Dysphagia refers to difficulty swallowing, a condition that can delay the movement of substances from the mouth to the stomach. This impairment can range from mild difficulty with certain foods to a complete inability to swallow. Safely administering medications to individuals with dysphagia is thus important to ensure they receive the full therapeutic benefit of their prescribed treatments and to prevent potential health complications.
Understanding Dysphagia’s Impact on Medication
Dysphagia presents challenges for medication administration due to the complex nature of swallowing. A safe swallow involves coordinating muscles and nerves to move substances from the mouth to the stomach while bypassing the airway. When this coordination is impaired, there is a risk of aspiration, where medication enters the lungs, potentially leading to serious infections like pneumonia. Choking is another risk, occurring when medication obstructs the airway and interferes with breathing.
Improper medication administration can result in incomplete dosages, reducing the medication’s therapeutic effect. For instance, if a pill gets lodged in the throat or is partially aspirated, the full dose may not reach the digestive system for absorption. Different medication forms, such as solid pills, capsules, and liquids, can pose unique difficulties for individuals with swallowing impairments. Swallowing a solid pill, often with water, requires controlling both solid and liquid components, which can be challenging.
General Principles for Safe Medication Administration
Administering medications safely to someone with dysphagia requires careful attention. Position the individual upright, ideally at a 90-degree angle, to help gravity assist the swallow and reduce the risk of aspiration. This upright posture should be maintained for at least 30 minutes after medication administration to allow time for the medication to clear the esophagus.
Patience is important; give each medication one at a time, allowing ample time for the individual to swallow each dose completely. Offer small sips of water or an appropriate liquid, as advised by a healthcare professional, to facilitate the swallow and ensure the medication travels down the esophagus. After administration, gently check the individual’s mouth for any retained medication, ensuring no residue remains that could be aspirated later.
Before modifying any medication, such as crushing or dissolving, consult a pharmacist or doctor. They can advise if the medication’s formulation allows alteration without compromising its effectiveness or safety. When appropriate, liquid or dissolvable forms of medication are preferred due to easier swallowability. If liquids are too thin for safe swallowing, a healthcare professional might recommend thickening agents to achieve a safer consistency, such as a syrup or custard-like texture.
Medications That Should Not Be Modified
Certain medications should never be crushed, chewed, or altered, as modifying them can lead to serious health consequences. Extended-release (ER), sustained-release (SR), controlled-release (CR), or long-acting (LA/XL/XR) formulations release medication slowly. Crushing them can cause the entire dose to be released at once, potentially leading to an overdose and increased side effects.
Enteric-coated tablets should also not be modified. These have a special coating that protects them from stomach acid or prevents stomach irritation by releasing the drug in the intestines. Crushing them destroys this layer, leading to stomach upset, reduced effectiveness, or degradation by stomach acid before absorption. Sublingual or buccal medications, designed for absorption under the tongue or in the cheek, rely on specific routes for proper absorption. Altering these forms can make them less effective.
Chemotherapy drugs and other hazardous medications should not be modified by untrained individuals. The powders created from crushing these drugs can be unsafe for caregivers through exposure. Modifying them can lead to rapid drug release, loss of effectiveness, or harm to the individual and administrator.
When to Consult Healthcare Professionals
Consulting various healthcare professionals is necessary to ensure safety and effectiveness in dysphagia and medication administration.
Physician
A physician is the primary point of contact for diagnosing dysphagia, reviewing current medications, and prescribing alternative formulations. They assess the underlying cause of swallowing difficulties and guide overall treatment.
Pharmacist
A pharmacist provides specific advice on medication forms, determines if a medication can be safely crushed or modified, and identifies liquid alternatives. Pharmacists possess detailed knowledge about drug formulations and potential interactions from altering medications.
Speech-Language Pathologist (SLP)
SLPs are experts in swallowing assessments and physiology, offering specific techniques and recommendations for safe food and liquid consistencies. They conduct assessments to identify issues like aspiration.
Registered Dietitian
A registered dietitian addresses nutritional concerns related to dysphagia, working to ensure adequate dietary intake and prevent malnutrition or dehydration. They collaborate with SLPs to implement suitable food and fluid consistencies, optimizing nutrition.
Self-modification of medications without professional guidance can be dangerous, potentially leading to adverse effects or reduced treatment efficacy.