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Dima M. Qato, PharmD, MPH; G. Caleb Alexander, MD, MS; Rena M. Conti, PhD; Michael Johnson, BA; Phil Schumm, MA; Stacy Tessler Lindau, MD, MAPP

JAMA. 2008;300(24):2867-2878.

Context  Despite concerns about drug safety, current information on older adults' use of prescription and over-the-counter medications and dietary supplements is limited.

Objective  To estimate the prevalence and patterns of medication use among older adults (including concurrent use), and potential major drug-drug interactions.

Design, Setting, and Participants  Three thousand five community-residing individuals, aged 57 through 85 years, were drawn from a cross-sectional, nationally representative probability sample of the United States. In-home interviews, including medication logs, were administered between June 2005 and March 2006. Medication use was defined as prescription, over-the-counter, and dietary supplements used "on a regular schedule, like every day or every week." Concurrent use was defined as the regular use of at least 2 medications.

Main Outcome Measure  Population estimates of the prevalence of medication use, concurrent use, and potential major drug-drug interactions, stratified by age group and gender.

Results  The unweighted survey response rate was 74.8% (weighted response rate, 75.5%). Eighty-one percent (95% confidence interval [CI], 79.4%-83.5%) used at least 1 prescription medication, 42% (95% CI, 39.7%-44.8%) used at least 1 over-the-counter medication, and 49% (95% CI, 46.2%-52.7%) used a dietary supplement. Twenty-nine percent (95% CI, 26.6%-30.6%) used at least 5 prescription medications concurrently; this was highest among men (37.1%; 95% CI, 31.7%-42.4%) and women (36.0%; 95% CI, 30.2%-41.9%) aged 75 to 85 years. Among prescription medication users, concurrent use of over-the-counter medications was 46% (95% CI, 43.4%-49.1%) and concurrent use of dietary supplements was 52% (95% CI, 48.8%-55.5%). Overall, 4% of individuals were potentially at risk of having a major drug-drug interaction; half of these involved the use of nonprescription medications. These regimens were most prevalent among men in the oldest age group (10%; 95% CI, 6.4%-13.7%) and nearly half involved anticoagulants. No contraindicated concurrent drug use was identified.

Conclusions  In this sample of community-dwelling older adults, prescription and nonprescription medications were commonly used together, with nearly 1 in 25 individuals potentially at risk for a major drug-drug interaction.

Author Affiliations: Department of Obstetrics and Gynecology (Drs Qato and Lindau), Section of General Internal Medicine, Department of Medicine (Drs Alexander and Conti), MacLean Center for Clinical Medical Ethics (Drs Alexander and Lindau), Center for Health and Social Sciences (Drs Alexander and Conti), Section of Pediatric Hematology/Oncology (Dr Conti), Department of Health Studies (Mssrs Johnson and Schumm), and Section of Geriatrics, Department of Medicine (Dr Lindau), University of Chicago, Chicago, Illinois; Chicago Core on Biomarkers in Population-based Research, NORC, and University of Chicago Center on Demography and Economics of Aging, Chicago (Drs Qato and Lindau); Department of Health Policy and Administration, University of Illinois at Chicago School of Public Health (Dr Qato); and Department of Pharmacy Practice, University of Illinois at Chicago School of Pharmacy (Dr Alexander).

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