A substantial proportion of older people have problems swallowing that can inhibit effective adherence to solid oral treatment regimens. Causes of dysphagia include reductions in gastrointestinal motility with age, consequences of age-related diseases, and side-effects of other treatments. Patients are sometimes advised to open capsules or to crush tablets to aid swallowing, but this practice is contrary to guidelines, largely because interfering with some formulations can alter their pharmacokinetics. Because of these compliance issues and because dysphagia is an alarm symptom, doctors should be aware of and enquire about older patients’ ability to swallow as part of the standard consultation.