Potentially Inappropriate Prescribing of Oral Solid Medications in Elderly Dysphagic Patients

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.

Keywords: capsules; compounding; inappropriate prescriptions; manipulation; old-old patients; solid oral dosage form; tablets.

Figure 1

Distribution of (A) number of prescriptions per patient and (B) number of potentially inappropriate prescriptions (PIPs) per patient at admission and discharge.

Figure 2

Percentage distribution of (A) the four different PIPs at admission and discharge and (B) the PIPs grouped as API-related PIPs (IDA + IDDP) and dosage form-related PIPs (IDF + IDM) at admission and discharge. Abbreviations: PIPs, potentially inappropriate prescriptions, API, active pharmaceutical ingredient; IDA, inappropriate drug association; IDDP, inappropriate drug for dysphagic patient; IDF, inappropriate dosage form for dysphagic patient; and IDM, inappropriate dosage form modification.