Older adults with difficulty swallowing oral medicines: a systematic review of the literature

Difficulty swallowing oral medicines may arise due to swallowing disorders or due to patient self-reported difficulty in the absence of objective evidence of swallowing dysfunction. Medication use increases with age; therefore, difficulty swallowing medication may complicate medicine administration to older patients. Modifying oral medicines can impact on the safety, quality and efficacy of the medication. The objective of this systematic review is to critically appraise the evidence regarding the prevalence of difficulty swallowing oral medicines and the modification of oral medicines to overcome swallowing difficulties in the older cohort. A systematic search of PubMed, EMBASE, MEDLINE, CINAHL, Scopus, Web of Science, The Cochrane Library, PsycINFO and ProQuest databases was conducted from database inception to November 2014. Studies investigating the prevalence of difficulty swallowing oral medicines or the modification of oral medicines were eligible for inclusion. A narrative analysis of the results was conducted. Five studies met the inclusion criteria. The results suggest that approximately 14 % of community-dwelling older patients experience difficulty swallowing medicines. Between one quarter and one third of occasions of medicine administration to older patients involve the modification of oral medicines. Difficulty swallowing oral medicines and the modification of medicines are reported as being common issues in the older cohort. However, evidence to support such contentions is limited. Future research should investigate the prevalence of medicine modification for older patients in all settings and identify what medicines are modified. This will allow targeting of interventions to optimise medicine administration to older patients.