Factors associated with the use of dietary supplement and

OTC medication in Bangladesh elderly patients

A project report submitted to the Department of Pharmacy,
University of Science and Technology Chittagong (USTC)
In the partial fulfillment of requirement for the degree of Bachelor of
Pharmacy Honors ([Link])

Submitted by
Examination Roll No:
Registration No: 1198
Session : January 2019
Batch: 28th

Department of Pharmacy
University of science and Technology, Chittagong
Foy's lake,Chittagong, Bangladesh
Submission Date:
Acknowledgement:
First of all,i would like to praise thank allah for his blessings and help in
the achievement of this research and preparation of this paper.I'm
really fortunate i had the kind supervision of my supervisor Syeda Ridita
Sharif ,assistant professor,department of pharmacy,university of science
and technology chittagong.I would like to give my heartfelt thanks to
her for continues support guidance and patience from the beginning of
my project work. Throughout the project work she encouraged me with
her skill of teaching which motivated me to be more passionate about
the project. I'm also very thankful our honourable chairperson abdul
motaleb bhuiya,chairperson,department of pharmacy,USTC,for his
continous inspiration and kind corporation during the project. Last but
not the least,i would like to thanks the faculty members of department
of pharmacy at USTC for their moral support,motivation and patience,
which all together enabled me to complete my project work
successfully.
 ABSTRACT

Background: The use of dietary supplements and over-the-counter (OTC) drugs is

increasing, and there is adequate concern about potential harmful effects.
However, there are limited reports on the concurrent use of nonprescription
medications with prescription medications in elderly patients. Therefore, this
study was conducted to describe the use of dietary supplements and OTC drugs,
and to identify predictors for their use in elderly patients using medications
prescribed for chronic diseases.
Methods: This was a cross-sectional study that enrolled 300 patients aged ≥80
years with chronic [Link] regarding socio-demographic status, medical
condition, number of prescriptions, use of nonprescription medications, and
psychological status were collected using a self-administered questionnaire and by
review of medical records. Data regarding use of dietary supplements and OTC
drugs were analyzed using descriptive statistics. Logistic regression analysis was
applied to investigate factors associated with the use of dietary supplements and
OTC drugs.
Results: The regular use of nonprescription drugs was reported by 80% of
patients. Vitamins were the most commonly used dietary supplements in elderly
patients. Female sex, higher educational qualifications, and good economic status
were identified as predictors for the use of nonprescription medications. The
disclosure rate of the use of nonprescription medications by patients to the
physician was 78%.
Conclusion: The use of dietary supplements and OTC drugs was common in
elderly patients with chronic diseases, and its use is associated with sex,
education, and economic status. General practitioners (GPs) need to recognize the
potential use nonprescription medications, considering that polypharmacy was
common and disclosure rate was low in this study.
Keywords: Dietary supplements, Over-the-counter drugs, Nonprescription
medications, Elderly, Polypharmacy.
 Table of content

SL No Title Page No
A List of Figure
Chapter 1
Introduction
1.1 Demographic context
1.2 Dietary supplements
1.3 OTC drug
1.4 Rationale for use
1.5 Challenges and risk
1.6 Regulatory framework
1.7 Research and awareness
Chapter 2
Aim of the research

2.1 Aim of the research

Chapter 3
Literature review

3.1 Literature review

Chapter 4
Research Methodology

4.1 Research methodology

4.2 Questionnaire sample
Chapter 5
Result and discussion

5.1 Result and Discussion

Chapter 6
Conclusion and Future
recommendations
6.1 Conclusion
6.2 Future
recommendations
Chapter 7
Reference

7.1 Reference

List of figure

SL No Title Page no
1.1 Dietary supplement and
OTC drug use
1.2 Dietary supplement
1.3 OTC drug
1.4 Variation of age
1.5 Gender percentage
1.6 Percentage of smoking
status
1.7 Percentage of lives alone
1.8 Percentage of economic
status
1.9 Percentage of
educational qualification
2.1 Percentage of medical
conditions
2.2 Percentage of dietary
supplement use
2.3 Percentage of OTC drug
use
2.4 Percentage of do we
take otc medication with
 dietary supplement
2.5 Percentage of
experience any side
effect with dietary
supplement use
2.6 Frequency of use
2.7 Percentage of usually
consume OTC medicine
 Chapter 1
Introduction

Introduction:
The use of dietary supplements and over-the-counter (OTC) drugs
among elderly patients in Bangladesh has become increasingly
prevalent in recent years. As the elderly population grows, so does the
demand for products that can potentially address age-related health
concerns or improve overall well-being. This trend raises important
questions about the safety, efficacy, and regulation of these products in
Bangladesh's healthcare landscape.

Figure 1.1: Dietary supplement and OTC drug use

1.1 Demographic Context: Bangladesh is experiencing a demographic shift with a
rising aging population. As per data available up to September 2021, around 8% of
the population was aged 65 and above. With improvements in healthcare and
living conditions, this percentage is expected to increase in the coming years. The
elderly population is more susceptible to chronic illnesses and may turn to dietary
supplements and OTC drugs for relief. The demographic shift towards an aging
population in Bangladesh is a significant factor influencing the use of dietary
supplements and over-the-counter (OTC) drugs. Here's a closer look at this
demographic context and its implications:
 Aging Population: The proportion of elderly individuals (aged 65 and above)
in Bangladesh has been steadily increasing, as reported up to September
2021. This demographic shift can be attributed to factors such as improved
healthcare, nutrition, and overall living conditions. As the population
continues to age, it presents both opportunities and challenges for
healthcare and pharmaceutical sectors.
 Chronic Illnesses: The elderly population is more susceptible to chronic
illnesses, including cardiovascular diseases, diabetes, osteoporosis, and
cognitive disorders. These conditions often require ongoing management
and treatment. As a result, elderly individuals may seek additional support
through dietary supplements and OTC drugs to alleviate symptoms or
improve their overall health.
 Self-Care Practices: In Bangladesh, cultural norms often emphasize family
support and caregiving. However, with the aging population, there is a
growing need for elderly individuals to engage in self-care practices. This
can lead to an increased reliance on readily available products like OTC
drugs and dietary supplements to address health concerns without the
need for frequent visits to healthcare providers.
 Healthcare Accessibility: While healthcare infrastructure has improved in
Bangladesh, access to healthcare facilities, especially in rural areas, can still
be limited. This may prompt elderly individuals to turn to OTC drugs and
dietary supplements as a more accessible means of managing health issues.
 Educational Initiatives: Given the rising elderly population and their
potential reliance on supplements and OTC drugs, there's a need for
educational initiatives that promote informed and safe usage. Healthcare
 providers and policymakers can play a role in raising awareness about
potential risks and benefits associated with these products.
 Regulatory Oversight: As the demand for dietary supplements and OTC
drugs increases with the aging population, regulatory bodies like the
Directorate General of Drug Administration (DGDA) in Bangladesh must
continually assess and strengthen oversight to ensure product quality and
safety.
1.2 Dietary Supplements: Dietary supplements encompass a wide range of
products, including vitamins, minerals, herbal remedies, and nutritional
supplements. These are often marketed as beneficial for maintaining health or
addressing specific age-related issues such as bone health, cognitive function,
or joint pain. The availability of these supplements in local pharmacies and
markets is extensive.

Figure 1.2: Dietary supplement

Let's explore some key aspects of dietary supplements:
 Vitamins and Minerals: Dietary supplements often include vitamins like
vitamin C, vitamin D, and minerals such as calcium and magnesium.
These supplements are commonly used to address nutritional
deficiencies or support overall health. The importance of vitamins and
minerals in dietary supplements:
a) Vitamins C: This vitamin is known for its role in supporting the
immune system, skin health, and wound healing. It's also an
antioxidant that helps protect cells from damage. Vitamin C
supplements are often taken to address deficiencies, particularly in
individuals with limited fruit and vegetable intake.
b) Vitamin D: Vitamin D is crucial for bone health as it aids in the
absorption of calcium and phosphorus. It also plays a role in immune
function and mood regulation. Many people, especially those with
limited sun exposure, may require vitamin D supplements to maintain
optimal levels.
c) Calcium: Calcium is essential for strong bones and teeth, as well as
proper muscle and nerve function. Calcium supplements are
commonly used by individuals at risk of osteoporosis, such as
postmenopausal women and the elderly, to prevent bone loss.
d) Magnesium: Magnesium is involved in hundreds of biochemical
reactions in the body, including muscle and nerve function, blood
glucose control, and bone health. Some individuals take magnesium
supplements to address deficiencies or manage conditions like
muscle cramps.
e) Nutritional Deficiencies: Dietary supplements containing these
vitamins and minerals are often taken to address specific nutritional
deficiencies. Blood tests and healthcare provider guidance can help
determine if such deficiencies exist and whether supplementation is
necessary.
f) Overall Health: Beyond addressing deficiencies, vitamins and minerals
are crucial for maintaining overall health and well-being. They play
roles in energy production, immune function, and various
physiological processes.
 g) Balanced Diet: While supplements can be beneficial, they should not
replace a balanced diet rich in fruits, vegetables, whole grains, and
lean proteins. Whole foods provide a wide range of nutrients and
phytochemicals that are essential for health.
h) Dosage and Safety: It's important for individuals to follow
recommended dosages for vitamins and minerals as excessive intake
can have adverse effects. For example, excessive vitamin D can lead
to toxicity, and excessive calcium can contribute to kidney stones.
i) Consulting Healthcare Providers: It's advisable to consult healthcare
providers before starting any new supplement regimen, especially if
there are concerns about nutritional deficiencies or interactions with
medications.
 Herbal Remedies: Herbal supplements, derived from plants and herbs,
have a long history of use in traditional medicine in Bangladesh. They are
often perceived as natural and safe alternatives for various health issues.
a) History: Herbal remedies have a rich history in Bangladesh, dating
back to ancient times. Traditional healers, known as "Kavirajes" or
"Hakims," have passed down knowledge of herbal medicine through
generations.
b) Natural and Safe: Herbal supplements are often perceived as natural
and safe because they are derived from plants. However, it's essential
to note that natural does not always mean safe, as some herbs can
have side effects or interact with medications.
c) Types of Herbs: Bangladesh boasts a diverse range of plant species,
many of which are used in herbal remedies. Some commonly used
herbs include neem, turmeric, ginger, aloe vera, and tulsi (holy basil).
d) Traditional Uses: These remedies are employed to address various
health issues, such as digestive problems, skin conditions, respiratory
ailments, and more. For example, neem is used for its antibacterial
properties, while turmeric is valued for its anti-inflammatory effects.
e) Preparation and Administration: Herbal remedies are often prepared
in various forms, including decoctions, infusions, powders, and
ointments. They can be taken orally, applied topically, or inhaled,
depending on the specific ailment.
 f) Safety and Precautions: While herbal remedies can be beneficial, it's
crucial to use them with caution. Some herbs may have
contraindications or cause allergic reactions. Consultation with a
qualified healthcare professional is advisable before using herbal
supplements, especially if you are pregnant, nursing, or taking other
medications.
g) Regulation: In Bangladesh, the Directorate General of Drug
Administration (DGDA) oversees the regulation of herbal products to
ensure their safety and quality. It's essential to purchase herbal
supplements from reputable sources that adhere to these
regulations.
h) Research and Modern Medicine: Many herbs have gained attention in
modern scientific research for their potential health benefits.
Traditional knowledge is being combined with scientific evidence to
develop herbal-based pharmaceuticals and supplements.
i) Cultural Significance: Herbal remedies are deeply rooted in the
cultural heritage of Bangladesh and continue to be an essential part
of healthcare practices in rural and urban areas.

 Nutritional Supplements: These supplements may include protein

powders, amino acids, or dietary fibers. They are used to enhance
nutrition and support overall well-being, which can be particularly
important for elderly individuals who may have dietary restrictions or
challenges in obtaining balanced meals. Nutritional supplements and
their importance for the elderly:
a) Protein Powders: Protein is essential for maintaining muscle mass,
strength, and overall health. Elderly individuals may experience
muscle loss, and protein supplements, such as whey or plant-based
protein powders, can help meet their protein needs.
b) Amino Acids: Amino acids are the building blocks of proteins and are
crucial for various physiological functions. Certain amino acid
 supplements may be recommended to support specific health
concerns or conditions.
c) Dietary Fibers: Fiber is vital for digestive health and can help alleviate
constipation, a common issue among the elderly. Fiber supplements,
such as psyllium husk or soluble fiber supplements, can be beneficial
for digestive comfort.
d) Enhancing Nutrition: Nutritional supplements are used to fill
nutritional gaps in the diet. Elderly individuals may have reduced
appetites or difficulty chewing and swallowing, making it challenging
to obtain all the necessary nutrients from food alone.
e) Meeting Specific Dietary Needs: Some elderly individuals may have
dietary restrictions due to medical conditions or personal
preferences. Nutritional supplements can help ensure they receive
essential nutrients, even if they have limited food choices.
f) Bone Health: Calcium and vitamin D supplements are often
recommended to support bone health, which is crucial for preventing
osteoporosis and fractures in the elderly.
g) Convenience: Nutritional supplements provide a convenient way to
obtain specific nutrients without the need for extensive meal
preparation. This can be particularly helpful for elderly individuals
living independently.
h) Individualized Approach: The choice of nutritional supplements
should be based on individual needs and preferences. Healthcare
providers can offer guidance on selecting the right supplements and
appropriate dosages.
i) Consulting Healthcare Providers: It's essential for elderly individuals
to consult with healthcare providers before incorporating nutritional
supplements into their routine. This helps ensure that supplements
are suitable for their specific health conditions and do not interact
with medications.
j) Quality and Safety: Quality control and safety are critical when using
nutritional supplements. Choosing reputable brands and products is
important to minimize risks associated with contamination or
misleading labeling.
 Targeted Health Concerns: Dietary supplements are often marketed to
address specific age-related health issues. For instance, supplements with
calcium and vitamin D are promoted for bone health, while those with
omega-3 fatty acids may be marketed for cognitive function and heart
health.
a) Bone Health: Supplements containing calcium and vitamin D are
commonly recommended for bone health. Calcium is essential for
maintaining bone density, and vitamin D aids in calcium absorption.
Adequate calcium intake is especially important for older individuals, as
bone density tends to decrease with age, increasing the risk of fractures.
b) Cognitive Function: Omega-3 fatty acids, particularly EPA
(eicosapentaenoic acid) and DHA (docosahexaenoic acid), are often
associated with cognitive function. These fatty acids are found in fish oil
supplements and are thought to support brain health. Some studies
suggest that omega-3 fatty acids may help reduce the risk of cognitive
decline in older adults.
c) Heart Health: Omega-3 fatty acids are also marketed for heart health.
They are believed to have several cardiovascular benefits, including
reducing triglyceride levels, lowering blood pressure, and decreasing the
risk of heart disease. Additionally, supplements like coenzyme Q10
(CoQ10) and resveratrol are sometimes taken for heart health support.

 Accessibility: The availability of dietary supplements in local pharmacies and

markets across Bangladesh is extensive. This accessibility makes it
convenient for individuals to purchase these products without a
prescription.
 Consumer Awareness: As dietary supplements are readily available, it's
important for consumers to be well-informed. Reading product labels,
understanding dosages, and consulting healthcare providers when
necessary can help individuals make informed decisions about supplement
use.
 Quality and Safety: Quality control and safety standards for dietary
supplements can vary. It's advisable for consumers to choose reputable
brands and products that adhere to good manufacturing practices (GMP) to
minimize risks associated with contamination or inaccurate labeling.

a) Quality Control and Safety Standards: The quality and safety of dietary
supplements can indeed vary significantly. Regulations and standards
governing these products vary from country to country. In the United
States, for example, dietary supplements are regulated by the U.S. Food
and Drug Administration (FDA) under the Dietary Supplement Health
and Education Act (DSHEA). In other countries, regulations may differ.
b) Good Manufacturing Practices (GMP): GMP refers to a set of guidelines
and practices that ensure the quality, safety, and consistency of dietary
supplements and other products. Companies that adhere to GMP
standards follow strict procedures for ingredient sourcing, product
formulation, manufacturing, and quality testing.
c) Label Accuracy: Reputable supplement manufacturers are committed to
accurately labeling their products. This includes providing information
about the ingredients, their amounts, and any potential allergens or
additives. Consumers should look for supplements with clear and
transparent labeling.
d) Third-Party Testing: Some supplement companies voluntarily submit
their products to third-party testing organizations. These independent
labs assess the product's quality, purity, and potency. Look for
supplements that have been verified by such organizations, as this adds
an extra layer of assurance.
e) Adulteration and Contamination: Contamination of dietary supplements
can be a concern. Reputable manufacturers take steps to prevent
contamination of their products, such as regular testing for
contaminants like heavy metals, pesticides, and microorganisms.
Additionally, they may use quality ingredients sourced from trusted
suppliers.
f) Consumer Education: Consumers should educate themselves about the
supplements they intend to take. Research the ingredients, their
potential benefits, and any known interactions or side effects. Consulting
with a healthcare professional before starting any new supplement
 regimen is advisable, especially if you have underlying health conditions
or are taking medications.
g) Reputable Brands: Choosing reputable supplement brands is crucial.
Look for well-established companies with a track record of producing
high-quality products. Reading reviews and seeking recommendations
from trusted sources can help identify reliable brands.
h) Regulatory Oversight: Be aware of the regulatory environment in your
region. Some countries have stricter regulations and oversight of dietary
supplements than others. Familiarize yourself with the relevant
authorities and regulations governing dietary supplements in your area.
 Regulatory Oversight: Regulatory agencies like the Directorate General of
Drug Administration (DGDA) play a critical role in monitoring and regulating
dietary supplements. However, regulatory standards can vary, and ensuring
product safety is an ongoing challenge.
 Consulting Healthcare Providers: Before starting any new supplement
regimen, especially for elderly individuals or those with underlying health
conditions, it's advisable to consult with healthcare providers. This is
essential to ensure that supplements do not interact with medications or
exacerbate existing health issues.

1.3 OTC Drugs: Over-the-counter drugs are non-prescription medications available

without a doctor's prescription. Elderly individuals may use OTC drugs for various
health concerns like pain management, gastrointestinal issues, or cold and flu
symptoms. The accessibility of OTC drugs makes them a convenient option for
self-treatment.
 Figure1.3: OTC drug

The role of OTC drugs and their convenience for self-treatment among the elderly:
 Accessibility: OTC drugs are readily available in pharmacies, supermarkets,
and convenience stores, making them highly accessible for elderly
individuals. This accessibility allows them to address minor health issues
without the need for a prescription or a healthcare provider's visit.
 Pain Management: OTC pain relievers, such as acetaminophen, ibuprofen,
and aspirin, are commonly used by the elderly to manage pain related to
conditions like arthritis, headaches, or muscle aches.
 Gastrointestinal Issues: Antacids, laxatives, and anti-diarrheal medications
are examples of OTC drugs that can help elderly individuals manage
gastrointestinal discomfort or irregularities.
 Cold and Flu Symptoms: OTC cold and flu remedies, including
decongestants, cough suppressants, and fever reducers, are often used by
the elderly to alleviate symptoms during illness.
 Allergy Relief: OTC antihistamines and nasal sprays are used to manage
allergy symptoms, which can be particularly bothersome for the elderly, as
allergies can exacerbate existing respiratory issues.
  Sleep Aids: Some elderly individuals turn to OTC sleep aids to address
occasional sleep disturbances or insomnia. These medications can help
improve sleep [Link]-Treatment: OTC drugs empower elderly
individuals to take control of their health and self-treat common, non-
serious health issues. This can be especially valuable for those who prefer
self-care or face barriers to accessing healthcare.
 Dosage and Safety: While OTC drugs are generally considered safe when
used as directed, it's crucial for elderly individuals to follow dosage
instructions carefully. Some OTC medications may interact with prescription
drugs, so consulting with a healthcare provider is advisable, especially if
taking multiple medications.
 Educational Initiatives: Promoting awareness about the proper use of OTC
drugs and potential risks associated with misuse is important to ensure that
elderly individuals make informed decisions about self-treatment.
 Regular Medication Review: Healthcare providers should conduct regular
medication reviews with elderly patients to assess the need for OTC drugs
and ensure they do not interfere with prescribed medications.
1.4 Rationale for Use: Elderly patients in Bangladesh may opt for dietary
supplements and OTC drugs due to factors such as limited access to healthcare
facilities, financial constraints, or a cultural preference for self-care. The perceived
benefits of these products often drive their consumption. The rationale for their
use:
 Limited Access to Healthcare Facilities: In many parts of Bangladesh,
especially in rural areas, access to healthcare facilities can be limited.
Elderly patients may face challenges in reaching medical centers or may
encounter long wait times for appointments. As a result, they may turn to
readily available dietary supplements and OTC drugs to address minor
health concerns independently.
 Financial Constraints: Healthcare costs, including doctor's fees, diagnostic
tests, and prescription medications, can be a significant burden for elderly
individuals, especially those on fixed incomes. OTC drugs and dietary
supplements are often more affordable options, making them an attractive
choice for managing health issues.
  Cultural Preference for Self-Care: Cultural norms in Bangladesh often
emphasize self-care and home remedies. Elderly individuals may have
grown up with these traditions and may prefer using dietary supplements
and OTC drugs as a first line of defense for common ailments.
 Perceived Benefits: Marketing and advertising often promote the potential
benefits of dietary supplements and OTC drugs. Elderly patients may be
influenced by these messages, believing that these products can improve
their health, alleviate symptoms, or provide a sense of well-being.
 Autonomy and Empowerment: Self-treatment with dietary supplements
and OTC drugs can provide a sense of autonomy and empowerment for
elderly individuals. They can take charge of their health and well-being
without depending solely on healthcare providers.
 Privacy and Stigma: Some health concerns, such as gastrointestinal issues or
minor pain, may be perceived as private matters. Elderly patients may
prefer the privacy of self-treatment with OTC drugs rather than discussing
such issues with healthcare professionals.
 Lack of Awareness: In some cases, elderly individuals may not be fully
aware of the potential risks associated with dietary supplements and OTC
drugs. More education and awareness efforts are needed to ensure they
make informed choices.
 Complementary Approach: In many cases, elderly individuals may use
dietary supplements and OTC drugs in combination with conventional
medical care. They may consult healthcare providers for serious health
issues while using OTC options for minor ailments.
 Community Influence: The influence of friends, family, or community
members who have had positive experiences with dietary supplements and
OTC drugs can also drive their use among the elderly.
 Chronic Conditions: Elderly patients with chronic conditions may use dietary
supplements and OTC drugs as part of their self-management strategy to
alleviate symptoms or support their treatment plan.
1.5 Challenges and Risks: The use of dietary supplements and OTC drugs in the
elderly population also poses several challenges. These include the risk of adverse
reactions, drug interactions, inadequate regulatory oversight, and potential
misuse. Elderly individuals may be particularly vulnerable to these risks due to
age-related changes in metabolism and multiple comorbidities.
 Adverse Reactions: Dietary supplements and OTC drugs can cause adverse
reactions, including allergies, side effects, and unexpected interactions with
other medications. Elderly individuals may be more susceptible to adverse
reactions due to age-related changes in their metabolism and organ
function.
a) Allergies: Some individuals may be allergic to specific ingredients in
dietary supplements or OTC drugs, such as certain herbs, vitamins, or
additives. Allergic reactions can range from mild rashes to severe
anaphylaxis.
b) Side Effects: OTC drugs and supplements can have side effects that vary
depending on the product. Common side effects include gastrointestinal
issues like nausea, diarrhea, or constipation, as well as dizziness,
headache, or changes in blood pressure.
c) Drug Interactions: Dietary supplements and OTC drugs can interact with
prescription medications. This can lead to either reduced effectiveness
or increased side effects of the medications. Elderly individuals often
take multiple prescription drugs, increasing the risk of interactions.
d) Metabolic Changes: Aging can affect how the body processes drugs and
supplements. Liver and kidney function may decline, affecting the
clearance of substances from the body. This can result in increased drug
concentrations in the bloodstream.
e) Organ Function: Age-related changes in organ function can affect drug
metabolism and elimination. For example, decreased renal function can
lead to reduced drug excretion, potentially increasing the risk of adverse
reactions.

 Drug Interactions: Elderly patients often take multiple prescription

medications to manage chronic conditions. The use of OTC drugs and
dietary supplements can increase the risk of drug interactions, potentially
affecting the effectiveness and safety of both prescribed and non-
prescribed treatments.
 Inadequate Regulatory Oversight: Regulatory oversight for dietary
supplements and some OTC drugs may be less stringent than that for
prescription medications. This can lead to issues with product quality,
safety, and misleading claims. Ensuring that these products meet regulatory
standards is a significant challenge.
 Potential Misuse: Elderly individuals may misuse dietary supplements and
OTC drugs by taking excessive dosages, using them for extended periods
without professional guidance, or using them to replace necessary
prescription medications. Such misuse can lead to health risks.
 Comorbidity Complexity: The elderly often have multiple comorbidities,
which can complicate treatment decisions. The use of dietary supplements
and OTC drugs without proper consideration of these conditions can lead to
unintended health consequences.
 Polypharmacy: Polypharmacy, the concurrent use of multiple medications,
is common among the elderly. Adding dietary supplements and OTC drugs
to this mix can increase the complexity of medication regimens and
heighten the risk of drug interactions and adverse events.
 Cognitive Impairment: Some elderly individuals may experience cognitive
decline or memory issues, making it challenging for them to manage their
medication regimens effectively. This can result in confusion or errors when
taking supplements and OTC drugs.
 Limited Professional Guidance: Due to the cultural preference for self-care
and limited healthcare access, elderly individuals may not always seek
professional guidance when using these products. This lack of oversight can
lead to uninformed choices.
 Delayed Medical Attention: Relying solely on OTC drugs and dietary
supplements for symptom relief may delay seeking medical attention for
underlying health issues, potentially allowing conditions to progress
untreated.
 Lack of Evidence-Based Care: The efficacy and safety of many dietary
supplements and OTC drugs have not been rigorously studied, and evidence
supporting their use for specific health conditions may be lacking.
1.6 Regulatory Framework: Bangladesh has regulatory bodies like the Directorate
General of Drug Administration (DGDA) responsible for overseeing
pharmaceuticals and related products. However, the regulation of dietary
supplements and some OTC drugs may be less stringent than that of prescription
medications. This raises concerns about product quality and safety. Some key
considerations regarding this issue:
 Regulatory Oversight: It's essential for regulatory bodies like the DGDA to
continuously assess and strengthen oversight of dietary supplements and
OTC drugs. This includes setting and enforcing quality standards, monitoring
product labeling, and conducting regular inspections to ensure compliance.
 Product Quality and Safety: The quality and safety of dietary supplements
and OTC drugs are of paramount importance. Ensuring that these products
meet established quality standards is critical to safeguarding the health of
consumers, particularly elderly individuals who may be more vulnerable to
adverse effects.
 Good Manufacturing Practices (GMP): Enforcing good manufacturing
practices for dietary supplements and OTC drugs is crucial to maintaining
product quality. Manufacturers should adhere to strict guidelines to prevent
contamination, ensure accurate labeling, and produce consistent and safe
products.
 Labeling and Claims: Regulators should pay close attention to product
labeling and marketing claims associated with dietary supplements and OTC
drugs. Misleading or unverified claims can misguide consumers and pose
health risks.
 Consumer Education: Public awareness campaigns can educate consumers,
including the elderly population, about how to assess the quality and safety
of dietary supplements and OTC drugs. This can empower individuals to
make informed choices.
 Collaboration with Healthcare Providers: Regulatory bodies should
collaborate with healthcare providers to establish guidelines for the
appropriate use of dietary supplements and OTC drugs. These guidelines
can help healthcare professionals advise patients effectively.
 Periodic Review: Regular review of regulatory standards and their alignment
with international best practices is important. The regulatory framework
 should evolve to address emerging health concerns and advancements in
the industry.
 Data Collection and Reporting: Robust data collection and reporting
mechanisms can help identify and address safety concerns promptly.
Encouraging healthcare providers and consumers to report adverse events
associated with these products is crucial.
 International Comparisons: Comparing regulatory practices and standards
for dietary supplements and OTC drugs with those in other countries can
provide valuable insights and help align regulations with international
norms.
 Transparency: Regulatory bodies should be transparent in their processes
and decisions related to these products. This transparency can build trust
among consumers and industry stakeholders.
1.7 Research and Awareness: Limited research has been conducted on the
specific patterns of dietary supplement and OTC drug use among the elderly in
Bangladesh. Moreover, there is a need to raise awareness among both
healthcare providers and the elderly population about the potential risks and
benefits associated with these products.
 Research on Elderly Use Patterns:Conducting comprehensive research
specific to the patterns of dietary supplement and OTC drug use among the
elderly in Bangladesh is crucial. This research can provide valuable insights
into the prevalence, motivations, and health outcomes associated with their
[Link] the types of supplements and OTC drugs commonly used by
elderly individuals, as well as the reasons behind their choices, can help
inform healthcare policies and recommendations.
 Safety and Efficacy Studies:Scientific studies on the safety and efficacy of
dietary supplements and OTC drugs that are commonly used by the elderly
are essential. This research can help identify potential risks, benefits, and
interactions, particularly in the context of the elderly population.
 Regulatory Evaluation:Regulatory bodies in Bangladesh should evaluate and
update existing regulations related to dietary supplements and OTC drugs.
Stricter oversight and quality control measures can help ensure that these
products meet safety and efficacy standards.
 Public Awareness Campaigns:Raising awareness among healthcare
providers, elderly individuals, and their caregivers about the potential risks
and benefits of dietary supplements and OTC drugs is crucial. Public
awareness campaigns can provide information on responsible use, potential
interactions, and the importance of consulting healthcare professionals.
 Professional Education:Healthcare providers, including doctors,
pharmacists, and nurses, should receive education and training on dietary
supplements and OTC drugs. They can then provide informed guidance to
elderly patients about the safe and appropriate use of these products.
 Patient-Centered Education:Elderly individuals should be encouraged to
actively engage in their healthcare decisions. Providing them with easy-to-
understand information about the products they are using and the potential
risks involved can empower them to make informed choices.
 Promoting Dialogue:Encouraging open communication between healthcare
providers and elderly patients is essential. Patients should feel comfortable
discussing their use of supplements and OTC drugs with their healthcare
team, enabling better-informed decisions.
 Accessible Information:Providing accessible written and digital resources in
local languages can help disseminate information about dietary
supplements and OTC drugs to a wider audience, including those with
limited literacy.
 Regular Medication Reviews:Healthcare providers should conduct regular
medication reviews with elderly patients, taking into account all
supplements and OTC drugs they are using. This helps ensure the safe
integration of these products into their healthcare plans.
 Collaboration and Data Sharing:Collaborative efforts between healthcare
institutions, regulatory agencies, and researchers can help gather data on
supplement and OTC drug use among the elderly. Sharing this data can lead
to evidence-based recommendations.
Chapter 2
Aim of
Research
2.1 Aim of the research
The aim of conducting research on the use of dietary supplements and over-the-
counter (OTC) drugs among elderly patients in Bangladesh is to gain
comprehensive insights into various aspects of this practice. Here's a detailed
overview of what such research aims to achieve:
 Prevalence and Patterns of Use: The research seeks to determine the
prevalence of dietary supplement and OTC drug use among elderly
individuals in Bangladesh. It aims to identify which specific supplements
and OTC drugs are most commonly used and how frequently they are used.
 Safety and Efficacy: A key objective is to assess the safety and efficacy of
these products in the elderly population. This involves evaluating the
potential risks and benefits associated with the use of dietary supplements
and OTC drugs, especially in the context of aging and common health
conditions among the elderly.
 Health Outcomes: The research aims to investigate how the use of dietary
supplements and OTC drugs affects the health outcomes of elderly patients.
This includes examining whether these products have a positive impact on
health, mitigate symptoms, or lead to adverse effects.
 Knowledge and Awareness: It seeks to assess the level of knowledge and
awareness among elderly patients regarding the proper use of dietary
supplements and OTC drugs. Understanding whether elderly individuals are
adequately informed about these products is crucial for their safe
consumption.
 Regulatory Compliance: The research may investigate whether dietary
supplements and OTC drugs available in Bangladesh comply with regulatory
standards and whether these standards are effective in ensuring product
quality and safety.
 Healthcare Provider Guidance: One of the objectives is to understand to
what extent healthcare providers in Bangladesh inform and advise elderly
patients about the use of dietary supplements and OTC drugs. This can help
identify gaps in healthcare provider knowledge and communication.
 Socioeconomic Factors: Exploring how socioeconomic factors, such as
income, education, and access to healthcare, influence the use of dietary
 supplements and OTC drugs among the elderly is important. It can reveal
disparities in usage patterns.
 Policy Recommendations: Based on research findings, the aim is to develop
evidence-based policy recommendations and guidelines regarding the use
of dietary supplements and OTC drugs in the elderly population. These
recommendations can be used to improve healthcare practices and ensure
the well-being of elderly patients.
The research on the use of dietary supplements and OTC drugs among elderly
patients in Bangladesh is a multifaceted study aiming to provide a comprehensive
understanding of this important healthcare aspect. It addresses issues related to
prevalence, safety, knowledge, regulatory compliance, and healthcare practices,
ultimately contributing to informed healthcare decision-making and policy
development for the elderly population in Bangladesh.
 Chapter 3
Literature
Review

3. 1 Literature review :

[Link], S., Sato, M., Maeno, T., Ichinohe, Y. and Maeno, T., [Link]'s
important to study the concurrent use of dietary supplements and over-the-
counter drugs with prescription medications in elderly patients, as potential
interactions and harmful effects can occur. Understanding the predictors for their
use can help improve patient safety and healthcare practices
The use of nonprescription medicines among elderly patients with chronic
illness
[Link], K., 2010
It's important to study the use of OTC and CM products among elderly patients, as
well as pharmacist interventions. Gender differences can provide valuable insights
too.
Concomitant use of prescription drugs and dietary supplements in
ambulatory elderly people
[Link], R.L., Pecha, M., Welmerink, D.B., Sink, K., DeKosky, S.T.,
Fitzpatrick, A.L. and Ginkgo Evaluation of Memory Study Investigators,
2009 the study Analyzing baseline data from the Ginkgo Evaluation of Memory
(GEM) , which collected information on the concomitant use of prescription drugs
and dietary supplements among elderly participants, can provide valuable insights
into medication patterns and potential interactions. This data can be essential for
identifying trends, risks, and opportunities for improving healthcare for the elderly
population.
Use of prescription and over-the-counter medications and dietary
supplements among older adults in the United States.
[Link], D.M., Alexander, G.C., Conti, R.M., Johnson, M., Schumm, P. and
Lindau, S.T., 2008 the study to estimate the prevalence and patterns of
medication use among older adults (including concurrent use), and potential
major drug-drug interactions.
The use of dietary supplements among older persons in southern Germany
—results from the KORA-age study
[Link], S., Heier, M., Schneider, A., Fischer, B., Huth, C., Peters, A. and
Thorand, B., [Link]'s study important to gather data on dietary supplement use
in older individuals for health research
Factors associated with excessive polypharmacy in older people
6., D., Van der Heyden, J. and Tafforeau, J., 2015 It's essential to study
medicine utilization patterns in older populations, given their increasing numbers
and the complexity of managing multiple chronic diseases. The prevalence and
determinants of excessive polypharmacy in Belgium should provide valuable
insights into healthcare for this demographic.
Over‐the‐Counter Medication Use in an Older Rural Community: The Mo
VIES Project
[Link], G.P., Ganguli, M., Seaberg, E.C., Echemen, D.A. and Belle, S.,
1997. To examine the self-reported use of over-the-counter (OTC) medications
and the factors associated with OTC use in a rural older population, we would
typically conduct a research study. This study could involve surveys, interviews, or
data analysis to gather information on OTC medication usage among the target
population and identify the factors that influence their choices. Common factors
to investigate might include demographics, health conditions, access to
healthcare, and socioeconomic status. Researchers would then analyze the data to
draw conclusions about OTC medication use in this specific population.
The use of herbal and dietary supplement among community-dwelling
elderly in a suburban town of Malaysia
[Link], M.S.A., Zaini, M.H., Ali, A.A., Sahudin, S., Mehat, M.Z., Hamid,
H.A., Mustaffa, M.F., Othman, N. and Maniam, S., [Link]'s important to
study the use of herbal and dietary supplements (HDS) among the elderly
population in Malaysia to understand their prevalence and patterns of use, as well
as potential interactions with conventional medicines. This research can provide
valuable insights into healthcare practices among the elderly in suburban areas
and help ensure their safety and well-being.
Chapter 4
Research
Methodology

4.1 Research Methodology :

The step of research methodology include :
 [Link] Objective and Question: Define the primary research objective
and formulate a specific research question related to the use of dietary
supplements and OTC drugs by elderly patients in Bangladesh.
 [Link] Review: Review existing literature on the topic to understand
previous findings, identify gaps in knowledge, and refine your research
question.
 [Link]: Define the target population (e.g., elderly patients aged 60 and
above in Bangladesh). Determine the sample size and sampling method
(e.g., random sampling or stratified sampling).
 [Link] Collection: a. Survey Questionnaire: Develop a questionnaire to
collect data from elderly patients. Include questions about their
demographics, health conditions, dietary supplement usage, OTC drug
usage, and reasons for usage. b. Informed Consent: Ensure ethical
considerations by obtaining informed consent from participants. c. Data
Collection Process: Administer the survey through face-to-face interviews,
phone calls, or online surveys, depending on feasibility.
 [Link] Analysis: a. Quantitative Analysis: Use statistical software to analyze
the quantitative data, such as frequencies, percentages, and correlations. b.
Qualitative Analysis: If applicable, conduct qualitative interviews or content
analysis of open-ended survey responses to gain deeper insights.
 [Link] Considerations: Ensure that the research complies with ethical
guidelines, including privacy and confidentiality of participant information.
 [Link] Interpretation: Interpret the findings in the context of your research
question and existing literature. Identify any patterns, trends, or significant
associations.
 [Link] and Recommendations: Summarize the research findings and
draw conclusions. Provide practical recommendations for healthcare
providers, policymakers, and elderly patients based on the results.
 [Link] and Dissemination: Share your research findings through
academic publications, presentations, or reports to contribute to the body
of knowledge in this field.
 [Link] and Future Research: Discuss the limitations of your study
and suggest areas for future research to further explore the topic.
  [Link] Review (Optional): If possible, submit your research for peer
review to ensure its quality and credibility.
 [Link]: If your research leads to policy recommendations,
work with relevant authorities or organizations to implement changes or
interventions based on your findings.

4.2 Survey questionnaire :

University of Science and Technology, Chittagong

 Department of Pharmacy
Survey Questionnaire OTC medication in Elderly patients :
1)Name:-
2)Age:-a)40-50 b)51-60 c)61-70 d)71-80
3) Gender:-
a)Male b)Female
4) Smoking Status :-
a)Current smoker
b) Past Smoker
c) Never Smoker
5) Lives Alone:- a) yes b) No
6) Economic Status :-
a) less than average
b) average
c) more than average
7) Educational Qualifications :-
a) <High School
b) >High School
8) Underlying Medical Conditions :-
a) Hypertension
b) Hyperlipidemia
c) CKD
 d) Respiratory disease
e) Gastric Ulcer
f) Liver disease
g) Cardiovascular disease
h) Diabetes Mellitus
9) Dietary Supplement are Used:-
a) Vitamin minerals
b) Calcium
C) Vitamin C
d) Vitamin D
e) Combined natural product
f) Zinc
g) Amino acid
h) Enzyme
i) Multivitamin
10) OTCs are used:-
a) Digestive
b) Laxative
c) Analgesic
d) Antihistamines
11) Do you take over the counter medication with dietary
supplement :
 a) yes
b) No
12) Do you experience any side effect with dietary supplement use?
a) Yes
b) No
13) Frequency of use:-
a) Daily
b) Weekly
c) Occasionally
d) Once in a while
14) When do you usually consume OTC medicines:-
a) Symptoms are minor or manageable
b) Whenever I feel sick
c) whenever I cannot visit doctor
Photo gallery in hospital and pharmacy -
 Chapter 5
Result and
discussion

5.1 Result and discussion :

[Link] Data:
 Age range

43.33

26.66

20
130

80
10
60

30

40-50 51-60 61-70 71-80

No of patients percentage

Figure 1.4: Variation of Age

Discussion: From the figure we can see that different age of people use
dietary supplement and OTC drug. Age from (40 to 80+).
 Gender

male

46% female

54%

Figure 1.5: Gender percentage

Discussion: From the figure we can see that 138 patients are male and
162 patients are female from 300 and the percantage of male 46% and
female is 54%.So female the highest percentage dietary supplement
and OTC drug used than male.
 Lives Alone

10%

Yes
No

90%

Figure 1.7: Percentage of lives Alone

Discussion : From the figure we can see that 90% are no lives alone and
10 are lives alone.
 Economic Status

15%

average
less than average
more than average

25%
60%

Figure 1.8: Percentage of Economic status

Discussion :From the figure we can see that the economic status of 60%
are average, 25% are less than average and 15% are more than average
total 300 patients.
 Educational Qualification

8%

<High School
>High school

92%

Figure 1.9: Percentage of Educational qualification

Discussion :From the figure we can see that the educational

qualification of 92% are >high school and 8% are <high school.

[Link] Habit :
 Smoking Status

7%

17%
Current Smoker
Past Smoker
Never Smoker

76%

Figure 2.1: Percentage of smoking status

Discussion :From the figure we can see that 76% are never smoker,17% are
past smoker and 7% are current smoker from total 300 patients.

[Link] pattern data :

 Medical conditi ons
70

60

50

40

30

20

10

0
Hypertension Hyperlipidemia Chronic Kidney Respiratory Gastric ulcer Liver disease Cardiovascular Diabetes
disease Disease disease

Medical conditions

Figure 2.1: Percentage of Medical conditions

Discussion: From the comparison figure we can see that percentage of
Diabetes is higher than the other factor and respiratory disease
percentage is lower than the other factor.

[Link] use pattern data :

 Dietary supplements Use

Multivitamins 17

Vitamin D 13

Enzyme 18

Amino Acid 12

Zinc 10

Combined natural product 29

Vitamin C 17

Calcium 20

Vitamins /minerals 52

0 10 20 30 40 50 60

Dietary supplements Use

Figure 2.2: Percentage of Dietary supplement use

Discussion: From the comparison figure we can see that percentage of

vitamins /minerals is higher than the other factor and zinc percentage
is lower than the other factor.
 OTCs Used
OTCs Used

40

30

18

12

Antihistamine Analgesia Digestive Laxative

Figure 2.3: Percentage of OTCs drug use

Discussion :From the figure we can see that the 30% OTCs are used
antihistamine, 40% are used analgesic, 18% are used digestive and 12%
are laxative total 300 patients.
 22%

Yes
No

78%

Figure 2.4: Percentage of do we take OTC medication with dietary

supplement
Discussion :From the figure we can see that 78% take OTC medication
with dietary supplement and 22% no take OTC medication with dietary
supplement.
 Yes No

16%

84%

Figure 2.5: Percentage of experience any side effect with dietary

supplement use

Discussion : From the figure we can see that 16% experience any side
effect with dietary supplement use and 84% no experience any side
effect with dietary supplement use.
 44

21
20

15

Daily Weekly Occasionally once in a while

Series1

Figure 2.6: Frequency of OTC drug use

Discussion : From the figure we can see that the highest percentage
frequency of OTC drug use are occasionally and the lowest percentage
are use daily.
 whenever I cannot visit doctor

Whenever I feel sick

symptoms are minor or manageable

0 10 20 30 40 50 60

Series1

Figure 2.7: Percentage of usually consume OTC medicine

Discussion : From the figure we can see that the highest percentage of
usually consume OTC medication are whenever I feel sick.
 Chapter 6
Conclusion
and Future
recommend
ations
Conclusion :
The use of dietary supplements and over-the-counter (OTC) drugs
among elderly patients in Bangladesh is a significant concern, and a
comprehensive analysis yields the following conclusions:
Prevalence of Use: There is a notable prevalence of dietary supplement
and OTC drug use among elderly patients in Bangladesh. Factors
contributing to this include perceived health benefits, limited access to
healthcare, and cultural preferences for self-medication.
Polypharmacy Risks: The simultaneous consumption of multiple dietary
supplements and OTC drugs among the elderly increases the risk of
polypharmacy. This poses potential hazards, such as adverse drug
interactions, side effects, and compromised therapeutic outcomes.
Regulatory Challenges: The regulatory framework overseeing dietary
supplements and OTC drugs in Bangladesh faces shortcomings.
Inadequate quality control, labeling standards, and post-market
surveillance create vulnerabilities, potentially exposing elderly patients
to substandard or unsafe products.
Limited Awareness: Many elderly patients lack adequate awareness of
the potential risks and benefits associated with dietary supplements
and OTC drugs. This knowledge gap contributes to uninformed decision-
making and may lead to health complications.

Future Recommendations:
Education and Awareness: Launch comprehensive educational
programs targeting elderly patients and caregivers. These initiatives
should aim to raise awareness about the safe and appropriate use of
dietary supplements and OTC drugs, emphasizing the importance of
consulting healthcare professionals for guidance.
Regulatory Reforms: Strengthen regulatory oversight to enhance the
quality and safety of dietary supplements and OTC drugs. This includes
enforcing strict labeling standards, rigorous quality control measures,
and robust post-market surveillance to protect elderly patients.
Improved Healthcare Access: Enhance access to healthcare services for
elderly individuals. This involves increasing the availability of affordable
healthcare facilities and professionals, reducing barriers to access, and
facilitating regular health check-ups.
Health Literacy Promotion: Develop and implement health literacy
programs tailored to the elderly population. These initiatives should
empower elderly individuals the knowledge and skills necessary for
informed decision-making regarding their health and medication usage.
Healthcare Provider Training: Provide training to healthcare
professionals to help them identify dietary supplement and OTC drug
usage among elderly patients. Additionally, equip healthcare providers
with effective communication strategies to engage in meaningful
discussions about these products.
Research Initiatives: Encourage research efforts to investigate the
prevalence, patterns, and health outcomes associated with dietary
supplement and OTC drug consumption in Bangladesh's elderly
population. These findings can guide evidence-based interventions and
policy changes.
 Chapter 7
References

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