Potentially Inappropriate Prescribing of Oral Solid Medications in Elderly Dysphagic Patients.

Marco Cespi,Iolanda Grappasonni,Matteo Sestili,Paolo Blasi,Letizia Ferrara,Serena Logrippo,Silvia Busco,Giulia Bonacucina,Roberta Ganzetti,Giovanni Palmieri

doi:10.3390/pharmaceutics10040280

Marco Cespi, Iolanda Grappasonni + Show 8 more

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https://doi.org/10.3390/pharmaceutics10040280

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Abstract

Pharmaceutical formulations suitable for dysphagic patients are not always commercially available, motivating caregivers to crush tablets or open capsules to facilitate swallowing. Since this action may modify the characteristics of the medicine, it should be considered potentially inappropriate. This paper is the first to focus on how hospitalization affected the rate of potentially inappropriate prescriptions (PIPs) and the incidence of dosage form-related PIPs in elderly patients with dysphagia. Data was collected by reviewing patient medical records in the Italian National Research Center on Aging of Ancona. The therapy at admission and discharge was analysed in terms of: inappropriate drug associations, inappropriate drugs for dysphagic patients, inappropriate dosage forms and inappropriate dosage form modifications. Forty-one dysphagic patients with an average age of 88.3 years were included in the study and 451 prescriptions were analysed. PIPs were widespread at admission, and hospitalization did not improve the situation in a statistically significant manner. The most common PIPs identified (>80%) were related to dosage form selection and modification. This study highlights a clear need for continuing medical education about prescription appropriateness and modification of solid dosage forms in patients with dysphagia.

Highlights

Dysphagia, defined as a condition involving perceived or real difficulty in forming or moving a bolus safely from the oral cavity to the oesophagus, is a common issue in the elderly population [1,2]
This paper is the first to focus on how hospitalization affected the rate of potentially inappropriate prescriptions (PIPs) and the incidence of dosage form-related PIPs in elderly patients with dysphagia
The therapy at admission and discharge was analysed in terms of: inappropriate drug associations, inappropriate drugs for dysphagic patients, inappropriate dosage forms and inappropriate dosage form modifications

Summary

Introduction

Dysphagia ( called oropharyngeal dysphagia), defined as a condition involving perceived or real difficulty in forming or moving a bolus safely from the oral cavity to the oesophagus, is a common issue in the elderly population [1,2]. Physicians should opt for an appropriate formulation, such as a syrup, when it is available on the market, or an alternative route of administration When this is not the case, physicians are obliged to prescribe SODFs, such as tablets or capsules, which must be modified by crushing or opening them to allow for easier swallowing [18]. The practice of crushing tablets or opening capsules is very common in geriatric wards and nursing homes, but its consequences are often overlooked [19,20,21] These actions can modify the pharmacokinetics of the medicinal product by compromising its established bioavailability, effectiveness and toxicity [14,22,23]. Extended-release formulations, such as prolonged-release or enteric-coated forms, should not be crushed in order to avoid adverse events due to changes in pharmacokinetics [25,26]

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