The objectives of this study were to establish the level of prescription drug safety knowledge in older adults and assess pharmacy readiness to promote prescription drug safety in pharmacies. In the first part of the survey, patients indicated high levels of belief about the issues surrounding interactions between alcohol and prescription medication, with women tending to show a greater understanding. However, across genders, participants were not very aware that alcohol consumption at any level can be harmful, and that it is important to refrain from drinking more than one drink a day. These latter two findings suggest that while participants were mostly aware that alcohol and prescription medications can interact with undesired consequences, they were less aware of how even low levels of alcohol consumption can be harmful, and that they should monitor their personal levels of alcohol consumption.
The majority of participants drank alcohol, averaging almost a drink per day across genders, which is in accord with previous research.43
Regardless of drinking status, the participants appeared to be knowledgeable about the harmful effects of alcohol, but responses to most questions about safe alcohol and prescription drug use reveal that only half of the sample correctly identified harmful interactions between the two, making this domain a particular area of concern in our study. Further, our results indicate that women tended to have greater knowledge of prescription drug safety, but appeared to be less willing than men to talk to a doctor about interactions between alcohol and prescription medication. This gender difference contradicts prior literature that has found older women to be more likely to make healthy behavior changes than older men.41
Unfortunately, there is a dearth of literature addressing prescription drug safety, making it difficult to interpret the gender differences found in this study.
Of note, individuals who consumed alcohol were less knowledgeable about prescription drug safety, and less willing to talk to others about safe use of these substances. Considering that overall levels of prescription drug safety knowledge and practice in this sample of older adults was low, it is of particular concern that older adults who had consumed a drink in the recent past were even less knowledgeable about prescription drug safety, because they are at greater risk of experiencing harmful side effects as a result of interactions between alcohol and prescription drugs.7
Further, almost all participants reported having never experienced an alcohol and prescription drug interaction, but participants’ low level of prescription drug safety knowledge and motivation to change prescription drug safety habits suggest that they might not know whether they have actually experienced an alcohol and prescription drug interaction. This notion is bolstered by the fact that half of participants did not even know a specific drug interaction for a drug they were taking and were not able to detail which of their medications should not be taken with alcohol. This finding is concerning, given that most older adults take at least one prescription medication that can interact with alcohol.11
In sum, our findings for the first part of this survey indicate that older adults do not have an adequate understanding of prescription drug safety and how alcohol can interact with prescription drugs, in particular, with regard to: beliefs, there was inadequate understanding that alcohol can be harmful; behavior, individuals were not consulting with doctor or pharmacist about alcohol and medication interactions; knowledge, inadequate knowledge about healthy alcohol consumption levels, over the counter medication and alcohol interactions, and harmful alcohol and prescription medication interaction outcomes; literacy, inadequate level of drug-interaction literacy; and motivation, moderate motivation to promote safe alcohol and prescription drug use. Most importantly, inadequate prescription drug safety was especially true for those who drink alcohol; about two thirds of the sample reported consuming alcohol, and were thus at an inherently higher risk of suffering interactions between alcohol and prescription drugs.
The second part of our survey revealed that pharmacists were willing to administer brief interventions to older adults in order to increase their knowledge about prescription drug safety. This finding is encouraging in light of research indicating pharmacists are concerned that older adults may react negatively in response to brief interventions.45
Brief pharmacist interventions would likely increase older adults’ awareness of prescription drug safety, given that prescription warning labels are apparently not an effective means of warning older adults of the dangers of prescription drug and alcohol usage.
Alarmingly, research has shown that one third of older adults do not even look at prescription warning labels, and the remaining two thirds do not attend to the information as much as younger adults do.46
This pattern has the unfortunate consequence of reducing one’s memory for the warning, particularly for older adults. However, when older adults do pay attention to the warning label, they tend to remember the information at a later point in time. As such, these findings suggest that increasing older adults’ awareness of prescription drug safety will help them to retain that knowledge in the future.
Notably, pharmacists preferred a one-minute or 5-minute intervention to a 10-minute intervention, and research has indicated that brief interventions can be effective at reducing alcohol consumption.17
While such interventions appear to be more effective in men than in women, it should be noted that most participants reviewed have been men. Regardless, it is feasible that brief interventions with older adults explaining potential interactions between prescription drugs and alcohol might reduce alcohol consumption in men and potentially in women. Given that adults taking prescription medications tend to feel that pharmacists in particular are doing a good job at ensuring prescription drug safety,47
future studies assessing the benefits of pharmacist-based interventions promoting prescription drug safety are likely to yield encouraging results.
Another important finding from this study is that rural pharmacists in particular appear to be more willing to engage in in-depth consultations or screenings with patients than urban pharmacists. This result is particularly noteworthy, given that rural pharmacists reported being open for fewer hours and dispensing fewer medications than urban pharmacists. It is plausible that rural pharmacists feel a greater need to intervene with their clients given that they do not have as many opportunities to do so. Alternatively, it could be the case that urban pharmacists do not feel that they have the extra time to devote to educating clients about the dangers of alcohol and prescription drug use. However, given urban pharmacists’ willingness to disseminate relevant prescription drug safety information to older adults, it is feasible that brief pharmacist-based interventions would be particularly effective in rural environments.
While this study adds to the existing literature by identifying prescription drug safety knowledge in older adults, there are a number of factors that limit the generalizability of our findings. Demographically, the sample was 93.8% white, with an average of 16.89 years of education, and an annual income of USD 64,000. These demographics differ from older adults in the US, who are approximately 80% white,48
fewer than half of whom have a bachelor’s degree,49
and report a median personal income of USD 19,000.50
Kentucky state statistics indicate older adults are 88% white, 21% have a bachelor’s degree or higher, and a mean household income of USD 58,904.51
Given these characteristics, it is difficult to know whether our findings are relevant for minorities, those with little education, or older adults with low incomes, for example. Future studies addressing knowledge of prescription drug safety should aim to include these underrepresented groups. Another limitation is that most participants reported never having experienced an interaction between alcohol and a prescription drug, even though they were unaware of potential interactions with the medications they were currently taking. This lack of awareness makes it difficult to determine whether participants would even be able to identify an alcohol and prescription drug interaction, were they to experience one. Future studies might ask participants to choose from a list of potential interactions instead of asking an open-ended question. It is also possible that changing the order of the questions could provide more accurate responses, so that participants are first asked about potential interactions with their own medications and then about which interactions they have personally experienced. Lastly, neither sample of participants (older adults or pharmacists) was randomly selected, making it difficult to know if nonresponse bias could have influenced the results. It is possible that older adults who chose not to participate were less knowledgeable about prescription drug safety, or that pharmacists who did not participate were less willing to intervene with older adults. Future studies will ideally employ a random selection of participants or utilize a larger sample of participants to reduce this potential bias. Finally, it is extremely important to note that the surveys utilized in this study require analysis of psychometric properties. For the purposes of the study objectives, with the exception of the alcohol and literacy components, the survey items were created under the assumption of face validity because no existing surveys were identified. Future research that examines psychometric properties would increase the reliability of such study findings.
In sum, the results of these two surveys show that older adults have inadequate knowledge of prescription drug safety and potential interactions with alcohol, and that pharmacists in both rural and urban settings are willing to intervene in order to raise awareness about prescription drug safety issues. Such interactions between pharmacists and older adults would likely lead to fewer medical visits as a result of fewer alcohol and prescription drug interactions requiring medical attention. Fewer medical visits would, in turn, lower the medical costs incurred by older adults misusing alcohol and prescription drugs. As such, future research should focus on pharmacist interventions designed to increase awareness of prescription drug safety and alcohol use in older adults.