Page 5 - Index

MEDICATION, ADMINISTRATION, COMPLIANCE AND SWALLOWING DIFFICULTIES
Elderly psychiatric care settings
Within elderly psychiatric care settings, matters of mental capacity and
consent compound the difficulties of medication administration.
Issues such as confused patients who do not understand the need to
take medication, patients with swallowing difficulties and patients who
refuse to swallow medicines are regularly being encountered by care
givers during medication administration.
In one study of older adults with mental illness in an institutionalised
setting, a number of patients were observed spitting out their
medication12. Literature suggests that the most common course of
action to overcome these problems when administering medication is
changing the prescription to a liquid formulation13
.
Refusing medication
Refusal of medication is a major problem in mental health care. The mean
daily incidence rate for refusal of medication is once per day in an average
acute psychiatric ward14. Whilst patients do have the right to refuse
treatment if they are competent, in some circumstances (such as being
admitted to hospital under the Mental Health Act 1983) patients might be
required by law to take their medication15. Liquids can be an alternative for
patients who need encouragement to take their medication16
.
Depression and dysphagia
Medications have become the mainstay of psychiatric treatment14. The
treatment of major depressive disorders specifically requires prolonged
pharmacotherapy, and lack of compliance due to a swallowing difficulty
can result in poor long-term outcomes and ultimately, treatment
failure17
.
Compliance with medication is poor in patients with depression and is
particularly prevalent in patients who do not like, or have difficulty in
swallowing, tablets and capsules17. A study published in 2012 found that
there was an association between depression severity and swallowing
difficulties, with patients who had high depression scores reporting
more general swallowing difficulties than those with lower scores18. If
a patient is unable to swallow their medicines, they are unlikely to take
them, and a licensed liquid medicine may therefore be a better choice19
.
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