Oral drug therapy in elderly with dysphagia: between a rock and a hard place!

Abstract

Demographic indicators forecast that by 2050, the elderly will account for about one-third of the global population. Geriatric patients require a large number of medicines, and in most cases, these products are administered as solid oral solid dosage forms, as they are by far the most common formulations on the market. However, this population tends to suffer difficulties with swallowing. Caregivers in hospital geriatric units routinely compound in solid oral dosage forms for dysphagic patients by crushing the tablets or opening the capsules to facilitate administration. The manipulation of a tablet or a capsule, if not clearly indicated in the product labeling, is an off-label use of the medicine, and must be supported by documented scientific evidence and requires the patient’s informed consent. Compounding of marketed products has been recognized as being responsible for an increased number of adverse events and medical errors. Since extemporaneous compounding is the rule and not the exception in geriatrics departments, the seriousness and scope of issues caused by this daily practice are probably underestimated. In this article, the potential problems associated with the manipulation of authorized solid oral dosage forms are discussed.

Nurses’ self‐assessments of adherence to guidelines on safe medication preparation and administration in long‐term elderly care

“…This may also occur when tablets are crushed . Because these practices are often hazardous, alternative solutions such as the use of different forms of medication or administration via different routes should be considered, and the possibility of adverse events should be assessed .…”

The effect of a residential care pharmacist on medication administration practices in aged care: A controlled trial

“…However, physiological decline or the presence of conditions such as dementia, Parkinson's disease or previous stroke can contribute to a high prevalence of dysphagia in the RACH population . Dysphagia has been reported in 40%‐60% of RACH residents, which could present difficulties with the oral administration of drugs . Consideration from prescribers of practical issues such as oral drug administration in the RACH setting is often overlooked …”

Quality Verification of Six Medicines in Wholes and Halves Tablets, Re-Packaged in Individual Plastic Compartments During Sixty Days

“…[19] Another problem to be considered is the professional acts regulation, arguing that the manipulation of pharmaceutical forms may have legal and ethical consequences. [20] However, professional practice contemplates that the therapeutic decision-making of marketed drugs is also presumably assumed by the prescriber [21] who bases his expert judgment on the best available evidence, clinical experience, references of scientific articles and the risk-benefit balance, to obtain the guidelines to be followed in an individual patient therapy. [22] The official agency, which regulates medicines in different countries, determines whether the marketing authorization of the products is given, such authorization is specific to indications, doses and population.…”

“…[32] These is a subtropical zone according to the ICH classification (25 oC to 60% of relative humidity). [20] Hence, this study aim was to evaluate the doses accuracy and the quality attributes, of wholes and halves tablets, of furosemide, hydrochlorothiazide, spironolactone, warfarin sodium, atenolol and levothyroxine sodium, re-packaged in individual plastic compartments for sixty days. These drugs were selected because they are used for the pharmacological treatment of high relevance pathologies in Costa Rica.…”