDR). At the same time, this information was compared to similar drugs
listed in the PDR. Researchers were looking for listings of negative side effects to the
prescribed medicines. They concluded that although possible adverse effects were listed,
these results were not specific to the aging population. This was a concern to the
researchers because the elderly tend to react differently to certain drugs than those under
age 65 (Steinmetz, et al., 2005).
In addition to the importance of reading information about medications, the ability
to read the possible side effects is vital. According to Hwang, Tram and Knarr (2005),
over 40 million Americans are uneducated and unable to read; furthermore, an additional
50 million people in the United States read less than basic words. Because of these
staggering statistics, labels included with medications need to be clear for everyone who
needs to understand them. This study researched the effectiveness of using illustrations
in addition to writing on medication labels. The results were not conclusive in that using
images on the labels did not always assist someone who did not read well. Consequently,
physicians and pharmacists need to consult with patients about new medications to ensure
the person understands how and when to administer the drug (Hwang, et al, 2005).

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Most labels on prescription and over-the-counter medications are no larger than
the print used in this document. Additionally, over 6,000,000 seniors suffer from some
vision loss. Many seniors have very limited vision or are completely blind (Macaulay,
Cook, Fink, Rapp, & Vincent, 2009).
Although The Rehabilitation Act of 1973 and the Americans with Disabilities Act
order that data that is distributed needs to be understandable to anyone, this does not
always occur. McMahon and Curtis (2009) surveyed 1,000 vision-impaired seniors from
a particular section of the United States with regard to labeling of medications. Less than
30 percent of the surveys came back; however, the majority of those who did complete
the survey reported that they generally have someone read the medication information to
them rather than attempting to do it themselves. The researchers concluded that further
investigation is needed to reduce errors in medication administration and to assist those
who are visually impaired (McMahon & Curtis, 2009).
Furthermore, a study conducted among health professionals in Great Britain
showed that even experts in the field had difficulty discerning proper labels. This
experiment was done on computers showing drug labels that the skilled person was to
match to the medication. The occurrence was more frequent in those labels shown in the
layout where the information was only partial. On the other hand, in the layout where
the information was complete, the margin of error was less than five percent. When a pill
organizer was used to help one know the name of the medication and the correct time to
take it, the results were improved. Although this study was done as a mock-up, it
illustrates the need for concentration and precision when it comes to administration and
dosing of medications (Moisan, Gaudet, & Gregoire, 2002).

24
Young (2007) defined paperless labels as “electronic medication package
inserts.” The use of “paperless labels” for drugs would help doctors and pharmacists be
assured that they are giving the correct medication. Not only that, it would also allow the
health care professionals instant access to all of the kinds of medicines a person is taking.
This may greatly reduce errors in dispensing and possible contraindications with other
medications the elderly patient is consuming. Besides helping with “routine” drugs, this
system will be valuable when dispensing dangerous medications such as sleeping pills
and anti-anxiety remedies (Young, 2007).
Medication errors
Taking the wrong medication can be life threatening and even fatal. Equally
important is proper and concise labeling of drugs for the health care professionals who
use them. Furthermore, these errors will lead to increasing costs to the consumer as well
as insurance companies. In Canada, a new regulation for marking medications was
implemented. The significant information was made larger so that it can be easily read
when time is of the essence (Orser, 2000).
In spite of approval by the FDA, some drugs are not tested as to the full extent of
their usefulness. Oftentimes physicians are using medications not approved by the FDA
for cancer patients and those who are gravely ill with other diseases. Doctors have
accountability to their patients when prescribing drugs; therefore, they must inform the
person who will take the drug about any ill effects or contraindications with other
medicine. Physicians do not necessarily follow through concerning this responsibility;
therefore, people experience reactions without knowing the cause. This lack of
information not only affects patients, doctors and pharmacists; drug company

25
representatives also need to be aware of all of the possible consequences if a drug is used
improperly. Therefore, proper labeling and approval of pills is vital to the health and
well-being of our senior population (Macaulay, Cook, Fink, Rapp, & Vincent, 2009).
Non-compliance with medication use
Moisan, et al (2002) showed that over half of elderly people who use medications
do not take them as directed. There are numerous reasons that this happens. The main
reason is that older persons simply may not understand how to take their medications
properly. Additionally, lack of contact with their physician can be a problem. Other
causes are dislike of the doctor, lack of knowledge about their condition, deficiency of
help from family, and lack of money. On the other hand, trouble reading the instructions
can cause many problems regarding proper use of medicine. Moisan, Gaudet, and
Gregoire (2002) found that almost half of the people surveyed had trouble reading the
information enclosed with their medications. The researchers concluded that clear-cut
instructions for seniors helped them use their prescriptions in the proper way (Moisan, et
al., 2002).
Moreover, Schillinger (2006) stated that our medical organizations in the United
States presume that everyone who is receiving prescription medications is able to read the
labels. Again, he found that an extensive segment of our population does not read or
understand, especially labeling on a prescription bottle. The ability to be aware of any
complications from medications is crucial regarding drugs that may cause harmful side
effects if not taken correctly. Not only can this be harmful to patients, it can cause
difficulties for physicians and pharmacists should an incident occur because of a
misunderstanding concerning the instructions. Dr. Schillinger suggests implementing

26
stricter regulations that would require improved labeling of medications so that everyone
is able to comprehend what effects, if any, could result from taking a certain drug
(Schillinger, 2006).
Furthermore, Hughes (2007) concluded that several factors decide the beneficial
result of medication. First, the medication must be used or administered as directed.
Second, the effect needs to be in line with the drugs’ intent. In addition, the connection
of the drug and the disease need to be in alignment. However, it is not always feasible to
know if these factors are connected. Therefore, lack of reaction to drug treatment is not
always due to nonconformity of use. In order to come to accurate determinations
regarding proper use, more advanced systems need to be in place to monitor this
(Hughes, 2007).
Safety of prescription medications
Certainly, seniors should always be aware of the safety of the medication they are
consuming. Young (2004) reported that physicians are prescribing antidepressants that
not yet approved by the FDA. Congress requires doctors and pharmacists to place a
warning label on all drugs prescribed to prevent or reduce depression. Oftentimes
antidepressants can cause thoughts of suicide even though their intent is to reduce such
thoughts. Because of this issue, Congress demands that all drugs used as antidepressants
are approved by the FDA before use by patients (Young, 2004).
Surprisingly, some medications being prescribed to seniors are considered “off-
label” drugs. This means that they are approved by the FDA but are not regulated by that
organization. Sometimes a drug gets approved to treat a certain illness, but a physician
might feel it would work for a different disease. Subsequently, this could have adverse

27
affects if the drug was prescribed to treat high blood pressure, for example, but was
originally approved to treat heart disease or high cholesterol. Researchers found that
although medications used “off-label” are less expensive, if a drug gets used incorrectly,
the cost could be higher than ever anticipated (Gillick, 2009).
Adverse affects on the elderly
Non-steroidal anti-inflammatory drugs, also known as NSAIDs, can be a risk if
taken improperly. General effects of NSAIDs are stomach problems and balance issues.
These could include getting dizzy, head pain, change in disposition and some delirium.
Dizziness and delirium can put seniors in jeopardy for falls. Injuries from these falls can
range from small cuts and bruises to broken bones that can leave them debilitated for a
short time or for life. Even though these drugs were not classified as medications that
will add to possibilities of falling, studies show that elderly who use them are at risk of
having a catastrophe. Hegeman, van den Bemt, Duysens and van Limbeck (2009)
concluded that the utilization of any drug by seniors, prescription or over-the-counter,
adds to the risk of falls (Hegeman, et al, 2009).
Furthermore, a study conducted among the elderly in the Netherlands showed that
many issues related to medications are due to the use of numerous drugs. The
investigation took place over the period of one full year in 16 different drug stores. The
patients in the study were 65 or older and used 6 or more medicines on a daily basis. The
pharmacists involved gave suggestions to patients and physicians about changes in
medication regimens. After four months of implementing the changes, the same patients
were assessed again. There was a major improvement in the number of problems in each
of the participants. This observation concluded that there could be an affirmative effect

28
on possible issues with medications when a pharmacist assists patients with their drug
management (Vinks, Egberts, de Lange, & de Koning, 2009).
Improving use of medications among older adults
As the population of people over the age of 65 increases, it will become more
essential to make certain they have proper and affordable medications available. Over 85
percent of people over 65 take at least one prescribed drug, but most use more. In fact,
during the year 2002, over 3 billion prescriptions purchased in the United States cost the
elderly almost 200 billion dollars. Additionally, over a million elderly people use over-
the-counter drugs in addition to their prescribed medications. Because of this vast use of
medicines, there is a need for researchers to find drugs that are not only helpful but are
not harmful. Not only is safety a factor, the way medications are used and taken becomes
an important issue. What’s more, new medications get promoted every year. Not only
will this influence the types of drugs used by the elderly, increasing costs will be a major
consideration (Murray & Callahan, 2003).
Besides the concern regarding cost and safety of medications, there is still
disparity concerning information and application. For instance, although there is strong
proof that controlling high blood pressure reduces risk of strokes and death, a small
number of elderly with this problem have well-controlled blood pressure. There are
many reasons for this discrepancy; however, it is usually because patients do not follow
their drug regimens properly. Additionally, elderly tend to ignore doctor’s orders in
regard to maintaining good health. Reasons for lack of staying on track are intolerance of
adverse effects, and failure to make continued commitment to their overall health. In
addition, many seniors find they are unable to afford medications that must be taken over

29
a long time period. On the other hand, many do not have access to a health care
professional. All of these reasons are cause for concern regarding care of the elderly.
Considering that this population is the major consumers of any drugs, prescription and
nonprescription, there is great need to make certain the medications they are taking are
safe and effective (Murray & Callahan, 2003).
Perception of medication use
Because many elderly people cannot afford their medications, they do not always
take them as directed. Research by Lau et al (2008) was conducted to examine older
patients’ perception of their use of medicines. Three questions were being addressed by
the researchers:
1. “Do patients perceive different levels of importance among their medications?
2. What factors influence perceptions of medication importance?
3. Is perceived importance associated with the worth patients assign to their
medications, and does expense impact on that association?”
The researchers theorized that believed significance of medications probably has a clear
relationship with the patients’ perception of self. Equally important is how the person
feels about his/her ability to afford medications. Investigators sensed that people would
be prepared to spend money on drugs that were costly if they thought they were essential;
however, they would spend money for less expensive medicines if they think these would
be effective. The conclusion of this study was that the elderly give different amounts of
significance to their drugs based on ideas outside of scientific worth. Knowledge of these
perceptions can assist in advances in involvement by health care professionals to help

30
lessen the chances of elderly not taking their medications as prescribed (Lau, et al.,
2008).
By comparison, the elderly person’s perception of over-the-counter medication
use is no clearer than perception of use of prescription drugs. Over-the-counter drugs
have to be nontoxic and important; additionally, they need to have labels that provide
information for the user. If used correctly, these medications are useful but can also have
some harmful side effects if used improperly. Hanlon, et al (2001) acknowledged that
approximately 40 percent of all nonprescription drugs sold in the United States are used
by people over the age of 65. Many elderly people do not consider over-the-counter
drugs to be “medicine” and therefore do not inform their doctor of their use. This can be
harmful if the senior is using a nonprescription drug that may interfere with his/her
prescription medication. Therefore, it is essential that the elderly person inform his/her
physician of all over-the-counter medication use (Hanlon, et al, 2001).
Differences of medication use in varying cultures
Compared to other cultures and races, Caucasian Americans use far more over-the
counter medications than non-white people. For example, Hispanic elders use fewer than
half the amount of nonprescription drugs than white people. Additionally, African
Americans report less use of over-the-counter drugs. In addition to differences in race
and culture, there is also a difference of use among women and men. Women use more
over-the-counter medications than men do. These results seem to be consistent across the
United States. Furthermore, people who live in large cities tend to use more
nonprescription drugs than those who reside rurally (Hanlon, et al, 2001).

31
Furthermore, in a study conducted by Aroian, Vander Wal, Peters, and Tate
(2007) it was shown that elderly African Americans have the highest disease and death
rate of all national populations in the United States. Additionally, they have a
discrepancy in availability of assistance with their health care. Blacks in America are
more likely to use emergency rooms for their medical needs rather than seeing a doctor
on a regular basis. Of course, this is disquieting to health care professionals due to the
possibility of lack of follow up care and less chance of recovering. However, in this
particular study, elderly African Americans are almost as likely to seek regular care for
their health because they have health insurance available through Medicare. On the other
hand, older African Americans are still less healthy than their Caucasian equivalents
because they are at higher risk for hypertension, as well as other diseases, and do not
always care for themselves as they ought to (Aroian, et al, 2007).
Drug costs among the elderly
Even though seniors have access to drug plans through Medicare, over 30 percent
of them fall into the “doughnut hole.” Rick (2009) defines it this way: “Under Plan D,
when a Medicare client’s prescription costs reach $2,700, their drug coverage ends until
they pay a total of $4,350 out-of-pocket for the year.” The difference between the $2,700
and $4,350 is the “doughnut hole” or disparity in their protection. This is overwhelming
to some elderly, especially those who are on lower fixed incomes. This gap in coverage
is one major reason so many seniors are in favor of the health care reform that has been a
key issue recently (Rick, 2009).
As has been noted earlier, many seniors do not communicate well with their
physicians regarding their medication use. Wilson et al (2007) surveyed almost 20,000

32
seniors in all 50 states who live independently and receive Medicare coverage. The
information about the elderly participants is from the Centers for Medicare and Medicaid
Services (CMS) in each state. The reply proportion was a little over 50 percent of those
surveyed. Elderly living in low-income areas have been identified with the help of the
U.S. Census Bureau. The study found that over 25 percent of the elderly skipped
medication without letting their physician know. Additionally, almost 40 percent who
had difficulty paying for their medications did not tell their doctors or ask for any help. If
a person did ask their doctor for information about saving money on drugs, the physician
attempted to change to a generic equivalent. The results that were gathered showed that a
large portion of seniors in the United States have difficulty paying for their prescription
medications. Furthermore, there is need for more communication between elderly
patients and their health care providers (Wilson, et al., 2007).
By comparison, research conducted by Tseng et al (2007) showed similar results
as the previously mentioned study. In this case, a little over 1100 seniors were surveyed
with approximately 60 percent responding. Everyone who completed the questionnaire
had medication expenses in the top 25 percent of their limit of spending. Over 60 percent
of the respondents stated that they struggled with meeting the cost of their medications.
In fact, over 25 percent cut down on their prescribed doses to save money. The majority
wished for their doctors to inquire regarding their ability to afford their prescriptions. In
addition, that same group desired health care professionals to think about the cost of the
medication that was being prescribed. Additionally, seniors wanted choices offered to
them. Lastly, researchers concluded that seniors desired to have physicians influence
them or make the decision as to which drug to use. Less than 20 percent of responders

33
stated that doctors asked about ability to pay; however, another 20 percent said that their
doctor talked to them about costs or gave them alternatives. Almost all of the seniors
said that the doctor made the final decision as to which medication to take, regardless of
the cost. Again, even though all of the seniors interviewed had Medicare coverage, it just
was not enough to cover the entire cost of all of the drugs that they require (Tseng, et al.,
2007).
Additionally, Evans-Molina, Regan, Henault, Hylek, and Schwartz (2007)
surveyed 472 people over age 65 with Medicare Part D coverage and were at risk for
stroke. When Part D passed, lawmakers imagined a customary reimbursement similar to
personal insurance coverage. Seniors need to pay a deductible of $250; additionally,
elderly were expected to pay another $2000, but would only have to pay 25 percent of
that. There is a monthly premium incurred by the policy holder, amounting to about $35
per month. Unfortunately, even though this plan appeared to be good for seniors, many
of them fall into the “doughnut hole” gap mentioned previously. The participants in this
particular study also carried additional coverage offered through the American
Association of Retired Persons (AARP). These individuals required more medications
due to their stroke risk. The coverage through the AARP policy offered decreases in out-
of-pocket spending around 40 percent. On the other hand, this plan, similar to other
personal health care policies, has some restrictions on which medications are available.
The researchers acknowledge more investigation should be conducted to establish the
outcome of Medicare Part D on seniors’ well-being, the manner in which doctors
recommend drugs and how medications are used among seniors (Evans-Molina, et al
2007).

34
Summary of Literature Review
Without a doubt, there is still a great deal of research to be done regarding seniors
and their use of medications. With the current controversy surrounding the proposed
health care reform, there will be more investigation into this topic. According to the
Merck Online Manual (2005), inappropriate use of medications can lead to undesirable
effects for the elderly. In addition, the reactions could do greater harm if a senior has
several ailments.

35
Chapter III: Methodology and Presentation of Data
Importance of the issue
The issue-at-hand is the perception by the elderly regarding use of prescription
and nonprescription medications. This topic is important because the improper use of a
medication could result in adverse effects for an elderly person. This is especially true if
one is being treated for multiple diseases because the drugs could work against one
another. Oftentimes an undesirable reaction to a medication is diagnosed as a new
illness. A common response is for a physician to prescribe a new medication; however, a
domino effect can occur (Merck Manual editors, 2005).
The purpose of this study was to explore the awareness of seniors regarding use of
medications. This chapter will discuss the research methods and procedures used in this
investigation. It will consist of the type of research method used, who participated, and
the results of the research. This section will also discuss the thoughts of health care
professionals regarding this topic.
As told in the review of literature, elderly people tend to react differently to
medications than their younger counterparts. Physicians and pharmacists need to be
cautious when prescribing drugs for the elderly. Additionally, health care professionals
should be aware of all medications that patients are using. This is very important because
many elderly people do not inform physicians of the over-the-counter drugs used on a
daily basis.
Methods
The methods used were both qualitative and quantitative research. The
quantitative research was an anonymous survey distributed to the seniors at an apartment

36
facility. The qualitative research came from the focus groups conducted while the
surveys were answered and collected. My hope was to obtain more accurate information
with the use of two research types.
Because it was important that the seniors were aware of their medication usage,
surveying people from an independent living facility made sense. The seniors take care
of their activities of daily living without assistance. Additionally, these elderly do not
need help with medications. The first step was to speak to the manager of the building to
obtain permission to survey the residents. She signed a consent form (Appendix A) that
explained the purpose for my research. After permission was granted by the manager, the
survey was delivered directly to each tenant and they were given a two week period in
which to complete the questionnaire. Questions with one word or multiple-choice
answers were used. This format allowed for simple data processing and was quick and
simple for the people to complete. The collection box was located at the front desk of the
building, very prominently displayed.
As the tenants were working on the survey, focus groups were organized. The
concentration of the focus group was to expand on the survey questions. The purpose
for the focus groups was to help me learn if the data from the surveys would coincide
with group discussion. Additionally, I hoped to obtain a greater perspective regarding
use of prescription and nonprescription medications. Furthermore, I wanted to know if
these seniors were informed about the use of medications. Finally, I wished to learn if
my mother was unique regarding her apparent lack of concern in relation to her
medication use. The survey (Appendix B) was distributed to the residents of a senior

37
independent living facility in Coon Rapids, Minnesota. The average age of tenants here
is approximately 70 years of age.
Objectives
In order to find out if other elderly people had similar thoughts regarding
medication use as my mother, I concluded that a survey would be in order. I wanted to
know how many medications people take, if they take them as directed and if they read
the instructions that are included with their drugs. These were questions that my mother
had difficulty answering because she did not pay attention to how many medications she
took regularly. My hope was to learn if my mother’s attitude toward medication use was
common among other elderly.
The purpose of the focus group was to learn about how much knowledge the
seniors had concerning their medications. Responses from the survey indicated a fair
amount of awareness regarding medication use; however, reactions during the focus
group indicated more information would be welcome.
Results
There are 70 seniors living in the facility and 32 completed and turned in the
surveys. That is a 45.7 percent return rate. Residents were asked their age and how
many prescription medications they take daily. The youngest resident responding was 58
and the oldest was 97. The average age of participants was 78.5, average number of
prescription medications taken was 5.56, and the median number of over-the-counter
drugs used was 2.59. Additionally, the survey inquired as to their use of nonprescription
medications, and if they use any herbal remedies. None reported the use of herbal
medications. The first table shows the varied ages of participants.

38
Table 1 – age of participants
The second table shows the various results regarding prescription and over-the-
counter medication usage. Some of the “prescription” lines stand alone because the
person taking those medications does not take over-the-counter medications. Similarly,
one of the “otc” lines is single because the respondent did not take any prescription drugs.
Therefore, the lowest number of nonprescription medications used was 0, and the largest
number was 8. The lowest number of prescription medications taken was also 0, and the
greatest number in that category was 16. All respondents, except 1 person, took at least
one medication daily. No one reported using any herbal remedies. The focus group
participants each used at least one prescription medication.
0
20
40
60
80
100
120
age
age

39
Table 2 – medication usage
Other questions included in the survey were regarding the participant’s perusal of
the information that is included with their medications. Everyone who completed a
survey reported that they take their medicine as told by their physician. Additionally, the
survey asked if the person takes their medication as directed. Only one respondent does
not take their medication as directed. In response to the inquiry regarding asking about
possible contraindications, 11 respondents, or 34 percent, replied that they do not ask
about mixing different drugs. I find this to be quite significant because it is important to
0
2
4
6
8
10
12
14
16
18
prescription
otc

40
know what side effects, if any, might occur when mixing different drugs. When asked
about the ability to afford medications, only 6 people stated that they are not able to do
so. As a general rule, the respondents to the survey seemed to be knowledgeable about
their medication use. The table below shows the comparison between the yes and no
answers.
Table 3 – additional answers to survey questions
These answers were reassuring because of the experience with my mother’s lack
of following directions. Nine of the thirty-two participants replied that they do not ask
questions of either the doctor or pharmacist. That gives me pause to wonder if these
particular seniors really are taking their medicine as directed. Additionally, only 6
reported that they are not able to afford their medications, which is reassuring to this
researcher. Finally, only five stated that they needed assistance with the survey.
0
5
10
15
20
25
30
35
Take as
directed
Ask questions afford meds assitance with
survey
yes
no

41
Focus group results
Focus groups were held at the same facility where the surveys were distributed.
The focus groups were held to expand on the answers from the surveys. The researcher
hoped to glean more precise information than could be obtained from the survey. The
hope was to learn if the elderly truly were knowledgeable about medications. Members
joined via a sign-up sheet posted in a central location. Before the meeting began, the
researcher explained the Consent Form and asked participants to sign a copy (Appendix
C). Only two men participated in the first session; however, each fully participated in the
discussion. One of the gentlemen suggested that the researcher have him recruit people
for the next session. Apparently he has some influence because there were five people at
the second session.
The specific questions (Appendix D) required more than one word answers from
the participants. The hope for the researcher was that further dialogue might give details
about perceptions of use. During discussion in the focus groups, some participants
appeared less confident concerning knowledge of medications. The first question asked
of the group was: What kind of information would you like to receive regarding your
medication? One person stated that he needs to know what over-the-counter medications
can be taken with his prescription drugs. Another person asked if there might be a certain
time to take his medications. In addition, one gentleman said that clearer instructions
would be helpful. Finally, one woman was receiving an injection of a drug for
osteoporosis. She felt that she would like more explanation about the injection and what
it does for her.

42
The next question asked if the residents would be interested in having medical
personnel at the facility to answer questions. One gentleman said that a representative
from his health insurance company would answer all of his questions. Another man said
that Health Partners provides a counselor to assist with medication management. Finally,
a woman said that this type of thing would need to be cleared with the management.
When asked if the members had any ill effects from medications, several stated
that they had. The researcher then asked what action was taken when there was a side
effect. One gentleman stated that he simply stopped taking the medication without
consulting his physician. Other members did not have adverse effects from any
medications.
The next question asked was: When you receive a new prescription, do you ask
questions, and if so, what kind of questions do you ask? A woman said that she does not
ask questions simply because she does not like to take medicine. However, if she does
have side effects, she will talk to her doctor. Another woman reported that her daughter
asks the questions. One gentleman was quite confident regarding his knowledge of
medication. He reads all of the information included with the prescription so he knows
what to expect and if he should anticipate side effects.
Although affordability of medications was part of the anonymous survey, further
discussion was in order. Knowing that many elderly do struggle caused concern for the
researcher. However, all of the members of the focus group stated that they are able to
afford their medicines because they have drug coverage, either through Medicare or
Veteran’s benefits. The conclusion was that this particular group was not concerned
about affordability issues.

43
Additionally, participants were asked for practical advice to give people who may
be confused or unsure about their medications. One person said to ask more questions of
your doctor. Another stated you should have a family member go with you to the doctor.
And yet another person said to have someone make a chart for you of all of the
medications you take. One of the members had a son-in-law who made a chart for the
member’s wife. An excellent suggestion by one participant was to keep a list of all the
medications and the dosages and bring the list to the doctor with you. All of the
suggestions were welcomed by other members.
Furthermore, there was discussion about what the participants would do if they
had a problem with a medication. Regarding problems with medicine, all members stated
they would ask the nurse on staff, a doctor, or a family member. Finally, the researcher
inquired about using mail-order pharmacies. Without a doubt, all felt that this was the
best way to obtain their medications because they did not need to drive to a pharmacy or
rely on someone else to take them.
Thoughts from health care professionals
While preparing to consult with seniors concerning medication use, the researcher
found three nurses who were willing to discuss their experiences with the elderly. The
reason for asking questions of these nurses was to obtain their thoughts on elderly
perception of medication use. Kathy Helm gave me information about the facility where
she works as well as her opinions regarding medication use. Becky Berglund agreed to
assist with this project because she has a heart for the elderly and feels that this topic is
important. Valerie Heintz also agreed that research concerning medication use among
elderly is a topic of interest. All three women gave verbal consent to use their quotes.

44
No formal questions were asked; the researcher requested some general thoughts on this
topic of medication use.
In a conversation with Kathy Helm, a registered nurse at a local assisted living
facility, she stated that many of the residents come with a grocery bag full of over-the-
counter medications. She stated, “They do not think of them as medicine” (K. Helm,
personal communication, January 26, 2010). Additionally, Kathy felt that many seniors
do not thoroughly understand how to use their medications properly.
Becky Berglund, a nurse who works with the elderly in an assisted living facility,
offered some insights regarding this topic. She said that in her 20 years experience with
seniors, “I would say the majority of them are very accepting of having to take their
medications because ‘I’ll do what I have to do if it keeps me healthier.’ Some, on the
other hand, are very reluctant to take anything, especially for pain and discomfort. They
say, ‘I don’t want to get addicted.’” She also said that many men seem to think they can
“tough it out” instead of taking a pain pill. However, some women would rather suffer or
take chances instead of taking medicine. “Then there is the group that seems to think
they need a pill for everything, every time they see their doctor. They are the ones that
have 20 or more medications and some more than one time per day. There is no
convincing that group even when pointing out side effects and drug interactions.” They
say, “If I don’t have a pill for this, I won’t get better.” (B. Berglund, personal
communication, May 4, 2010).
Another nurse who works with the elderly on a daily basis is Valerie Heintz. Her
views regarding elderly and their thoughts about medication are similar to Becky’s. She
says that she has seen elderly who do absolutely everything the doctor wishes for them to

45
concerning their medications without asking any questions. They know the names of all
their medications, why they are taking them, when they need to take them and they take
them on time. Some of the elderly feel it is very important to take their medications.
They often make comments on the number of different kinds of pills they take. Several
take 12 or more pills at one time, and that is only once per day. They may have to take
that same number morning and evening. They comment on how full the medications
make them; in other words, they often do not have an appetite when they are done taking
their pills. Some elderly are very knowledgeable with regard to their medications; they
not only know which ones they take, but exactly how it affects them. These particular
elderly conduct research, question and ask why a certain medication is prescribed.
Oftentimes, these folks will refuse certain medications. On the other hand, some refuse
to take their medications because of the cost. They feel that they cannot afford their
medicine and still be able to live month to month with their other bills. “This is very sad
to see, especially when you know that these folks do need their medications. Things are
different once they come into the nursing home and we are able to help provide the
medications needed related to cost (V. Heintz, personal communication, May 5, 2010).
Concluding thoughts
The elderly participating in the research appeared knowledgeable concerning use
of medications. On the other hand, during focus groups participants had many questions
regarding reasons for taking certain medications. Although only 70 people were given
the survey, over half of them responded. Additionally, the 7 participants in the focus
groups appeared eager to learn more about medications and how some might react
negatively when mixed.

46
Chapter IV: Conclusions
Review of the issue
Looking back at the literature review, we see that people over the age of 65 use
about 30% of all prescription medications that are purchased in the United States (Merck
Manual editors, 2005). Additionally, the current population of seniors seems to prefer
medication to alternative methods for relief of aches and pains (Blomqvist & Hallberg,
2002). The purpose of this study was to determine if a select population of elderly had
similar thoughts and ideas regarding use of medications.
Equally important, the literature showed that approximately 15 to 50 percent of
seniors claim economic need. This problem can lead to not purchasing the medications
necessary for the particular ailments. In addition, the elderly may obtain the
prescriptions, but take less than directed to save money. The elderly patient does not
always know the significance of the medications prescribed. Therefore, he or she may
not be aware of the consequences if the drugs are not properly administered (Lau, et al.,
2008).
Limitations to research
The number of people who were given the survey was less than 100; therefore the
comparison to what the literature has to say was not well balanced. Additionally, only 7
of the possible 70 residents participated in the focus groups. In order to obtain more
accurate and possibly different results, a great number of people would need to be
studied. Again, the small number of participants was most likely the reason for this
discrepancy in results. Having found this to be true, in the future a greater number of
people should be surveyed in order to have results that more closely match the studies
published by scholarly sources.

47
Comparing results to Literature Review
Several sources from the literature review showed that it is not uncommon for
people over the age of 65 to have negative reactions to medications. Responses from the
survey and focus group showed that very few participants experienced negative side
effects from any medication. Additionally, researchers found that about 30 percent of the
elderly use herbal remedies in addition to their other medications. However, the results
from this study showed that the elderly surveyed reported not using any kind of herbal
remedies; in addition, very few had adverse reactions to any of their medications.
Furthermore, most of the respondents to the survey claimed that they take their
medications as directed. Perhaps this response was given because the participants felt it
was the “expected” answer. In contrast, sources cited in the literature review found that
over half of the elderly do not take their medicine correctly.
Summary of findings
The seniors who were surveyed feel that they are aware of how they use their
medications. Additionally, these participants seemed confident that if there ever was a
problem, they know who to turn to for help. On the other hand, during the focus groups,
a little more hesitation showed from some of the members. Although they answered yes
in the survey when asked about their ability to find information, they did not appear as
certain about that capability in the focus group.
Information from three geriatric nurses coincided with literature findings. Becky
noted that elderly tend to trust their doctor and not question what medications are
prescribed. On the other hand, some do refuse to take medicine for fear of an adverse
effect. Valerie worked with many elderly who are knowledgeable concerning their

48
medications; in fact, some conduct research to learn more information. Kathy’s
experience showed the elderly have little knowledge of over-the-counter drugs and the
possible interactions with prescription medicines.
The answers given on the survey did not coincide with discussions during focus
groups. Most of the participants stated that they did not need any assistance with
medications; however, during the discussion most of the respondents felt a need for
further information. The quantitative research was helpful to learn about how many
medications are being used by seniors. In addition, the qualitative part of the research
through discussion found that the participants were not very confident concerning their
medicines.
Summary and conclusions
A great deal of the research showed that elderly often do not take medications
properly. Additionally, we saw that it is not always the fault of the elderly patient.
Oftentimes, physicians will prescribe a medication based on symptoms reported by the
elderly person rather than doing a thorough examination and learning about all of the
drugs the person is taking.
If we compare the results of research done with 70 seniors to the literature, we
find compelling differences. Only 32 of the 70 surveyed returned the questionnaire, so
this made for minimal data. A great amount of research has been done by scholars in
relation to the topic of medication use. These studies showed very different results than
what my research concluded. Given a chance to repeat this inquiry, it would be wise to
find a greater number of seniors who would be willing to participate. Possibly, if 1,000

49
or more seniors completed the survey, there would be a large number reporting that they
do not always follow instructions, nor do they always ask relevant questions.
Clearly, there is need for more research on this subject. As the “baby boomers”
age, new difficulties could occur. Information is vital for the health and well-being of the
elderly. Changes in health care may make it easier or more difficult for people to afford
their medications. There will be a need for more physicians and pharmacists who are
willing to specialize in gerontology. Some of our current physicians need to become
more aware regarding all the aspects of aging.
By the year 2050, the population of elderly in the United States will be over
86,000,000. Currently there are approximately 37,000,000 seniors in America. This
means that by 2050, this population will have increased by well over 100 percent
(Longley, 2005). More elderly most likely means more prescriptions, which could lead
to further problems. As gerontologists, we need to be equipped for the potential issues
that will arise.
The field of gerontology is a rapidly growing area. In the next 20 to 30 years, we
are going to need professionals who are well versed in this area. People are living longer,
and well-trained experts can help them to live life robustly. This topic of medication use
is one that needs further and deeper study. Not only will experts need knowledge; the
elderly are going to have to be proactive in managing their health. If seniors are willing
to advocate for good health, they can have better quality of life.

50
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56
Appendix A - Consent Form for Manager of facility
By signing this form as the manager for Margaret Place, you are allowing me to conduct
research with the residents for my Master’s thesis through Bethel University. All
information received will be held in strict confidence and no resident’s names will be
used in the thesis; additionally, the name “Margaret Place” will not appear anywhere in
the paper.
Printed name of manager
______________________________________________________________________
Signature
________________________________________________________________________
Date
Beth Tomlinson
Date

57
Appendix B - Survey
1. How many prescription medications do you take?
2. How many over the counter medications do you take?
3. Do you take your medications as directed? Yes No
4. Do you read the instructions that are included with your prescription?
Yes No
5. Do you read about possible side effects? Yes No
6. Do you take herbal remedies? Yes No
7. Do you ask your doctor about the medication that he/she prescribes? Yes No
8. Do you ask the pharmacist about possible interactions with other medications?
Yes No
9. Have you ever had a negative side effect from medication? Yes No
10. If you have questions about your medications, who do you ask? (for example:
doctor, nurse, pharmacist, family member, friend, look for info on internet, other)
Please circle one or write here
11. Did you receive assistance in filling out this survey? Yes No
12. Do you feel you are able to afford your medications? Yes No
13. What is your age?

58
Appendix C - Consent Form for participants
You are invited to participate in a study of the use of prescription and nonprescription
drugs and your perception of your usage.
I hope to learn what perceptions elderly have regarding their use of prescription and
nonprescription medications.
You were selectedas a possible participant in this study because you are elderly
living independently and are aware of your use of prescription and nonprescription drugs.
If you decide to participate in a focus group, I Beth Tomlinson will meet with you
once or twice to discuss your use of prescription and nonprescription drugs to help me
determine if many elderly people feel a need for more education regarding their
prescription drugs.
Any information obtained in connection with this study that can be identified with
you will remain confidential and will be disclosed only with your permission. In any
written reports or publications, no one will be identified or identifiable and only
aggregate data will be presented. I will use the information obtained to add to the
practicum portion of my graduate thesis for Bethel University in the Gerontology
Master’s program.
Your decision whether or not to participate will not affect your future relations with
Bethel University or Margaret Place in any way
If you decide to participate, you are free to discontinue participation at any time
without affecting such relationships.
This research project has been reviewed and approved in accordance with Bethel’s
Levels of Review for Researchwith Humans. If you have any questions about the
research and/or research participants’ rights or wish to report a research related
injury, please call Pamela Zimmerman or Harley Schreck at Bethel University – 651-
638-6400.
You will be offered a copy of this form to keep.
________________________________________________________________________
You are making a decision whether or not to participate. Your signature indicates that
you have read the information provided above and have decided to participate. You may
withdraw at any time without prejudice after signing this form should you choose to
discontinue participation in this study.
Printed name
______________________________
Signature _____________________________
Date

59
Appendix D - Questions for focus group
What kind of information would you like to receive regarding your medication?
Would you be interested in having someone assist you in finding information about your
medications?
What kind of problems, if any, have you had with medication?
When you receive a new prescription, do you ask questions, and if so, what kind of
questions do you ask?
Can you afford your medications?
Do you have some practical tips for those who are confused or unsure about their
medications?
If you have problems with your medications, what do you do?
Who would you ask? Would you ask your family, a friend, a physician or pharmacist?
Do any of you order your medications online or through the mail? How is that working
for you? Do you have any problems with this? If you do have problems, who do you
ask?
Do you use more than one pharmacy? If so, why?

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