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Pill Bottle Warnings Often Go Unnoticed

Those colorful warning labels on vials of medication don’t always capture a patient’s attention, especially if the patient is older, researchers found.

When groups of older and younger participants were tested on their ability to notice information on medication vials, just 54 percent of the older group fixed their gaze on the prescription warning labels, compared with 91.8 percent of the younger participants, according to Laura Bix, PhD, of Michigan State University in East Lansing, Mich., and colleagues.

And that means that many older patients simply fail to remember their contents and act on them, Bix and colleagues argued online in PLoS ONE. The finding may help to explain why older patients — who often take several medications — are at greater risk for adverse drug events.

The researchers tested two age groups — 15 volunteers ages 20 to 29, and 17 volunteers ages 51 to 77 — for their ability to notice the information on the vials, using eye-tracking technology to see what parts they examined.

In addition, they were tested on how well they remembered what they had looked at, Bix and colleagues reported.

The vials had different-colored warning labels, a white pharmacy label, and a cap with opening instructions.

The color of the label had no effect on the probability that participants would notice it.

As was the case with noticing the warning labels, a similar difference between older and younger patients was seen for the vial cap — 2.4 percent of the older population and 24.4 percent of the younger group looked at it.

On the other hand, 100 percent of both groups looked at the white pharmacy label.

To test recall, participants were presented with a sheet of 10 warning labels and asked which had been on the five vials they had examined, Bix and colleagues reported.

Recognition differed significantly between age groups, with a probability of correctly identifying the warning labels of 68.5 percent for the younger group and 53.6 percent for the older participants.

But when the researchers analyzed the results using a model that included whether participants had actually fixed their gaze on the colored warning labels, the effect of age disappeared.

The volunteers were significantly more likely to recognize the labels if they had fixated on them first. Specifically:

  • When participants fixated on the warning labels, recognition rates were 61.7 percent for young adults and 54.0 percent for the older group.
  • When they failed to fixate on the labels, rates were low — 23.9 percent for the younger group and 9.5 percent for the older volunteers.

In other words, Bix and colleagues argued, the differences in recall appear to be a result of differences in paying attention to the labels in the first place.

Interestingly, that lack of attention was common — when handed five vials in succession, only half of the volunteers fixated on all five warning labels and 22 percent did not fixate on any, the researchers reported.

They concluded that the first step in getting warning messages across is to design labels that will attract attention, and only after that should wording and content be tweaked.