Over-The-Counter Medicines And Their Impact On Seniors

Introduction

Pharmacological treatment is one of the most common ways for people to manage their diseases and obtain relief with time. Still, as soon as people get access to various drugs, they should get some education and support from healthcare professionals to avoid undesirable outcomes. With aging, the need for medicines rises, and seniors face the challenge of polypharmacy or the usage of more than five drugs simultaneously (Hales, Servais, Martin, & Kohen, 2019). This practice influences people in a variety of ways, including the possibility of buying over-the-counter (OTC) medicines. This paper aims at analyzing the opinions of nurses and older adults about the possibility of using OTCs by seniors and the effects of this decision on human health. The author will discuss and review several articles and studies that explain the idea of OTC use with aging.

OTCs represent a group of drugs that remain available for citizens without a prescription. Their impact is ambiguous because, on the one hand, they help relieve symptoms and pain quickly, and, on the other hand, they may develop addiction and lead to new health problems (Ylä-Rautio, Siissalo, & Leikola, 2020). In most cases, a patient has to address a local clinic, share a chief complaint, take several diagnostic exams, and be properly diagnosed to get a prescription. This procedure is usually required when a person is not aware of the root of his or her problem and expects a professional opinion about the current condition. Still, if more information about pain or discomfort is available, people are free to visit a local drugstore and find the necessary OTC. It does not take many efforts to buy aspirin or acetaminophen to manage pain and fever, phenylephrines to deal with cold, or antihistamines to predict allergy complications.

With age, the number of complaints among seniors grows, and people want to have as many drugs as possible to treat their chronic conditions, prevent blood pressure, or reduce pain within a short period. Unfortunately, if a person relies on personal experience only, multiple medications may provoke unwanted side effects. Seniors become more sensitive to some medications with time, and they do not want to ask a medical care provider for some pieces of advice or recommendations. More than 69% of American adults aged between 40-79 use more than one prescription drug officially (Hales et al., 2019). The number of people who buy OTCs is hard to predict as pharmacists or family members are the only experts who more or less have access to this information but do not find it necessary to share facts. In other words, it is difficult to check and help all people who use OTCs from time to time, but seniors remain a vulnerable part of the population. Therefore, human age turns out to be a crucial factor in managing OTCs today.

Background and Significance

In many countries, it is possible to buy a number of drugs that are legally allowed. The benefits of such an opportunity include cheap and fast health care and help. People believe in the law that allows using some drugs without a prescription, and healthcare organizations review this public access regularly. As a result, patients prefer to visit a pharmacist and use OTCs instead of visiting a doctor and assessing a condition (Marathe, Kamat, Tripathi, Raut, & Khatri, 2020). They cherish their freedoms and do not want to disclose their information to physicians or the laboratory staff for different personal reasons (Marathe et al., 2020). It is normal to develop various attitudes to OTC practice: self-care management is highly appreciated to save time and control symptoms, but it may be harmful without education. People find it enough to read the instructions and follow the required dosage.

The Problem

OTCs are medicines that do not need a prescription because they are defined as safe and effective if all the directions on the label are followed. Still, not all older patients are aware of the adverse effects of drugs they choose for regular usage. For example, due to their uncontrolled interactions, OTCs may result in increased blood pressure, cardiovascular toxicity, hyperglycemia, and renal dysfunction (Stone et al., 2017). People expect OTCs to bring benefits to their health and the possibility of controlling their insignificant health problems individually, without scheduling another doctor’s appointment. Some nurses and doctors also consider such medications as positive because they get a chance to focus on patients who require more serious medical attention. However, self-treatment has its shortages, and seniors must understand that their conditions hardly get better with age. Older people must take responsibility for determining safe dosage and understanding side effects. Nurses have to identify possible risks with their conditions and deliver information. OTC practice does not include the explanation of free from prescription medications’ impact on seniors, and sometimes, improvements are necessary for people to avoid unwanted complications.

Purpose of the Research

This evidence-based project (EBP) aims at exploring current information about OTCs and defining the opinions and knowledge of nurses and seniors about these types of drugs. The first task is to gather credible literature on the chosen topic and analyze the already obtained findings in this area. This background will be enough to understand why people use OTCs, under which conditions they prefer self-treatment instead of addressing a professional healthcare provider, and what outcomes are observed. The second step is to communicate with nurses and seniors in order to clarify their personal attitudes toward OTCs and readiness to improve this practice within a short period. Finally, regarding the literature review findings and survey results, a guideline about the effects of OTCs on seniors will be developed. An overall goal of this EBP is to investigate the nature of OTC-related outcomes on seniors and introduce a solid background for practice improvement by increased communication between pharmacists and ordinary people and brief, free, educative courses or brochures.

Implications for Nursing Practice and Research

It is expected to advance nursing practice by exploring OTCs’ characteristics and contribute to the development of new programs with the help of which people can learn more about how free-from-prescription medicines affect seniors. Pharmacists are the only medical workers who cooperate with people in drugstores and provide them with OTC medicines. The process of buying does not require much knowledge or assessment – a person enters the store, names a medicine, pays money, and leaves. OTC safety risks grow by the increased number of adverse effects, hospitalizations, and even deaths (Shah et al., 2020). For example, more than 178,000 hospitalizations are reported annually because of adverse drug events due to OTCs, and about one million older adults are at risk (Chui et al., 2017). This EBP project focuses on the evaluation of the current situation and sharing data about the existing threats to underline the role of nurses and pharmacists in OTC practice. Further implications for nurses include improved communication with seniors at hospitals and drugstores and free counseling about the use of OTCs at home.

Research Question

The main research question in this project is “What are the effects of OTCs on seniors that may be predicted and managed by in-time nursing counseling?”.

Hypothesis

The null hypothesis is that there is no statistical significance between additional counseling for people who use OTCs and the development of adverse effects of free-from-prescription medicines on seniors.

The major hypothesis is that there is a statistical significance between free counseling for seniors and the possibility for seniors to buy OTCs independently.

Research Variables

OTC medicines introduce a group of independent variables in this EBP project. It means that the characteristics of OTCs do not change during the study.

The dependent variables are the nurses’ communication with older adults, the outcomes of OTCs on seniors’ health, and the reasons for buying OTCs without professional counseling and prescriptions.

Theoretical Model

The theme of OTCs and how they affect seniors can be accessed from multiple perspectives, and one of them is human behavior. People are free to decide whether to buy medications without a prescription or address a healthcare professional to make sure their choice is correct. Therefore, in addition to analyzing the characteristics of OTCs and their effects on people, behavioral patterns have to be identified in this study. Kamekis et al. (2018) recommend the theory of planned behavior (TPB) to be implemented for evaluation of patients’ intentions to consume OTCs. This socio-psychological theory helps comprehend people and why they prefer unsafe behaviors. The relationship between human beliefs and behaviors has already been examined, but there are many external factors that may bring new conditions. Therefore, the TPB is necessary to understand and predict human actions through three variables, namely subjective norms, control, and attitudes (Kamekis et al., 2018). When a person decides to buy OTCs, certain norms and attitudes are taken into consideration, while poor or no outside control is observed. The TPB is necessary to develop an appropriate questionnaire for a survey in this EBP project.

Assumptions of the Model

The main assumption of the TPB is that humans demonstrate rational and critical thinking before they take some actions. The consumption of OTCs is one of the possible activities in which seniors are involved. According to the TPB, it is possible to ask people about their intentions to behave in this specific way and clarify if their attitudes correspond to the existing norms and available forms of control. Kamekis et al. (2018) were the first who use the TPB to analyze people’s intention to consume OTCs and other medication. This EBP project is based on their findings to apply the same theory within a narrowed context – the OTC choice of seniors.

Review of Literature

Introduction

This chapter aims at investigating and synthesizing the studies about OTCs and their impact on seniors. Any EBP project is based on the knowledge of researchers on the current topic and evaluation of the offered material within the chosen context. First of all, it is necessary to identify the variables with the help of which the sources will be found and used in the project. The second step is the review of literature that reveals findings and contributes to the background of a new project to improve nursing practice. Finally, the researcher will discuss the offered theoretical framework (the TPB in this case) and the ways of how it can be applied to answer the research question and prove the hypothesis. In other words, this section is a step that allows learning what has already been discovered, if there are any significant gaps in the literature, and if any further research makes sense.

Major Variables

As it has already been said, there are dependent and independent variables in this EBP project. The use of OTCs is an independent variable that has a direct effect on seniors and their behaviors. It cannot be changed during the research process, and the review of literature aims at introducing its clinical characteristics. The description of OTCs is a necessary research background to explain the existing dependent variables. In this study, they are the reasons why seniors choose to consume drugs without prescriptions, communication with a healthcare or medical expert, and the outcomes these drugs could have on older adults. People demonstrate different attitudes toward OTC medicines, and the conditions under which they buy and use them depend on programs and policies in nursing practice. The task is to classify the reasons (attitudes toward behaviors and subjective norms), educative communication (control means), and outcomes (positive and negative effects of OTC on seniors).

Review of Literature

When patients are sick, they have several ways to follow: appoint a meeting with a doctor and get professional help, visit a local drugstore and pay some OTCs, or wait some time to see the development of the events. If a person does not have an opportunity to get the doctor’s counseling and pain is critical, the consumption of a drug is the only reasonable decision at the moment. Stone et al. (2017) interviewed the locals of the mass-merchandise store in south-central Wisconsin and found out that sleep medication and pain relievers are the most commonly misused drugs. Older adults comprise 13% of the population in the United States, and 30% of them use and combine several OTC and prescribed medications simultaneously (Stone et al., 2017). When a doctor appoints several drugs as a part of a treatment plan that is developed after the necessary diagnostic tests, he or she takes responsibility for outcomes. When a person stops using them, changes them for available OTCs, or replaces without permission, the level of responsibility has to be re-evaluated.

The history of the usage of OTC medicines by older adults is long and meaningful. The main reasons for choosing OTCs are related to greater freedoms, fast help, and self-control. In addition, some seniors believe that their experience and past medical history make them sufficient enough to decide without additional medical counseling. They use OTCs to control their blood pressure, relieve pain, and solve digestive problems. According to Marathe et al. (2020), OTCs are drugs that are legally allowed to be available for ordinary citizens and sold by a pharmacist without a prescription. It is possible to purchase a specific medication in most countries, achieving fast and cheap health care. Although many OTCs are defined as safe and helpful, Sobczak and Goryński (2020) remind that some medications, including opioids like codeine, loperamide, and dihydrocodeine, are misused. Problems occur due to the fact that their mechanisms of action depend on enzymatic activity and protein functions that vary in patients (Sobczak & Goryński, 2020). Still, aspirin, ibuprofen, and acetaminophen are available with no risks being recognized (Chui, Stone, & Holden, 2017). Regarding such multiple outcomes and opinions, researchers continue investigating OTC impact.

One of the factors to approve the effectiveness of OTCs is its connection to self-care. The concept of self-medication has already been identified by professional organizations as the use of medicines by people to treat illnesses that are self-recognized without consultation with a care professional (as cited in Bekele et al., 2020). Self-medication was considered unnecessary and even dangerous because people could not identify the severity of their decisions. With time, pharmacy and medical students were allowed to promote self-medication as future health care practitioners (Bekele et al., 2020). The researchers conducted a cross-sectional study to assess OTC medication use and other influential factors (Bekele et al., 2020). It was revealed that dosage inadequacy, the progress of adverse effects, lack of attention to expiration dates, and inappropriate storage of the already used medicines OTCs create danger for participants. Sobczak and Goryński (2020) reviewed the articles from several online databases and concluded that OTC medicines could be misused unintentionally or for non-medical intents. The limitation of their study is the focus on particular drugs without establishing the definite boundaries for demographic factors, which is crucial for the current EBP project.

People who are not involved in the field of medicine by their occupation directly put themselves in greater danger when they make a decision to use OTCs. A system redesign intervention consisting of three phases was applied by Chui et al. (2017) to evaluate the effectiveness of new practices in preventing misuse of OTC medications by older adults. The scholars admit that adults under 65 years are vulnerable to adverse drug events provoked by OTCs because of poor communication between seniors and pharmacists (Chui et al., 2017). Shah et al. (2020) introduced another scenario-based approach to prove that the use of OTCs has to be thoroughly investigated because factors like personal knowledge, perceptions, and unreasonable beliefs contribute to seniors’ decision-making. People want to believe that their skills and awareness are enough to make self-care independent decisions, but findings were not promising, and more cooperation and education were required. OTC drugs may not as dangerous as prescribed medicines, but the risk for addiction and health problems cannot be ignored. Medications for cough, fever, or allergy provoke different outcomes, and people without medical education do not understand how to manage their treatment.

Researchers introduce their studies to explain the nature of OTC adverse effects in relation to people of all ages, genders, and ethnicities, including seniors and their health characteristics. For example, Ylä-Rautio et al. (2020) conducted an observational study with a questionnaire survey as its research instrument to determine the number of OTC-related problems and prove the role of pharmacists in mistake prevention. Uncertainty about drug indication and insufficient knowledge about drug interaction or reaction should be the reasons for people not to buy OTCs and address their therapists. For example, an unintentional overdose of acetaminophen results in about 50% of acute liver failures annually (as cited in Chui et al., 2017). However, a more serious threat lies in the possibility of obtaining dangerous compounds from so-called safe OTCs. Desomorphine, also known as “Krokodil” is a codeine derivative that leads to poor concentration, decreased motor functions, and speech impairment (Sobczak & Goryński, 2020). Not many seniors are aware of this fact, and they can experience the side effects when they buy codeine to relieve pain or suppress cough. In their intention to improve the level of comfort, people neglect invisible threats.

Another important factor in OTC consumption is the impact of social and mass media sources and other people who could have some impact on seniors. Kamekis et al. (2018) used their cross-sectional study to investigate several countries, including Cyprus, France, and Turkey, and discover that family and friends play an important role in determining behaviors in relation to OTC practice. The process of information and medication exchange is simple: one person has some drugs and shares them with another person as a result of communication. This exchange may occur within one family or outside, when neighbors or friends are involved (Kamekis et al., 2018). Sometimes, seniors enlarge their knowledge about OTCs online or via media. However, if China and many European countries allow drug advertising in media, the United States uses the law to permit such marketing steps (Marathe et al., 2020). Although the spread of information about OTCs has certain benefits because people could learn more about the positive and negative effects of self-treatment, more control is obligatory to predict addiction, misuse, and overdose.

Older adults cannot stop using their medicines because they help control their health conditions and predict changes that may negatively influence their health. A qualitative approach with interviews organized by Shah et al. (2020) showed several elements that seniors consider when they make decisions to use OTCs. Some of them touch upon the sources of information, label instructions, decisions to stop consuming drugs, and safety implications (Shah et al., 2020). For example, patients can cease medications if they feel relief. If insignificant changes occur with time, it is normal to use some OTC drug and control pain or another discomfort (Shah et al., 2020). It also happens that pharmacists cannot offer the necessary medication to the patient and try to find an analog not to waste time and search for other options. If some OTCs can replace a prescribed medication, seniors prefer to use this option. However, not many seniors take caution while using OTCs or follow safety issues when decide to use it with another prescribed drug (Bekele et al., 2020). They need more attention from pharmacists and nurses to comprehend the level of responsibility for their health.

To understand the effects of OTCs on seniors, some researchers recommend identifying common health concerns among the chosen population. The intervention implemented by Chui et al. (2017) was necessary to prove that many older adults may have visual or cognitive impairment. Their chronic conditions made them dependent on some medications, but it is also impossible to predict all insignificant diseases like a cold or rash. The outcomes of OTCs vary in patients: some of them report heart attack or stroke, while others suffer from gastric reflux and stomach bleeding (Shah et al., 2020). The level of cooperation between seniors and their doctors depends on different factors, but, in most cases, older adults prefer to talk about their concerns but make independent decisions. Sometimes, they choose to talk to a pharmacist and discuss the expected and actual outcomes of OTCs (Shah et al., 2020). All these studies and findings prove that communication and the choice of informative sources are critical for adult patients.

When seniors prefer self-treatment with OTCs over professional counseling and communication, they complicate the risks of many medication-related problems. Drug-drug interaction is hard to predict or identify without a solid knowledge base, and older adults usually experience specific degrees of confidence about OTC safety (Shah et al., 2020). The pharmacological profile of every drug is unique, and it is important to understand that doctors investigate and examine the impact of every compound when they prescribe medications (Sobczak & Goryński, 2020). The factors that affect the choice of OTCs among seniors are less scientific, and older adults observe their current health issues, compare their past experiences, and analyze their financial and personal concerns (Shah et al., 2020). As a result, positive effects such as pain relief, health management, and temporary comfort must be considered together with negative outcomes like motor or cognitive impairment, weight changes, dizziness, and other complications.

Theoretical Framework

The evaluation of people’s decisions either to take OTC drugs or not prove the presence of multiple determinants, and one of them is a behavioral pattern. As it has already been mentioned, this EBP project includes the application of the theory of planned behavior. It was introduced at the end of the 20th century as the theory of reasoned action and improved with time on the basis of three variables (attitudes, norms, and control) (Kamekis et al., 2018). First, a person should ask if he/she wants to do something at the moment. This question allows identifying if some action deserves attention and effort. The next step is to ask what other people could think about this decision. In the end, it is important to clarify if there are enough resources and abilities to do that. The benefit of the chosen model is the analysis of personal knowledge, skills, and available recourses.

Each variable in this model has its purpose and impact on assessing human behaviors and decisions. For example, attitudes toward the behavior concentrate on behavioral beliefs according to which people are confident that their decisions bring certain outcomes (Ajzen, 2020). Subjective norms are used to find the approval of the chosen behavior. A person needs another person or a group of people to support behavior, remove social pressure, and comply with public opinions (Ajzen, 2020). Finally, perceived behavioral control is a variable that defines individual abilities and the possibility to control a situation. In his review, Ajzen (2020) specifies such control factors as time, cooperation, and money. In the TPB, all these factors affect people’s attitudes and subjective norms, which makes this model dependent on internal and external beliefs and resources. In this EBP project, the offered model allows explaining the process of buying OTCs by seniors and understanding of drug outcomes. The elements of the TPB are necessary for creating a survey and developing questions for nurses as potential participants of the study.

Summary

In general, this section contains a number of essential facts and information about OTCs, their positive and negative effects, and the peculiarities of the use of these drugs by seniors. People demonstrate different attitudes toward the possibility of buying medicines without professional healthcare and medical employees’ counseling. Older adults prefer to rely on their personal experience, knowledge, and past medical history to make the correct choice and reduce the necessity to visit local hospitals. However, as soon as they buy and use OTCs, they remove any responsibility from doctors and have to manage their health conditions independently. The review of the literature helps identify the main aspects of the chosen topic and promotes a background for further study. Besides, this synthesis determines the existing gaps and proves the worth of this EBP project as an attempt to improve practice and predict adverse effects. When older adults buy drugs without a prescription, they could have different reasons, but their awareness of the side effects and other safety risks has to be the same.

Methodology

Introduction

In this section, the researcher will discuss the methodological aspects of the EBP project. The outcomes of OTCs on seniors depend on many factors, and the goal of this study is to gather enough evidence, define the worth of clinical expertise, and consider patient values. The findings from the literature review could be used as evidence for this work. The next step is to communicate with nurses and the chosen group of patients (older adults). The opinions of these individuals are critical for improving current practice. It is not only an opportunity to see what is known about OTCs and their impact on seniors but also find out what people think about this decision to buy drugs without a prescription. Lack of knowledge about OTCs could lead to bad outcomes and increased risks of overdose or misuse (Bekele et al., 2020). This project promotes a survey for nurses and older adults from a living center to gather quantitative data with the participants’ perceptions to encourage or limit the use of drugs by seniors without a prescription.

Research Question

The question to be answered in this EBP project is “What are the effects of OTCs on seniors that may be predicted and managed by in-time nursing counseling?”.

Hypothesis

In this paper, there are two types of hypotheses for evaluation. A null hypothesis aims at proving that there is no statistical relationship between the dependent and independent variables). A research hypothesis is developed to define a scientific statement that shows the relationship between the variables. The following hypotheses are introduced:

• H₀: there is no statistical significance between additional counseling for people who use OTCs and the development of adverse effects of free-from-prescription medicines on seniors.
• H_A: there is a statistical significance between free counseling for seniors and the possibility for seniors to buy OTCs independently.

Identification of Setting

The setting for the study will be either home settings or a local senior assisted living center with nurses and older adults for cooperation.

Research Design

In this study, a quantitative approach will be applied to present a descriptive, exploratory survey. Attention will be paid to the opinions of nurses and older adults about OTCs and their effects on seniors. Exploring the perception of the participants allows recognizing the current knowledge about medicines that can be obtained at drugstores without a prescription. Description of OTC characteristics is an essential part of the study that demonstrates positive and negative outcomes on the chosen group of people. The descriptive design will be effective in identifying the relationships between dependent and independent variables. The quantitative design will be enhanced as a primary research method to select the most significant outcomes and improve practice. Regarding the fact that this study is a survey type to involve data from the population at a specific period, this research design is cross-sectional, with the possibility to measure the outcomes and exposures. Although non-experimental research is characterized by a low level of evidence, it aims at discussing the relationships between the variables, answering the research question, and proving the research hypothesis. The presence of a qualitative component has several important contributions.

All questionnaires will be developed by the researcher beforehand, relying on the TPB variables, namely attitudes, norms, and control. As a part of a questionnaire, several demographic factors like age, gender, and years of experience will be defined to prove the appropriateness of a sample. The next part of a questionnaire will be devoted to the level of the population’s awareness of OTCs’ adverse effects and positive experiences. Finally, several questions will be focused on seniors and the conditions under which they buy and use OTC medicines. The confidence level of the chosen statistical tests will be about 95%. Multiple regression analysis will be conducted on the basis of SPSS to determine the factors associated with OTC’s outcomes on seniors.

Population and Sample

A convenience sample will be applied in the study to make sure that this non-probability type includes participation from a group of people that is easy to reach. Participants will include nurses from a local senior assisted center and older adults in the region. Anonymous questionnaires will promote confidence and guarantees for all participants. Regarding the total population samples, it is expected to invite at least 20 nurses and 20 seniors for communication. The inclusion criteria for patients will be their age (older than 65) and the diagnosis of at least one chronic disease, which requires taking medications on a regular basis. The inclusion criteria for nurses will be their years of experience (at least ten years) and the area of experience (home settings or living centers where seniors receive traditional help and counseling). The exclusion criteria will be the field of practice (nursing or medical students, interns, and other healthcare workers, except nurses) and age for patients (younger than 65 years).

Measurement Methods

The essence of this nursing research is to examine the phenomenon of OTCs and their impact on seniors, which is why measurement methods are usually required. Several approaches can be applied in this case, and a questionnaire is probably the most effective and reliable tool, assessing the outcomes of OTCs on seniors. Every participant will get a separate self-reported questionnaire with an average content validity of 0.95. The first section will be simple questions for the participants to indicate their gender, age, health problems (for older adults), or experience (for nurses). Rating scales will be applied in several sections about the effects of OTCs on seniors and include such frequencies as “never,” “sometimes,” “regularly,” and “all the time.” One section will contain three scales, “agree,” “neutral,” and “disagree,” to identify the opinions of participants about the reasons and effects of OTC practice. In total, there will be three sections in every questionnaire.

Data Collection Process

Special attention should be paid to how questionnaires will be delivered to every participant. First of all, it is crucial to obtain approval from a local Institutional Review Board. The next step is to approach nurses and seniors and provide them with all the necessary material about the study and their role in this research. Informed consent is an obligatory requirement for any research project, including EBP. Then, the researcher will communicate with every participant to discuss a data collection process that is the most convenient for them. Two options will be offered: a printed questionnaire or the one delivered via e-mail. A two-week period is identified to accept an invitation and answer all the questions. Regarding the age of patients (older adults) and their possible health problems, some could face challenges while working with computers or other technical devices. Therefore, printed questionnaires with a large and clear font will be preferred. The anonymity of every participant will be protected, and all names or other possible identifies will be kept confidential and available to the researcher only. To predict invasion, password protection will be applied to store personal information.

Coding

The researcher should also take responsibility for the survey coding process that ensures reliable results in the study. There are three types of questions in this project, which means that three approaches to coding data are necessary. Likert-scale items will be coded from 1 for “never,” 2 for “sometimes,” 3 for “regularly,” and 4 for “all the time.” It is possible to use more than one code for this project, but it is also normal to use “agree,” “neutral,” and “disagree” as they are in the questionnaire. Demographic factors will be calculated the same way as their purpose is to present some background about participants. To obtain an equal value of all responses, it is planned to consider coding % of respondents, not their responses. If the researcher faces difficulties in understanding the nature of a coding system, the possibility to address for professional help should be identified and mentioned in budget planning.

Data Analysis

A data collection process represents a major part of this EBP project, and data analysis should not be neglected as it helps make sense of all previous steps. Surveys and questionnaires aim at gathering quantitative data for statistical analysis that may be organized in several ways like trend analysis, conjoint analysis, and gap analysis. Cross-tabulation is one of the most common quantitative data analysis methods, the tabular form of which identifies inferences between research variables. Each answer will be given by participants, and it is possible to calculate the response percentage. Cross-tabulation is a means to focus on each insight that is evident from answers to the offered questions. When multiple variables are used for the creation of one table, the researcher is able to narrow down survey results and specify an appropriate target audience.

Statistical Package for Social Sciences (SPSS) will be used to analyze research data. Chi-square analysis will be a part of multivariable logistic regression analysis to identify the relationship between seniors (the age of a person), OTC drugs, and their effects on the population. A p-value is expected less than 0.05 to declare its statistical significance. In medical and healthcare research, chi-square tests allow comparing the same condition in different people and analyze its incidence from different perspectives. This method of analysis will be effective for identifying and describing the effects of OTCS on seniors, the information about which is taken from personal questionnaires.

Bias

The success of research depends on several factors, and one of them is the possibility to recognize and deal with bias. In the current project, self-report questionnaires will be the main source of bias because the answers are determined by people of a certain age group and their unique interests, demands, and needs. Regarding the fact that all questions are developed by the researcher, this person can also be a source of bias. Either intentional or unintentional bias, it might result in false conclusion and mislead research. Therefore, its identification and discussion are necessary to reduce the deviation from true results.

Ethical Considerations

The study has to be approved by the appropriate research ethics committee and a local facility from which participants are chosen. Along with a two-week period to get approval and contact from participants, two more weeks should be added to gather information. Initial contact with seniors and nurses as the central participants and data sources will be accomplished by visiting healthcare facilities. Informed consent will be offered and obtained from each respondent separately to make sure they are aware of the purposes of the study and their roles and responsibilities. It is necessary to have verbal and signed consent and explain every step of a research process that requires nurses’ or seniors’ participation. Confidentiality and anonymity are the guarantees that a researcher should offer to all participants as this person is the only one who has access to this personal information. If a person wants to withdraw his or her participation, this right cannot be ignored and accepted without any additional explanations.

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