Drugs Aging 2009; 26 (1): 51-60

ORIGINAL RESEARCH ARTICLE 1170-229X/09/0001-0051/$49.95/0

© 2009 Adis Data Information BV. All rights reserved.

Self-Medication in Older
Urban Mexicans
An Observational, Descriptive, Cross-Sectional Study
Fernando Ruiz Balbuena,1 Alfredo Briones Aranda2 and Albert Figueras3
1 Post-degree Department, Universidad de Ciencias y Artes de Chiapas (UNICACH), Tuxtla
Gutiérrez, Chiapas, México
2 Department of Pharmacology, Faculty of Human Medicine, Universidad Autónoma de
Chiapas (UNACH), Tuxtla Gutiérrez, Chiapas, México
3 Fundació Institut Català de Farmacologia, Universitat Autònoma de Barcelona, HU Vall
d’Hebron, E-08035-Barcelona, Spain

Abstract Background: Self-medication in older adults can be problematic, especially if

remedies taken without prescription interact with prescribed medications or if
they produce adverse effects. Before designing interventions to improve self-
medication, it is important to characterize patterns of self-medicating in local
populations. This can be easily achieved through the conduct of simple surveys.
Objective: To quantify and describe the demographic, socioeconomic and phar-
macological characteristics of self-medication among a geriatric urban population
in Chiapas, Mexico.
Methods: An observational, descriptive, cross-sectional study was conducted,
using a conglomerate sampling technique. A total of 245 older (aged ≥65 years)
residents in the downtown area of Tuxtla Gutierrez (Chiapas, Mexico) participat-
ed in the study. Information on self-medication and demographic and socioeco-
nomic variables was obtained from a specific structured interview that was
conducted by a single specially trained physician.
Results: More than half of the 245 interviewed older adults (131 [53.5%; 95% CI
47.2, 59.7]) reported taking a medicine without prescription during the last 30
days. Self-medication was significantly more frequent among older adults who
lived alone compared with married people (p = 0.0274) and among the illiterate or
those with a low level of education compared with people with secondary and
high-school degrees (p = 0.0036). NSAIDs (36.2% of medications) and antihista-
mines (12.6%) were the most frequent drugs taken as self-medication. The most
frequently cited reasons for self-medicating were muscle and joint pain (19.9% of
medications), upper respiratory tract problems (15.9%) and cough (7.3%). How-
ever, 13% of people who self-medicated took a remedy for hypertension (11% of
all medications) without medical supervision. Previous prescriptions could have
52 Balbuena et al.

served as the basis for future self-medication in 33 (25.2%) patients. Finally, 35

(26.7%) patients who self-medicated reported that they had experienced adverse
effects from the drug they were taking.
Conclusion: Self-medication in older adults is a problem that should be carefully
addressed in public health policies. Surveys such as the present one are easy to
carry out (and could conveniently be conducted in primary care settings), rapidly
yield information about the true nature of self-medication in local populations,
and provide a basis on which to design future interventions. Factors associated
with self-medication in this study, including both socioeconomic characteristics
(e.g. most self-medicators were poorly educated or lived alone) and therapeutic
considerations (e.g. substantial proportions of patients self-medicated for hyper-
tension, used previous prescriptions as the basis for self-medication, or reported
adverse effects of self-medication), are vital clues to the design of effective and
appropriately targeted interventions in the future.

Background medication. Some studies have shown that use of

A multicentre study of self-medication carried
out in 242 pharmacies in six Latin American coun-
tries (Argentina, Brazil, Chile, Colombia, Costa Ri-
ca and Nicaragua) concluded that only 34% of the
nearly 11 000 purchased products had approved
over-the-counter status, that 5% were for cardio-
vascular use and that 8% were purchased for older
adults’ consumption.[1]
Self-medication in elderly populations deserves
special attention because it poses more potential
problems in this age group than in younger popula-
tions. This is because of (i) the well known in-
creased incidence of adverse drug reactions (ADRs)
and (ii) the risk of interactions as a result of a higher
consumption of medicines in this age group. The
consequences of ‘irresponsible’ self-medication also
include increased bacterial resistance resulting from
inappropriate use of antibacterials, masking of
symptoms or illnesses that delay diagnosis, and de-
creased efficacy of medicines because of inappro-
priate dosages or duration of treatment.[2,3]
Cultural and/or religious beliefs about health and
disease, together with the use of traditional and
herbal remedies, can add to the problems of self-
traditional and herbal remedies is probably more
prominent among low-income populations;[4] how-
ever, no relationship between the characteristics of
older adults who self-medicate and education level
has been found.[5]
Several studies have characterized self-med-
ication in geriatric populations, a practice that is
more frequent in women than in men and is asso-
ciated with solitude, anxiety, abandonment, depres-
sion and other common conditions in elderly peo-
ple.[6,7] A survey conducted in Granada, Spain re-
ported self-medication in 46% of 416 elderly people
included in the study.[8] A similar proportion (41%)
was reported amongst 118 adults in a very different
healthcare setting in Cuba.[9] In Mexico, self-med-
ication has been analysed only fragmentally. A
study of self-medication conducted in Cuernavaca,
Mexico, found that 53% of medicines consumed by
the general population could be considered self-
medication; this study also showed that more than
half (60%) of the medicines consumed were avail-
able in pharmacies without restrictions.[4] However,
we were unable to find any published study on self-
medication in Mexican elderly populations that in-
cluded an analysis of related socio-cultural factors.

© 2009 Adis Data Information BV. All rights reserved. Drugs Aging 2009; 26 (1)
Self-Medication in Older Urban Mexicans
The present study was carried out to fill this gap
in the available knowledge. Specifically, the aim of
the study was to quantify and describe the character-
istics of self-medication in a geriatric population in
the urban area of Chiapas, Mexico.
Methods
An observational study design was utilized. The
survey was conducted by a specially trained physi-
cian in a sample of men and women aged ≥65 years
living in the downtown urban area of Tuxtla Guitier-
rez (Chiapas, Mexico) during September and Octo-
ber 2006. The downtown area was chosen because it
is the city centre; in addition, the streets and houses
are well established (not newly built) and the popu-
lation is not a ‘floating population’ originating from
rural areas.
Study Sample
In 2006, Tuxtla Gutierrez had 490 455 inhabi-
tants. Of these, 19 272 were aged ≥65 years and
3176 of these lived in the downtown area. The
minimum sample size was calculated using the
formula proposed by Daniel for populations (see
equation 1):[10]
N · Z2 · pq
n=
d2 · (N –1) + Z2 · pq
(Eq. 1)
where n = sample size; N = population size; Z = Z
statistic for a level of confidence = 1.96; p = expec-
ted proportion; q = 1–p (1–0.46) = 0.54, and d =
absolute sample error.
For the purposes of the present survey, an expec-
ted proportion of self-medicated people of 0.46,[6] an
absolute sample error of 6.0% and a degree of
security of 95% meant 7.7% of the downtown popu-
lation aged ≥65 years (n = 3176) was required for
the minimum sample size. This figure represented a
total sample size of 245 inhabitants, which included
an additional 10% for potential losses.
© 2009 Adis Data Information BV. All rights reserved.
53
These 245 inhabitants were identified using a
conglomerate sampling technique. Blocks were se-
lected from an official downtown map provided by
the City Hall. All houses in the chosen blocks were
visited to identify older adults (aged ≥65 years).
Verbal agreement to participate in the survey was
obtained from all participants before the question-
naire was administered. Sixteen people refused to be
interviewed and additional inhabitants were there-
fore obtained to make up the study sample of 245.
Study Variables
A structured questionnaire was designed to col-
lect personal data and information relating more
specifically to socioeconomic factors, present ill-
nesses, use of self-medication and ADRs. The Graf-
far method as modified by Méndez[11] was used to
classify socioeconomic level; this method classifies
populations according to five social layers on the
basis of family members’ professions, monthly in-
come and living conditions. According to this classi-
fication, I is the highest socioeconomic level and V
the lowest. Information on chronic conditions was
obtained by asking participants if they had hyperten-
sion, diabetes mellitus, hypercholesterolaemia, joint
disease, sleep disorders or depression; the diagnosis
was then confirmed by the results of laboratory tests
or a medical record provided by the interviewee.
Educational level was categorized as ‘high’, ‘medi-
um’ and ‘low’, according to the highest finished
school degree; low educational level included illiter-
ate participants and those who had not completed
primary school.
The main variable of the survey was self-med-
ication. This included all remedies taken by the
interviewees on their own initiative (i.e. had not
been prescribed) during the previous 30 days, ex-
cluding those for topical use. The following infor-
mation was identified for each medicine: name, use,
dosage and administration pattern. Medicines were
grouped according to the Anatomical Therapeutic
Drugs Aging 2009; 26 (1)
54 Balbuena et al.

Table I. Age and sex distribution of the study population

Age group (y) Womena Men Total
n % n % n %
65–70 69 28.2 48 19.6 117 47.8
71–75 29 11.8 20 8.2 49 20.0
76–80 25 10.2 11 4.5 36 14.7
81–85 12 4.9 5 2.0 17 6.9
>85 17 6.9 9 3.7 26 10.6
Total 152 62.0 93 38.0 245 100
a χ2 = 2.126; p = 0.7126.

Classification criteria.[12] The interviewer asked the
participant to bring all medicines they had taken
during the past 30 days to the interview; the partici-
pant was then asked to indicate which of these they
had taken on their own initiative.
ADRs were identified in accordance with WHO
criteria:[13,14] each patient was asked to name any
potential unwanted effects associated with his/her
medication. When an affirmative answer was given,
the interviewer carried out an in situ assessment
using the Naranjo algorithm.[15]
Data Analysis
The statistical programme EPIINFO version
3.3.2 (Centers for Disease Control and Prevention,
Atlanta, GA, USA) was used to construct the data-
base and conduct subsequent statistical analysis of
the variables. The Pearson chi-squared (χ2) signifi-
cance test was used to calculate the independence of
qualitative variables. Both a bivariate and a multi-
variate analysis (with self-medication as the depen-
dent variable and adjusting for age, sex, educational
level, socioeconomic level, marital status and retire-
ment status) were carried out. The level of statistical
significance adopted was 0.05.
Results
The survey was conducted in 245 persons (152
women [62.0%] and 93 men [38.0%]) aged ≥65
years (mean = 73.4 years; standard deviation = 8.0).
Almost half of the sample (117, 47.8%) were aged
65–70 years. No difference in sex distribution by
age group was noted (χ2 = 2.126; p > 0.5; see table
I).
Half of the participants declared self-medication
practices (131; 53.5% [95% CI 47.2, 59.7]). No
differences in the proportion of participants declar-
ing self-medication were found between men (49 of
93 [52.7%; 95% CI 46.4, 58.9]) and women (82 of
152 [53.9%; 95% CI 47.6, 60.0]) [χ2 = 0.04; p =
0.8479; see table II].
The relationship between reported self-med-
ication and other social and cultural variables was
analysed. There was a significant difference in re-
ported self-medication according to marital status.
Older adults who lived alone (single, divorced or
widowed) were significantly more likely to report
self-medication than married adults (61.1% vs
47.0%, respectively; χ2 = 4.86; p = 0.0274; see table
II). Additionally, significantly more individuals in
the illiterate and low-level education subgroup re-
ported self-medication than in the secondary and
high-school education subgroup (57.6% vs 32.5%,
respectively; χ2 = 8.45; p = 0.0036; see table II).
Similarly, older people belonging to higher socio-
economic groups (I and II) tended to be less likely to
report self-medication than those belonging to lower
socioeconomic groups (III, IV and V), although the
significance level was not attained in this case
(39.5% vs 56%, respectively; χ2 = 3.54; p = 0.0598;
see table II). No significant difference in reported
self-medication was observed by working status of

© 2009 Adis Data Information BV. All rights reserved. Drugs Aging 2009; 26 (1)
Self-Medication in Older Urban Mexicans 55

Table II. Demographic and socioeconomic characteristics of the 245 study participants according to reported self-medication (SM) status
Characteristic SM No SM Total χ2; p-value
n % n % n %
Sex
Women 82 53.9 70 46.1 152 100 0.04; 0.8479
Men 49 52.7 44 47.3 93 100
Marital status
Alonea 69 61.1 44 38.9 113 100 4.86; 0.0274
Marriedb 62 47.0 70 53.0 132 100
Educational level
Illiterate/low 118 57.6 87 42.4 205 100 8.45; 0.0036
Secondary/high 13 32.5 27 67.5 40 100
Socioeconomic levelc
I, II 15 39.5 23 60.5 38 100 3.54; 0.0598
III, IV, V 116 56.0 91 44.0 207 100
Employment status
Unemployed 78 55.3 63 44.7 141 100 0.46; 0.4991
Employed 53 51.0 51 49.0 104 100
a People living alone (single, widowed, divorced).
b Married or de facto couple or living with other family members.
c According to the Graffar classification as modified by Méndez[11] (see Methods section)

the participants (p > 0.05). These relationships were
confirmed in a multivariate analysis.
The 131 participants who reported self-med-
ication described taking 246 medicines (table III).
The most frequently cited reasons for taking these
medications were muscle and joint pain (49 medi-
cines; 19.9% of total medicines taken), upper
respiratory tract problems (39; 15.9%) and cough
(18; 7.3%). Importantly, ‘hypertension’ was the stat-
ed reason for self-medication by 17 participants (27
medicines, 11.0% of total medicines taken). The
indications responsible for the highest proportion of
medicines taken per person were gastric complaints/
dyspepsia (1.71 medicines), weakness (1.67) and

Table III. Reasons for taking the 246 medicines reported as self-medication by the 131 study participants
Indications for use n medicines (A) % n people (B) % A/B
Gastric complaints/dyspepsia 12 4.8 7 5.3 1.71
Weakness 20 8.1 12 9.2 1.67
Hypertension 27 11.0 17 13.0 1.59
Upper respiratory tract problems 39 15.9 30 22.9 1.30
Infections 13 5.3 10 7.6 1.30
Diabetes mellitus 9 3.7 7 5.3 1.29
Muscle and joint pain 49 19.9 42 32.1 1.17
Cough 18 7.3 16 12.2 1.13
Headache 17 6.9 16 12.2 1.10
Diarrhoea 10 4.1 10 7.6 1.00
Osteoporosis 8 3.3 8 6.1 1.00
Abdominal pain 7 2.8 7 5.3 1.00
Other 17 6.9 17 13.0 1.00
Overall 246 100 131a 100 1.88
a Some participants took self-medications for more than one indication.

© 2009 Adis Data Information BV. All rights reserved. Drugs Aging 2009; 26 (1)
56 Balbuena et al.

Table IV. Therapeutic classes of the 246 medicines reported to be taken as self-medication by the 131 study participants
Therapeutic class n medicines %
NSAIDs 89 36.2
Antihistamines 31 12.6
Antihypertensives 22 8.9
Vitamins 20 8.1
Antibacterials 13 5.3
Antacids/anti-ulcer agents 11 5.3
Calcium supplements 9 3.7
Antihyperglycaemics 8 3.3
Mucolytics 8 3.3
Cough remedies 7 2.8
Anti-spasmodics 4 1.6
Anti-parasitic agents 4 1.6
Antidiarrhoeals 3 1.2
Other 17 6.9
Total 246 100

hypertension (1.59) [see table III]. Table IV shows
the most commonly used self-medications grouped
by therapeutic class. NSAIDs were the most fre-
quently used (36.2% of the medicines reported),
followed by antihistamines (12.6%), antihyper-
tensives (8.9%) and vitamins (8.1%). These four
therapeutic classes comprised two-thirds of the
medicines consumed as self-medication.
When participants who reported self-medication
were asked who induced that practice, the most
frequently reported stimuli were a family member
(40 participants, 30.5% [95% CI 24.7, 36.7]) or a
nurse or pharmacist (36 participants, 27.5% [95% CI
21.9, 33.1]). Interestingly, 33 participants (25.2%;
95% CI 19.7, 30.6) identified previous prescriptions
as the stimulus to self-medicating with the treat-
ment. Twelve participants began the treatment on
their own initiative (9.2%; 95% CI 5.5, 12.7) and 10
participants (7.6%; 95% CI 4.3, 10.9) following a
recommendation made in the media.
Finally, it is important to emphasize that 35 pa-
tients (26.7% of those who declared self-med-
ication) said they had experienced at least one ADR
supposedly associated with the drug they were tak-
ing. These 35 patients reported 40 ADRs, the most
frequent of which were gastrointestinal (heartburn
in 12 participants [30.0% of all ADRs] and nausea in
nine participants [22.5%]; see table V). Both of
these adverse effects appeared mostly after exposure
to NSAIDs or antibacterials.

Table V. Suspected adverse drug reactions (ADRs) attributed to medicines taken as self-medication
ADRs n % Suspected medicine (patient’s attribution)
Heartburn 12 30.0 NSAID, antibacterial
Nausea 9 22.5 NSAID, antibacterial, cough remedy
Somnolence 7 17.5 Antihistamine
Dizziness 4 10.0 Antihypertensive, antihyperglycaemic
Asthenia 3 7.5 Antihypertensive, antihyperglycaemic
Malaise 3 7.5 Antihyperglycaemic
Cough 2 5.0 Antihypertensive
Total 40 100

© 2009 Adis Data Information BV. All rights reserved. Drugs Aging 2009; 26 (1)
Self-Medication in Older Urban Mexicans
Discussion
Self-medication, when inappropriate, can be self-
defeating in elderly populations. According to the
results of the present survey, half of the elderly
urban downtown population of Tuxtla Gutierrez,
Mexico self-medicates, mainly to relieve joint pain
and symptoms of respiratory diseases, but also to
treat other chronic and serious diseases such as
hypertension. In addition, the present study showed
that elderly people tend to self-medicate if they live
alone, are illiterate or poorly educated, and/or be-
long to low socioeconomic groups.
Self-medication is a growing phenomenon that is
a potential public health problem, especially among
the geriatric population. Being aware of its magni-
tude and the factors that favour its development is
important for designing future strategies to reduce
self-medication or to make it more appropriate. In
the present survey, 53.5% of the 245 older people
interviewed disclosed that they had taken at least
one medicine on their own initiative over the pre-
vious 30 days. The prevalence of self-medication in
elderly populations reported in other studies is simi-
lar to that found here, ranging from 46% in a study
conducted in Spain[8] to just over 60% in Cuba.[16]
The term ‘responsible self-medication’ has been
coined to define the symptoms and situations that
justify the decision of an individual to take a medi-
cine without counselling by a health professional.[17]
The prescription or non-prescription (over-the-
counter) status of medicines in a country helps to
limit the medicines that patients can buy without a
written prescription. Notwithstanding, in practice, a
proportion of prescription-only medicines are taken
on the individual’s own initiative,[1] and in some
situations, signs and symptoms that are suggestive
of even complex or severe diseases are treated by
self-medication, at least initially. However, the
causes and the magnitude of inappropriate self-med-
ication differ from one healthcare setting to an-
other,[1] and from one country to another,[1] and such
© 2009 Adis Data Information BV. All rights reserved.
57
variations highlight the need to undertake local stud-
ies to analyse patterns of self-medication and identi-
fy key elements for future interventions to minimize
this public health problem.
The results of this survey carried out among a
population of older adults living in an urban area of
Chiapas, Mexico provide interesting data on the use
of drugs taken as self-medication. The most fre-
quently treated symptoms were joint and muscle
pain (19.9% of the medicines taken) and upper
respiratory tract (‘cold’) symptoms (e.g. chills, in-
fluenza-like or pseudo-influenza symptoms; 15.9%
of medicines). However, it is also important to note
that 11% of the medicines were taken to self-med-
icate ‘hypertension’, a chronic and serious disease
that requires medical control. The 27 medicines for
hypertension were taken by 17 patients (13.0% of
the population who self-medicated). A possible ex-
planation for this pattern of self-medication is that
these drugs were taken because the patients
remembered their previous prescriptions and decid-
ed to continue these without any prescriber control,
as has been found by other authors.[18,19] Future
interventions at local level should address this issue
because self-medication for hypertension, without
any control by a health professional, could delay the
achievement of stabilized blood pressure, thereby
favouring the development of complications.
On the other hand, the lack of psychotropic medi-
cines used as self-medication may be considered
surprising, especially given the results of similar
studies conducted in other Latin American coun-
tries. In Brazil, 7% of medicines used as self-med-
ication in an elderly population were psycho-
tropics[20] and, in Chile, 58% of the benzodiazepines
consumed in the city of Conception were taken on a
self-medication basis.[21] The surprisingly ‘good’ re-
sult obtained in the present survey could be ex-
plained by the very strict legislation in Mexico relat-
ing to use of psychotropics, including the require-
Drugs Aging 2009; 26 (1)
58
ment for pharmacists to keep a copy of the
prescription for future inspections.
Several studies have investigated the association
between socioeconomic factors and self-medication.
A Danish survey identified social differences in the
pattern of use of prescription drugs (use was greater
in people with lower socioeconomic standing) but
not in the use of over-the-counter medicines.[22]
Another survey conducted in a Spanish population
found a significant association between self-med-
ication and higher level of education, sex, lower age
and smoking habit.[23] Our survey, conducted exclu-
sively in an elderly population in a society with
fewer economic resources than the abovementioned
European countries, revealed a significant relation-
ship between self-medication and several variables,
such as living alone, lower education level and
lower socioeconomic level, but not employment sta-
tus. These discrepancies among the published stud-
ies could be explained both by the different study
designs and the different populations analysed (i.e.
all age samples vs older adults only). However, in
keeping with our findings, a study conducted in the
north of Brazil found that 37% of elderly people
who took at least one drug as self-medication lived
in the outskirts of the city, an area with a lower
socioeconomic level.[20] A significant association
between self-medication and low socioeconomic
level was also found in a study conducted in Mexico
in 2006.[24]
Studying the factors that induce self-medication
is difficult because of potential interactions among
them. Social pressure and the growing profile of
medicines in the media interplay with recommenda-
tions from friends or relatives, making analysis dif-
ficult. In our survey, patients were asked in an open-
ended way to describe who or what prompted them
to commence self-medication. The results showed
that the main alleged instigators of self-medication
in elderly people living in an urban area of Chiapas
were relatives, friends, nurses and pharmacists, as
© 2009 Adis Data Information BV. All rights reserved.
Balbuena et al.
has been reported similarly in other studies.[25] How-
ever, one finding of the present study that should be
highlighted is that previous prescriptions prompted
self-medication in one-quarter of interviewed pa-
tients who declared self-medication. This potential
misuse of prescriptions some time after they were
initially written emphasizes the need for improved
doctor-patient communication. Unfortunately, these
often forgotten parts of the prescription process can
have deleterious consequences, as in the case of
antibacterials and many other medications.
The last noteworthy finding of the present survey
was the high proportion of older adults who self-
medicated and complained of having experienced an
ADR attributed to the medicine/s they had decided
to take. One-quarter of participants who self-medi-
cated complained of at least one adverse effect while
taking their medication. This proportion was higher
than the 15% reported in the study conducted in
Spain.[8] Most suspected ADRs reported in the pre-
sent survey were mild symptoms that could be easily
identified even by people who are not health profes-
sionals. However, the number of ADRs identified in
the present survey could have been an underestimate
since some symptoms attributed to medicines are
difficult to identify, particularly if they are confused
with symptoms usually attributed to the aging pro-
cess or to the patient’s chronic illness.[26] Considera-
tion of the most frequently reported suspected ADRs
in the present survey revealed a pattern similar to
that found in a study conducted in a geriatric unit of
a Brazilian hospital, where acute gastritis was re-
ported by 22.7% of all self-medicating patients and,
as in the present survey, was largely caused by
NSAIDs.[27]
Participation in the present survey was refused by
only 16 people. This high participation rate might be
explained by the fact that the interviewer was a
medical doctor whose visits could have been seen as
a way to receive free health assistance at home.
Drugs Aging 2009; 26 (1)
Self-Medication in Older Urban Mexicans
The present study has several limitations that
should be taken into account when interpreting its
findings. The first limitation relates to the fact that
the study was conducted in a sample of older adults
living in an urban area of one state of Mexico; one
should therefore be cautious about extrapolating the
results of this survey to other communities given the
methodological, geographical and temporal limita-
tions of the study sample. However, the problems
with self-medication identified in the present survey
can and should be taken into account when design-
ing future studies or interventions to investigate this
issue. Indeed, widespread diffusion of localized data
is important because such information can contrib-
ute to improvements in the design of similar studies
to be conducted in the future as well as provide
support for interventions.
The second potential limitation relates to the
data-collection method. Information on self-med-
ication was obtained by means of a structured inter-
view administered to the study population. A ten-
dency to deny self-medication in the presence of a
health professional, despite previous reassurances
that the interview is solely for the purpose of gather-
ing information, cannot be ruled out; accordingly,
the results obtained could have been an underesti-
mate of actual self-medication practices in the urban
area of Chiapas. Another possible limitation of the
data-collection method is that suspected ADRs men-
tioned by the participant were assessed by the inter-
viewer (a medical doctor) according to the Naranjo
algorithm using information provided by the partici-
pant. A more accurate analysis conducted in a clin-
ical setting with recourse to the patient’s complete
clinical chart may have facilitated the identification
of several additional adverse effects or, conversely,
ruled out some ADRs. However, the purpose for
including this variable in the present survey was
simply to draw attention to the frequency of ADRs
associated with self-medication.
© 2009 Adis Data Information BV. All rights reserved.
59
Conclusion
The present survey indicates that interventions
aimed at reducing self-medication among older ur-
ban adults in Chiapas, Mexico should take into
account factors such as: (i) the association of the
problem with circumstances such as living alone,
illiteracy and poor educational level (which means
written messages will probably have less impact
than oral messages on the radio or television); (ii)
the fact that chronic or serious conditions are some-
times treated by self-medication after the initial
visit, and prescriptions written in the past can be
used at some future point as a basis for self-med-
ication (which highlights the need for specific pro-
grammes to follow up on patients with chronic con-
ditions); and (iii) the fact that self-medication can be
a source of ADRs that may eventually prompt the
patient to seek medical care (which means taking a
good medication history is mandatory to allow rec-
ognition of some nonspecific symptoms as ADRs
and enable the suspected medicine to be withdrawn,
if necessary, rather than treat such symptoms unnec-
essarily).
Self-medication in older adults is a problem that
must be carefully addressed in public health poli-
cies. Studies such as the present one are easy to
conduct, even within the primary healthcare setting,
and they provide results in a short space of time. It is
important that health professionals start designing,
conducting and interpreting the findings of such
studies, which can be a useful tool for improving
local knowledge and developing intervention cam-
paigns tailored to local patterns of self-medication.
Acknowledgements
This study was funded by PROMEP (Programa de
Mejoramiento del Profesorado de Educación Superior [Mexi-
can Program for the Improvement of High-degree Education
Professors]) and UNICACH (Universidad de Ciencias y
Artes de Chiapas [University of the Sciences and Arts of
Chiapas]). The authors have no conflicts of interest that are
directly relevant to the content of this study.
Drugs Aging 2009; 26 (1)
60
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Correspondence: Dr Albert Figueras, Servei de Farmaco-
logia Clínica, Hospital Vall d’Hebron, Passeig Vall
d’Hebron, Barcelona, 119-129, E-08035, Spain.
E-mail: afs@icf.uab.es
Drugs Aging 2009; 26 (1)