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Letter to the Editor

Letter to the Editor by Ursula Chizhik to the topic “Health Care and the Aging Population: What are today’s Challenges?”

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October 30, 2014

Response by Ursula Chizhik to the topic “Health Care and the Aging Population: What are today’s Challenges?” (May 31, 2003)

Dear Editor:

Medication therapy is a critical component of chronic disease state management, but rarely is tablet size, smell, or taste factored into therapy selection. Patient anxieties and apprehensions about swallowing, whether they are psychological and/or physiological, are similarly not taken into consideration. Patients will either suffer through the discomfort or avoid taking the offending medication at the expense of positive health outcomes. Swallowing is a complex issue that most certainly pertains to medication adherence and we must recognize that as people age, swallowing becomes an increasingly complex task.

Swallowing disorders, categorized as dysphagia, may or may not be inherent to aging; however, they are relatively prevalent in the elderly population.  It is estimated that 400,000-800,000 individuals worldwide develop neurogenic dysphagia per year (Robbins, 1999).  Neurogenic dysphagia can be caused by: Alzheimer’s disease, Stroke, Parkinson’s disease, Multiple Sclerosis, and certain Cancers, which are typically associated with the older population. Statistics show that 65% of acute Stroke patients (Daniels et al., 1998) and 50% of Parkinson’s patients suffer from dysphagia (Lieberman et al., 1980).  These conditions can weaken or affect coordination of the swallowing muscles or limit sensation in the mouth and throat resulting in swallowing difficulties. Swallowing difficulties can not only undermine quality of life and exacerbate malnutrition but also complicate medication administration. Subsequently, crushing tablets or opening capsules to facilitate medication adherence among such patients appears to be a widespread activity.  Unfortunately crushing tablets and opening capsules is a practice that can endanger patient safety and conflicts with legal and professional requirements. 

In that case, what can these patients do? A product currently on the market called Pill Glide has proven to be a practical and successful solution to many of these problems. Pill Glide, a non-prescription, water-based, flavored lubricating spray, was designed to help people swallow tablets and capsules easily and with no discomfort.  Pill Glide enables patients to take their medications as commercially intended, avoiding the need for crushing tablets or opening capsules to facilitate adherence. Pill Glide helps patients suffering with dysphagia to overcome these psychological and/or physiological hurdles and stay on schedule with their medications.

Dysphagia is common among geriatric patients and that has a profound impact on medication management, especially when we are discussing chronically ill adults.  For chronically ill patients who face a mental or physiological swallowing barrier, medication adherence becomes an everyday struggle. As a society, we need to discover practical ways to meet this challenge. Pill Glide may be one such solution, but moreover, it brings to light the need for swallowing issues to be recognized and considered when treating patients with chronic diseases. Even the most powerful medications are ineffective if a patient is unwilling or unable to take them.  We may not be able to cure many of the chronic conditions plaguing our society today, but we can certainly make it easier and less stressful for chronically ill patients to adhere to their necessary medication regimens. 

Ursula Chizhik, PharmD
Pharmacist & Director of Pharmacy Programs
FLAVORx Inc.

References

Daniels, S. K., Brailey, K., Priestly, D. H., Herrington, L. R., Weisberg, L. A., & Foundas, A. L. (1998). Aspiration in patients with acute stroke. Archives of Physical Medicine and Rehabilitation, 79, 14-19.

Lieberman, A. N., Horowitz, L., Redmond, P., Pachter, L., Lieberman, I., & Leibowitz, M. (1980). Dysphagia in Parkinson’s disease. American Journal of Gastroenterology, 74, 157-160.

Robbins, J. (1999). The evolution of swallowing neuroanatomy and physiology in humans: A practical perspective. Annals of Neurology, 46, 279-280.

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