Swallowing pills – a double-edged sword

Pill swallowing can be daunting. In fact, one survey revealed around 40% of adults who otherwise had no swallowing problems struggled with pills. What if, on the other hand, pills themselves make food and liquid difficult to swallow – otherwise known as dysphagia?

Drugs and dysphagia

Medication use is widespread in older people. According to a survey published in 2012, more than 80% of Australians over 50 reported taking one or more medicines within the past 24 hours. Over 40% had taken five or more medications – both prescription and complementary.

Medication side effects, particularly in aging, can cause drug-induced dysphagia. Directly or indirectly, this can result from a specific medication, a certain combination of medications or ‘polypharmacy’ – taking more than 5 medications, as is common in older people.

Dry mouth or confusion, central nervous system suppression and muscle relaxation are medication side effects that can interfere with swallowing either temporarily or persistently. Some drugs can directly damage swallowing mechanisms.

Making swallowing easier

Much of this drug-induced dysphagia can be avoided by thoroughly and accurately assessing a patient’s medication use. Patients should be informed and empowered to request this from their practitioners. Where possible, unnecessary or harmful prescriptions can be eliminated or replaced with alternative or liquid medications.

Other strategies to facilitate easy swallowing include taking medications at least 30 minutes before bedtime with plenty of fluid and sitting at a 45-90-degree angle, sipping water regularly throughout the day, using a saliva substitute, and taking one pill at a time.

One study tested two further methods to help pills go down.

The first is a “pop-bottle method.” This involves filling a bottle with water, placing the tablet on your tongue and drinking the fluid and pill with a sucking motion, lips placed firmly around the bottle opening. Study participants reported swallowing large pills was 60% easier doing this than sipping water from a cup.

The next method yielded an 89% perceived improvement. Somewhat counterintuitive, this approach involves putting the pill on your tongue, taking a sip of water without swallowing, then dropping the chin down to your chest to swallow the pill.

Unavoidable dysphagia can be managed by a team including speech pathologists and dietitians to facilitate swallowing and recovery. Most importantly, nutritional needs must be addressed to avoid malnutrition and further complications, where necessary using texture-modified food.









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