Understanding Complex Older Adult Decision-Making while Selecting Over-the-Counter Medication from the Community Pharmacy: A Hierarchical Task Analysis
Event Type
Oral Presentations
TimeFriday, April 162:20pm - 2:40pm EDT
LocationPatient Safety Research and Initiatives
DescriptionIn the US, older adults disproportionately consume 30% of over the counter (OTC) medications but only account for 13% of the population. What is unsettling about the prevalence of older adult OTC use is that certain OTC medications have been correlated with such geriatric outcomes as falls, worsened adherence, and increased frequency of adverse drug effects (ADEs). Older adults are required to make more complicated decisions when selecting OTCs (because of age-related changes in the body, developed comorbidities, and/or increased medication regimen) but are sometimes less capable of making these decisions because of the increased likelihood for cognitive impairment. It is no surprise older adults are 2-7 times more likely to experience an adverse drug reaction compared to younger adults. Combined with the evidence that indicates most older adults are not familiar with the need to determine if OTC medications interact with their other medications or how to appropriately dose an OTC medication, the lack of provider awareness that OTC medications are being consumed by older adult patients may lead to the duplication of therapies and dangerous overdosing. Therefore, it is largely the responsibility of the older adult to select safe OTC medication options to treat minor conditions. Yet, we know very little about how older adults make decisions when selecting and using OTC medications, making it nearly impossible to effectively design patient-centered interventions to improve older adult OTC medication safety.

This presentation will share the findings of a study that aimed to discover the cognitive decision-making process older adults utilize when seeking to self-medicate with OTC medications. This study is a task analysis using a subset of think-aloud interview and video data collected from a larger study that aims to improve older adult OTC medication safety by implementing a system-redesign intervention. A representative sample (n=12) of the 87 participants were included in this sub-analysis, determined by data saturation. Hierarchical task analysis (HTA) was performed and a HTA diagram was constructed consisting of 8 goals and 15 sub-goals. This analysis demonstrated older adult decision-making is far more complex than just picking OTC medication off the shelf in the pharmacy aisle. Factors that are important when selecting OTCs change considerably over time. Although older adults are experts in self-medicating using OTC medications, there are new age-related invisible challenges (e.g., memory loss, physiological changes) that are being largely ignored in their existing mental model about OTC medication safety, selection, and use.

The implications of these findings suggest that we, as healthcare providers and researchers, can be doing more to facilitate safer older adult decision-making surrounding OTC medications. In this presentation, I will discuss how HTA can be used as a tool in future innovative research seeking to improve older adult OTC medication safety when shopping in the community pharmacy setting, by designing thoughtful, systems-focused interventions that alter the salience of critical sub-goals. For example, HTA-informed decision profiles can provide pharmacists and others critical insights into safety issues that older adults may not be considering, such as factors related to safety, strength, or appropriateness of OTC for symptoms. This presentation will focus on the benefit of using hierarchical task analysis, an analysis tool grounded in human factors principles, in this research that seeks to understand how these patients select over-the-counter medications.