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Older adults with difficulty swallowing oral medicines: a systematic review of the literature

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Abstract

Purpose

Difficulty swallowing oral medicines may arise due to swallowing disorders or due to patient self-reported difficulty in the absence of objective evidence of swallowing dysfunction. Medication use increases with age; therefore, difficulty swallowing medication may complicate medicine administration to older patients. Modifying oral medicines can impact on the safety, quality and efficacy of the medication. The objective of this systematic review is to critically appraise the evidence regarding the prevalence of difficulty swallowing oral medicines and the modification of oral medicines to overcome swallowing difficulties in the older cohort.

Methods

A systematic search of PubMed, EMBASE, MEDLINE, CINAHL, Scopus, Web of Science, The Cochrane Library, PsycINFO and ProQuest databases was conducted from database inception to November 2014. Studies investigating the prevalence of difficulty swallowing oral medicines or the modification of oral medicines were eligible for inclusion. A narrative analysis of the results was conducted.

Results

Five studies met the inclusion criteria. The results suggest that approximately 14 % of community-dwelling older patients experience difficulty swallowing medicines. Between one quarter and one third of occasions of medicine administration to older patients involve the modification of oral medicines.

Conclusions

Difficulty swallowing oral medicines and the modification of medicines are reported as being common issues in the older cohort. However, evidence to support such contentions is limited. Future research should investigate the prevalence of medicine modification for older patients in all settings and identify what medicines are modified. This will allow targeting of interventions to optimise medicine administration to older patients.

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Acknowledgments

AMG is in receipt of a University College Cork Strategic Research Fund PhD Scholarship.

AMG would like to acknowledge Professor John Browne, University College Cork, Ireland, who teaches PG7016, a postgraduate module in Systematic Reviews in the Health Sciences. Undertaking this module proved extremely beneficial to the completion of this review.

The authors wish to acknowledge Mr. Joe Murphy, Medical Librarian, for his assistance in devising the search strategy for the systematic review.

The authors wish to thank Ms. Maria Kelly for her comments and feedback on the final draft.

Contributions of authors

All authors are responsible for the manuscript.

AMG was responsible for protocol design, study selection, data extraction, quality assessment, drafting of the manuscript and approval of the final manuscript. AC was responsible for protocol design, study selection, data extraction, drafting of the manuscript and approval of the final manuscript. LS was responsible for protocol design, study selection, quality assessment, drafting of the manuscript and approval of the final manuscript.

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Authors and Affiliations

  1. Pharmaceutical Care Research Group, School of Pharmacy, University College Cork (UCC), Cork, Ireland

    Aoife Mc Gillicuddy & Laura J. Sahm

  2. School of Pharmacy, University College Cork (UCC), Cork, Ireland

    Abina M. Crean

  3. Department of Pharmacy, Mercy University Hospital, Cork, Ireland

    Laura J. Sahm

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  1. Aoife Mc Gillicuddy
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Correspondence to Aoife Mc Gillicuddy.

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Mc Gillicuddy, A., Crean, A.M. & Sahm, L.J. Older adults with difficulty swallowing oral medicines: a systematic review of the literature. Eur J Clin Pharmacol 72, 141–151 (2016). https://doi.org/10.1007/s00228-015-1979-8

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