Image of multivitamins scattering from opening bottle on pink background.

Adults aged 65 years and older are more likely to choke on dietary supplements than are younger adults, a new Federal Drug Administration report states. The biggest culprits are multivitamins and calcium tablets.

Unlike generic drugs, there’s no oversight for the sizing of dietary supplements, the agency says. Eldercare providers and residents should therefore be especially mindful about pills larger than 17 mm in length. In a review of adverse swallowing events over 10 years, products of that size and larger were most likely to be associated with choking and injury.

Older adults “should avoid taking several pills at once, avoid extra-large pills or capsules, and swallow supplements with plenty of water or other fluid,” FDA spokesperson Lindsay Haake told Reuters.

More than a quarter of seniors regularly take multivitamins, and the risk of choking is also higher in this age group. Problems with swallowing, or dysphagia, increase with age, with up to 22% of adults over age 50 experiencing the disorder. That number is likely higher in assisted living and nursing homes, according to one study.

The FDA report was published online in the August issue of Annals of Internal Medicine.