What is the key precaution when using bulk-forming laxatives like psyllium in older adults with swallowing difficulties?

• A. Ensure adequate water intake to prevent choking or obstruction
• B. Take with minimal water
• C. Take with alcohol
• D. Take on an empty stomach

Answer: (A)

Bulk-forming laxatives swell when they contact water, so in older adults with swallowing difficulties the key precaution is you must take them with plenty of water to prevent choking or an obstruction. Psyllium forms a gel as it hydrates, and without enough liquid it can stick in the throat or the esophagus or create a blockage in the intestines. Practice is to drink a full glass of water with each dose and then follow with additional water, ensuring the powder or granules have ample fluid to move through the GI tract. The idea of using only a small amount of liquid, drinking alcohol, or taking the product on an empty stomach doesn’t provide the necessary lubrication and can raise the risk of choking or irritation. If swallowing remains a significant challenge, it’s important to discuss alternative options with a healthcare provider.