Medications and Dysphagia: A match made in polypharmacy

As a result of our medical field's dependence on pharmaceuticals (is there a pill for that?) and the aging population, more medications are flying around than ever before. Over a third of the elderly population are on more than 5 prescription drugs, which can be defined as polypharmacy. This is an issue for two main reasons...

#1 Medications affect medications

With 5 or more artificial chemical compounds jumping around the body, two or more are bound to bounce into each other occasionally. The problem is that the effects of these medications on one another need to be better understood. With so many different combinations and possibilities for reactions with so many kinds of people, the possibilities are endless (and not in a good way). The more medications someone is on, the higher the risk for an adverse drug reaction.

#2 Elderly patients are already at an exceptionally high risk

Our senior population, who tend to be the ones on the most medication, are at an exceptionally high risk of adverse reactions given their increased risk of specific side effects like delirium. Further, people of a certain age may have delays in gastric absorption and metabolism of those medications, making it take longer for them to enter and leave the body than for younger people. This may increase the risk of an initial dose overlapping with future doses or other medications. One of the scariest aspects of this issue is that adverse reactions may not occur until days or weeks after the drug is started. This means pinpointing the cause and managing the complication can be incredibly difficult.

Which medications should we be mindful of?

Outside of being generally mindful of the number of medications your patient is on, we should watch for specific drugs that may cause swallowing issues. The chart at the bottom of this blog post provides the most comprehensive list that I have come across in my research, and it brings me great pleasure to promote the fantastic work of Karen Sheffler in the process. This list describes the adverse reactions we should be wary of and an extensive list of the meds that may cause those reactions. Please keep in mind that it is not within the scope of practice of the SLP to recommend or directly manage medications, but we should be aware of possible reactions so that we can help raise potential issues with the team.

Our role

This begs the question of what our role is in managing medication-induced dysphagia. While we are responsible for managing dysphagia, we cannot make specific recommendations as it relates to medication management. That leaves us in a gray area when we become suspicious of a particular drug's impact on a patient's swallowing ability. The best way to navigate this is to master the art of raising thought-provoking questions. "Hey doc, I've noticed this patient has been a bit sleepy recently. Are there any specific medications we should be mindful of that may be causing decreased alertness?" By asking more general questions such as these,, we can build a productive discussion from the ground up and allow the team to weigh the costs and benefits of a particular medication given the potential adverse reactions. We should not shy away from these kinds of discussions. Bringing up potential issues with our patients is NOT some extracurricular activity we dabble with. It is our responsibility as medical practitioners. Doctors depend on us for this information so they can get a 360-degree view of what's happening to our patients to care for them most effectively.

Summary

We take a lot of medications. Especially our seniors who are at an increased risk of adverse reactions from those medications. Nobody really understands what polypharmacy means for an individual patient because there are so many different possibilities of responses that are not well studied in patients with advanced age. Understanding possible adverse reactions will help us help the interdisciplinary team to effectively care for the patient. While it is not within our scope of practice to make any medication-related recommendations, it is within our scope AND imperative to understand and discuss potential risks as they relate to dysphagia.