Swallowing dysfunction and dysphagia is an unrecognized challenge for oral drug therapy.

There is evidence that swallowing issues and dysphagia are an increasing problem of the aging population in the coming decades that is affecting oral medication administration. There is a variety of clinical expressions of swallowing dysfunction caused by aging, acute or chronic disease conditions, decline in physiological functions and adverse drug reactions. About one third of patients in long term care facilities experience serious difficulties with swallowing solid oral dosage forms (SODF). Manipulations of the solid oral drug products occur frequently in nursery homes leading to medication errors and potential changes in drug product performance. The alteration of the drug products is performed with the best intention of the care giver to help the patients but bears concerns about safety and lawfulness. Alternative SODF and drug delivery technologies should be considered in the development of new and generic products and their prescription to overcome medication administration problems in patients with swallowing difficulties of SODF.

[1]  Laura Fratiglioni,et al.  Prevalence of chronic diseases and multimorbidity among the elderly population in Sweden. , 2008, American journal of public health.

[2]  Jimmy J Caudell,et al.  Dosimetric factors associated with long-term dysphagia after definitive radiotherapy for squamous cell carcinoma of the head and neck. , 2010, International journal of radiation oncology, biology, physics.

[3]  J. Robbins,et al.  Age effects on the temporal evolution of isometric and swallowing pressure. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[4]  I. Cook,et al.  Influence of aging on oral-pharyngeal bolus transit and clearance during swallowing: scintigraphic study. , 1994, The American journal of physiology.

[5]  J. Wood,et al.  Medicine administration errors in patients with dysphagia in secondary care: a multi-centre observational study. , 2011, Journal of advanced nursing.

[6]  P. Fox,et al.  Interactions of the Salivary and Gastrointestinal Systems , 1991 .

[7]  David R. Thomas,et al.  Loss of skeletal muscle mass in aging: examining the relationship of starvation, sarcopenia and cachexia. , 2007, Clinical nutrition.

[8]  O. Ekberg,et al.  Quantitative aspects of swallowing in an elderly nondysphagic population , 2004, Dysphagia.

[9]  G. Dickens,et al.  Dose form modification – a common but potentially hazardous practice. A literature review and study of medication administration to older psychiatric inpatients , 2008, International Psychogeriatrics.

[10]  J. Ship,et al.  The Importance of Oral Health in the Older Patient , 1995, Journal of the American Geriatrics Society.

[11]  D. Wright,et al.  Medication administration in nursing homes. , 2002, Nursing standard (Royal College of Nursing (Great Britain) : 1987).

[12]  B. Bloem,et al.  Diurnal and nocturnal drooling in Parkinson’s disease , 2011, Journal of Neurology.

[13]  C. P. McAdam,et al.  Clinical Assessment of Swallowing and Prediction of Dysphagia Severity , 1997 .

[14]  N. Taylor,et al.  Dysphagia is a Common and Serious Problem for Adults with Mental Illness: A Systematic Review , 2012, Dysphagia.

[15]  L. Riley,et al.  Postoperative Dysphagia in Anterior Cervical Spine Surgery , 2010, Spine.

[16]  W. Allum,et al.  Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer , 2011, Gut.

[17]  C. Delcourt,et al.  Biomarkers of Inflammation and Malnutrition Associated with Early Death in Healthy Elderly People , 2008, Journal of the American Geriatrics Society.

[18]  Tami L. Remington,et al.  Drug-Induced Esophageal Injuries and Dysphagia , 2003, The Annals of pharmacotherapy.

[19]  J. Chouinard Dysphagia in Alzheimer disease: a review. , 2000, The journal of nutrition, health & aging.

[20]  J. Weiss,et al.  Senescent swallowing: impact, strategies, and interventions. , 2009, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition.

[21]  L. Rofes,et al.  Pathophysiology of oropharyngeal dysphagia in the frail elderly , 2010, Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.

[22]  D. Na,et al.  Dysphagia in Patients With Dementia: Alzheimer Versus Vascular , 2009, Alzheimer disease and associated disorders.

[23]  G. D'cruz,et al.  Patients with dysphagia: experiences of taking medication. , 2010, Journal of advanced nursing.

[24]  E. Roughead,et al.  Crushing or altering medications: what's happening in residential aged‐care facilities? , 2002 .

[25]  K. Engedal,et al.  What is the matter with crushing pills and opening capsules? , 2010, International journal of nursing practice.

[26]  P. Clavé,et al.  Approaching oropharyngeal dysphagia. , 2004, Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva.

[27]  T. Wilkins,et al.  The Prevalence of Dysphagia in Primary Care Patients: A HamesNet Research Network Study , 2007, The Journal of the American Board of Family Medicine.

[28]  G. D'cruz,et al.  A Qualitative Study of the Problems Surrounding Medicine Administration to Patients with Dysphagia , 2009, Dysphagia.

[29]  J. Potter,et al.  Effect of Dysphasia and Dysphagia on Inpatient Mortality and Hospital Length of Stay: A Database Study , 2009, Journal of the American Geriatrics Society.

[30]  Mark Speechley,et al.  Dysphagia After Stroke: Incidence, Diagnosis, and Pulmonary Complications , 2005, Stroke.

[31]  Gabriela Studer,et al.  Dysphagia in head and neck cancer patients following intensity modulated radiotherapy (IMRT) , 2011, Radiation oncology.

[32]  T. Han,et al.  Dysphagia Development after Surgery Unrelated to Laryngeal and Pharyngeal Structures , 2009, Dysphagia.

[33]  E. Ringelstein,et al.  Neuroleptic-Induced Dysphagia: Case Report and Literature Review , 2006, Dysphagia.

[34]  Denis Gerstorf,et al.  Ageing differently : Potential and limits , 2004 .

[35]  J. Ciocon,et al.  Xerostomia: A Prevalent Condition in the Elderly , 1999, Ear, nose, & throat journal.

[36]  C. Ritchie,et al.  Sarcopenia, weight loss, and nutritional frailty in the elderly. , 2002, Annual review of nutrition.

[37]  Clive G. Wilson,et al.  In vivo imaging of drug delivery systems in the gastrointestinal tract. , 2011, International journal of pharmaceutics.

[38]  D. Chadwick,et al.  A descriptive investigation of dysphagia in adults with intellectual disabilities. , 2009, Journal of intellectual disability research : JIDR.

[39]  G. Dickens,et al.  An observational study of medication administration errors in old-age psychiatric inpatients. , 2007, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[40]  Safe medication swallowing in Dysphagia: a collaborative improvement project. , 2008, Healthcare quarterly.

[41]  R. Endacott,et al.  Medication administration via enteral tubes: a survey of nurses' practices. , 2011, Journal of advanced nursing.

[42]  R. Turnbull,et al.  Xerostomia: clinical aspects and treatment. , 2003, Gerodontology.

[43]  D. Castell,et al.  Upper esophageal sphincter and pharyngeal function and oropharyngeal (transfer) dysphagia. , 1996, Gastroenterology clinics of North America.

[44]  I. Walsh,et al.  Prevalence of Dysphagia in Acute and Community Mental Health Settings , 2006, Dysphagia.

[45]  F. Lichtenberg Are Increasing 5-Year Survival Rates Evidence of Success Against Cancer? A Reexamination Using Data from the U.S. and Australia , 2010 .

[46]  R. Leonard,et al.  Common Medical Conditions in the Elderly:Impact on Pharyngeal Bolus Transit , 2003, Dysphagia.

[47]  R. Shaker,et al.  Laryngo-upper esophageal sphincter contractile reflex in humans deteriorates with age. , 2004, Gastroenterology.

[48]  Ianessa A. Humbert,et al.  Dysphagia in the elderly. , 2008, Physical medicine and rehabilitation clinics of North America.

[49]  V. Arreola,et al.  The effect of bolus viscosity on swallowing function in neurogenic dysphagia , 2006, Alimentary pharmacology & therapeutics.

[50]  A. Mudge,et al.  Helping understand nutritional gaps in the elderly (HUNGER): a prospective study of patient factors associated with inadequate nutritional intake in older medical inpatients. , 2011, Clinical nutrition.

[51]  O. Ekberg,et al.  Altered swallowing function in elderly patients without dysphagia: radiologic findings in 56 cases. , 1991, AJR. American journal of roentgenology.

[52]  N. Talley,et al.  Dysphagia: epidemiology, risk factors and impact on quality of life – a population‐based study , 2008, Alimentary pharmacology & therapeutics.

[53]  Y. Sumi,et al.  Reaction Time in the Submental Muscles of Normal Older People , 2002, Journal of the American Geriatrics Society.

[54]  D. Jaspersen Drug-Induced Oesophageal Disorders , 2000, Drug safety.

[55]  Shaheen Hamdy,et al.  Social and Psychological Burden of Dysphagia: Its Impact on Diagnosis and Treatment , 2002, Dysphagia.

[56]  V. Arreola,et al.  PREVALENCE OF OROPHARYNGEAL DYSPHAGIA AND IMPAIRED SAFETY AND EFFICACY OF SWALLOW IN INDEPENDENTLY LIVING OLDER PERSONS , 2011, Journal of the American Geriatrics Society.

[57]  J. Mort Geriatric primer: implications and management of decline for the elderly patient. , 2009, The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists.

[58]  Dorothee Volkert,et al.  Undiagnosed malnutrition and nutrition-related problems in geriatric patients , 2010, The journal of nutrition, health & aging.

[59]  S. Looney,et al.  Standardization of clinical criteria required for use of the 12.5 millimeter barium tablet in evaluating esophageal lumenal patency. , 1996, Gastrointestinal endoscopy.

[60]  T. Doherty Invited review: Aging and sarcopenia. , 2003, Journal of applied physiology.

[61]  R. Gangnon,et al.  Esophageal Clearance Patterns in Normal Older Adults as Documented with Videofluoroscopic Esophagram , 2009, Gastroenterology research and practice.

[62]  N. Roy,et al.  Dysphagia in the Elderly: Preliminary Evidence of Prevalence, Risk Factors, and Socioemotional Effects , 2007, The Annals of otology, rhinology, and laryngology.

[63]  V. Jain,et al.  Gastrointestinal Side Effects of Prescription Medications in the Older Adult , 2009, Journal of clinical gastroenterology.

[64]  L. Trahms,et al.  Oesophageal transport of solid dosage forms depends on body position, swallowing volume and pharyngeal propulsion velocity , 2004, Neurogastroenterology and Motility.

[65]  Cai Grau,et al.  Late swallowing dysfunction and dysphagia after radiotherapy for pharynx cancer: frequency, intensity and correlation with dose and volume parameters. , 2007, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[66]  Alfred L Fisher,et al.  Of Worms and Women: Sarcopenia and its Role in Disability and Mortality , 2004, Journal of the American Geriatrics Society.

[67]  Jörg Breitkreutz,et al.  Paediatric and geriatric drug delivery , 2007, Expert opinion on drug delivery.

[68]  A. Zimmer,et al.  Geriatric drug therapy: Neglecting the inevitable majority , 2010, Ageing Research Reviews.

[69]  J. Robbins,et al.  Comparison of effortful and noneffortful swallows in healthy middle-aged and older adults. , 2001, Archives of physical medicine and rehabilitation.

[70]  K. Engedal,et al.  Concealment of drugs in food and beverages in nursing homes: cross sectional study , 2004, BMJ : British Medical Journal.

[71]  Edie R. Hapner,et al.  Prevalence of Perceived Dysphagia and Quality-of-Life Impairment in a Geriatric Population , 2007, Dysphagia.

[72]  H. Allescher,et al.  Drug-induced dysphagia , 2005, Dysphagia.

[73]  M. Crary,et al.  Pill swallowing by adults with dysphagia. , 2005, Archives of otolaryngology--head & neck surgery.

[74]  E. Luschei,et al.  Age effects on lingual pressure generation as a risk factor for dysphagia. , 1995, The journals of gerontology. Series A, Biological sciences and medical sciences.

[75]  P. Lambin,et al.  Maximal neutropenia during chemotherapy and radiotherapy is significantly associated with the development of acute radiation-induced dysphagia in lung cancer patients. , 2007, Annals of oncology : official journal of the European Society for Medical Oncology.

[76]  H. Hasselbalch,et al.  Oesophageal transit of six commonly used tablets and capsules. , 1982, British medical journal.

[77]  C. Steele,et al.  Mealtime Difficulties in a Home for the Aged: Not Just Dysphagia , 1997, Dysphagia.

[78]  D J Burn,et al.  Swallowing problems in Parkinson disease: frequency and clinical correlates , 2008, Journal of Neurology, Neurosurgery & Psychiatry.

[79]  Viridiana Arreola,et al.  Accuracy of the volume-viscosity swallow test for clinical screening of oropharyngeal dysphagia and aspiration. , 2008, Clinical nutrition.

[80]  S. Hassall,et al.  Malnutrition prevalence and nutrition issues in residential aged care facilities , 2008, Australasian journal on ageing.

[81]  E. Hansen,et al.  Adolescents’ struggles with swallowing tablets: barriers, strategies and learning , 2007, Pharmacy World & Science.

[82]  Y. Motohashi,et al.  Prevalence of Dysphagia Among Community-Dwelling Elderly Individuals as Estimated Using a Questionnaire for Dysphagia Screening , 2004, Dysphagia.

[83]  L. Gallagher,et al.  Prescription Drugs and Their Effects on Swallowing , 2009, Dysphagia.

[84]  P. Cornish,et al.  “Avoid the crush”: hazards of medication administration in patients with dysphagia or a feeding tube , 2005, Canadian Medical Association Journal.

[85]  A. Gilbert,et al.  Making sure the residents get their tablets: medication administration in care homes for older people. , 2006, Journal of advanced nursing.

[86]  C. Prakash,et al.  Medication-induced esophageal injury: survey of the literature. , 1986, The American journal of gastroenterology.

[87]  B. Bloem,et al.  Impact of drooling in Parkinson’s disease , 2007, Journal of neurology.

[88]  P. Clavé,et al.  Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia. , 2010, Age and ageing.

[89]  J. Breitkreutz,et al.  Acceptance of uncoated mini-tablets in young children: results from a prospective exploratory cross-over study , 2012, Archives of Disease in Childhood.

[90]  Seth M. Cohen,et al.  Impact of voice and swallowing problems in the elderly , 2008, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[91]  D. Wright,et al.  An analysis of two incidents of medicine administration to a patient with dysphagia. , 2011, Journal of clinical nursing.