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J. Lamure, P. Brocker, S.M. Schneider, R. Collomp, F. Bertin-Hugault, P. Denormandie, I. Prêcheur

Jour Nursing Home Res 2015;1:55-61

Background & Aims: Many frail elderly patients are polymedicated. Whether they suffer from dysphagia (due to stroke, Parkinson’s disease, etc.) or cognitive troubles (due to Alzheimer’s disease, etc.), they are often given blended food, with drugs crushed and mixed into the food. Health Authorities recommend to crush and to administrate crushed drugs separately, for pharmacologic reasons, but the drugs are usually mixed together to facilitate ease of case by nursing staff. Crushed drugs can have a bad taste, leading to drug / food refusal, worsening malnutrition, but this qualitative aspect has been scarcely studied in geriatric populations. The present study aimed to evaluate the taste of the ten drugs most frequently prescribed in nursing homes, in order to determine which drugs are acceptable or not when crushed and mixed into food. Methods: This one-step observational study was designed like a food or wine tasting. A jury of healthy volunteers was recruited among medical staff (8 volunteers) and other people involved in food and gastronomy (8 volunteers, including a starred Chef). Every tablet or capsule was mixed into 100 mL of berry-flavored jelly or apple sauce. It was a blind tasting of 24 verrines, containing the ten drugs randomly distributed, a control without drug and a combination of the 6 top-list drugs. Twelve jelly verrines were followed by 12 apple sauce verrines. Tasters spat the spoonful content out after they had assessed its taste. Each verrine was scored from 0 (bad taste) to 10 (good). Qualitative and free comments were also recorded. Results: The lowest scores were attributed to the combination of paracetamol, alprazolam, furosemide, levothyroxine sodium, memantine and zopiclone (1.5 + 1.6; 0 to 5), followed by zopiclone (1.9 + 2.3; 0 to 8), clopidogrel (4.3 + 2.1; 1 to 7) and paracetamol (4.6 + 1.8; 1 to 8). All these drugs had a long-lasting bitterness. Zopiclone mixed and alone was qualified as unbearable and one participant exhibited nausea by taking it. Five participants did not take lunch after the study for lack of hunger (5/16: 31.3 %). Drug-free jelly and apple sauce were scored 6.7 + 1.4 (4 to 9) and 7.1 + 1.1 (5-9.5), respectively. Other scores ranged from 6.1 to 7.9, for alprazolam, ramipril, oxazepam, levothyroxine sodium, donezepil and furosemide. Conclusions: The taste of some drugs may be unbearable when they are crushed and mixed into food, and caregivers should avoid mixing a bad-tasting drug with the other drugs. There are wide differences of taste acceptability from one person to another. Thus, during workshops, every patient could taste once separately any single drug in his prescription list. If a bad taste leads to drug refusal, caregivers should inform physicians and pharmacists, who in turn should seek alternative medical solutions (drug discontinuation or substitution). Caregivers could also seek alternative food or administration conditions. On a mid-term basis, pharmaceutical companies should also develop specific pharmaceutical forms, as they do for children.

J. Lamure ; P. Brocker ; S.M. Schneider ; R. Collomp ; F. Bertin-Hugault ; P. Denormandie ; I. Prêcheur (2015): TASTE OF TEN DRUGS FREQUENTLY PRESCRIBED IN NURSING HOMES CRUSHED AND MIXED IN FOOD: OBSERVATIONAL STUDY IN 16 HEALTHY VOLUNTEERS. The Journal of Nursing Home Research Science (JNHRS). http://dx.doi.org/10.14283/jnhrs.2015.12


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