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Official websites use. Share sensitive information only on official, secure websites. Correspondence to co-authors : Vicente A. Older adults are a particularly vulnerable group to drug use and self-medication. The aim of the study was to evaluate self-medication as a factor associated with the purchase of brand-name and over-the-counter OTC drugs in older adults in Peru. A secondary analysis was performed using an analytical cross-sectional design of data from a nationally representative survey from to The exposure variable was self-medication, defined as the purchase of medicines without a prescription. Information of sociodemographic variables, health insurance, and the types of drugs purchased by the participants was collected. Crude prevalence ratios PR were calculated and adjusted using generalized linear models of the Poisson family, considering the complex sample of the survey. In this study, 1, respondents were evaluated, with a mean age of The prevalence of self-medication was This study evidenced a high prevalence of self-medication in Peruvian older adults. Two-thirds of the surveyed people bought brand-name drugs, whereas one-quarter bought OTC drugs. Self-medication was associated with a greater likelihood of buying brand-name and OTC drugs. Keywords: health of the elderly, aged, pharmacies, self-medication, drugs, generic, nonprescription drugs, Peru. In Peruvian older, self-medication was associated with a greater likelihood of buying the brand-name and over-the-counter drugs. Aging is a complex phase that includes loss of function, reduced autonomy, and increased morbidity. For older adults, medication is a crucial instrument for maintaining and recovering health. This condition increases the probability of adverse effects, mainly if self-medication potentially affects its functional capacities. Self-medication is defined as the use of medications without a prior medical prescription to treat symptoms and self-perceived or identified diseases by a family member6. Various types of self-medication have been identified as follows: nonprescription drugs, drug refills, drug recommendations to friends and family, the use of leftover drugs from previous prescriptions, or altering the dose of prescription drugs. Pharmacology in older adults experiences changes due to aging, like changes in the distributions of muscle mass, fat, and body water; the alteration of liver and kidney metabolism, which hinders the elimination of metabolites; and accumulation of toxic substances, 12 in addition to the interaction of comorbidities. However, its frequency and characteristics vary depending on national health systems. In Peru, the drug market is highly concentrated and insufficiently regulated. Considering the demographic transition process in Peru, the proportion of older adults increased from 5. Therefore, the objectives of this study was to report the prevalence of self-medication, describe the practices of using brand-name and OTC drugs, and evaluate self-medication as a factor associated with the purchase of brand-name and OTC drugs in older adults in Peru. The primary sampling units, namely the IPRESS of the Ministry of Health and regional governments, the social health insurance system in Peru EsSalud , the health-care system of the armed forces and police, and the private sector clinics, were randomly selected. The secondary unit was the users of drugstores and pharmacies, who were selected in a non-probabilistic manner for convenience. Twenty-five strata corresponding to the 25 political regions of Peru were established, based on which expansion factors were estimated. Thus, the final sample size was 1, participants, representing an expanded population of , people Figure 1. Two outcomes were considered. First, the use of brand-name drugs was defined as the purchase of at least one brand-name drug. In Peru, all drugs are authorized by the Ministry of Health. These are marketed according to the name that identifies them, as a brand and generic drugs. Brand-name drugs use a name assigned by a pharmaceutical company, while generic drugs have the same name as the active ingredient in the drug. On the other hand, the condition of sales, such as controlled sales and OTC medications, refers to the need to have a prescription or not. Likewise, according to the Peruvian legislation, the health professionals capable of issuing a medical prescription are doctors, dentists, and obstetricians. Two authors independently coded these variables, and discrepancies were resolved with a third author. Self-medication was operationalized, considering the participants who bought drugs without a prescription and those who did not show the prescription at the survey time. All potential participants gave their verbal consent to participate in the survey. No identification was recorded on the identity of each participant to guarantee the confidentiality of the information provided by the participants. As Peru has established only regulation for the execution of clinical trials, 28 with a gap for observational studies, international regulations govern these studies. Therefore, as a secondary analysis of open-access data without identifiers and following the international regulations, this study was exempt from review by an ethics committee. The chi-square test with Rao-Scott correction for complex sampling was used to determine whether significant differences existed between the independent variables according to the proposed outcomes. The Wald test was used to determine the differences between the numerical variables. The first model was a crude bivariate regression, while the second model was adjusted for confounding variables according to an epidemiological approach. The prevalence of self-medication in older adults was The proportions of purchases of brand-name and OTC drugs were Furthermore, of the participants, The mean age of the participants was In addition, Weights and the design effect of the complex survey sampling were included. Statistically significant differences in self-medication were found between the drug groups. Higher proportions of self-medication were found among the users of gastrointestinal drugs By contrast, the proportions of self-medication with antibiotics In addition, the highest proportion of participants who self-medicated resided in Jungle, while the lowest proportion were those from the Highlands region Table 2. General characteristics of the elderly users of drugstores and pharmacies according to self-medication a. Refers to the statistical significance obtained from the comparison of the proportions between the categories of the variables, considering the complex sampling design of the survey. By contrast, the probabilities of buying OTC drugs for cardiac pathologies 7. Types of medicine purchased by the elderly according to the use of brand-name and over-the-counter drugs a. The proportion of brand-name drug purchases was higher in the participants who resided in Metropolitan Lima On the other hand, the proportion of purchases of brand-name medicines was lower among those who had health insurance Likewise, the proportion of brand-name medicine purchases among those who self-medicated was higher. However, it only had marginal statistical significance In the analysis according to the use of OTC medicines, self-medication was associated with a greater purchase of OTC medicines Similarly, those who bought OTC medicines were older on average General characteristics of elderly users of drugstores and pharmacies according to the use of brand-name and over-the-counter drugs a. Crude prevalence ratio and adjustment for the use of brand-name and over-the-counter drugs according to self-medication in older adults. A generalized linear model of the Poisson family was used with link log, considering the effect of the design and weights of the complex sampling design of the survey. Adjusted for age, sex, educational level, language, health insurance, geographic region of residence, and type of institution. Additionally, we evaluated the differences between OTC drugs and brand-name drugs. We found that eight out of 10 OTC medications were brand-name Only six of 10 controlled sale drugs were brand-name These differences were statistically significant. The present findings show that two of three Peruvian older adults self-medicated, two of three bought brand-name drugs, and one of four bought OTC drugs. Thus, an association was observed between self-medication and the higher probability of buying brand-name and OTC medicines in older adults in Peru. The frequency of self-medication in older adults has been increasing, as observed in other countries. For example, a study using microdata from the European Survey of Health Interviews — showed that the prevalence of self-medication in older European adults was On the contrary, the prevalence of self-medication in older adults in the present study was lower than that in a Brazilian study which found a prevalence of However, various criteria were used to measure self-medication, where some studies identified periods of up to one year, increasing the probability of self-medication or memory biases in older adults over a longer period. This study did not monitor older adults, but only assessed self-medication on the basis of whether a medical prescription was presented during the purchase of medicines in drugstores and pharmacies in Peru. In Peru, although the population covered by health insurance increased from Older adults are most affected by ineffective access to medicines, which probably also explains the The increase in health insurance coverage has not been homogeneous. This coverage in the Jungle region has not changed significantly from to Similarly, people from this region have problems accessing intercultural health services, despite the advances made to address this issue in the country, 32 limiting the access of Quechua-speaking patients even though they have health insurance. Though with some similarities, the type of drugs also varies between countries. In Brazil, the most widely used drugs for self-medication were centrally acting muscle relaxants, analgesics and antipyretic agents, NSAIDs, and antirheumatic drugs. The findings from this study indicate that although older adults with health insurance buy brand-name drugs, this may be related to the perception of the efficacy of these drugs in the study population. A nationwide study in Peruvian hospitals showed that A study of the acceptance of generic drugs by users from the low-income sectors of Metropolitan Lima showed that, despite the high consumption of generic drugs, this acceptance was linked more to economic capacity than to trust toward this type of medication, as there are doubts about its safety and efficacy. The prices of drugs vary according to the type of pathology, and this variation could explain the more frequent use of generics for cardiovascular diseases in this study. For example, in , the brand-name box of Enalapril 10 mg with 30 tablets cost USD 2. Self-medication is not always considered as a negative behavior when practiced using OTC drugs. Therefore, it can signify a sign of self-care that emphasizes the role of each individual in their health care. The list of OTC medications is established by the General Directorate of Medicines, Supplies, and Drugs, which also supervises the compliance with their supply. In this study, a quarter of older adults self-medicated with OTC. On the contrary, a Brazilian study showed that OTC medications are usually considered to have fewer adverse effects than prescription medication drugs. However, recent studies have warned about the risks associated with their use. In France, a study investigated the main adverse drug reactions by using data from a pharmacovigilance database and found that they were mainly caused by NSAIDs, analgesics, and benzodiazepines. On the other hand, a study found that in the United States, around half of all adults had used at least one dietary supplement in the past month. The use of micronutrients was involved in The potential risk from self-medication to which older adults are exposed is evident. Thus, interventions and public policies must be developed to integrate the commitments of those involved, the health insurance system, and pharmacies. Thus, this study highlights one of the potential interventions that have been developed to reduce the frequency of harmful self-medication in older adults. Integrated care for older people iCOPE is a proposal for care adapted to older adults at different levels of care. In Peru, health insurance coverage increased among patients over 65 at Our results showed that the majority of OTC drugs were brand-name. Therefore, strategies must also be directed towards the regulation and availability of more OTC and non-OTC medicines that are generic medicines in order to reduce out-of-pocket costs when there is no access to health insurance. This study has limitations. First, as a secondary analysis, questions pre-established in the survey were used for the study variables. However, these questions have been elaborated by experts from the National Institute of Statistics and Informatics of Peru. Second, as a cross-sectional study, the evaluation of the association between self-medication and the proposed outcomes is not necessarily causal. However, the study design allowed assessment of this association with adjustment for potential confounding factors, following an epidemiological model. Third, selection bias might have resulted from the inclusion of patients who went to pharmacies, even though selecting the first sampling unit was probabilistic. Finally, some variables, such as family members at home, comorbidities, and cognitive impairment, could be addressed in future research to better understand self-medication and the purchase of brand-name and OTC drugs. Self-medication was present in two-thirds of the Peruvian older adults in this study. A quarter of them bought OTC drugs, and two-thirds bought brand-name drugs. Thus, self-medication with brand-name and OTC drugs was more likely in the older adults in Peru. As a library, NLM provides access to scientific literature. Can Geriatr J. Find articles by Benoit Mougenot. Find articles by Jerry K Benites-Meza. Find articles by Maria A Boyd-Gamarra. Find articles by Fernando M Runzer-Colmenares. Find articles by Vicente A Benites-Zapata. Collection date Mar. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Type of Medicine Purchased by the Participants.

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