Health of the elderly at risk from pill-crushing culture in aged care facilities

As many as one in five older patients has difficulty swallowing tablets and capsules (a condition called dysphagia), however the most obvious solution – liquid medicine – is rarely available for the kinds of drugs commonly prescribed for the elderly.

This reality has led to many staff at Australian aged-care facilities crushing a patient’s prescribed tablets or pills and adding it to food and drink. This makes administration more comfortable for the resident and lessens the risk of medication being skipped. It seems the most obvious solution and it’s easy to understand why aged-care staff would employ this method.

However the ‘pill-crushing’ approach has been proven to be at best problematic, and at worst, dangerous to a patient’s long term health.

Is pill-crushing dangerous?

According to the government’s NPS MedicineWise agency, “The stability and bioavailability of drugs can be significantly changed by the simple act of crushing a tablet, preparing an oral liquid from a tablet or capsule, or mixing a crushed tablet or capsule powder with food or other thickening agents.”

“Manipulating solid dosage forms remains a significant source of medication error and harm to patients.”

And this assertion is backed by research.

A study conducted by the University of South Australia found that 17 per cent of the medications that were altered for ease of administration in South Australian aged care homes had the potential to subsequently cause, “…increased toxicity, decreased efficacy, unpalatability, safety or stability concerns.”

The authors of the study also noted, “In all occasions where more than one medicine was altered, they were crushed together within the same vessel. In 59{648ff2b140dd79f8b10f01740237e66061b7c0f8b396ba52d99047c684c8722c} of occasions where the same vessel was shared amongst residents, the vessel was not cleaned between residents and in 70{648ff2b140dd79f8b10f01740237e66061b7c0f8b396ba52d99047c684c8722c} of cases where medicines were altered, spillage, and thus potential loss of dosage, was observed.”

Last year researchers from the University of Queensland found that up to 24 per cent of a medication’s mass could be lost when a pill was crushed, depending on the method employed. The US Food and Drug Administration recommends less than 3{648ff2b140dd79f8b10f01740237e66061b7c0f8b396ba52d99047c684c8722c} mass loss should occur when a medication is altered by a method such as crushing.

Alternatives to pill-crushing

NPS MedicineWise recommends that in cases of dysphagia, if a commercially available liquid version of a drug, or a suitable drug alternative cannot be found, then health care workers should consider, “extemporaneously compounded medicine – this remains off-label use but is produced using an evidence-based approach.”

Compounded medication refers to medication that is made by hand, to order, by a fully qualified compounding pharmacist.

Few aged care facilities or community pharmacies have the specially trained staff and purpose-built facilities to compound medication, however a reputable compounding pharmacy can help.

With a script from the patient’s doctor, a compounding pharmacy like National Custom Compounding can make up, as a liquid or trouche, many of the medications commonly prescribed to older Australians.

To find out more about how compounded medication can help patients who have trouble swallowing medication, contact one of the friendly team at National Custom Compounding on 1300 731 755 or email [email protected].