133 IJPP 2005, 13: 133–140 ß 2005 The Authors Received August 8, 2004 Accepted February 21, 2005 DOI 10.1211/0022357056217 ISSN 0961-7671 Faculty of Pharmacy, Department of Public Health Science and Institute for Human Development, Life Course and Aging, University of Toronto, Canada Peri J. Ballantyne, assistant professor Center for the Study of Aging and Human Development, Duke University, North Carolina, USA Philippa J. Clarke, postdoctoral fellow Faculty of Pharmacy, University of Toronto, Canada Joan A. Marshman, professor Judith E. Fisher, PhD research student Department of Public Health Science, University of Toronto, Canada J. Charles Victor, PhD research student Correspondence: Peri J. Ballantyne, Leslie Dan Faculty of Pharmacy, University of Toronto, 19 Russell Street, Toronto, Ontario, Canada, M5S 2S2. E-mail: p.ballantyne@utoronto.ca Acknowledgements: We thank two anonymous reviewers for helpful comments on the paper. Ms Miranda Mak provided assistance with drug coding. This research was supported by the University of Toronto Connaught Fund for New Faculty (to P Ballantyne). Use of prescribed and non-prescribed medicines by the elderly: implications for who chooses, who pays and who monitors the risks of medicines Peri J. Ballantyne, Philippa J. Clarke, Joan A. Marshman, J. Charles Victor and Judith E. Fisher Abstract Objective To examine overall medicine use and the prevalence and distribution of use of the different types of medicines by the community dwelling elderly; and to discuss the implications of these use profiles for the health of this population. Method We examined aggregate levels of self-reported use of prescription (Rx) and over-the- counter (OTC) medicines, and natural health products (NHPs) among community-dwelling elderly. Analysis focused on the relative balance of use of different types and combinations of medicines, and differences between five-year age categories, and sex. Setting Data are based on Canada’s National Population Health Survey (1996/1997), and reflect population estimates of medicines use (over the previous two days) by elderly persons living in Ontario, Canada. Key findings In the total population, and in age- and sex-groups, a quarter of respondents reported using no medicines; use of OTC medicines (56%) was more prevalent than use of prescrip- tion medicines (48%). Seven per cent of respondents reported using NHPs. The proportions of elderly people using combinations of different types of medicines are reported. Conclusion The study findings place the use of prescription medicines by elderly people in the context of overall use of medicines. Over half of the study respondents were using one or more OTC medicines. There is a need for further examination of how individuals select and gain access to medicines of different types (distinguishing medicines selected for the patient and those selected by the patient), who pays for those medicines (distinguishing insured products and those purchased out-of-pocket), and what role pharmacists and other healthcare professionals ought to play in mediating the potential risks arising from medicine use in the elderly population. Introduction Concern about the use of drugs by the elderly is typically analysed within the context of rising overall healthcare costs, and the increasing reliance on drugs in healthcare systems in the developed world. For example, in North America and elsewhere, drug expenditure studies show that drug costs are growing faster than any other type of healthcare expenditure, 1–3 with rising costs attributed to more (and more expensive) drugs on the market, and to greater use of drugs in the context of population ageing. 4–7 . An examination of studies investigating quantities of prescribed medicines, or individual use of drugs, reveals that among the elderly, multiple drug use or ‘polypharmacy’ is common, 4,8–16 and that the elderly receive more prescriptions and (self-) report using more prescription medicines and combinations of prescription/non-prescription drugs, when compared to other age-groups. 4,8,13–15,17 . This conclusion remains, irrespective of the time frame in which medicine use is quantified (point of interview, 12 preceding week, 8,9,16 past month, 4,17 past year 13–15 ), of the method used to determine medication use (self-reported use based on telephone interview 4,8 or mailed survey; 14 face-to-face interview with self-report only, 12,17 or with ‘brown bag’ or home medicine cabinet checks to verify self-reports; 9–11,16 prescriptions filled, as recorded in administrative data files 13,15 ); or of the definition of ‘drug’ used (prescription medicines only, 9,13,15 prescriptions and over-the-counter (OTC)