Preventive Health Therapy and Behavior Outcomes From a Brown Bag Medication Review for Older Adults

Feng Chang PharmD; Mary Beth O'Connell PharmD; Megan E. Mills PharmD; Jamie M. Hwang PharmD; Hanan S. Khreizat PharmD; Candice L. Garwood PharmD; Ashley Houser PharmD


J Am Geriatr Soc. 2022;70(9):3202-3209. 

In This Article

Abstract and Introduction


Background: Morbidity and mortality associated with preventable diseases can be reduced with the use of preventive health services. We evaluated the uptake and retention of preventive health behaviors and management of accidental medication poisonings in older adults after a health prevention educational component was combined with a brown bag medication review.

Methods: This study used a cohort design and was conducted in six urban senior centers and three independent senior living communities in Detroit, Michigan. Participants included 85 older adults (>60 years old) taking five or more medications with 63 participants returning follow up materials. Pharmacy personnel conducted brown bag medication reviews that were combined with a preventive health education component. Information was collected on medications, vaccinations, supplement use, and accidental medication poisoning management. Participants were given written recommendations on prescription medications and preventive health therapies to improve health and medication use. An investigator developed program satisfaction survey was administered immediately after the review. An investigator-developed follow-up preventive health implementation survey was conducted at least 3 months later to assess recommendation implementation.

Results: Participants' mean age was 75.9 ± 8.5 years. Fifty-six older adults had 124 recommendations in preventive health in total (1–5/participant). Eleven participants had no recommendations. Sixty-three participants (74%) returned follow-up preventive health surveys. Twenty-three percent of recommendations were already implemented with 34% planned to be done in the future. Poisoning management knowledge increased for 13 participants, reporting they would call the poison control center. The program was well received, with participants reporting high satisfaction scores (4.8 ± 0.7 out of 5).

Conclusions: Brown bag medication reviews can be an effective method to promote the uptake of preventive health behaviors among older adults, but additional accidental medication poisoning management education is still needed.


Preventable diseases are placing high financial and social demands on people and communities worldwide.[1] With an aging population, the prevalence of chronic preventable diseases is on the rise.[2] Preventive health services, such as vaccinations and aspirin prophylaxis, can reduce morbidity and mortality.[3] Patients who manage their chronic conditions are more likely to seek out, or be interested in, preventive health services.[4] With the optimal implementation of preventive care services, it is estimated that 42,600 deaths per year could be avoided for individuals under the age of 80 years.[5] Fifty-five percent of these preventable deaths would occur in older adults 65–80 years old.

Although older adults have access, many lack preventive health care. Only 25% of adults aged 50–64 years, and approximately 50% of adults aged 65 years or older, are up to date on their preventive health therapies (e.g., medications and vaccinations).[6] Preventive health therapies are highly recommended for older adults as age-related physical decline increases susceptibility to illness.[7,8] Preventive health services that are targeted to older adults include vaccinations against influenza and pneumonia, vitamin D for falls prevention, and screening for hypertension, hypercholesterolemia, and cancers.[9,10] Vaccinations, specifically influenza and pneumococcal, are among the most efficient methods for preventing infectious disease-related deaths.[11–13]

Death due to accidental poisoning, which has increased dramatically over recent years, is another preventable health issue.[14] In the last two decades, a fourfold increase in the age-adjusted accidental drug-poisoning death rate (per 100,000 people/year) has occurred in the United States. Although the factors driving this change remain unclear, a recent emphasis on the need to strengthen overdose prevention programs and policies has occurred.[15,16] Poison prevention education and the creation of appropriate action plans, such as contacting a Poison Control Center, can provide rapid, time-sensitive expertise for critical situations in underserved populations (e.g., older adults, low-income, and rural populations).[17] Time constraints on health care providers that inhibit poison prevention education could also be a contributing factor, creating a need for further patient education and the creation of poison preventive programs.[18]

One potential method that could aid in the delivery of preventive health services and patient education is a brown bag medication review. In a brown bag medication review, the entirety of the patient's medical history and current medications (including prescribed, herbal, and over-the-counter medications) is reviewed by a pharmacist using the information provided by the patient in a single appointment. This model is useful in community settings and health fairs where accesses to primary care providers and/or medical records are not available. Previous brown bag programs have minimized medication misadventures, corrected medication use, identified adherence issues, and assisted with patient education.[19–23] To date, brown bag medication reviews have not yet been evaluated for their potential use in the delivery of preventive health and management of accidental medication poisoning education. In this study, the effectiveness of a brown bag medication review to act as an education avenue for older adults to increase their preventive health behaviors and knowledge about correct treatment of accidental medication poisoning was evaluated.