Archives of Gerontology and Geriatrics 91 (2020) 104189

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Archives of Gerontology and Geriatrics

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Self-medication in older European adults: Prevalence and predictive factors T

a,b a,c, c,d a,c
Gabriela Rangel Brandão , Laetitia Teixeira *, Lia Araújo , Constança Paúl ,
Oscar Ribeiroc,e
a
Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto. Porto, Portugal
b
Universidade Federal de Ciências da Saúde de Porto Alegre. Porto Alegre, Brazil
c
Centro de Investigação em Tecnologias e Serviços de Saúde (CINTESIS), Aveiro/Porto, Portugal
d
Escola Superior de Educação, Instituto Politécnico de Viseu, Viseu, Portugal
e
Departamento de Educação e Psicologia, Universidade de Aveiro, Aveiro, Portugal

A R T I C LE I N FO A B S T R A C T

Keywords: Background/objectives: Self-medication, despite some benefits, carries many risks, especially when practiced by
Europe older adults who are polymedicated. Information addressing the prevalence and associated factors of self-
Nonprescription drugs medication in older age in a European context is scarce and sometimes contradictory. This paper aims to esti-
Epidemiologic factors mate the prevalence of self-medication among older adults across Europe and to identify its predictive factors.
Health survey
Design: Cross-sectional study.
Cross-sectional studies
Setting: Micro-data from the European Health Interview Survey (2006–2009) was used.
Participants: The sample comprised 31,672 community-dwelling individuals aged 65 and over living in private
households in 14 European countries.
Measurements: The analyses explored the use, over the last two weeks, of any medicines, supplements, or vi-
tamins that were not prescribed by a doctor.
Results: The mean self-medication prevalence was 26.3 %, being the highest in Poland (49.4 %) and the lowest in
Spain (7.8 %). Greater odds of self-medication were found for women and for participants who were younger,
divorced, or presented a higher educational degree. The presence of long-standing illness and physical pain or
not using prescribed medication also significantly increased the possibility of self-medication. A wide variation
in the odds of self-medication between countries was also observed (up to 8 times more for Poland, compared to
Spain).
Conclusion: Self-medication is a prevalent problem among older Europeans, and even though some think it is
risk-free, dangers tend to be greater with advancing age. This study will help identify the groups most likely to
have this behavior so that we can focus on targeted educative and preventive initiatives.

1. Introduction
Self-medication concerns the use of medicinal products by the
consumer to treat self-recognized disorders/symptoms or the inter-
mittent or continued use of a medication previously prescribed by a
doctor for chronic or recurrent disorders/symptoms. It also includes the
use of medication belonging to family members, especially where the
treatment of children or the elderly is involved (World Health
Organization [WHO], 2000). Nonprescription medicine, over-the-counter
medication, self-care, self-treatment, and self-prescription are examples of
different terms that have been used in self-medication-related pub-
lications (Mansouri et al., 2015). Although it is a behavior associated
with several benefits (e.g., rapid access to treatment, financial savings,
and an active role in one’s own health), it also carries numerous po-
tential risks that range from incorrect self-diagnosis or incorrect choice
of therapy to a failure in recognizing potential pharmacological risks
(World Health Organization, 2000).
Older adults experience several age-related changes in the physical
functional system that affect the absorption, distribution, metabolism,
and elimination of drugs (Vali, Pourreza, Foroushani, Sari, & Pharm,
2012) and frequently present multiple comorbid illnesses that make
them more susceptible to the risks of self-medication. Low levels of
health literacy and lack of education about the risks attributed to self-
medication constitute important problems to be solved, since laypeople
often assume the absence of risks (Hughes, Whittlesea, & Luscombe,
2002). Illustratively, a recent survey carried out in Northern Ireland on

⁎
Corresponding author at: Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto. Rua Jorge Viterbo Ferreira, 228 4050-313, Porto, Portugal.
E-mail address: lcteixeira@icbas.up.pt (L. Teixeira).

https://doi.org/10.1016/j.archger.2020.104189
Received 25 May 2020; Received in revised form 14 July 2020; Accepted 18 July 2020
Available online 21 July 2020
0167-4943/ © 2020 Elsevier B.V. All rights reserved.

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G.R. Brandão, et al.
the general public’s opinion and perception of over-the-counter medi-
cines—including on their safety, potency, and effectiveness—revealed
that more than 47 % of the sample believed that nonprescription
medicines were totally safe to use (Wazaify, Shields, Hughes, &
McElnay, 2005).
Prevalence of self-medication is diverse across studies and countries.
The highest rates of prevalence are found in US studies ranging from 72
to 87 % (Hanlon et al., 1992; Stoehr, Ganguli, Seaberg, Echemen, &
Belle, 1997; Stuck et al., 1994). In Brazil, where there is a large number
of epidemiological studies on this subject, prevalence rates of 6.7–51.8
% have been observed (Coelho Filho, Marcopito, & Castelo, 2004; de
Oliveira, Francisco, Costa, & Barros, 2012; Loyola Filho, Uchoa, Firmo,
& Lima-Costa, 2005; Marin et al., 2008; Miralles & Kimberlin, 1998;
Neves et al., 2013; Pinto, Ferré, & Pinheiro, 2012; Sá, Barros, & Sá,
2007; Santos et al., 2013; Schmid, Bernal, & Silva, 2010). Particularly in
Europe, reported prevalence ranges from 13.3 % in Spain (Carmona-
Torres et al., 2018) up to 57 % in Serbia (Gazibara et al., 2013). Studies
comparing the fluctuation of rates over time have observed a statisti-
cally significant increase of the prevalence of self-medication, as ob-
served in the case of Spain, in which self-medication grew from a
prevalence of 7.79 % in 2009 to 13.3 % in 2014 (Carmona-Torres et al.,
2018).
In order to standardize the results of prevalence studies for this
subject and facilitate comparisons and epidemiological research, Jerez-
Roig et al. (2014) presented a set of recommended questions regarding
self-medication to be used with older adults. These comprise con-
sidering the consumption of at least one drug without the prescription
of a licensed practitioner (usually a physician or dentist, according to
the legislation of each country) during the last 14 days (longer periods
of time could predispose memory bias) and considering all types of
medicines (i.e., also alternative medicines, vitamins, and other dietary
supplements).
It is important to know the main characteristics that represent the
elderly, who are more likely to self-medicate, in order to focus special
professional attention on this group. According to Jerez-Roig et al.
(2014) systematic review, the most frequently analyzed associated
factors with self-medication are sex, age, education level, and socio-
economic status. However, there were contradictions among the ana-
lyzed factors between studies: some of them were positively associated,
whereas others were negatively associated; some studies even presented
no association at all.
Considering that knowledge on the factors associated with self-
medication is still limited and that there is a scarce number of large-
scale studies considering multivariable analysis (Jerez-Roig et al.,
2014), the present study aims to present information on the prevalence
of self-medication among older Europeans and increase the available
information on those who are most at risk for having such behavior.
2. Design and methods
2.1. Data
This study is based on data from Eurostat’s first wave of the
European Health Interview Survey (EHIS 1) conducted between the
years 2006 and 2009. The participating member states conducted the
survey in different years: Austria and Estonia in 2006; Slovenia in 2007;
Belgium, Bulgaria, Czech Republic, Cyprus, France, Latvia, Malta, and
Romania in 2008; and Greece, Spain, Hungary, Poland, and Slovak
Republic in 2009. This survey consists of four modules on health status,
health-care use, health determinants, and socioeconomic background
variables. The EHIS targets those in the population who are at least 15
years old and living in private households. The 16 participating EU
member states strived toward comparability via a standard ques-
tionnaire, guidelines, and translation recommendations. For this parti-
cular study, only 14 countries covered the question about self-medi-
cation (excluding Greece and France), and only participants aged 65
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Archives of Gerontology and Geriatrics 91 (2020) 104189
years or older having no missing information for the outcome variable
were selected. The responsibility for all conclusions drawn from the
data lies entirely with the authors.
2.2. Self-medication definition
The following question was used to asses self-medication: “During
the past two weeks, have you used any medicines or dietary supplement
or herbal medicines or vitamins not prescribed or recommended by a
doctor?” An affirmative answer meant the participant was considered a
self-medicated participant.
2.3. Independent variables
The following sociodemographic variables were included in the
analysis: sex (male or female), age group (65–69, 70–74, 75–79, 80–84,
or 85+), highest degree of education (no formal education, primary,
lower secondary, upper secondary, post-secondary, first stage of ter-
tiary, or second stage of tertiary), marital status (single, married, wi-
dowed, or divorced), and country of residence (Austria, Belgium,
Bulgaria, Cyprus, Czechia, Greece, Spain, Hungary, Latvia, Malta,
Poland, Romania, Slovenia, or Slovakia).
The variables chosen as health characteristics of the sample were as
follows: self-perception of health (very good, good, fair, bad, or very
bad), assessed with the question “How is your health in general?”; use
of prescribed medication (yes or no), assessed with the question
“During the past two weeks, have you used any medicines that were
prescribed or recommended for you by a doctor?”; long-standing illness
(yes or no), assessed with the question “Do you have any longstanding
illness or [longstanding] health problem? [By longstanding I mean ill-
nesses or health problems which have lasted, or are expected to last, for
6 months or more]”; health-problem limitation (severely limited, lim-
ited but not severely, or not limited at all), assessed with the question
“For at least the past six months, to what extent have you been limited
because of a health problem in activities people usually do?”; physical
pain or discomfort (none, mild, moderate, severe, or extreme), assessed
with the question “Overall during the past four weeks, how much
physical pain or physical discomfort did you have?”; current smoking
status (yes, daily; yes, occasionally; or not at all), assessed with the
question “Do you smoke at all nowadays?”; alcohol frequency (never,
monthly, two to four times a month, two to three times a week, four to
six times a week, or every day), assessed with the question “During the
past 12 months, how often have you had an alcoholic drink of any
kind?”; binge drinking (never, less than monthly, monthly, weekly, or
daily/almost daily), assessed with the question “During the past 12
months, how often did you have six or more drinks on one occasion?”;
days of vigorous physical activities per week (zero up to seven); days of
moderate physical activities per week (zero up to seven); days of 10-
minute walk per week (zero up to seven); and body mass index (BMI)
groups (underweight: ≤ 18.5; normal weight: 18.5–25; pre-obesity:
25–30; obesity class I: 30–35; obesity class II: 35–40; or obesity class III:
≥ 40).
2.4. Statistical analysis
Descriptive analyses using absolute and relative frequencies were
performed. A comparison of groups according to categorical and con-
tinuous variables was performed using a chi-square test and an in-
dependent-samples t-test, respectively. Univariable logistic regression
models were performed to identify potential predictive factors asso-
ciated with the dependent variable: the presence of self-medication (as
a dichotomous variable, contrasting the absence of self-medica-
tion)—results not shown. In addition, and considering the significant
factors identified in the univariable analysis, a multivariable binary
logistic regression model was performed to identify the independent
variables associated with self-medication, based on the enter method.
G.R. Brandão, et al. Archives of Gerontology and Geriatrics 91 (2020) 104189

Table 1
Association between sociodemographic characteristics and self-medication status.
Total Self-medication p

Yes No
n (%) n (%) n (%)

Sex (n = 31.672) Male 12,535 (39.6) 2758 (22.0) 9777 (78.0) < 0.001a
Female 19,137 (60.4) 5567 (29.1) 13,570 (70.9)
Age group (n = 31,672) 65–69 8875 (28.0) 2550 (28.7) 6325 (71.3) < 0.001a
70–74 8177 (25.8) 2198 (26.9) 5979 (73.1)
75–79 6935 (21.9) 1804 (26.0) 5131 (74.0)
80–84 4543 (14.3) 1091 (24.0) 3452 (76.0)
85+ 3142 (9,9) 682 (21.7) 2460 (78.3)
Marital Status (n = 31,672) Single 1588 (5.0) 345 (21.7) 1243 (78.3) < 0.001a
Married 16,481 (52.0) 4223 (25.6) 12,258 (74.4)
Widowed 12,488 (39.4) 3368 (27.0) 9120 (73.0)
Divorced 1115 (3.5) 389 (34.9) 726 (65.1)
Highest Degree of Education (n = 31,672) No formal education 4608 (14.5) 595 (12.9) 4013 (87.1) < 0.001a
Primary 9802 (30.9) 2472 (25.2) 7330 (74.8)
Lower secondary 6196 (19.6) 1487 (24.0) 4709 (76.0)
Upper secondary 7516 (23.7) 2582 (34.4) 4934 (65.6)
Post-secondary 589 (1.9) 177 (30.1) 412 (69.9)
First stage of tertiary 2539 (8.0) 903 (35.6) 1636 (64.4)
Second stage of tertiary 422 (1.3) 109 (25.8) 313 (74.2)
Country of Residence (n = 31,672) Austria 3500 (11.1) 767 (21.9) 2733 (78.1) < 0.001a
Belgium 2377 (7.5) 463 (19.5) 1914 (80.5)
Bulgaria 1430 (4.5) 437 (30.6) 993 (69.4)
Cyprus 1228 (3.9) 150 (12.2) 1078 (87.8)
Czechia 420 (1.3) 186 (44.3) 234 (55.7)
Greece 2023 (6.4) 454 (22.4) 1569 (77.6)
Spain 6003 (19.0) 468 (7.8) 5535 (92.2)
Hungary 1041 (3.3) 354 (34.0) 687 (66.0)
Latvia 1404 (4.4) 595 (42.4) 809 (57.6)
Malta 652 (2.1) 151 (23.2) 501 (76.8)
Poland 6147 (19.4) 3037 (49.4) 3110 (50.6)
Romania 4347 (13.7) 793 (18.2) 3554 (81.8)
Slovenia 393 (1.2) 127 (32.3) 266 (67.7)
Slovakia 707 (2.2) 343 (48.5) 364 (51.5)

a
Chi-Square test.

Odds ratios (OR) were estimated with their respective 95 % confidence
intervals (95 % CI). In all analyses, a significance level of 0.05 was
considered. The statistical analysis was performed with IBM SPSS
Statistics version 26 (IBM Corp, Armonk, NY, USA).
3. Results
3.1. Sample characteristics
The total sample composed of 31,672 older adults from 14 European
countries. Of these, 26.3 % were considered self-medicated partici-
pants. Main characteristics of the sample are presented in Table 1.
By comparing groups according to their self-medication status, this
study found that individuals who were more likely to be self-medicated
were women, older adults between 65 and 69 years of age, or divorced
or had a high-educational degree (first stage of tertiary) (Table 1).
The vast majority of the sample (83.2 %) used some prescribed
medication in the past two weeks: most used were vitamins, minerals,
or tonics (52.0 %). More prevalently, they were from Poland (19.4 %)
and Spain (19.0 %). Information regarding health status is presented in
Table 2.
The presence of self-medication was associated with a poor or very
poor overall self-reported health status, the presence of a long-standing
illness, a severe limitation related to health problems, regular alcohol
consumption (on a monthly basis), obesity, and use of prescribed
medication (Table 2).
remained significant predictors of self-medication after adjustment
were sex, age, marital status, education, country, prescribed medica-
tion, long-standing illness or health problem, and physical pain. BMI
groups, self-perception of health, physical limitation, days of vigorous
activities in the last seven days, and alcohol frequency did not remain
significant predictors in the multivariable model but were included in
the final model.
Older individuals presenting greater odds of self-medication were
women (1.64 times more than men) and persons with all degrees of
physical pain (ranging from 1.77 up to 2.19 times more likely) when
compared with those having no physical pain. Comparing with Spain,
participants from other countries were also more likely to be self-
medicated, namely Poland (8.22 times more likely), Slovakia (6.81
times more likely), and Czechia (6.63 times more likely) (Table 3).
Other variables that also showed a positive significant association
with self-medication include: those in the age group between 65 and 69
years old were 1.18 times more likely than those 85 years old or older),
those who were divorced (1.30 times more likely than widowed), par-
ticipants who did not use prescribed medication (1.17 times more likely
than those who used), and participants who presented long-standing
illnesses (1.19 times more likely than those who did not). Regarding the
participants’ educational levels, all degrees (except the highest one)
showed increased odds of self-medication when compared to those with
no formal education (from 1.15 up to 2.18 times more likely) (Table 3).
4. Discussion and implications

3.2. Predictive factors of self-medication This study showed, through a large number of older European
participants (31,672), an overall 26.3 % prevalence of self-medication,
Within the multivariable analysis (n = 19.211), the variables that following the trends of previous studies within Europe that point to

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Table 2
Association between health characteristics and self-medication status.
Total Self-medication p

Yes No

n (%) n (%) n (%)

Self-perception of health (n = 31,108) Very good 1482 (4.8) 264 (17.8) 1218 (82.2) < 0.001a
Good 8469 (27.2) 1756 (20.7) 6712 (79.3)
Fair 12,813 (41.2) 3610 (28.2) 9203 (71.8)
Bad 6351 (20.4) 2005 (31.6) 4346 (68.4)
Very bad 1993 (6.4) 595 (29.9) 1398 (70.1)
Prescribed Medication (n = 31,672) Yes 5331 (16.8) 7007 (26.6) 19,334 (73.4) 0.005a
No 26,341 (83.2) 1318 (24.7) 4013 (75.3)
Long-standing Illness (n = 31,020) Yes 23,878 (77.0) 6769 (28.3) 17,109 (71.7) < 0.001a
No 7142 (23.0) 1445 (20.2) 5697 (79.8)
Health-Problem Limitation (n = 31,040) Severely limited 6384 (20.6) 1842 (28.9) 4542 (71.1) < 0.001a
Limited, not severely 12,237 (39.4) 3478 (28.4) 8759 (71.6)
Not limited at all 12,419 (40.0) 2890 (23.3) 9529 (76.7)
BMI Groups (n = 28,373) Underweight 385 (1.4) 90 (23.4) 295 (76.6) 0.001a
Normal weight 9353 (33.0) 2439 (26.1) 6914 (73.9)
Pre-obesity 12,764 (45.0) 3457 (27.1) 9307 (72.9)
Obesity class I 4682 (16.5) 1362 (29.1) 3320 (70.9)
Obesity class II 950 (3.3) 282 (29.7) 668 (70.3)
Obesity class III 239 (0.8) 74 (31.0) 165 (69.0)
Smoke at all nowadays (n = 30,407) Yes, daily 2372 (7.8) 617 (26.0) 1755 (74.0) 0.204a
Yes, occasionally 594 (2.0) 176 (29.6) 418 (70.4)
Not at all 27,441 (90.2) 7362 (26.8) 20,079 (73.2)
Alcohol Frequency (n = 26,857) Never 12,623 (47.0) 3254 (25.8) 9369 (74.2) < 0.001a
Monthly 7185 (26.8) 2500 (34.8) 4685 (65.2)
2–4 times a month 2805 (10.4) 820 (29.2) 1985 (70.8)
2–3 times a week 1117 (4.2) 260 (23.3) 857 (76.7)
4–6 times a week 654 (2.4) 144 (22.0) 510 (78.0)
Every day 2473 (9.2) 396 (16.0) 19,483 (84.0)
Binge Drinking (n = 6354) Never 4753 (74.8) 912 (19.2) 3841 (80.8) < 0.001a
Less than monthly 999 (15.7) 238 (23.8) 761 (76.2)
Monthly 307 (4.8) 82 (26.7) 225 (73.3)
Weekly 204 (3.2) 34 (16.7) 170 (83.3)
Daily/almost daily 91 (1.4) 19 (20.9) 72 (79.1)
Vigorous Activities (days), mean (sd) (n = 27,263) 0.62 (1.67) 0.58 (1.62) 0.63 (1.69) 0.020b
Moderate Activities (days), mean (sd) (n = 28,212) 2.48 (2.88) 2.71 (2.88) 2.40 (2.87) < 0.001b
Ten-Minute Walk (days), mean (sd) (n = 28,574) 4.20 (2.96) 4.40 (2.88) 4.12 (2.98) < 0.001b
Physical Pain or Discomfort (n = 25,684) None 6408 (24.9) 990 (15.4) 5418 (84.6) < 0.001a
Mild 6294 (24.5) 1991 (31.6) 4303 (68.4)
Moderate 8148 (31.7) 2585 (31.7) 5563 (68.3)
Severe 4116 (16.0) 1282 (31.1) 2834 (68.9)
Extreme 718 (2.8) 225 (31.3) 493 (68.7)

a
Chi-Square test.
b
independent sample t-test.

prevalence ranging from 13.3 % in Spain (Carmona-Torres et al., 2018)
up to 57 % in Serbia (Gazibara et al., 2013). This study also found some
predictive factors associated with self-medication: sex, age, marital
status, high degree of education, country of residence, use of prescribed
medication, presence of long-standing illness, and presence of physical
pain. The female gender was found to be an independent associated
factor in this study, a fact that some authors attribute to greater self-
care and frequency of medical appointments (Balbuena, Aranda, &
Figueras, 2009; Loyola Filho et al., 2005; Nielsen, Hansen, &
Rasmussen, 2003; Sá et al., 2007). As already seen in previous studies
(de Oliveira et al., 2012), younger age was also associated with self-
medication, since those from 65 to 69 years old had greater odds of
presenting such behavior than those aged 85 years old or older.
Marital status was found to be associated with self-medication, as a
previous study found (Balbuena et al., 2009). Here, being divorced
proved to be a higher risk than being widowed. The association be-
tween married people and better health and mortality outcomes is well
known (Ben-Shlomo, Smith, Shipley, & Marmot, 1993; Gove, 1973; Hu
& Goldman, 1990). In particular, divorced individuals not only have
worse perceptions of mental health (Hewitt, Turrell, & Giskes, 2012)
but also tend to present a higher relative risk of death (16 %) (Manzoli,
Villari, Pirone, & Boccia, 2007) when compared with married
individuals. Since marital status is often associated with health status, it
is expected that such an association also be reflected in the self-medi-
cation behavior. In addition, divorced adults (singular individuals, in
general) may also have less encouragement to seek medical attention.
Regarding the level of education, all degrees of higher education
(except the highest one), compared with lower education levels, were
found to increase the odds of self-medication. Although the education
level may have different influences in self-medication depending on
where the participant lives, as seen in studies conducted in different
countries (Coelho Filho et al., 2004; Loyola Filho et al., 2005; Miralles
& Kimberlin, 1998; Stoehr et al., 1997), it is a trend in some studies that
the increase of educational attainment also increases the risk of self-
medication (Al-Windi, Elmfeldt, & Svärdsudd, 2004; Carrasco-Garrido
et al., 2014; Delaney, Biggs, Kronmal, & Psaty, 2011). A possible ex-
planation for this may be that people with higher educational levels
may feel more confident in their active search for self-diagnosis and/or
self-medication.
The participants that did not use any medication prescribed by a
doctor had a higher chance of self-medicating. It could be due to diverse
aspects, including both individual choice (by self-diagnosing or by re-
peating old prescriptions) (Balbuena et al., 2009) and health-system
barriers to medical appointments (Jain, Malvi, & Purviya, 2011).

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Table 3 This association seems to be the main reason for divergences regarding
Multivariable logistic regression model. prevalence and factors associated with self-medication in previous
Variable OR 95 % CI p studies (Jerez-Roig et al., 2014). Mackenbach et al. (2008) showed that
there is a highly variable magnitude in the health inequality associated
Sex (Reference: Male) Female 1.647 1.517–1.788 < 0.001 with socioeconomic status among European countries. Consequently,
Age Group (Reference: 85+) 65–69 1.184 1.012–1.385 0.035
such variances and its explanations may be intimately associated with
70–74 1.095 .938–1.278 0.253
75–79 1.082 .926–1.263 0.321
the observed findings, since self-medication is influenced by numerous
80–84 1.009 .855–1.190 0.919 factors: from aspects related to the individual (beliefs, health condition,
Legal Marital Status Single 1.024 0.856–1.224 0.795 purchasing power, etc.), to aspects related to each country’s health
(Reference: Widowed) Married 1.046 0.965–1.134 0.269 system (e.g., differences in access to primary care, types of access to
Divorced 1.307 1.091–1.565 0.004
medications, and costs and barriers involved in the process). Thus, the
Highest Degree of Education Primary 1.156 1.013–1.320 0.031
(Reference: No formal Lower 1.218 1.037–1.431 0.016 observed variation in the odds of self-medication among countries
education) secondary shows that perhaps the health and cultural system in which the in-
Upper 1.501 1.300–1.734 < 0.001 dividual is embedded is even more decisive than previously thought in
secondary
predicting the self-medicating behavior.
Post- 1.471 1.123–1.927 0.005
secondary
Despite the strengths of this study—large sample size, cross-national
First stage of 2.189 1.843–2.599 < 0.001 study, standardized survey—limitations are to be acknowledged,
tertiary namely its cross-sectional nature (cannot determine both cause and
Second stage 1.350 0.943–1.934 0.101 effect of associated variables and self-medication) and the fact that data
of tertiary
collection has been made by interviews, which are prone to sub-
Country of Residence Bulgaria 3.734 3.117–4.472 < 0.001
(Reference: Spain) Cyprus 1.450 1.170–1.798 0.001 jectivism and memory-recall problems. Additionally, some limitations
Czechia 6.639 5.184–8.502 < 0.001 related to methodological options should be addressed. This study
Greece 2.915 2.478–3.429 < 0.001 could have been seen as a cross-cultural study, focusing on differences
Hungary 4.158 3.432–5.038 < 0.001 between countries. However, rigorous methodological aspects need to
Latvia 5.636 4.689–6.773 < 0.001
Malta 3.798 2.944–4.900 < 0.001
be addressed, such as sampling and data collection (Buil, de
Poland 8.222 7.160–9.441 < 0.001 Chernatony, & Martínez, 2012), and that cannot be guaranteed in this
Romania 1.765 1.377–2.263 < 0.001 study.
Slovenia 3.587 2.762–4.660 < 0.001 Sometimes people think that self-medication is risk-free (Wazaify
Slovakia 6.814 5.519–8.413 < 0.001
et al., 2005), but the risks tend to gain great proportion, especially
Prescribed medication No 1.175 1.056–1.308 0.003
(Reference: Yes) among the elderly (Vali et al., 2012). Although several groups (and
Long-standing illness or Yes 1.191 1.059–1.340 0.004 countries) at higher risk of self-medication were presented here, there
health problem? are still innumerous remaining factors to understand clearly who (and
(Reference: No) which groups) health professionals should focus their attention on in
Amount of physical pain in Mild 1.770 1.592–1.968 < 0.001
past four weeks Moderate 1.824 1.631–2.039 < 0.001
order to educate them preventively about the risks of an inadequate use
(Reference: None) Severe 1.888 1.650–2.160 < 0.001 of nonprescribed medicines. Thus, future qualitative research is needed
Extreme 2.195 1.756–2.743 < 0.001 to understand the whole picture.

Note: model was also adjusted for BMI Groups, Self-Perception of Health,
Physical Limitation, Days of Vigorous Activities in Last Seven Days, and Alcohol Author contributions
Frequency (non-significant variable in the multivariable model).
LT performed the analyses of data. GB and LT performed the in-
Concerning the overall health condition, previous research has shown terpretation of data and wrote the manuscript. LA, CP, and OR revised
an association of long-standing illnesses with a higher chance of using a the manuscript critically for important intellectual content. All authors
medication prescribed by a doctor (suggested to be due to a higher approved the final version of the manuscript.
number of regular appointments) (Coelho Filho et al., 2004; de Oliveira
et al., 2012). In this study we found that long-standing illnesses are
associated with higher odds of self-medication. These results, seeming CRediT authorship contribution statement
to be contradictory, may reflect a greater knowledge the patients have
about their own health conditions and symptoms or results of the in- Gabriela Rangel Brandão: Formal analysis, Writing - original
teraction between illnesses and medication prescribed by a doctor. draft. Laetitia Teixeira: Methodology, Formal analysis, Writing - ori-
These are, however, interpretative hypotheses that need further re- ginal draft. Lia Araújo: Writing - review & editing. Constança Paúl:
search. Writing - review & editing. Oscar Ribeiro: Supervision, Writing - re-
The presence and the degree of physical pain felt by the patient view & editing.
were associated with higher odds of self-medication. Pain is extremely
prevalent among older adults. The prevalence of chronic pain in par-
Declaration of Competing Interest
ticular ranges from 29 % up to 50 % in European countries (Eriksen,
Jensen, Sjøgren, Ekholm, & Rasmussen, 2003; Jakobsson, 2010), a fact
that leads analgesics and antipyretics to be the classes of drugs most The authors have declared no conflicts of interest.
often self-prescribed by the elderly, as seen in previous studies (Jerez-
Roig et al., 2014). The high prevalence and the poor management of
Acknowledgements
pain by health professionals (Schofield, 2007) seem to partially explain
the need for these older adults to seek self-medication as a way to re-
We acknowledge the database from EUROSTAT. The results and
lieve physical pain.
conclusions are the responsibility of the authors of this publication and
A remarkable finding of this study is the strong association between
not of the responsibility of Eurostat, the European Commission or any
the country of residence and self-medication, which, to the best of our
of the national statistical authorities whose data have been used in this
knowledge, has not been observed before in studies with older adults.
study.

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November 11, 2021. For personal use only. No other uses without permission. Copyright ©2021. Elsevier Inc. All rights reserved.
G.R. Brandão, et al.
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