Acceptability of oral liquid pharmaceutical products in older adults: palatability and swallowability issues.

BACKGROUND: In institutional care, oral liquid pharmaceutical products are widely prescribed for older patients, especially for those with swallowing disorders. As medicines acceptability is a key factor for compliance in the older population, this study investigated the acceptability of oral liquid pharmaceutical products in this targeted population. METHODS: An observational, multicenter, prospective study was conducted in eight geriatric hospitals and eight nursing homes in France. Observers reported several behaviours/events describing the many aspects of acceptability for various pharmaceutical products' uses in patients aged 65 and older. Acceptability scores of oral liquid pharmaceutical products were obtained using an acceptability reference framework (CAST - ClinSearch Acceptability Score Test®): a 3D-map summarizing the different users' behaviors, with two clusters defining the positively and negatively accepted profiles materialized by the green and red zones, respectively. RESULTS: Among 1288 patients included in the core study and supporting the acceptability reference framework, 340 assessments were related to the administration of an oral liquid pharmaceutical product. The mean age of these patients was 87 (Range [66-104y]; SD = 6.7), 68% were women and 16% had swallowing disorders. Globally, the oral liquid pharmaceutical products were classified as "positively accepted," the barycenter of the 340 assessments, along with the entire confidence ellipses surrounding it, were positioned on the green zone of the map. Sub-populations presenting a different acceptability profile have also been identified. For patients with swallowing disorders, the oral liquid pharmaceutical products were classified as "negatively accepted," the barycenter of the 53 assessments along with 87% of its confidence ellipses were associated with this profile. A gender difference was observed for unflavored oral liquids. In women, they were classified "negatively accepted," the barycenter of the 68 assessments with 75% of its confidence ellipses were located in the red zone, while they were classified "positively accepted" in men. CONCLUSION: This study showed that oral liquid pharmaceutical products are a suboptimal alternative to solid oral dosage forms in patients with swallowing disorders. To ensure an optimal acceptability, prescribers should also consider the presence of a taste-masker in these oral liquids. As highlighted herein, palatability remains crucial in older populations, especially for women.

A Decision Support Tool Facilitating Medicine Design for Optimal Acceptability in The Older Population.

PURPOSE: Medicine acceptability, which is of the utmost importance for vulnerable patients' adherence, is driven by both user and product characteristics. Herein, a novel multivariate approach integrating the many aspects of acceptability is used to discriminate positively and negatively accepted medicines in the older population. METHODS: An observational study was carried out in eight hospitals and eight nursing homes to collect a large set of real-life data on medicines uses in older patients (≥65 years). Mapping and clustering explored these multiple observational measures and summarised the main information into an intelligible reference framework. Resampling statistics were used to validate the model's reliability. RESULTS: A three-dimensional map and two clusters defining acceptability profiles, as positive or negative, emerged from the 1079 evaluations. Factors of interest (medicines, user features…) were positioned on the map at the barycentre of their evaluations and assigned to an acceptability profile. Focusing on patients' ability to swallow, we have highlighted the tool's efficacy in demonstrating the impact of user features on medicine acceptability. CONCLUSIONS: This multivariate approach provides a relevant judgement criterion for this multi-dimensional concept. Facilitating the choice of the most appropriate dosage form to achieve optimal acceptability in a targeted population, this tool is of real potential to improve clinical decisions.

[Orthostatic hypotension: epidemiology and mechanisms]. / Hypotension orthostatique : épidémiologie et mécanismes.

Orthostatic hypotension (OH) is defined as a decrease in systolic blood pressure more than or equal to 20 mm Hg or diastolic more than or equal to 10 mm Hg within three minutes of standing up. Discharge records for 0.4% of all hospitalizations include OH as a diagnosis. The prevalence of OH is related to aging, reaching 5 to 30% in unselected elders aged more than or equal to 65 years, especially those treated for hypertension and/or living in nursing homes or health care facilities. OH is associated with an increased risk of syncope and subsequent cardiovascular mortality. Standing results in pooling of 25-30% of blood in the lower extremities and splanchnic-mesenteric circulation, thereby reducing venous return, ventricular filling, cardiac output and, in turn, blood pressure. Compensatory mechanisms to maintain BP involve the baroreflex and the sympathetic nervous system (SNS). Failure of SNS results in neurogenic OH, which is severe in multiple system atrophy with dysautonomia (Shy-Drager syndrome), also commonly seen in patients with Lewy body dementia and in patients with Parkinson's disease, in whom OH is less severe and occurs later. Conversely, SNS function is preserved in secondary OH associated with hypovolemia, anemia, antihypertensive or psychotropic drugs. Clinical manifestations and tolerance of OH depends on its severity and on cerebral blood flow autoregulation, which both impact on the risk of syncope, trauma and subsequent prognosis.