ESSD

2016

Poster

presented at:

Older  adults  with  dysphagia:  administration  of  oral  medications  in  a  secondary  care  setting

S.  Patel¹,  N.  Bhalla¹  ²,  W.J.  McAuley¹,  F.  Liu¹¹School  of  Life  and  Medical  Sciences,  University  of  Hertfordshire,  Hatfield,  AL10  9AB  UK

²Cambridge  University  Hospitals  NHS  Foundation  Trust,  Cambridge,  CB2  0QQ  UK

References

Introduction  and  Aims

Results  &  Discussion

Methods

Conclusions

.

The number of older adults in the population is rising and will comprise almost 30% of the total EU population in 2050. The oldercohort require more prescribed medicines due to comorbidities. They are also more vulnerable to dysphagia due to the naturalprocess of aging and age related diseases, which can make swallowing medicines challenging.

The practice of manipulating dosage forms, e.g. crushing tablets or opening capsules to release contents is common practice tofacilitate medicines administration to older patients. This can be particularly hazardous for sustained release oral dosage forms whichhave more drug content to allow slow release of drug over a prolonged period of time. The aim of this study was to determine theextent of problems surrounding the administration of solid oral dosage forms to older adults with dysphagia in secondary care.

A prospective study of reviewing medical notes and drug charts (Figure 1) was conducted during September to November 2014 in Addenbrooke’s hospital,Cambridge, NHS Ethics (Ref 14/YH/1105) was obtained prior to conducting the study.

Figure  1:  Outline  of  the  data  collection  process

*For the purposes of this study, swallowing difficulty was defined using the following criteria1; any difficulty in oral intake or no oral intake, frequent choking andexcessive coughing, need for diet modification in texture, history of aspiration pneumonia, or need for individual mealtime supervision.

Medicines  prescribed  for  oral  administration  were  documented  on  a  standardised  pro  forma.

Patient’s  over  the  age  of  65  with  *swallowing  difficulties   were  

identified  by  ward  pharmacists.

Any  changes  made  to  prescribed  solid  oral  dosage  forms  to  facilitate  

ingestion  were  documented.

Two hundred and nine participants identified as having dysphagia were recruited (42% female) with a median age of 79 years (range 65 to 100 years). A total of 1321medicines for oral administration were prescribed (an average of 6 medicines prescribed per participant). Within these, 947 (72%) medicines were immediaterelease tablets and capsules and 68 (5%) were sustained release tablets and capsules. On 809 occasions, tablets or capsules were changed or modified to facilitateswallowing, accounting for 61% total medicines or 76% tablets and capsules prescribed. Methods used for the modification are shown in Figure 3 and 4.

Figure  2:  Types  of  formulations  prescribed  for  oral  administration

Figure  3:  Methods  used  in  drug  administration  to  overcome  swallowing  difficulties

Figure  4:Most  common  alternative  formulations  sought  to  overcome  difficulties  in  administration

Sixty-­‐eight sustained release tablets and capsules were prescribed to 63 participants. Of these 38% (n=26) were modified to facilitate administration, includingcrushing sustained release tablets, opening capsules, allowing chewing prior to swallowing and changing to alternative formulations. The most common alternativessought were immediate release solid oral dosage forms (67%) and liquid formulations (25%).

Modification of oral solid dosage forms occurs routinely to facilitate medicine administration to older adults with swallowing difficulties in secondary care practice.Sustained release dosage forms for oral administration were sometimes modified before administration to patients, this may cause potential harm to patients andmore appropriate formulations are in need to improve patient care and medication safety in older adults.

1  Groher,  M.  E.,  &  Bukatman,  R.  (1986).  The  prevalence  of  swallowing  disorders  in  two  teaching  hospitals.  Dysphagia,  1(1),  3–6.

3--15ISimmi Patel DOI: 10.3252/pso.eu.ESSD2016.2016

Poster session I: Treatment