Tamper-resistant packaging is required for over-the-counter (OTC) medications to reduce the risk of tampering by persons with evil intent. However, the packaging may limit or prevent access by elderly patients with disabilities.

Features of tamper-resistant packaging that increase problems for the elderly:

(1) instruction in small print

(2) difficulty distinguishing the edge of the seal from the container, either because the seal is clear or of the same color as the container

(3) highly reflective coating causing glare

(4) pull rings on cans

(5) thick and tough seals

(6) absence of a grasping tab on seals

(7) cotton padding


Comorbid conditions that are likely to make opening tamper-resistant packages difficult for an elderly patients:

(1) hand paralysis or neuropathy

(2) reduced manual dexterity or strength

(3) severe tremor

(4) impaired vision, including contrast sensitivity

(5) apraxia

(6) confusion or memory loss


If there is a question about the ability of an elderly patient to open a tamper-resistant package, then the patient can be asked to open the package under observation.


Actions indicating difficulty in opening a tamper-resistant package:

(1) failure to gain access

(2) use a knife, scissors, pen or other implement

(3) struggles then gives up

(4) take an excessive time to open the container

(5) use their mouth, gums or teeth to open the container


Risk factors for aspiration of the packaging material when using the mouth for opening a container:

(1) elderly

(2) poor dentition

(3) Parkinson's disease

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