Medication Therapy Management in Hospitalized Elderly Patients

A Focus on OTC Agents

Lynn Chan, PharmD; Philip J. Gregory, PharmD, MS, FACN; Lee E. Morrow, MD, MSc, FCCP; Mark A Malesker, PharmD, FCCP, FCCP, FASHP, BCPS


US Pharmacist. 2016;41(10):HS16-HS21. 

In This Article

Abstract and Introduction


Despite the widespread use of OTC medications, many patients and healthcare professionals are not fully aware of the potential adverse events associated with these products. OTC agents can be associated with potential adverse effects upon multiple organ systems and numerous laboratory results. Elderly patients are more susceptible to adverse drug events compared to the general population. Many patients and healthcare providers also fail to add OTC drugs to their official medication list. It is critical that pharmacists recognize these concerns and identify appropriate monitoring parameters when completing a comprehensive medication therapy review that includes OTC products with each hospital admission.


Many patients, including the elderly, do not seek consultation with their healthcare provider or pharmacist before initiating OTC medications. OTCs are sold in over 750,000 locations in the United States, and the average American household spends approximately $340 per year on OTC products.[1] The seemingly endless product selection available, exacerbated by the trend for popular prescription products to become available OTC, has escalated concerns about potential adverse drug reactions (ADRs) in the elderly population, a large consumer group for these products. Like prescription drugs, the potential ADRs associated with OTCs can range from mild to severe and can be manifested by changes in the clinical condition of the patient or laboratory results. Reports have shown that adults >65 years of age represent 13% of the U.S. population but account for 30% of OTC medication use.[2] In addition, elderly patients represent 61.5% of emergency room visits associated with ADRs.[2]

As medication experts and thus essential members of the healthcare team, hospital pharmacists can help reconcile medications for the transition from outpatient to inpatient status. The challenge for the hospital pharmacist is to correctly identify the current medication list and refill history for both prescription and nonprescription drugs. One limiting factor is the lack of accuracy when it comes to the patient's list of OTC medications, as some patients do not think of OTC products as real drugs. The pharmacist can collect relevant OTC medication and compliance history from multiple sources such as existing patient records, the patient or patient's family members, and from pharmacies used by the patient. This information is necessary to address any potential medication-related problems and to optimize therapy.

An accurate medication list that includes a complete list of OTC products may result in early detection of medication-related problems and allow opportunities to reduce inappropriate use. Medication therapy management (MTM) also includes the evaluation of the patient to detect symptoms or adverse effects that can be caused by current medications and the interpretation, monitoring, and assessments of the patient's laboratory results.[3] As a result, it is essential that pharmacists be familiar with potential complications associated with the use of OTC products.