Some older people have difficulty swallowing. Caregivers therefore crush their tablets and mix them with their food. The taste that comes out is detestable, according to a test.
-1435683673.jpg "Seniors: crushed drugs make food taste bad")
You can’t do without them, but sometimes they taste very bad. Crushing drugs is a common practice in accommodation establishments for dependent elderly people (EHPAD): 32% of patients are affected. But so far, no study has looked at the impact of this mode of administration of the drug on the taste of food. This is now done, thanks to the Nice University Hospital (Alpes-Maritimes) and the Korian nursing home chain, which present the results of the MELA study.
Paracetamol disgusts tasters
Older people often have to take many medications. On average, they consume 6 to 8 per day … All spread over 6 to 20 intakes. Under these conditions, and taking into account the difficulty in swallowing, caregivers sometimes adopt great means: crush the drugs for easier administration.
The crushing of drugs, “it is a problem which is known”, according to Professor Isabelle Prêcheur, dental surgeon at the University Hospital of Nice. But no study has been conducted on the subject. No complaints have been made either, mainly because the dependent elderly “no longer communicate or communicate badly.” There will be no spontaneous complaint, and if we ask them the question, they will not necessarily answer, ”explains this practitioner who launched the MELA study.
16 healthy volunteers were recruited. 8 were caregivers, 8 were representatives of civil society. A Michelin-starred chef even agreed to play the game. Everyone tasted mixtures of the 10 most prescribed drugs, a “mix” of 6 drugs, a control, and compote or gelled water.
In total, 24 verrines were “tested” by these one-day experts, who then assigned a score from 0 to 10. “They were completely overwhelmed by realizing the extent of the problem”, testifies Isabelle Prêcheur . The worst marks were given to the hypnotic zopiclone, the antiplatelet agent clopidogrel and paracetamol.
“A factor of anorexia”
The mixture of six drugs is particularly appalling for tasters. And even if the recommendations of the Haute Autorité de Santé (HAS, see box) do not incite to indulge in these mixtures, it is a fairly common act. “In practice, nursing assistants do not have the means to do otherwise and we cannot blame them”, deplores the Preacher.
HAS recommendations
In 2010, the French National Authority for Health (HAS) issued recommendations framing the crushing of drugs. A list has been drawn up. The Autorité recommends limiting the use of this method as much as possible, looking for alternatives, specifying the reason for the limitation on the prescription and contacting the pharmacy if necessary. Experts also advise using a neutral “vehicle”, such as thickened water.
The bad taste of crushed medicines has several consequences on the health of the elderly. Between the bitter taste and the side effects, “the person does not finish their food. There is therefore poor compliance and a loss of appetite, details Isabelle Prêcheur. It is a real problem and a factor of anorexia. “
The adventure has proved useful in several ways. The chefs gave advice to the staff of the EHPAD: it is better to mix the drugs with jam, with a sweeter taste. After consumption, the white bread crumbs allow the bitter taste of the medicines to pass.
Caregivers should also pay attention to the bodily signs that patients express. The difference between swallowing and chewing disorders also needs to be established. This would prevent 10 to 15% of crushed drugs. “To chew, you need teeth and muscles of the tongue and cheeks. To swallow, you need muscles in the pharynx, explains Professor Prêcheur.
The study showed that when a person has bad teeth, they are given mixed or chopped food. 10 to 15% of them have bad teeth, but they swallow properly! »Changing galenic forms is also an avenue for the future.
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