Abstract
Presenting many advantages, solid oral dosage forms (SODFs) are widely manufactured and frequently prescribed in older populations regardless of the specific characteristics of patients. Commonly, patients with dysphagia (swallowing disorders) experience difficulties taking SODFs, which may lead to non-adherence or misuse. SODF characteristics (e.g., size, shape, thickness) are likely to influence swallowability. Herein, we used the acceptability reference framework (the ClinSearch acceptability score test (CAST))—a 3D-map juxtaposing two acceptability profiles—to investigate the impact of tablet size on acceptability. We collected 938 observer reports on the tablet intake by patients ≥65 years in hospitals or care homes. As we might expect, tablets could be classified as accepted in older patients without dysphagia (n = 790), while not in those with swallowing disorders (n = 146). However, reducing the tablet size had a significant impact on acceptability in this subpopulation: tablets <6.5 mm appeared to be accepted by patients with swallowing disorders. Among the 309 distinct tablets assessed in this study, ranging in size from 4.7 to 21.5 mm, 83% are ≥6.5 mm and consequently may be poorly accepted by institutionalized older people and older inpatients suffering from dysphagia. This underlines the need to develop and prescribe medicines with the best adapted characteristics to reach an optimal acceptability in targeted users.
Highlights
The proportion of the world’s population over 65 years is expected to double between 2019 and 2050, from 1 in 11 people in the world to 1 in 6 [1]
We investigated the acceptability of tablets in the older population, aiming to better understand how tablet size affects the acceptability in older patients with a swallowing alteration
The data were collected in a multicenter, prospective, cross-sectional and strictly observational study conducted in France and the United Kingdom (UK) between October 2016 and November 2019
Summary
The proportion of the world’s population over 65 years is expected to double between 2019 and 2050, from 1 in 11 people in the world to 1 in 6 [1]. Crushing a prolonged release tablet could seriously compromise the pharmacokinetics and/or pharmacodynamics of the product [10] Such unlicensed use may alter the efficiency of the treatment, or even induce toxic effects for the patients as well as for the caregivers [4,11,12]. Tablet characteristics such as the size, shape, and surface coating, are likely to influence the patient’s ability to swallow and the medicine’s acceptability [13]. We investigated the acceptability of tablets in the older population, aiming to better understand how tablet size affects the acceptability in older patients with a swallowing alteration
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