Oropharyngeal dysphagia is known to affect a high number of older people in the community, in care homes and in acute geriatric admissions to hospital. The authors of this study have recognised that many older people take drugs for chronic conditions, and while there is some anecdotal evidence to suggest that certain drugs may be associated with dysphagia, this is an understudied subject. The authors conducted a retrospective cross-sectional study of 996 patients admitted to a geriatric unit over a three-year period. They used an ATC (anatomical, therapeutic, chemical) system to code the drugs that patients were taking for a minimum of three months prior to admission. They undertook a volume-viscosity swallow test (V-VST) to determine swallow safety and efficiency. The test was previously shown to have good sensitivity and moderate specificity in identifying dysphagia when compared to videofluoroscopy. They also collected detailed demographic information, clinical data and risk factors associated with oropharyngeal dysphagia. A univariate analysis was performed to determine the conditions associated with dysphagia. Patients with dysphagia were older, often from care homes, and frequently presented with co-morbidities including dementia and cerebrovascular disease. The authors provide results on various categories of drugs, but based on multivariate analysis and controlling for confounding variables, they found that beta blocking agents demonstrated a protective trend towards preventing dysphagia. None of the other pharmacological groups (antidepressants, antipsychotics, dementia drugs etc) were associated with harmful swallowing or beneficial swallowing (anti-inflammatory, anti-rheumatic, non-steroids). The authors discuss their findings in the context of other work examining drugs with potential harmful or beneficial actions on swallowing and offer suggestions for further research on this subject. This is a useful paper that gives an overview of the impact of certain categories of drugs on swallowing physiology.

Drugs related to oropharyngeal dysphagia in older people.
Miarons M, Campins L, Palomera E, et al.
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Roganie Govender

University College London, Head & Neck Academic Centre, UK.

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