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Dysphagia in Care Homes

This report from the Patients Association has found as many as 50% of residents are affected by swallowing difficulties (dysphagia), which can make tablets difficult or even impossible to swallow. Despite the number of people affected by swallowing problems in care homes, only 10% of the homes surveyed had a specific protocol to guide staff in administering medication to people with dysphagia and only 20% had arranged training in this important area.


The report is based on a recent survey of 30 care homes which found that on a daily basis, staff are crushing tablets and mixing them with food to make medication easier to swallow. Altering medication (not designed to be crushed) increases the likelihood of side effects, may reduce the effectiveness of the drug and subsequently compromises residents’ safety. Yet staff had limited awareness of the impact of tampering with medication in this way.

The survey found:

  • Having a preferred GP to a care home has led to improved medication review and prescription arrangements based on GPs having a better understanding of the care needs of residents.
  • Despite liquid forms of medication being a preferable option for many people with swallowing difficulties, budget concerns were putting GPs off from prescribing medication in this form
  • Swallowing difficulties were a significant issue for residents, who often struggle to take medication in the form of tablets. They may chew the tablets or attempt to swallow them whole, leading to choking or coughing fits.
  • Of particular concern are older residents and those with dementia who ‘suffer in silence’, unable to communicate and unable to swallow their much needed medicines.
  • In over 70% of the homes medication was being mixed with food to make it easier to administer. This raised important concerns about ensuring that service users remain aware that medication is being administered in this way, together with the possibility of reduced or missed doses of medication, if the affected service user does not consume the full portion of food.
  • The majority of homes reported some awareness of the circumstances under which it would be legal to covertly administer medication to residents.


This report also includes 21 recommendations directed at care homes, Clinical Commissioning Groups and the Care Quality Commission to support improved care practice