{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T19:31:06Z","timestamp":1792697466105,"version":"4.5.0"},"reference-count":47,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T00:00:00Z","timestamp":1697673600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacy"],"abstract":"<jats:p>The aim of this systematic review was to identify and critically appraise the available evidence regarding solid oral dosage forms (SODFs), e.g., tablets, and challenges regarding the oral administration of medicine to inpatients in a variety of healthcare settings such as (1) hospitals, (2) nursing homes and (3) long-term stay units (LTSUs). A literature search was undertaken in September 2021 and repeated in June 2023 in the following databases: PubMed, EMBASE, CINAHL, Scopus, Web of Science, The Cochrane Library, PsycINFO and ProQuest. A Microsoft Excel\u00ae spreadsheet was devised to collate the following data from each eligible study: study author and year, country, number of participants, title, duration (follow-up period), study design, inclusion and exclusion criteria, method and data collection, relevant outcomes, and key findings. A total of 3023 records were identified, with 12 articles being included in the final systematic review. Seven of the twelve studies reported on the prevalence of difficulties swallowing SODFs, which varied from 10\u201334.2%. Nine of the twelve studies reported the methods used to manipulate SODFs, with the most reported method being tablet crushing. Given the prevalence of swallowing difficulties and the subsequent crushing of medicines in response to this, it is evident that concerns should be raised regarding the potential for a medication administration error to occur.<\/jats:p>","DOI":"10.3390\/pharmacy11050167","type":"journal-article","created":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T11:46:26Z","timestamp":1697715986000},"page":"167","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Adult Patients with Difficulty Swallowing Oral Dosage Forms: A Systematic Review of the Quantitative Literature"],"prefix":"10.3390","volume":"11","author":[{"given":"Anne","family":"Harnett","sequence":"first","affiliation":[{"name":"University Hospital Limerick, V94 F858 Limerick, Ireland"},{"name":"Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, T12 K8AF Cork, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Byrne","sequence":"additional","affiliation":[{"name":"Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, T12 K8AF Cork, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3948-1854","authenticated-orcid":false,"given":"Jennifer","family":"O\u2019Connor","sequence":"additional","affiliation":[{"name":"Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, T12 K8AF Cork, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Declan","family":"Lyons","sequence":"additional","affiliation":[{"name":"University Hospital Limerick, V94 F858 Limerick, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7496-9477","authenticated-orcid":false,"given":"Laura J.","family":"Sahm","sequence":"additional","affiliation":[{"name":"Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, T12 K8AF Cork, Ireland"},{"name":"Pharmacy Department, Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e036761","DOI":"10.1136\/bmjopen-2020-036761","article-title":"Translation to English, cross-cultural adaptation, and pilot testing of the self-report questionnaire on swallowing difficulties with medication intake and coping strategies (SWAMECO) for adults with polypharmacy","volume":"10","author":"Arnet","year":"2020","journal-title":"BMJ Open"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"675","DOI":"10.2147\/PPA.S29549","article-title":"Definitions, variants, and causes of nonadherence with medication: A challenge for tailored interventions","volume":"7","author":"Hugtenburg","year":"2013","journal-title":"Patient Prefer. Adherence"},{"key":"ref_3","unstructured":"ebin.pub (2023, October 08). Optimizing Pharmacotherapy in Older Patients: An Interdisciplinary Approach 3031280601, 9783031280603. Available online: https:\/\/ebin.pub\/optimizing-pharmacotherapy-in-older-patients-an-interdisciplinary-approach-3031280601-9783031280603.html."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.curtheres.2015.08.002","article-title":"Pill properties that cause dysphagia and treatment failure","volume":"77","author":"Fields","year":"2015","journal-title":"Curr. Ther. Res."},{"key":"ref_5","first-page":"28","article-title":"The legal and clinical implications of crushing tablet medication","volume":"100","author":"James","year":"2004","journal-title":"Nurs. Times"},{"key":"ref_6","first-page":"CD012419","article-title":"Interventions for improving medication-taking ability and adherence in older adults prescribed multiple medications","volume":"5","author":"Cross","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"155","DOI":"10.5001\/omj.2011.38","article-title":"Patient Medication Adherence: Measures in Daily Practice","volume":"26","author":"Jimmy","year":"2011","journal-title":"Oman Med. J."},{"key":"ref_8","unstructured":"Kim, J., and De Jesus, O. (2021). Medication Routes of Administration, StatPearls."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.ijpharm.2012.04.022","article-title":"Swallowing dysfunction and dysphagia is an unrecognized challenge for oral drug therapy","volume":"430","author":"Stegemann","year":"2012","journal-title":"Int. J. Pharm."},{"key":"ref_10","unstructured":"(2023, October 08). Dysphagia (Swallowing Problems). Available online: https:\/\/www.nhsinform.scot\/illnesses-and-conditions\/stomach-liver-and-gastrointestinal-tract\/dysphagia-swallowing-problems."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2643","DOI":"10.1111\/jgs.16137","article-title":"Swallowing disorders in the older population","volume":"67","author":"Christmas","year":"2019","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1002\/j.2055-2335.2009.tb00436.x","article-title":"Solid medication dosage form modification at the bedside and in the pharmacy of Queensland hospitals","volume":"39","author":"Nissen","year":"2009","journal-title":"J. Pharm. Pract. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"33","DOI":"10.7748\/ns.16.42.33.s1","article-title":"Medication administration in nursing homes","volume":"16","author":"Wright","year":"2002","journal-title":"Nurs. Stand."},{"key":"ref_14","unstructured":"(2023, October 08). Pharmaceuticalissuesdosageforms-(2).pdf. Available online: https:\/\/www.rpharms.com\/Portals\/0\/RPS%20document%20library\/Open%20access\/Support\/toolkit\/pharmaceuticalissuesdosageforms-%282%29.pdf."},{"key":"ref_15","first-page":"50","article-title":"Medications that should not be crushed","volume":"19","year":"2017","journal-title":"Med. Univ."},{"key":"ref_16","first-page":"132","article-title":"Tablet crushing is a widespread practice but it is not safe and may not be legal","volume":"269","author":"Wright","year":"2002","journal-title":"Pharm. J."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Johannesson, J., Hansson, P., Bergstr\u00f6m, C.A.S., and Paulsson, M. (2022). Manipulations and age-appropriateness of oral medications in pediatric oncology patients in Sweden: Need for personalized dosage forms. Biomed. Pharmacother., 146.","DOI":"10.1016\/j.biopha.2021.112576"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1016\/j.ijpharm.2016.12.032","article-title":"A systematic review of the use of dosage form manipulation to obtain required doses to inform use of manipulation in paediatric practice","volume":"518","author":"Richey","year":"2017","journal-title":"Int. J. Pharm."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.ijpharm.2013.08.061","article-title":"MODRIC\u2014Manipulation of drugs in children","volume":"457","author":"Richey","year":"2013","journal-title":"Int. J. Pharm."},{"key":"ref_20","unstructured":"(2016). CASPU Critical Appraisal Skills Programme (CASP) checklist for cohort studies."},{"key":"ref_21","unstructured":"Akers, J., Aguiar-Ib\u00e1\u00f1ez, R., and Baba-Akbari, A. (2009). Systematic Reviews: CRD\u2019s Guidance for Undertaking Reviews in Health Care, University of York."},{"key":"ref_22","first-page":"b92","article-title":"Guidance on the Conduct of Narrative Synthesis in Systematic Reviews","volume":"1","author":"Popay","year":"2006","journal-title":"Prod. ESRC Methods Programme Version"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"105906","DOI":"10.1016\/j.ijsu.2021.105906","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"88","author":"Page","year":"2021","journal-title":"Int. J. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Belissa, E., Vallet, T., Laribe-Caget, S., Chevallier, A., Chedhomme, F.X., Abdallah, F., Bachalat, N., Belbachir, S.-A., Boulaich, I., and Bloch, V. (2019). Acceptability of oral liquid pharmaceutical products in older adults: Palatability and swallowability issues. BMC Geriatr., 19.","DOI":"10.1186\/s12877-019-1337-2"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1111\/fcp.12116","article-title":"Impact of recommendations on crushing medications in geriatrics: From prescription to administration","volume":"29","author":"Bourdenet","year":"2015","journal-title":"Fundam. Clin. Pharmacol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1007\/s12603-017-0886-3","article-title":"Assessment of clinical practices for crushing medication in geriatric units","volume":"21","author":"Fodil","year":"2017","journal-title":"J. Nutr. Health Aging"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2615","DOI":"10.1111\/j.1365-2648.2011.05700.x","article-title":"Medicine administration errors in patients with dysphagia in secondary care: A multi-centre observational study","volume":"67","author":"Kelly","year":"2011","journal-title":"J. Adv. Nurs."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1016\/j.ijpharm.2016.02.036","article-title":"Medicines administration for residents with dysphagia in care homes: A small scale observational study to improve practice","volume":"512","author":"Santos","year":"2016","journal-title":"Int. J. Pharm."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1111\/j.1440-172X.2009.01814.x","article-title":"What is the matter with crushing pills and opening capsules?","volume":"16","author":"Kirkevold","year":"2010","journal-title":"Int. J. Nurs. Pract."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.gerinurse.2021.01.005","article-title":"Drug modification by nurses in Norwegian nursing homes: A cross-sectional study","volume":"42","author":"Solberg","year":"2021","journal-title":"Geriatr. Nur."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1002\/pds.3373","article-title":"Improving medication administration in nursing home residents with swallowing difficulties: Sustainability of the effect of a multifaceted medication safety programme","volume":"22","author":"Stuijt","year":"2013","journal-title":"Pharmacoepidemiol. Drug Saf."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"van Welie, S., Wijma, L., Beerden, T., van Doormaal, J., and Taxis, K. (2016). Effect of warning symbols in combination with education on the frequency of erroneously crushing medication in nursing homes: An uncontrolled before and after study. BMJ Open, 6.","DOI":"10.1136\/bmjopen-2016-012286"},{"key":"ref_33","first-page":"514","article-title":"Adaptation of oral medication in people institutionalized in nursing homes for whom medication is crushed: The ADECUA Study","volume":"40","year":"2016","journal-title":"Farm Hosp."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1111\/ajag.12037","article-title":"Safe to crush? A pilot study into solid dosage form modification in aged care","volume":"33","author":"Mercovich","year":"2014","journal-title":"Australas. J. Ageing"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Sestili, M., Logrippo, S., Cespi, M., Bonacucina, G., Ferrara, L., Busco, S., Grappasonni, I., Palmieri, G.F., Ganzetti, R., and Blasi, P. (2018). Potentially inappropriate prescribing of oral solid medications in elderly dysphagic patients. Pharmaceutics, 10.","DOI":"10.3390\/pharmaceutics10040280"},{"key":"ref_36","unstructured":"White, R., and Bradnam, V. (2015). Handbook of Drug Administration via Enteral Feeding Tubes, Pharmaceutical Press."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1007\/s00228-015-1979-8","article-title":"Older adults with difficulty swallowing oral medicines: A systematic review of the literature","volume":"72","author":"Crean","year":"2016","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"dox131","DOI":"10.1093\/dote\/dox131","article-title":"Economic and survival burden of dysphagia among inpatients in the United States","volume":"31","author":"Patel","year":"2018","journal-title":"Dis. Esophagus"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/s12603-010-0085-y","article-title":"Undiagnosed malnutrition and nutrition-related problems in geriatric patients","volume":"14","author":"Volkert","year":"2010","journal-title":"J. Nutr. Health Aging"},{"key":"ref_40","unstructured":"GOV.UK (2023, October 01). Guidance for \u2018Specials\u2019 Manufacturers, Available online: https:\/\/www.gov.uk\/government\/publications\/guidance-for-specials-manufacturers\/guidance-for-specials-manufacturers."},{"key":"ref_41","unstructured":"(2023, October 08). NEWT Guidelines\u2014Patients with Swallowing Difficulties. Available online: https:\/\/www.newtguidelines.com\/SwallowingDifficulties.html."},{"key":"ref_42","unstructured":"(2023, October 08). Medications. Available online: https:\/\/www.bapen.org.uk\/nutrition-support\/enteral-nutrition\/medications."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Tan, P.L., Chung, W.L., Sklar, G.E., Yap, K.Z., and Chan, S.Y. (2022). Development and validation of the INappropriate solid oral dosaGE form modification aSsessmenT (INGEST) Algorithm using data of patients with medication dysphagia from a neurology ward and nursing home in Singapore. BMJ Open, 12.","DOI":"10.1136\/bmjopen-2022-061774"},{"key":"ref_44","unstructured":"Connor, T.H., MacKenzie, B.A., DeBord, D.G., Trout, D.B., O\u2019Callaghan, J.P., and Cincinnati, O.H. (2016). NIOSH List of Antineoplastic and Other Hazardous Drugs in Healthcare Settings, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, DHHS (NIOSH)."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.1345\/aph.1D091","article-title":"Fatality from administration of labetalol and crushed extended-release nifedipine","volume":"37","author":"Schier","year":"2003","journal-title":"Ann. Pharmacother."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1136\/bmj.38875.675486.55","article-title":"A meta-analysis of the association between adherence to drug therapy and mortality","volume":"333","author":"Simpson","year":"2006","journal-title":"BMJ"},{"key":"ref_47","first-page":"411","article-title":"Medication-related swallowing difficulties may be more common than we realise","volume":"15","author":"Strachan","year":"2005","journal-title":"Pharm. Pract."}],"container-title":["Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2226-4787\/11\/5\/167\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:10:04Z","timestamp":1760130604000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2226-4787\/11\/5\/167"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,19]]},"references-count":47,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["pharmacy11050167"],"URL":"https:\/\/doi.org\/10.3390\/pharmacy11050167","relation":{},"ISSN":["2226-4787"],"issn-type":[{"value":"2226-4787","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,19]]}}}