Abstract
BackgroundIn institutional care, oral liquid pharmaceutical products are widely prescribed for older patients, especially for those with swallowing disorders. As medicines acceptability is a key factor for compliance in the older population, this study investigated the acceptability of oral liquid pharmaceutical products in this targeted population.MethodsAn observational, multicenter, prospective study was conducted in eight geriatric hospitals and eight nursing homes in France. Observers reported several behaviours/events describing the many aspects of acceptability for various pharmaceutical products’ uses in patients aged 65 and older. Acceptability scores of oral liquid pharmaceutical products were obtained using an acceptability reference framework (CAST - ClinSearch Acceptability Score Test®): a 3D-map summarizing the different users’ behaviors, with two clusters defining the positively and negatively accepted profiles materialized by the green and red zones, respectively.ResultsAmong 1288 patients included in the core study and supporting the acceptability reference framework, 340 assessments were related to the administration of an oral liquid pharmaceutical product. The mean age of these patients was 87 (Range [66-104y]; SD = 6.7), 68% were women and 16% had swallowing disorders. Globally, the oral liquid pharmaceutical products were classified as “positively accepted,” the barycenter of the 340 assessments, along with the entire confidence ellipses surrounding it, were positioned on the green zone of the map. Sub-populations presenting a different acceptability profile have also been identified. For patients with swallowing disorders, the oral liquid pharmaceutical products were classified as “negatively accepted,” the barycenter of the 53 assessments along with 87% of its confidence ellipses were associated with this profile. A gender difference was observed for unflavored oral liquids. In women, they were classified “negatively accepted,” the barycenter of the 68 assessments with 75% of its confidence ellipses were located in the red zone, while they were classified “positively accepted” in men.ConclusionThis study showed that oral liquid pharmaceutical products are a suboptimal alternative to solid oral dosage forms in patients with swallowing disorders. To ensure an optimal acceptability, prescribers should also consider the presence of a taste-masker in these oral liquids. As highlighted herein, palatability remains crucial in older populations, especially for women.
Highlights
In institutional care, oral liquid pharmaceutical products are widely prescribed for older patients, especially for those with swallowing disorders
This study showed that oral liquid pharmaceutical products are a suboptimal alternative to solid oral dosage forms in patients with swallowing disorders
Palatability remains crucial in older populations, especially for women
Summary
Oral liquid pharmaceutical products are widely prescribed for older patients, especially for those with swallowing disorders. Patient acceptability in the older population has been recently defined by the European Medicines Agency (EMA) as “the ability and willingness of the patient to self-administer and any of their lay or professional caregivers, to administer the medicinal product as intended” [2] It is a multidimensional concept, depending on characteristics of the drug product – such as route of administration, appearance, swallowability, and characteristics of the patients themselves – such as age and pathological state, in both pediatric and older populations [2, 3]. Altered swallowing function is a common disability concerning 2 to 16% of the community-dwelling older population, affecting up to 60% of patients in some institutions [6, 7] This age-related swallowing impairment is a major issue compromising the use of the most prescribed formulation in older patients, the solid oral dosage form (SODF). Despite the many well-known drawbacks for the older population (e.g., risk of dosage errors or an incomplete administration, risk of excipient overload [2]), switching from SODF to oral liquid formulations remains a common practice in institutional care
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