How do you give medication to an older person who struggles to swallow?

What to do when your father or mother finds it hard to swallow tablets: what must not be crushed, which alternatives exist and when to seek advice.

If an older person finds it hard to swallow tablets, do not crush or open anything on your own: ask the pharmacist or doctor to review each medicine, because many come in a form that is easier to take and some must not be altered.

Difficulty swallowing, called dysphagia, is common with age, after a stroke or in people with dementia or Parkinson's. A guide from the Pharmacy Department of La Paz University Hospital in Madrid estimates that it affects between 7 and 13% of older people and around half of those living in care homes.

Can tablets be crushed or capsules opened?

Some can and some cannot, and you cannot tell by looking. Crushing a tablet that must not be altered can stop it working or release the whole dose at once, with a risk of side effects.

A score line on a tablet does not mean it can be crushed either. Some medicines are also hazardous to handle for the person preparing them. To learn more, read how to cut tablets and what the alternatives are.

What alternatives are there to tablets that are hard to swallow?

Many medicines come in forms that do not need altering. According to the La Paz Hospital guide, the most suitable for people with dysphagia are orodispersible, sublingual and freeze dried tablets, dispersible capsules and chewable or effervescent tablets; there are also oral solutions and suspensions.

1. Make a list of all the medication with names and strengths.
2. Ask the doctor or pharmacist to check whether each medicine is still needed.
3. Ask whether there is another form that is easier to take.
4. If there is not, ask whether it can be crushed or dispersed and how to do it.
5. As a last resort, the doctor may consider another route or change the medicine.

Licensed forms are preferable to special preparations, and the professional will tell you the best option in each case.

Can I mix the medication with food or thickeners?

Only if the professional approves it for that medicine. Thickeners help people swallow safely, but they can delay the medicine dissolving and change its effect; pudding consistency causes the greatest delay.

• Some medicines that can be crushed may be mixed with purée, stewed fruit or a smooth dessert if their product information allows them to be taken with food.
• Yoghurt can be an alternative for those that can be taken with dairy products.
• Mix each dose with a small amount, to make sure the whole dose is taken.
• Do not mix several medicines together without asking.

Which precautions help people swallow better and more safely?

Posture and fluids make a difference. The La Paz guide recommends drinking a little water before taking the medicine and a glass afterwards, and staying upright for 5 to 10 minutes after the dose, or 30 minutes with bisphosphonates.

• Take the medication sitting up, with a straight back.
• Do not tip the head back or throw the tablet to the back of the throat.
• Some medicines, such as anti-inflammatories, bisphosphonates or potassium chloride, can damage the oesophagus: ask how to take them.
• If the person coughs, chokes or also has problems with food and drink, do not keep trying swallowing tricks and speak to their doctor.

A practical example: Manuel after a stroke

Take the case of Manuel, 81, who has had difficulty swallowing since a stroke and takes seven medicines, one of them prolonged release. His wife has started crushing all his tablets and mixing them in a glass of thickened water.

• His daughter takes the list of medicines to the pharmacy and asks about each one.
• The pharmacist explains that the prolonged release one cannot be crushed and recommends asking the doctor for an alternative.
• The doctor switches two medicines to an oral solution and stops one that was no longer needed.
• For the rest, the family follows the advice on how to give them and with which food.

If you use a pill crusher at home, first read what to consider when choosing a pill crusher.

How can IMA Health help?

When several medicines have different instructions, having them prepared dose by dose helps avoid confusion. IMA Health coordinates with a specialised pharmacy that prepares the medication by day and time in a personalised dosage system, delivers it to the home and provides personalised follow-up; for questions about how to give a particular medicine, the pharmacist or doctor is always the reference.

Sources

• La Paz University Hospital (SEFH): Guide to administering medicines to people with swallowing problems, 2nd ed. 2021 (Spanish)
• NHS 111 Wales: Problems swallowing pills
• NHS Specialist Pharmacy Service: Swallowing difficulties

This article is for information only and does not replace advice from your doctor or pharmacist.