Child Resistant Pill Bottles….

Louise Aronson, in her recent book Elderhood, cites the story of child resistant pill bottles to illustrate the casual disregard given to the needs of the elder generation when medical, governmental and corporate decisions are made.

Most of us remember when pill bottles were easily opened.  Children were often rushed to emergency rooms for stomach pumping after swallowing entire bottles of “candy.” My college roommate actually loved the taste of aspirin.  As a child, she had been hospitalized several times because of her ability to find the carefully hidden family supply of aspirin. It was obvious that pills should be more safely packaged. Thus, pediatricians and parents worked with lawmakers to pass the Poison Prevention Packaging Act in 1970, recommending pill bottles like the one pictured here. Almost immediately, the death rate from poisoning of children under five was cut in half.  Success!  Lives saved…EXCEPT

Half of those 65 years old or more have arthritis, a diagnosis which increases with age.  For those with arthritic hands, child resistant pill bottles are so difficult to open that the elderly often chose to leave the bottles open or they transfer the pills to bowls, or worse, they don’t take the medicine at all.  By 1995, 20% of children poisoned found their pills at the home of their grandparents, who had removed their medicines from the child resistant containers.  The Consumer Product Safety Commission met with stiff opposition from lawmakers and manufacturers when they recommended expansion of the testing age from the original 18 to 45, to include testers up to age 75.  Ultimately, CPSC compromised to include testers of pill packaging up to age 70. To underline the point,

it was 1995 before CPSC recommendations for changes to child resistant packaging included testers up to age 70!!

The pill bottle seen above is the current standard for child resistant packaging.  How many 80-year-olds can readily open this container?  What would the container look like if the testors had included 95-year olds?  I consider myself incredibly lucky to live in a senior community where prescriptions are filled in easy open containers. I’m pretty sure I could no longer open the pictured container. 

The point here isn’t really about children and pill containers. Aronson’s message is that public health and medical decisions may be successful for one segment of society, but too often do not consider the impact on the elderly and their health.   There are far more serious situations where the lack of inclusion of the elderly is incredibly dangerous.  Take a look at this graph, which I stumbled upon while researching child poisoning.   The graph tells many stories, divided by age group, some of which are listed below the graph.

A few of the many conclusions include:

• Emergency Department visits due to accidental (unsupervised) child poisonings are about 2 per 1000 population.  That’s amazing! And a sign of the success of the efforts of lawmakers and manufacturers to develop child resistant medicine containers.
• About twice 4 per thousand adolescents use medications for self-harm and many adolescents abuse medicines.  The mental health of our adolescents is a major public health problem, one not so easily solved with medicine bottle design.
• The last two columns of this informative chart point out the dramatic number of adults, particularly those over-65  who end up in the Emergency Department due to complications of medicines taken therapeutically!  The causes of this problem include inappropriate dosing, inadequate testing in the elderly and the increasing frequency of co-morbidities in the elderly.  “Iatrogenic illness”–defined as illness caused by medical treatment–is the fifth leading cause of death in the world. Both this chart and common sense would indicate that death associated with iatrogenesis in the elderly is even more common.

The focus on saving child lives worked well for pill bottles.  The 1995 CPSC revision recommending inclusion of testors from age 18-70 was a significant improvement in the health of both the elderly and their grandchildren, even though 85 year olds may still be unable to open the bottle above.  But again, this is merely an example of a systemic problem in which the elderly are overlooked and ignored when safety and efficiacy are under consideration. A far more dangerous example of that deficiency is found in clinical testing and prescriptive doses of medicine, and the entire topic of iatrogenic illness– a topic worthy of its own consideration on another day.