Article of 6 January 2017 in the Dutch Journal of Medicine (Ned Tijdschr Geneeskd. 2017;161:C3299)
Elderly people who have difficulty swallowing tablets mainly attribute this to the size and surface structure. Blister strips and sealed packaging are also regularly disruptive to use. Kim Nootenboom (RIVM) and colleagues learned this from interviews with 59 elderly people (Int J Pharm. 2016;517:128-34).
The participating over-70s used an average of 7 medicines. The researchers identified 45 ‘usage difficulties’ – it succeeds on its own after some effort – and 113 ‘use failures’ – it does not work without help or aid. 10% of the interviewees had no medication problems.
Most difficulties occurred with swallowing (38%), followed by pushing drugs from a strip (13%). The use failed mainly because of the blister packs (32%) and the opening of jars (16%). Most of the difficulty was due to size (30%) and surface structure of the drug (19%). It failed due to blisters that were too stiff (22%) and sealed packages or jars (12%). Child closures, faulty fault lines and a bad taste also threw a spanner in the works.
Tablets that were too large, tablets that melt quickly and rough tablets caused problems with swallowing – ‘I need a lot of water or it will get stuck’. If the drugs didn’t come out of the strip 1-2-3, the tablets would break or crumble regularly – ‘it almost always breaks, the other half is often elsewhere’ – or capsules opened. Plastic jars with a tamper evident screw cap also presented problems – ‘the cleaner opens them for me’ – and cardboard boxes with a perforated opening strip were sometimes difficult – ‘I can’t see the perforation line, I’m using scissors’.
More complex forms of intake, such as inhalation and injection, are not discussed.
Previously, the NTvG discussed 2 ‘remarkably effective’ ways to get rid of pills: the ‘bottle-water method’ and the ‘head forward method’ (2014;158:C2408).
