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How can people with dysphagia take their medication safely?

Wednesday, 01 February, 2023 - 13:25

The prevalence of dysphagia, which is a swallowing disorder, increases with age and with certain diseases such as stroke. In fact, caregivers in Austria's hospitals are often confronted with the question of how to safely administer prescribed medication in cases of dysphagia. Speech therapist PhDr. Michaela Trapl-Grundschober, MSc investigates whether common methods for facilitating swallowing in patients after stroke are safe and if they are necessary to the same extent as they are applied. The Survey takes place at the University Hospital Tulln, a teaching and research site of Karl Landsteiner University.

Swallowing problems taking tablets or capsules also affect the healthy and the young. People at the age of 65 years and having a stroke are at 60 to 80 per cent risk of a swallowing disorder.  Thus, a large group of patients is affected. Thus, a large group of stroke patients is affected. To ease necessary medication, tablets are often crushed and/or administered in liquids or porridges, so-called carrier substances or accompanying boluses. In some cases, medicines must not be mortar, as the change in consistency can lead to altered and adverse effects. Ingredients of food can also influence the effectiveness of the medication. Furthermore, there is a lack of evidence if solid medications can be better swallowed by people with dysphagia when they are mortared.

Survey of the caregivers
The current situation and the common practice at Austrian, German and Swiss hospitals are surveyed through a questionnaire. Which carrier substances are mainly used for the administration of solid or mortared medicines? What do the most applied tablets and capsules look like? The questionnaires have been distributed via hospital authorities in Austria, on stroke units in Germany and Swiss, as well as online via social media. Nurses and other staff at stroke units were asked to participate. The results of the survey provide important information for the second part of the study. Applesauce is used particularly frequently as a carrier substance and the most frequently applied drug forms on stroke units are small, round tablets with a diameter of 8mm, oval tablets with a diameter of 17mm and capsules of size 2. 

How many stroke patients have detectable dysphagia for solid medications?
To answer the research question, patients undergo a swallowing screening in the first week after stroke: a speech therapist assesses the oral status, and both the patients themselves and their caregivers or relatives complete a questionnaire on how they assess the patient´s tablet swallowing behaviour. In the endoscopic examination of the swallowing act, 3 teaspoons of a substance like applesauce are administered and the swallowing act is validated using certain scales and scores. Subsequently, all three placebo test drugs are administered together with one teaspoon (3ml) of the carrier substance tested at the beginning and the swallowing act is assessed by means of a standardised scale. The order of tablet administration was randomized. The swallowing efficiency and the swallowing safety of the placebo tablets as well as the accompanying boluses and the swallowing method are assessed by means of a standardised scale. If an aspiration risk occurs once during the test, the test is stopped. 

Research urgently needed
Caregivers need more security in their daily clinical routine dealing with difficulties swallowing tablets and capsules.  The results of the study at the University Hospital Tulln should help to establish clear guidelines for the administration of solid medication to stroke patients with swallowing disorders. "The research project is directly practical relevant and research results on the screening and the dealing with dysphagia in general and in particular with patients after acute stroke are urgently needed," says the author and study leader PhDr. Michaela Trapl-Grundschober, MSc.

Original work
Trapl-Grundschober, M. (2022). Einnahme von festen Arzneiformen: Ein Risikofaktor bei rezenter Dysphagie nach akutem Schlaganfall? Forschung Sprache. https://www.forschung-sprache.eu/fileadmin/user_upload/Dateien/Heftausgaben/2022_2/Trapl-Grundschober.pdf




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