Child‐resistant Packaging and the Geriatric Patient

Abstract

Child-resistant packaging of prescriptions and over-the-counter medications has reduced the incidence of accidental overdose by 75 percent. While critics express concern about poorer compliance among patients confronting more difficult bottle closures, the documented protection of young children that the packaging affords supports continued reliance on it."-Previous attempts to identify the prevalence of problems with child-resistant packaging among the elderly have relied largely on anecdote, telephone surveys, and quest i o n n a i r e~.~~~ Two prospective studies of patients' ability to use child-resistant containers failed to separate the aged atient from younger cohort^.^,^ were unale to use the containers and only 22 per cent (13 of 59) were able to use them with ease. The majority of the patients were 70 to 79 years of age, although the range for the entire study was 42 to 90 years of age. In an American study,6 14 per cent (10 of 71) had ongoing difficulty with the safety-closure lids, whereas 75 per cent (53 of 71) had no difficulty or had overcome their difficulty in opening the containers. The average age of the patients in this study was 58 years (range, 22 to 87 years), but the authors did not provide separate findings among the older patients. We decided to prospectively test a group of elderly outpatients to document the prevalence of difficulty with childresistant packaging.In a British study, F 70 per cent (41 of 59 patients) METHOD the size most commonly dispensed by our pharmacy ( fig. 1). The bottle cap is clearly marked in large letters with the instructions "Push and Turn" and cannot be turned or pried off without first being pushed down. Patients were initially asked only to "please open and then close this bottle for me," and were surreptitiously timed with the second hand of a wristwatch. If patients failed to remove the cap within a short period of time (approximately 30 seconds), they were given a larger container with an identical closure ( fig. 1) and asked again to try to open the bottle. If they failed to open the larger bottle, they were given instructions on how to open the container, including a demonstration, and then asked to try to open the container a third time. The scoring sheet included notations about observed limitations to finger dexterity and strength and information on how patients stored and accessed their medications, at home. RESULTS The average age of our patients was 86 years, and all but one were men. Fifty-four (75 per cent) were able to open and properly close the smaller child-resistant container without difficulty. Of the 18 patients who failed to open the standard smaller bottle, four (6 per cent) were able to open the The Denver Veterans Administration Medical Center has a weekly outpatient geriatric clinic staffed by physicians, nurses, and medical students, which serves approximately 200 octogenarians (mostly World War I veterans) for a variety of medical and geriatric problems. During a 12-week study period, 72 consecutive patients (aged 78 to 95 years)...

Medication Use By Ambulatory Elderly

“…Physical limitations proved to be somewhat less common than we had anticipated 18 . Most elderly could open child‐resistant containers and read standard pharmacy labels.…”

Towards patient‐centered packaging design: An industry perspective on processes, functions, and constraints

“…It is not unusual that medication packaging becomes a burden in the friendliness emerged after that. [68][69][70][71] Child resistance and senior friendliness is a see-saw trade-off, meaning that the more one does to produce a child-resistant package, the more difficult it will be to open, and vice versa. An important consideration here is that protection in medication packaging not only relates to keeping the medication safe along its journey through the supply chain but also refers to the safe use of the medication, which includes avoiding misleading use or counterfeiting.…”

Quantifying the Ease or Difficulty Older Persons Experience in Opening Medication Containers

“…However, several observers have noted that the same containers which discourage entry by young children often provide an unwanted barrier to many adults 1–10 . In particular, an accumulation of anecdotal evidence, survey results, and clinical impressions suggests that elderly persons frequently find some child‐resistant medication containers difficult or impossible to open 1–10 . Despite this conventional wisdom, we could find no reports specifically assessing the relative difficulty experienced by older people in opening various containers.…”

“…T he Federal statutes and regulations requiring most prescription and many over‐the‐counter oral medications to be dispensed in “child‐resistant” containers are thought to have sharply reduced the incidence of accidental child poisoning since they became effective in the early 1970s. However, several observers have noted that the same containers which discourage entry by young children often provide an unwanted barrier to many adults 1–10 . In particular, an accumulation of anecdotal evidence, survey results, and clinical impressions suggests that elderly persons frequently find some child‐resistant medication containers difficult or impossible to open 1–10 .…”