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Difficulties swallowing solid oral dosage forms in a general practice population: prevalence, causes, and relationship to dosage forms

  • Pharmacoepidemiology and Prescription
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European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

We assessed the prevalence of difficulties in swallowing solid oral dosage forms in a general practice population. Reasons, nature, and characteristics of tablets and capsules causing such difficulties were investigated as well as general practitioners’ (GP) awareness of these difficulties.

Methods

A questionnaire survey was conducted in 11 general practices and consecutive patients taking at least one solid oral dosage form for ≥4 weeks were invited to respond to a questionnaire at the practices and one at home. Physicians completed a short questionnaire for each included patient.

Results

Of all participants (N = 1,051), 37.4 % reported having had difficulties in swallowing tablets and capsules. The majority (70.4 %) of these patients was not identified by their GP. The occurrence of swallowing difficulties was related to gender (f>m), age (young>old), dysphagia [adjusted odds ratio (adOR): 7.9; p < 0.0001] and mental illness (adOR: 1.8; p < 0.05). By asking “Do you choke while eating or drinking?”, affected patients could be identified with a sensitivity of 62.6 % and a specificity of 78.1 %. Because of these difficulties, 58.8 % of the affected patients had already modified their drugs in a way that may alter safety and efficacy and 9.4 % indicated to be non-adherent.

Conclusions

One in 11 primary care patients had frequent difficulties in swallowing tablets and capsules while GPs grossly underestimated these problems. Therefore, physicians should rule out swallowing difficulties regularly to avoid non-adherence and inappropriate drug modifications. Special attention should be paid to specific patient groups (e.g. women and patients with dysphagia, dysphagia indicators, or mental illness).

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References

  1. Schwabe U, Paffrath D (2011) Arzneiverordnungsreport 2010, 1st edn. Springer Medizinverlag, Heidelberg

    Google Scholar 

  2. Heppner HJ, Sieber CC, Esslinger AS, Trogner J (2006) Drug administration and dosage forms in geriatric patients. Ther Umsch 63(6):419–422

    Article  PubMed  CAS  Google Scholar 

  3. Nunn T, Williams J (2005) Formulation of medicines for children. Br J Clin Pharmacol 59(6):674–676. doi:10.1111/j.1365-2125.2005.02410.x

    Article  PubMed  Google Scholar 

  4. Badgujar BP, Mundada AS (2011) The technologies used for developing orally disintegrating tablets: a review. Acta Pharm 61(2):117–139. doi:10.2478/v10007-011-0020-8

    Article  PubMed  CAS  Google Scholar 

  5. Singh J, Philip AK, Pathak K (2008) Optimization studies on design and evaluation of orodispersible pediatric formulation of indomethacin. AAPS PharmSciTech 9(1):60–66. doi:10.1208/s12249-007-9018-4

    Article  PubMed  CAS  Google Scholar 

  6. Miller CA (2003) Safe medication practices: administering medications to elders who have difficulty swallowing. Geriatr Nurs 24(6):378–379. doi:10.1016/j.gerinurse.2003.10.012S0197457203003471

    Article  PubMed  Google Scholar 

  7. Hansen DL, Tulinius D, Hansen EH (2008) Adolescents’ struggles with swallowing tablets: barriers, strategies and learning. Pharm World Sci 30(1):65–69. doi:10.1007/s11096-007-9142-y

    Article  PubMed  Google Scholar 

  8. Derkay CS, Schechter GL (1998) Anatomy and physiology of pediatric swallowing disorders. Otolaryngol Clin North Am 31(3):397–404

    Article  PubMed  CAS  Google Scholar 

  9. Garvie PA, Lensing S, Rai SN (2007) Efficacy of a pill-swallowing training intervention to improve antiretroviral medication adherence in pediatric patients with HIV/AIDS. Pediatrics 119(4):e893–e899. doi:10.1542/peds.2006-1488

    Article  PubMed  Google Scholar 

  10. Ekberg O, Feinberg MJ (1991) Altered swallowing function in elderly patients without dysphagia: radiologic findings in 56 cases. AJR Am J Roentgenol 156(6):1181–1184

    Article  PubMed  CAS  Google Scholar 

  11. Ney DM, Weiss JM, Kind AJ, Robbins J (2009) Senescent swallowing: impact, strategies, and interventions. Nutr Clin Pract 24(3):395–413. doi:10.1177/0884533609332005

    Article  PubMed  Google Scholar 

  12. Rittig T, Jäger M, Füsgen I (2009) Prävalenz und Bedeutung von Schluckstörungen bei Patienten in geriatrischen Einrichtungen—eine biometrische Multicenter-Erhebung (Teil I). Eur J Ger 11(2):69–78

    Google Scholar 

  13. Morris H (2006) Dysphagia in the elderly–a management challenge for nurses. Br J Nurs 15(10):558–562

    PubMed  Google Scholar 

  14. Lindgren S, Janzon L (1991) Prevalence of swallowing complaints and clinical findings among 50–79-year-old men and women in an urban population. Dysphagia 6(4):187–192

    Article  PubMed  CAS  Google Scholar 

  15. Steele CM, Greenwood C, Ens I, Robertson C, Seidman-Carlson R (1997) Mealtime difficulties in a home for the aged: not just dysphagia. Dysphagia 12(1):43–50, discussion 51

    Article  PubMed  CAS  Google Scholar 

  16. Wright D (2002) Medication administration in nursing homes. Nurs Stand 16(42):33–38

    PubMed  Google Scholar 

  17. Andersen O, Zweidorff OK, Hjelde T, Rodland EA (1995) Problems when swallowing tablets. A questionnaire study from general practice. Tidsskr Nor Laegeforen 115(8):947–949

    PubMed  CAS  Google Scholar 

  18. The free Library (2004) Farlex. http://www.thefreelibrary.com/40%25+of+American+Adults+Report+Experiencing+Difficulty+Swallowing…-a0112187875. Accessed 01/15 2012

  19. Morris H (2005) Dysphagia in a general practice population. Nurs Older People 17(8):20–23

    PubMed  Google Scholar 

  20. Kelly J, D’Cruz G, Wright D (2010) Patients with dysphagia: experiences of taking medication. J Adv Nurs 66(1):82–91. doi:10.1111/j.1365-2648.2009.05145.x

    Article  PubMed  Google Scholar 

  21. Paradiso LM, Roughead EE, Gilbert AL, Cosh D, Nation RL, Barnes L, Cheek J, Ballantyne A (2002) Crushing or altering medications: what’s happening in residential aged-care facilities? Australas J Ageing 21(3):123–127

    Article  Google Scholar 

  22. Kirkevold O, Engedal K (2010) What is the matter with crushing pills and opening capsules? Int J Nurs Pract 16(1):81–85. doi:10.1111/j.1440-172X.2009.01814.x

    Article  PubMed  Google Scholar 

  23. Griffith R, Tengnah C (2007) A guideline for managing medication related dysphagia. Br J Community Nurs 12(9):426–429

    PubMed  Google Scholar 

  24. Schier JG, Howland MA, Hoffman RS, Nelson LS (2003) Fatality from administration of labetalol and crushed extended-release nifedipine. Ann Pharmacother 37(10):1420–1423. doi:10.1345/aph.1D091

    Article  PubMed  Google Scholar 

  25. Quinzler R, Schmitt SP, Szecsenyi J, Haefeli WE (2007) Optimizing information on drug exposure by collection of package code information in questionnaire surveys. Pharmacoepidemiol Drug Saf 16(9):1024–1030. doi:10.1002/pds.1406

    Article  PubMed  CAS  Google Scholar 

  26. Bergk V, Gasse C, Schnell R, Haefeli WE (2005) Mail surveys: obsolescent model or valuable instrument in general practice research? Swiss Med Wkly 135(13–14):189–191

    PubMed  Google Scholar 

  27. Parker C, Power M, Hamdy S, Bowen A, Tyrrell P, Thompson DG (2004) Awareness of dysphagia by patients following stroke predicts swallowing performance. Dysphagia 19(1):28–35. doi:10.1007/s00455-003-0032-8

    Article  PubMed  Google Scholar 

  28. Dantas RO, Alves LM, Santos CM, Cassiani Rde A (2011) Possible interaction of gender and age on human swallowing behavior. Arq Gastroenterol 48(3):195–198

    Article  PubMed  Google Scholar 

  29. Gluckman A (1981) Sexual dimorphism in human and mammalian biology and pathology. Academic, New York

    Google Scholar 

  30. Grigoriadis S, Robinson GE (2007) Gender issues in depression. Ann Clin Psychiatry 19(4):247–255. doi:10.1080/10401230701653294

    Article  PubMed  Google Scholar 

  31. Bekker MH, van Mens-Verhulst J (2007) Anxiety disorders: sex differences in prevalence, degree, and background, but gender-neutral treatment. Gend Med 4(Suppl B):S178–S193

    Article  PubMed  Google Scholar 

  32. Aldridge KJ, Taylor NF (2011) Dysphagia is a common and serious problem for adults with mental illness: a systematic review. Dysphagia. doi:10.1007/s00455-011-9378-5

  33. Lee A, Sitoh YY, Lieu PK, Phua SY, Chin JJ (1999) Swallowing impairment and feeding dependency in the hospitalised elderly. Ann Acad Med Singap 28(3):371–376

    PubMed  CAS  Google Scholar 

  34. Kurosu A, Logemann JA (2010) Gender effects on airway closure in normal subjects. Dysphagia 25(4):284–290. doi:10.1007/s00455-009-9257-5

    Article  PubMed  Google Scholar 

  35. Smith CH, Logemann JA, Burghardt WR, Zecker SG, Rademaker AW (2006) Oral and oropharyngeal perceptions of fluid viscosity across the age span. Dysphagia 21(4):209–217. doi:10.1007/s00455-006-9045-4

    Article  PubMed  Google Scholar 

  36. Carnaby-Mann G, Crary M (2005) Pill swallowing by adults with dysphagia. Arch Otolaryngol Head Neck Surg 131(11):970–975. doi:10.1001/archotol.131.11.970

    Article  PubMed  Google Scholar 

  37. Barer DH (1989) The natural history and functional consequences of dysphagia after hemispheric stroke. J Neurol Neurosurg Psychiatry 52(2):236–241

    Article  PubMed  CAS  Google Scholar 

  38. Meng NH, Wang TG, Lien IN (2000) Dysphagia in patients with brainstem stroke: incidence and outcome. Am J Phys Med Rehabil 79(2):170–175

    Article  PubMed  CAS  Google Scholar 

  39. Easterling CS, Robbins E (2008) Dementia and dysphagia. Geriatr Nurs 29(4):275–285. doi:10.1016/j.gerinurse.2007.10.015

    Article  PubMed  Google Scholar 

  40. Clarke CE, Gullaksen E, Macdonald S, Lowe F (1998) Referral criteria for speech and language therapy assessment of dysphagia caused by idiopathic Parkinson’s disease. Acta Neurol Scand 97(1):27–35

    Article  PubMed  CAS  Google Scholar 

  41. Coates C, Bakheit AM (1997) Dysphagia in Parkinson’s disease. Eur Neurol 38(1):49–52

    Article  PubMed  CAS  Google Scholar 

  42. Gordon C, Hewer RL, Wade DT (1987) Dysphagia in acute stroke. Br Med J (Clin Res Ed) 295(6595):411–414

    Article  CAS  Google Scholar 

  43. Chouinard J (2000) Dysphagia in Alzheimer disease: a review. J Nutr Health Aging 4(4):214–217

    PubMed  CAS  Google Scholar 

  44. Regan J, Sowman R, Walsh I (2006) Prevalence of Dysphagia in acute and community mental health settings. Dysphagia 21(2):95–101. doi:10.1007/s00455-006-9016-9

    Article  PubMed  CAS  Google Scholar 

  45. Fuchs J (2009) The amount of liquid patients use to take tablets or capsules. Pharmacy Practice. Pharm Pract, vol 7

  46. Hey H, Jorgensen F, Sorensen K, Hasselbalch H, Wamberg T (1982) Oesophageal transit of six commonly used tablets and capsules. Br Med J (Clin Res Ed) 285(6356):1717–1719

    Article  CAS  Google Scholar 

  47. Davis DW (1968) Method of swallowing a pill. United States Patent Office

  48. MacLeod AD, Vella-Brincat J, Frampton C (2003) Swallowing capsules. Palliat Med 17(6):559

    Article  PubMed  CAS  Google Scholar 

  49. Cleary JD, Evans PC, Hikal AH, Chapman SW (1999) Administration of crushed extended-release pentoxifylline tablets: bioavailability and adverse effects. Am J Health Syst Pharm 56(15):1529–1534

    PubMed  CAS  Google Scholar 

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Acknowledgment

The work of JTS was funded by the Graduiertenkolleg 793 (German Research Foundation, DFG).

We are grateful to all participating GPs who supported us to perform this survey.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410,, 69120, Heidelberg, Germany

    Julia T. Schiele, Renate Quinzler, Markus G. Pruszydlo & Walter E. Haefeli

  2. Department of General Medicine and Health Services Research, University of Heidelberg, Voßstr. 2, 69120, Heidelberg, Germany

    Hans-Dieter Klimm

Authors
  1. Julia T. Schiele
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  2. Renate Quinzler
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  3. Hans-Dieter Klimm
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  4. Markus G. Pruszydlo
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  5. Walter E. Haefeli
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Corresponding author

Correspondence to Walter E. Haefeli.

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Schiele, J.T., Quinzler, R., Klimm, HD. et al. Difficulties swallowing solid oral dosage forms in a general practice population: prevalence, causes, and relationship to dosage forms. Eur J Clin Pharmacol 69, 937–948 (2013). https://doi.org/10.1007/s00228-012-1417-0

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  • DOI: https://doi.org/10.1007/s00228-012-1417-0

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