Dosage form modification and oral drug delivery in older people
Many people cannot swallow whole tablets and capsules. The cause ranges from difficulties overriding the natural instinct to chew solids/foodstuff before swallowing, to a complex disorder of swallowing function affecting the ability to manage all food and fluid intake. Older people can experience swallowing difficulties because of co-morbidities, age-related physiological changes, and polypharmacy. To make medicines easier to swallow, many people will modify the medication dosage form e.g. split or crush tablets, and open capsules. Some of the challenges associated with administering medicines to older people, and issues with dosage form modification will be reviewed. Novel dosage forms in development are promising and may help overcome some of the issues. However, until these are more readily available, effective interdisciplinary teams, and improving patient health literacy will help reduce the risk of medication misadventures in older people.
Conclusion
Swallowing a solid dosage form is a learned skill, requiring people to override their natural instincts to chew solid objects. Older people commonly experience swallowing difficulties because of aged-related physiological changes, co- morbidities, and polypharmacy. The strategy healthcare professionals and patients often use to make medicines easier to swallow, is to modify the dosage form. An integrated and collaborative approach is needed to reduce inappropriate dosage form modifications, and improve medication administration to older people. This needs to start from the point of dosage form design, to what medication is prescribed and dispensed, and how it is administered to/by the patient. Promising opportunities exist with novel dosage form designs that can bypass the need for solid oral dosage forms. However, until these delivery devices become more readily available, affordable and accessible, integrated approaches to improve healthcare professional awareness, work processes, and patient health literacy would contribute significantly to reducing the practice of inappropriate dosage form modification.
