Dysphagia is a complex disease that becomes a considerable health problem with age. Disphagya is mainly related with neurodegenerative and neuromuscolar diseases: dementia, Alzheimer disease, Parkinson’s disease, SLA, stroke. Elderly patients with polypharmacy have the highest risk for dysphagia. Dysphagic patients have difficulty swallowing solid oral dosage forms. Tablets and capsules are handled by nurses to facilitate swallowing and this practice represents a health hazard for patients and for nurses. Nurses know little about the characteristics of drugs and no “easy to use” guidelines exist. It is necessary to assess if there are alternative pharmaceutical forms with the same drug and the same dosage, before handling tablets and capsules. If no alternatives are available, a pharmacist can prepare galenic formulations (oral solution or oral suspension) to facilitate the oral administration of drugs to dysphagic patients.

Guidelines for crushability and for divisibility of tablets and capsules were drawn by some pharmacists of ASL TO2, among which Dr. Maria Giacomotti, at the Maria Vittoria Hospital, Turin, on the basis of studies carried out and by some colleagues, either in ASL TO2, or in Morbihan (Bretagne, France). These guidelines were used to evaluate the possibility of handling tablets and caspules administered to dysphagic inpatients in the nursing home of Cottolengo Hospital, Turin. Of 155 drugs, used in the nursing home, only 20 could be crushed without causing either alterations in absorption and therapy or health hazards for patients and for nurses. This study was the topic of a thesis project for a Pharmacy degree (Thesis degree of Matteo Lamberto – supervisor Prof. Clara Cena).

As a conclusion, in the management of drug therapy for polytherapic patients, the role of the pharmacist is getting always more important. A good collaboration between pharmacists and nurses and a proper education for nurse staff could guarantee a reduction of the risks for health related to the handling of solid oral forms of drugs.