Impact of Tablet Size and Shape on the Swallowability in Older Adults

Abstract

Older adults represent the major target population for oral medications, due to the high prevalence of multimorbidity. To allow for successful pharmacological treatments, patients need to adhere to their medication and, thus, patient-centric drug products with a high level of acceptability by the end users are needed. However, knowledge on the appropriate size and shape of solid oral dosage forms, as the most commonly used dosage forms in older adults, is still scarce. A randomized intervention study was performed including 52 older adults (65 to 94 years) and 52 young adults (19 to 36 years). Each participant swallowed four coated placebo tablets differing in weight (250 to 1000 mg) and shape (oval, round, oblong) in a blinded manner on three study days. The choice of tablet dimensions allowed for a systematic comparison between different tablet sizes of the same shape, as well as between different tablet shapes. Swallowability was assessed using a questionnaire-based method. All tested tablets were swallowed by ≥80% of adults, independent of age. However, only the 250 mg oval tablet was classified as well swallowable by ≥80% of old participants. The same was true for young participants; however, they also considered the 250 mg round and the 500 mg oval tablet as well swallowable. Furthermore, swallowability was seen to influence the willingness to take a tablet on a daily basis, especially for an intake over longer time periods.

Influence of Solid Oral Dosage Form Characteristics on Swallowability, Visual Perception, and Handling in Older Adults

“…The tested dosage forms (Table 1) covered the most common weights, sizes, and shapes of SODFs prescribed to people 65 years and older in Germany [1]. Placebo tablets for the deglutition and handling part of the study were produced by direct compression followed by film coating using the same composition as previously reported [1].…”

“…The tested dosage forms (Table 1) covered the most common weights, sizes, and shapes of SODFs prescribed to people 65 years and older in Germany [1]. Placebo tablets for the deglutition and handling part of the study were produced by direct compression followed by film coating using the same composition as previously reported [1]. Tablets for the visual perception part of the study were produced by 3D printing using selective laser sintering technology and were shown to the participants enclosed in showcases (Figure 1).…”

“…Solid oral dosage forms, SODFs, are the predominant type of dosage form for this route of administration. This also applies to older adults, being 65 years or older [1]. If tablets or capsules are too large, patients often modify their dosage forms with unknown consequences on the efficacy and/or safety.…”

“…Thus, we aimed to gain information on acceptable sizes and shapes of SODFs for older adults with respect to swallowability, visual perception, and handling. Hereby, we focused on tablets, as they are the major type of SODFs being prescribed to older adults [1]. Since the results of the deglutition part of the study have already been reported [1], this article addresses the handling assessment of the different tablets as well as the visual perception assessment of different SODFs.…”

“…Hereby, we focused on tablets, as they are the major type of SODFs being prescribed to older adults [1]. Since the results of the deglutition part of the study have already been reported [1], this article addresses the handling assessment of the different tablets as well as the visual perception assessment of different SODFs. Besides tablets, the visual perception part included capsules and mini tablets.…”