Impairment of the ability to swallow with advancing age has been identified as a major healthcare problem in an ageing population. Radiological studies of an asymptomatic group of 56 patients with a mean age 83 years showed that a normal pattern of deglutition was present in only 16% of individuals30. Oral abnormalities, which included difficulty in controlling and delivering a bolus to the oesophagus following ingestion, was noted in 63% of cases. Structural abnormalities capable of causing oesophageal dysphagia include neoplasms, strictures and diverticula although only minor changes of structure and function are associated directly with ageing. The difficulty appears therefore to relate to neurological mechanisms associated with the coordination of tongue, oropharynx and upper oesophagus during a swallow.
Impaired swallowing in the elderly will result in even small tablets (4 mm) adhering to the oesophagus31. Low dose tablets, including the aminobisphosphonates used to inhibit bone resorption, have been reported to cause ulceration32. This has led to a FDA recommendation that these medications be consumed with 240 ml water, the subject to remain erect for 30 minutes after administration. Dosage forms which float on the co-administered water may also present problems to the elderly by sticking to the roof of the oropharynx.
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