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As people age, they often develop multiple chronic conditions that require long-term treatment. Hypertension, diabetes, heart disease, and arthritis are common examples. This results in seniors taking many different medications daily, a situation known as polypharmacy.
Prevalence of polypharmacy in seniors
Studies show that over 60% of older adults take five or more medications each day. In nursing homes, the number can reach 90%. The more medicines prescribed, the higher the risk of drug interactions, administration errors, and swallowing difficulties.
Common medications and regimens
Elderly patients often take:
Antihypertensives (e.g. amlodipine, losartan)
Antidiabetics (e.g. metformin, gliclazide)
Lipid-lowering agents (e.g. atorvastatin)
Antiplatelets or anticoagulants (e.g. aspirin, warfarin)
Pain or dementia medications (e.g. paracetamol, donepezil)
Regimens differ in every elderly people, some are once daily, others several times a day. Each drug may also come in different forms, such as tablets, capsules, or controlled-release formulations.
How the problem is managed?
Healthcare staff or caregivers sometimes adapt medicines by:
Crushing tablets or opening capsules
Using liquid (syrup) or dispersible forms
Switching to patches or injections
Administering via feeding tubes
While these methods help ease administration, they must be done carefully to avoid harm.
Is crushing medicines safe?
Not all medicines are safe to crush. Some tablets are coated or specially designed to release the drug slowly or protect the stomach. Crushing such medicines can alter how they work or increase side effects.
Do not crush the following types:
Enteric-coated tablets (e.g. aspirin EC) – coating protects the stomach.
Modified-release or extended-release tablets (e.g. metoprolol CR, nifedipine XL) – designed for slow absorption.
Cytotoxic or hormone-based drugs (e.g. tamoxifen) – may expose caregivers to harmful particles.
Sublingual or buccal tablets (e.g. nitroglycerin) – meant to dissolve under the tongue for fast effect.
Why crushing medicines can be dangerous?
Crushing alters the drug’s structure and absorption. Possible consequences include:
Overdose or toxicity when the entire dose releases at once.
Reduced effectiveness when the active ingredient degrades.
Gastrointestinal irritation from removing the protective coating.
Chemical exposure risk for caregivers when inhaling crushed particles.
Unpredictable blood levels that lead to poor symptom control.
For example, crushing modified-release nifedipine can cause a sudden drop in blood pressure. Crushing enteric-coated aspirin can irritate the stomach and cause bleeding.
Conclusion
Crushing medicines for elderly patients should never be done without professional advice. Although it may appear to make swallowing easier, it can change how a drug works, increase side effects, or even cause harm. Some medicines have coatings that protect the stomach or are designed to release slowly over time. When crushed, these protections are lost, leading to toxicity or poor control of symptoms. Caregivers and staff should always check with a pharmacist or doctor before altering any medication form. Safer options such as liquid preparations, dispersible tablets, or patches are often available. The best way to prevent incidents from wrongly crushing medicines is through staff training, clear medication reviews, and strict adherence to “do-not-crush” guidelines.