Medicine Management & Administration

Understanding the challenge in terms of Management & Administration in patients with difficulties in swallowing or clinical dysphagia.

Dysphagia: current reality and scope of the problem

Dysphagia, or difficulty swallowing, affects many people in the UK including 50% of the elderly.^[1] A surprisingly high proportion of adults are unable to swallow tablets or capsules as highlighted in a survey of patients aged over 60 years carried out by community pharmacists; almost 60% of the 792 respondents experienced difficulty in swallowing medication in this form. A similar proportion reported opening capsules or crushing tablets to make ingestion easier, unaware of the negative effect it may have on the activity of the drug.^[2]

Patients with swallowing difficulties present a management challenge since: ^[2]

• Therapeutic outcomes may be affected in those not adhering to prescribed medications.
• Tablets or capsules may cause choking with consequent risk to the airway.
• There may be an increased risk of a tablet or capsule becoming lodged in the patient’s throat or oesophagus, resulting in incorrect drug dispersal and subsequent changes in efficacy and/or tolerability, and possible oesophageal damage. Altering the formulation of a medicine has important medical Implications.

Improved communication^[2]

• Healthcare providers should always ask the patient or carer whether they have difficulty swallowing medication and assess the reasons for this.
• Doctors should ensure that known swallowing difficulties are taken into consideration when prescribing medication.
• Community pharmacists should assess the suitability of medication formulations for individual patients, and report swallowing difficulties to the prescriber.
• Carers should inform the patient’s doctor if they know or suspect that swallowing medication is an issue.

People with swallowing difficulties often resort to crushing tablets or opening capsules. Over two thirds of the care homes surveyed stated that crushing, melting, dispersing or splitting medication was an activity taking place daily. ^[3]

Crushing, melting or dispersing tablets alters the normal arrangements for the body’s absorption of medication which can impact on efficacy and safety. This is compounded when considering that one of the most common types of medication administration error is incorrect crushing of tablets. However, in over two thirds of the homes crushing, melting or dispersing tablets had become a daily necessity to assist people with swallowing difficulties to take their medication. The prescription of liquid forms of medication offers a useful way to address this concern. ^[3]

ROS000051-005 DOP September 2023