Dysphagia is a common problem and can affect people of any age. Dysphagia is more common amongst older people, because older people are more prone to developing diseases linked to dysphagia - such as Cancer, stroke or Alzheimer's disease - than the general patient population.
It has been estimated that up to 40% (Finestone & Greene-Finestone, 2003) of stroke patients suffer from swallowing difficulties and a survey of patients undergoing palliative care showed that 63% (Stevenson, 2002) of patients with carcinoma reported symptoms of swallowing difficulties.
Decline in salivary gland function is common as patients get older. This can result in xerostomia (dry mouth), which in turn can contribute to dysphagia. Between 15% (Wright, 2002) and 33% (Stevenson, 2002) of patients in nursing homes have trouble swallowing medication.
In a recent pilot study conducted in community pharmacies across the UK where patients over the age of 65 were asked if they had problems swallowing their medication (Greener & Ferguson, 2005):
- 62% had experienced difficulty in swallowing solid dose medication at some time
- 58% had crushed tablets or opened capsules to aid administration of their medication
- 68% said that they would not tell their doctor or pharmacist if they were unable to swallow their tablets
In an audit carried out in the General Practice in the UK (Preston & Morris, 2005) out of a list of 3200 patients researchers performed a computer search to identify all patients over the age of 75 years (as mentioned below, dysphagia becomes increasingly common with advancing age) and all patients with history of stroke, transient ischemic attacks, dysmotility, oesophageal stricture or stenosis, other swallowing difficulties, Percutaneous Endoscopic Gastrostomy tubes and learning difficulties. Each patient or their carer was sent a questionnaire to assess if dysphagia caused difficulty swallowing medications. It also aimed to establish which medications were most likely pose a problem for those with swallowing difficulties.
182 questionnaires were sent out. Of the 171 returned 45 patients were between 12 and 74 years of age. The remainder were aged at least 75 years.
- 11% of the primary care sample reported problems swallowing their medication
- 6% found that some medication remains in the mouth for a time before they can swallow the drug properly
- 9% reported that, at some point, they crushed or opened capsules to make the medicine easier to swallow
- 8% put medication in food or drink to ease swallowing
- 5% have to chew or suck their medication
- 87% of patients questioned did not think that opening or crushing a tablet or capsule will affect the way in which the medication works
- 4% of patients have not been given or taken a medication because of difficulty swallowing the drug
- 80% of patients questioned said that they would not inform their doctor or pharmacist if they could not take their medication
- Only 22% of patients said that their doctor or nurse asked them if they have problems swallowing before issuing a prescription