Supplement pills can pose choking risks – especially for seniors

Some pills and capsules are large and difficult to swallow.
Some pills and capsules are large and difficult to swallow.

Large pills and dietary supplements can be tough for anyone to swallow, but new research finds they may pose a potentially dire risk to seniors.

A study from the US Food and Drug Administration found that between 2006 and 2015, almost 4 000 people had trouble swallowing dietary supplements that was serious enough to report. Three people died after choking on them.

A common hazard

More than three-quarters of the swallowing issues occurred in people over age 65.

"Elderly patients face a real dilemma when it comes to weighing the risk and benefits of taking vitamin supplements," said geriatric emergency medicine specialist Dr Teresa Amato.

"On the one hand, we know that taking a proper amount of supplements such as calcium and vitamins can lead to a more active life for the elderly. However, the actual intake of these supplements may increase a common hazard, namely choking and aspiration," she said.

Amato was not involved in the current research, but reviewed the findings. She's chair of emergency medicine at Long Island Jewish Forest Hills in New York City.

A previous study in the journal Dysphagia estimated that 15% of seniors have trouble swallowing. Muscles in the throat can lose mass and function with age, just like muscles in other parts of the body.

Pills too large for some

The current study – led by Dr Cecile Punzalan from the FDA and published as a letter in Annals of Internal Medicine – looked specifically at problems associated with taking dietary supplements. Over 10 years, almost 21 000 issues with supplements were reported to the FDA. Close to 4 000 were related to swallowing.

Women reported nearly 86% of problems swallowing supplements.

Choking was the most frequent problem (86%). Most of the reported swallowing trouble was related to taking multivitamins (73%), while another 17% was from taking calcium supplements.

The FDA also looked at the size of the most commonly reported pills. The average length of the pills was 19.3 millimetres (mm), roughly three-quarters of an inch.

For reference, the FDA recommends that generic products don't exceed 17mm (0.67 inch), with 22mm (0.87 inch) suggested as the limit. The FDA has no such guidelines for dietary supplements, however.

Swallowing troubles

Andrea Wong is vice president of scientific and regulatory affairs at the Council for Responsible Nutrition, a trade organisation for the supplement industry. Reacting to the study, she said: "Choking is preventable, and there are many reasonable solutions for consumers who may have difficulty swallowing dietary supplements, as indicated in this letter."

Wong suggested that adults talk with their health care provider or pharmacist if they're having trouble swallowing their supplements. Alternatives to pills such as liquids, gummies, melts or effervescent powders may be available.

She said more research is needed to learn the types and amounts of supplements that were linked to swallowing troubles.

If you have trouble taking supplements, the FDA offered the following tips:

  • Avoid taking several pills at once.
  • Avoid extra-large pills or capsules.
  • Swallow supplements and other pills or capsules with plenty of water or other fluid.
  • Discuss any difficulty with your doctor or pharmacist.

Image credit: iStock

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