David Wright, Professor of Pharmacy Practice at the School of Pharmacy, University of East Anglia and lead educator of the online course: ‘Dysphagia: Swallowing Difficulties and Medicines’ on the FutureLearn platform looks at the issues those with swallowing difficulties encounter, as well as what can be done to best support them.
Ageing, dementia, stroke, Parkinson’s disease, head and neck cancer and conditions commonly resulting in prescribed drugs are all associated with swallowing difficulties. Consequently, it is a relatively common condition which increases with age. Although dysphagia, the scientific term for physical problems causing swallowing difficulties, is not a disease it is a symptom which can seriously affect quality of life, particularly if it prevents individuals from eating and drinking with friends and family. However, the administration of medicines to people with swallowing difficulties is frequently overlooked, and if it is not considered carefully, it can cause further problems for the individual.
Due to reasons related to cost and convenience, it is usual practice in most countries to buy or prescribe tablets and capsules as first choice for the treatment of any condition. However, for a person with dysphagia, tablets and capsules can be an additional barrier to being able to take their medicines. Consequently, individuals and their carers can resort to crushing or dispersing their tablets before taking them to make them much easier to swallow. From a healthcare professional perspective this should always be the last choice of action as it is the most risky and can result in either medicines not working or causing potential harm. Furthermore, crushed tablets are frequently far more unpleasant to swallow taste wise than those still intact.
Interestingly, research suggests that patients and carers don’t like to bother their doctor or pharmacist with information regarding their inability to swallow as frequently there are other more pressing things which require discussion. However, without this conversation, the healthcare professional is not going to be able to give the right advice.
Alternative ways of administering medicines
The first question that should always be asked when someone has swallowing difficulties is whether the medicines are needed at all, and if this is the case, what is the best way to administer them? Increasingly different ways of administering medicines are being developed from patches to be applied to the skin for a few days, tablets which disperse in the mouth or absorb through the tongue or gums, to liquids which have the right consistency to minimise the chance of causing the patient to cough and are designed to be palatable.
There are websites which tell you what is available for your medicines (www.swallowingdifficulties.com) and whether it may be unsafe to tamper with tablets or capsules before taking them. Medicines which are designed to release a large dose over a long period should never be crushed, nor should those which are coated to protect the stomach from the drug, the drug from the stomach acid, or to release the drug further down the system. It is not possible to tell from looking at the medicine to decide what is best to do and therefore patients and carers should always seek advice. Your pharmacist will be able to provide advice to you about what your options are so that you can go to your doctor fully informed. Choosing the right medicine for someone with dysphagia is a complex decision, which the patient needs to be central to making, and this can only be done if they are aware of the options and possible consequences.