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A Difficult Pill to Swallow: An Investigation of the Factors Associated with Medication Swallowing Difficulties

Authors Radhakrishnan C, Sefidani Forough A, Cichero JAY, Smyth HE, Raidhan A, Nissen LM, Steadman KJ

Received 16 August 2020

Accepted for publication 22 December 2020

Published 11 January 2021 Volume 2021:15 Pages 29—40


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 5

Editor who approved publication: Dr Johnny Chen

Chandramouli Radhakrishnan,1 Aida Sefidani Forough,2 Julie AY Cichero,1,2 Heather E Smyth,3 Aisha Raidhan,4 Lisa M Nissen,1,2 Kathryn J Steadman1,2

1 School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia; 2 School of Clinical Sciences, Queensland University of Technology (QUT), Brisbane, Queensland, Australia; 3 Queensland Alliance for Agriculture and Food Innovation, The University of Queensland, Centre for Nutrition and Food Sciences, Brisbane, Queensland, Australia; 4Department of Pharmacy, King’s College London, London, UK

Correspondence: Kathryn J Steadman Tel +61 7 334 61886
Fax +61 7 3346 1999

Background: Many medications are available as solid oral dosage forms such as tablets and capsules; however, some people find these medications difficult to swallow.
Aim: To identify whether certain psychological, oral sensory, and oral motor characteristics contribute to medication swallowing difficulties.
Methods: A sample of healthy adults from two academic institutions in Brisbane were assessed for their experiences with swallowing solid oral dosage forms, food preferences, and food neophobia. The gag reflex, oral cavity size, fungiform papillae count, and chewing efficacy were also evaluated followed by a capsule-swallowing task. Primary outcome was the incidence of medication swallowing difficulties. Secondary outcomes were the association of medication swallowing difficulties with psychological, oral sensory, and oral motor factors.
Results: Of 152 subjects, 32% reported difficulty swallowing tablets or capsules whole. This group was significantly more likely to have had a memory of choking on medications compared to those without medication swallowing difficulties (OR = 7.25, p < 0.05). Current medication swallowing difficulties were significantly associated with a smaller mouth cavity size (OR = 2.98, p < 0.05), a higher density of taste receptors on the tongue (OR = 3.27, p < 0.05), and were higher among those who chewed a jelly candy to non-homogenous particle size (OR = 4.1, p < 0.05). Current medication swallowing difficulties were associated with lower confidence in swallowing large capsules (000 size: OR = 0.47, 00 size: OR = 0.39, p < 0.05). No associations were found between medication swallowing difficulties and the gag reflex or food neophobia.
Conclusion: A combination of heightened oral perception characterized by a small oral cavity and high taste sensitivity compounded by a past choking episode on medications may be precipitating factors for medication swallowing difficulties. These factors may be helpful in identifying individuals who are more likely to experience difficulty swallowing medications.

Keywords: dysphagia, medication swallowing, oral dosage forms, swallowing difficulties, tablets

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