A Spoonful of Sugar Won’t Help the Medicine Go Down
- OSCAR Care Group
- Mar 2
- 5 min read
Updated: Mar 13
A guide to safe medication intake for Older Australians with Dysphagia. Have you ever had trouble swallowing multiple vitamins, tablets, or even just Panadol? For older adults, swallowing difficulties, or dysphagia, can be a common issue. This aims to educate carers, aged care staff, and family members about dysphagia, its impact on medication intake, and evidenced based strategies to enhance safety and comfort. Let’s get the medicine down in not be the most delightful way.
What is Dysphagia?
Dysphagia is a term used to describe swallowing disorders or difficulties swallowing food or liquid. Dysphagia can occur at any age and can present differently amongst individuals.
Swallowing difficulties can be caused by several factors including:
Age related changes: Muscle loss, sensory loss, changes to overall swallow function
Neurological conditions: Stroke, dementia, Parkinson’s disease, multiple sclerosis, and head and neck cancer.
Neurodevelopmental disorders: autism spectrum disorder, cerebral palsy, and Down Syndrome.
Dentition and oral hygiene issues: Use of dentures, missing teeth, and poor oral care.
Dysphagia conservatively affects around 8% of the population, with infants and the elderly at the highest risk. Conditions such as premature birth, cerebral palsy, stroke, dementia, Parkinson’s disease, motor neurone disease, head and neck cancer, chronic obstructive pulmonary disease (COPD) and head injury are commonly associated with swallowing difficulties.
Risks of dysphagia
Dysphagia can lead to several health complications, including:
Choking: Occurs when the airway is blocked by food, liquid or foreign objects, leading to difficulty breathing. Choking can be life threatening, especially if the individuals cannot clear the blockage.
Aspiration: Happens when food, liquid, or foreign objects enter the lungs. Minor aspiration can usually be coughed, but if the individuals cannot cough effectively, it can lead to serious complications.
Aspiration pneumonia: When food or fluid enters the lungs, bacteria can also enter, causing an infection in the lungs known as aspiration pneumonia. Particularly in frail individuals, aspiration pneumonia can result in death.
Dehydration and Malnutrition: Difficulties swallowing food and liquids can lead to inadequate nutrition and fluid intake. This can weaken the immune system and worsen overall health.
Medication Non-Adherence: Trouble swallowing tablets or liquids can result in missed doses or improper medication intake, which can increase the risk or treatment failure and/or worsen health outcomes.
Challenges of swallowing tablet medications
Dysphagia, or difficulty swallowing, is a common condition amongst the older adults. In Australia, 20% of individuals over the age of 50 experience dysphagia. This increases up to 50% for individuals who reside in long-term care facilities. Dysphagia not only affects a person’s ability to swallow food and fluids, but it can also make it challenging to safely take oral medications.
Speech Pathologists play a crucial role in assessing swallow function and providing strategies to reduce the risk of choking, aspiration pneumonia, and medication non-adherence.
With age, medication use increases and so do the incidences of dysphagia. As many medications are available in tablets and capsules many individuals with dysphagia individuals experience difficulties swallowing medications.
About two-thirds of Australians aged 75 years, and over, take five or more medicines, including over the counter and complementary medicines and as many as one in five older patients have difficulties swallowing along with difficulties taking tablets and capsules.
Difficulties swallowing medications
Difficulties swallowing medications and refusal to take them can impact medication administration, treatment and potentially worsen health outcomes.
Key difficulties with swallowing tablets include:
Tablet size and shape: Larger or irregularly shaped tablets may be difficult to control in the mouth or pass through the throat safely.
Coating and texture: Some medications have rough, sticky or powdery coating that can be hard to swallow.
Dry Swallowing: Some individuals attempt to take pills with minimal liquid, which is not recommended as it can cause tablets to get stuck in the throat.
Delayed Swallow reflex: Some conditions cause a delayed or weakened swallow reflex, increasing the risk of aspiration.
Polypharmacy: The more medications an individual takes, the more complicated it can be to manage safe medication administration.
4 tips to swallow tablets easier
Ensure adequate hydration: This helps prevent dry mouth, which can increase swallowing difficulties.
Use fluids: Take tablets with plenty of fluids, consider use of dedicated medication lubricants.
Consult with a healthcare professional: Speak to your GP, nurse or pharmacist about alternative forms of medication (eg. liquid forms, or crushed tablets) or medication lubricants. Never crush tablets without professional guidance as this may affect the medication’s effectiveness.
Swallow Assessment: For individuals who continue to have swallowing difficulties, especially for individuals with dysphagia a Speech Pathologist can assess swallow function, make appropriate recommendations, provide strategies for safe swallowing of medications and liaise with care team.
Remember safe swallow strategies to help people with dysphagia
To ensure safe swallowing, the following strategies should be used:
Avoid tilting head back: When swallowing food, fluid or medications, do not tilt head back.
Maintain an upright posture: Sit at at 90 degrees prior to, during and 30 minutes after oral intake.
Minimise distractions: Where possible, allow the individual to focus fully on swallowing (eg. turning off TV or reducing background noise).
Ensure the person is awake and alert.
One tablet at a time: Swallow one tablet at a time with plenty of fluids.
Alternate food and fluids.
Consider techniques such as a chin-tuck or head turn. Consult with a Speech Pathologist or nurse for guidance.
Follow the correct IDDSI levels (International Dysphagia Diet Standardisation Initiative) Always ensure the correct IDDSI levels are used when providing food, fluids or medications to ensure safety.
The role of carers and aged care staff
Carers and aged care staff play a vital role in supporting individuals with dysphagia, particularly in managing safe medication intake.
Key responsibilities include:
Observe swallowing behaviour: Watch for signs of difficulty and report concerns to healthcare professional (eg. GP, nurse, Speech Pathologist)
Ensure proper hydration: Dehydration can worsen swallowing difficulties, so encouraging adequate fluid intake is crucial.
Communicating with healthcare providers: Always check with pharmacists, doctors and nurses before altering the form or any medication and seek safer alternatives if necessary.
Implement safe swallow strategies: Follow guidelines provided by healthcare professionals.
Review medication management regularly: Continuously assess swallowing difficulties and adjust medication management plans as needed.
Ensure medication is taken as instructed: If uncertain about dosage or form, always check with your healthcare provider.
Get swallow assessed: A speech pathologist can conduct a swallowing assessment to determine the safest method for medication intake. This may involve a bedside clinical evaluation or instrumental assessments such as a Videofluoroscopic Swallow Study (VFSS) or Fibreoptic Endoscopic Evaluation of Swallowing (FEES)
Speech Pathologists are here to support Older Australians with Dysphagia
Swallowing difficulties are a significant concern for individuals with dysphagia, especially when it comes to taking medication. With proper assessment, modification of medication forms and implementation of swallowing strategies, carers and aged care staff can significantly improve medication adherence and swallow safety.
Collaboration between speech pathologists, pharmacists, nurses and other medical professionals is essential in providing the best care for individuals with dysphagia.
If you care for someone with dysphagia or swallowing difficulties, consider consulting a Speech Pathologist for formal assessment and individualised recommendations. Ensuring safe medication intake not only improves health outcomes but also enhances quality of life for individuals with dysphagia.