By Linda Carroll

(Reuters Health) – Seniors may be more likely than younger adults to choke on vitamins and dietary supplements, or to have other problems swallowing them, especially when the pills are on the larger side, a new study suggests.

After poring over 10 years of adverse event reports, government researchers found that more than three-fourths of cases involving swallowing problems were in patients aged 65 and older, according to the study published in the Annals of Internal Medicine.

“Multivitamins are used by up to 35% and calcium supplements by up to 24% of older adults, who have higher rates (of swallowing issues)” than younger persons,” noted the team of researchers from the Food and Drug Administration and the Centers for Disease Control and Prevention.

While the authors were not available to comment, the FDA did offer some advice for seniors taking supplements.

“Older adults should be mindful of possible choking or other swallowing problems from taking supplements,” said Lindsay Haake, a spokesperson for the FDA. “They should avoid taking several pills at once, avoid extra-large pills or capsules, and swallow supplements with plenty of water or other fluid.”

If the supplement is on the large size, the FDA advises senior patients talk to their doctor.

“Tell your physician you are having difficulty swallowing pills and ask him/her or your pharmacist for other options or if you can cut the supplement in half,” Haake said in an email. “The FDA advises all consumers to talk to their doctor, pharmacist, or other health care professional before deciding to purchase or use a dietary supplement.”

To take a closer look at pill swallowing problems among seniors, the research team, led by FDA scientist Dr. Cecile Punzalan, turned to reports submitted to the FDA’s Center for Food Safety and Applied Nutrition Adverse Event Reporting System.

The team focused on reports filed from 2006 through 2015 that described cases involving problems swallowing supplement pills. Of the 3,932 reports, 64% included the patient’s age. Of those reports, 76.8% involved adults aged 65 and older.

The most frequent swallowing problem reported was choking, at 86.0%. And 14.3% described a serious adverse event, including three deaths, that were attributed to supplement-induced airway obstruction or aspiration.

Most of the reports of swallowing problems, 72.9%, involved multivitamins, while 17.3% involved calcium supplements. The ten supplements that were most commonly involved in swallowing reports had a length, on average, of three quarters of an inch (19.3 mm), a width of more than a third of an inch (9.8mm) and a height of nearly a third of an inch (7.8 mm).

Dr. Rupa Mokkapatti seconds the FDA advice to seniors to check with their doctors to find a better alternative.

“Patients need to know there are alternatives to large-sized pills for most supplements and medications,” Mokkapatti, an internist at UPMC Passavant Hospital in Pittsburgh, said in an email. “There are liquid forms, pills that come in small sizes, like calcium ‘petites,’ chewable forms, and supplements that can be crushed or dissolved in water. For supplements, given they are often purchased without a prescription, the in-store pharmacist may be able to guide the patient about alternatives that are easier to swallow. For prescription medications, if you are having difficulty swallowing prescription pills, it’s important to notify your doctor of any swallowing issues so alternatives can be ordered.”

SOURCE: Annals of Internal Medicine, online August 19, 2019.