Administration of medicines in food and drink: a study of older inpatients with severe mental illness

Haw, Camilla; Stubbs, Jean

doi:10.1017/s1041610209991669

Cited by 39 publications

(29 citation statements)

References 16 publications

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“…While the legacy of prior regulatory arrangements may help to explain this apparent anomaly, a limited engagement with standardised instruments and the low response rate to this question raise cause for concern. For example, weak or inadequate record keeping has often been associated with covert administration of medicines Stubbs, 2010a &2010b;Kirkevoid and Engedal, 2005;Treloar et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

Standardising assessment instruments and care planning in Ireland

Lente

Power²

2014

Quality in Ageing and Older Adults

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-In recent decades there has been a move internationally toward increased standardisation of assessment and care planning for older people in residential care. In the Republic of Ireland, this trend is manifest within national standards governing care for older people that were introduced in mid-2009. This study was conducted approximately one year after the introduction of these national standards and sought to survey providers (n=106) around the standardised instruments in use for assessment and the processes that surrounded assessment and care planning in residential centres.It found that there were substantial variations in the use of standardised instruments between domains of care. Within some domains standardised instruments were common, while in other domains they were largely absent or external professional input was the preferred option. In contrast, assessment and care planning processes and practices displayed little variation and were almost exclusively the preserve of medical professionals.There can be little doubt that the ageing of populations has become a matter of growing interest. Across many nations increased life expectancy coupled with diminishing birth rates have contrived to alter dependency ratios in a manner that poses significant challenges for care systems, especially long-term care (Bower et al., 2009; European Commission, 2008; OECD, 2005;Tsolova and Mortensen, 2006).Moreover, it is a set of circumstances that must be confronted against a backdrop of raised consumer expectations and diluted traditional family ties, which have contributed to a ratcheting upward of demand (European Commission, 2008;Guberman et al., 2012;Kroger, 2003). At the same time, supply side factors offer cold comfort to decision makers charged with managing health and social care systems.Socio-cultural shifts for instance, have encouraged increased female engagement with education and labour markets, depleting supplies both of formal and informal carers, which many nations have relied upon in the past (European Commission, 2008;Fujisawa and Colombo, 2009;Kroger, 2003;Pavolini and Ranci, 2008;Simonazzi, 2009;Walsh and O'Shea, 2009).While the particular configuration of these challenges is peculiar to each individual nation, a similarity in response is apparent. Many states have responded by introducing or updating regulations and standards governing residential care for older people, with particular attention devoted to assessment and care planning. In the U.S.A., for instance, a Minimum Data Set -Resident Assessment Instrument (MDS-RAI) was introduced in 1990, as part of major reforms aimed at improving quality of care in nursing homes (Morris et al., 1990). It is an approach that has been embraced by many other nations since that time. Sweden, Denmark, Norway, France, Germany, the U.K. and Japan have all moved toward increasingly standardised systems based upon MDS type instruments (Bernabei et al., 2008). Designed to improve quality through facilitating problem identification, integration of care, ...

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Section: Discussionmentioning

confidence: 99%

Standardising assessment instruments and care planning in Ireland

Lente

Power²

2014

Quality in Ageing and Older Adults

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“…honey, jam, thickened fluids). This happens throughout the community, nursing homes and on hospital wards, by the person taking the medication and by health professionals involved in medication delivery (Nissen et al, 2009, Rosenberg et al, 2002, Verrue et al, 2011, Haw and Stubbs, 2010. The most obvious outcome from this practice is faster drug release because the disintegration step has been bypassed by converting the tablet or capsule to a powder.…”

Section: Resultsmentioning

confidence: 99%

“…64 Community-dwelling 40% of females, 30% of males Norway (Andersen et al, 1995) 0-100 6,158 Patients from general practice 26%; 32% of females, 16% of males USA (Harris Interactive, 2004) 18+ 679 General population 40%; 51% of females, 27% of males Denmark (Hansen et al, 2008) 11-20 89 Public school 36% UK (Haw and Stubbs, 2010) 25 -87 110 Hospital in-patients 30.9%…”

Section: +mentioning

confidence: 99%

“…Alterations involve crushing or splitting tablets (using spoons or glass cups) and mixing with food and liquids (honey, jam, fruit juice, and thickened fluid) (Nissen et al, 2009, McLachlan and Ramzan, 2010, Haw and Stubbs, 2010. It is not only the patients modifying their medications, but is also common to see drugs modified by caregivers, nursing homes and on hospital wards by health professionals such as nurses (Nissen et al, 2009, Rosenberg et al, 2002, Verrue et al, 2011, McLachlan and Ramzan, 2010, Haw and Stubbs, 2010.…”

Section: Coping With Medication Swallowing Issuesmentioning

confidence: 99%

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Oral medication dose form alteration: patient factors and the effect of adding thickened fluids

Radhakrishnan¹

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Solid oral dosage forms such as tablets and capsules are often crushed and mixed with foods or fluids to aid drug delivery for those who cannot or prefer not to swallow them whole. Some people have a physiological problem limiting swallowing (dysphagia), and their fluids are thickened to ensure safe swallowing; these thickened fluids are also used to deliver crushed medication in replacement of water. This thesis explores the issues surrounding the swallowing of whole tablets and capsules, their modification by crushing and the influence of coadministration with thickened fluids on absorption pharmacokinetics. The literature review (Chapter 1) examines the physiology and pathophysiology of swallowing and considers the particular issues surrounding swallowing tablets and capsules. It also explores the possible consequences of crushing the medications and mixing the powder with vehicles such as jam, honey, yoghurt and thickened water.This thesis contains two sections. In Section A (Chapter 2), the potential influence of psychological issues, oral sensation, sensory effect and motor ability of an individual on swallowing pills was investigated. It is hypothesised that swallowing tablets and capsules will be an issue in people with a memory of gagging on food and medication, strong gag reflex, heightened taste sensation, or who tend to chew their food for extended periods.Volunteers (153) completed a written survey and one-on-one assessments. Psychological issues were addressed by questions on memory of choking incidents on food or medication, and regularity of medication use. Sensory effects were assessed by measuring the person's gag reflex, taste receptor density, size of the mouth (mallampati classification), and on food neophobia. Motor effects were assessed as efficiency in chewing a jelly snake. Finally, the volunteers were observed swallowing a capsule and the quantity of water used, and head position was recorded.In the survey, 33% of the population reported that they have had trouble swallowing medication.These people were more likely to have choked on medication in the past, have a smaller mouth cavity, and a medium or high taste receptor density. There was no relationship between trouble swallowing medication and gag reflex, food neophobia, chewing efficiency, quantity of water used to swallow, and head position.In Section B (Chapters 3, 4, and 5), the effect of crushing medication and mixing with water thickened with a commercial thickening agent on absorption pharmacokinetics was studied.ii Paracetamol tablets were used as the model drug, and saliva samples were used to measure the PK profile. Chapter 3 assessed the inter-and intra-individual variability as the coefficient of variation of paracetamol in saliva. Volunteers took whole tablets of paracetamol (2 x 500 mg) on two different days separated by a week. Saliva production was stimulated using citric acid and paracetamol levels in the saliva were measured using high-performance liquid chromatography. Non-compartmental pharmacokinetic analy...

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“…Crushing tablets and mixing with food products is common practice to help people with swallowing disorders to take their oral medicines (Wright, 2002, Stubbs et al, 2008, Haw and Stubbs, 2010, Schiele et al, 2013. Method variant 1 with manual mixing was designed to be most similar to typical clinical practice, in which thickened fluid is prepared and then crushed tablet added into it and mixed with a spatula or spoon.…”

Section: Discussionmentioning

confidence: 99%

Understanding the mechanism of drug delivery from thickened fluids to aid swallowing of medications

Torres¹,

Juliana²

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Medications are often crushed and mixed with foods or fluids to aid drug delivery for those who cannot or prefer not to swallow whole tablets or capsules. Dysphagic patients have the added problem of being unable to safely swallow fluids, so thickeners are added to ensure safe swallowing. These thickened fluids are then also used to deliver crushed medications in replacement of water. This thesis explores the influence of thickened water co-administration on drug release in gastric fluid, the effect of rheological properties of these agents and their contribution to describing the mechanism of release. The literature review (Chapter 1) examines oral dosage form administration, rheological properties of these agents as a means to ensure medication delivery and mechanisms of drug release. It is highlighted that thickened fluids have the potential to alter drug release but prediction of the effect of co-administration is not currently reported.Chapter 2 investigates the delivery of medications with thickened fluids as an indicator for potential compromise of drug bioavailability. In vitro dissolution in simulated gastric fluid is investigated for crushed atenolol immediate release tablets mixed with thickened fluids. Five commercial viscosityincreasing agents of varied polysaccharide composition are used at three thickness levels prescribed for dysphagic patients (levels 150, 400, 900). All types of thickening agents are non-Newtonian shear thinning fluids. The greatest thickness (level 900) significantly restricts dissolution, and products that are primarily based on xanthan gum also significantly delay dissolution at the intermediate thickness level (level 400). The interactions of the polysaccharide chains, particularly the rigid rod type conformation of xanthan gum, traps drug molecules within it resulting in impaired dissolution. Under the conditions of this experiment, the higher concentrations of thickening agents remain in large lumps rather than disintegrating into the media. Drug release is generally affected to a greater extent by high-viscosity fluids than low-viscosity fluids at 50 s -1 , but viscosity at this single shear rate of 50 s -1 is not a good indicator for effect on drug dissolution because viscosity changes with shear rate. The determination of other rheological parameters such as viscoelasticity and the effect of breaking up of the structures may be required.To investigate whether it is possible to improve drug release from thickened fluids, in Chapter 3 the effect of the state of aggregation of the active ingredient with thickened fluids is investigated.Paracetamol is the model drug because it is available in a range of formulations with the drug in solution (elixir, dissolved effervescent tablet) or dispersion (suspension). Xanthan gum, which causes the greatest restriction on dissolution (Chapter 2), is used at level 900 as the thickener.ii Crushed tablets with thickener are prepared using manual (i.e. the standard method in clinical practice) or mechanical mixing. The unthickene...

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Administration of medicines in food and drink: a study of older inpatients with severe mental illness

Cited by 39 publications

References 16 publications

Standardising assessment instruments and care planning in Ireland

Standardising assessment instruments and care planning in Ireland

Oral medication dose form alteration: patient factors and the effect of adding thickened fluids

Understanding the mechanism of drug delivery from thickened fluids to aid swallowing of medications

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