When pills pose problems

There's no denying that getting older can be a tough pill to swallow. But actually swallowing pills, capsules, or tablets often becomes one of the challenges of aging—though the task can be tricky for a host of reasons that have nothing to do with age.

About three-quarters of Americans ages 50 to 64 take prescription drugs, a proportion that climbs to nine in 10 people at 65 and older. The situation is similar with over-the-counter drugs, which adults 65 and up use more of than any other age group. Half take such a product daily or weekly, while one-quarter use a combination of 10 or more prescription and over-the-counter medications.

Having trouble swallowing all these medications is an extremely common scenario. Up to 40% of American adults have reported problems, experiencing gagging, choking, or vomiting when pills won't easily slide down the throat.

"It's something that can affect people across the life span, but older adults are particularly susceptible because they tend to be on more medications," says Dylan Moriarty, an advanced practice clinical pharmacist at Harvard-affiliated Brigham and Women's Hospital. "Older adults may also have more chronic conditions that contribute to difficulty swallowing."

Beyond being unpleasant, swallowing difficulties (known medically as dysphagia) also pose far-reaching implications: they often prompt people to abandon their medication regimens, threatening their health. About 125,000 Americans die each year because they don't adhere to their prescribed drug regimen, according to the CDC.

What gets in the way

Swallowing problems can be hit or miss. You might have trouble with just medications, even as food and drinks go down without a hitch. Reasons for pill-related difficulties can be remarkably basic: some people have an especially strong gag reflex; others simply dislike taking medications.

But swallowing problems are usually traceable to either the medication itself or a condition in the person taking it, Moriarty says. These include

• cancer (especially of the head and neck)
• stroke
• neurological conditions such as dementia, Parkinson's disease, or multiple sclerosis
• gastroesophageal reflux disease (GERD)
• hiatal hernia (when the top of the stomach slides above the diaphragm)
• fractures in the neck.

Sometimes the medication itself creates an obstacle. Some pills are just plain huge — such as metformin, a highly common medication for diabetes taken by more than 19.5 million Americans. "The shape, size, texture, or taste of a medication might trigger swallowing difficulties," Moriarty says.

Additionally, drug side effects may also indirectly affect how easily pills are swallowed by causing dry mouth, affecting taste, irritating the esophagus, or producing sedative effects.

Pill-swallowing strategies

If you're noticing difficulty swallowing pills, the first step is to tell your doctor — especially if the problem is affecting your ability or willingness to keep taking the medicine. An easy fix may be to get the drug as a liquid, powder, or cream, if it's marketed in one of those forms. Or, if it's available in a smaller pill at a lower dose, you might be able to take two or more of those instead of one large one.

Crushing or cutting pills might also solve the problem, but not all medications are safe to break apart. Doing so sometimes changes the how your body absorbs the drug. It's also never safe to open or break a capsule. Check with your pharmacist or prescribing doctor first.

A variety of at-home measures can help pills glide down more easily:

Pop-bottle method (for tablets): Fill a bottle with water. Place the pill on your tongue and bring the bottle opening to your lips. Close lips tightly around the bottle opening and take a drink. Keep contact between the bottle and your lips, using a sucking motion to swallow both pill and water without allowing air into the bottle.

Lean-forward method (for capsules): Place a capsule on your tongue and take a sip of water, but don't swallow. Tilt your chin toward your chest and swallow the water and capsule with your head in a bent position.

Swallowing aids: Gels, sprays, and other products coat either your mouth or the pill. Sold in drug stores and online, these items can mask unpleasant tastes, stimulate saliva production, or lubricate the pill.

Lastly, Moriarty recommends asking your doctor to determine if any medications you're taking can be eliminated. This may prove to be the easiest fix.

"Often, older patients see multiple doctors and are prescribed multiple medications for the same reason, and some are continued long after a medical issue has been resolved," he says. "You may have trouble swallowing a specific one, but there's a chance that medication isn't even needed anymore."

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