Abstract
BackgroundLaxatives are efficient drugs, but the effectiveness has been questioned. In nursing homes, the prevalence of constipation is high and laxatives are commonly used drugs. The aims of the study were to assess the effectiveness of laxative therapy in an everyday setting in Norwegian nursing homes, study differences between treatment regimens and factors associated with normal bowel function.MethodsA cross-sectional study. After giving informed consent, residents above 60 years of age using laxatives for functional constipation were included, and their characteristics, medical history, use of drugs and bowel functions were recorded. Normal bowel function was defined as bowel movements from 3 times/week to 3 times/day and stool consistency 3-5 on Bristol Stool Form Scale.ResultsOut of 647 residents in the nursing homes, 197 were included and 116 (59%) had normal bowel function. The treatment effect did not differ significantly between the laxatives, treatment regimens or expected efficacy of the regimens. The treatment was unsatisfactorily adapted to individual needs. In subjects with normal bowel function, 113 (97%) had persistent complaints; 68 (59.5%), 10 (8.0%), 34 (28.6%) and 26 (22.5%) reported straining, manual manoeuvre to facilitate bowel movements, feeling of incomplete bowel movements, and feeling of anorectal obstruction respectively. Good nutritional status, previous or present cancer disease and anxiety/depression were predictors of normal bowel function.ConclusionsTreatment of constipation in nursing homes was unsatisfactory. Nearly all patients with normal stool frequency and consistence had some persistent complaints. Improved nutrition and individualization of the treatment could improve the outcome.
Highlights
Laxatives are efficient drugs, but the effectiveness has been questioned
In contrast to the overall good results in clinical trials, patients’ satisfaction with everyday use of laxatives is low, only 47% were satisfied in a web-based survey in the general population [8]
Study design and methods In 2008-2009, this cross sectional study was performed in nursing homes in the counties of Oppland and Hedmark, Norway
Summary
The prevalence of constipation is high and laxatives are commonly used drugs. The aims of the study were to assess the effectiveness of laxative therapy in an everyday setting in Norwegian nursing homes, study differences between treatment regimens and factors associated with normal bowel function. The prevalence of constipation in nursing homes is up to 74% and more than half of the residents use laxatives [1,2]. Constipation is most often a primary or functional disorder of unknown aetiology associated with gut dysmotility (slow transit) and pelvic floor dysfunction, but might be secondary to an organic disease. After exclusion of organic diseases, these symptoms are the basis for the diagnosis of functional constipation according to the Rome criteria [4]. Knowledge of the treatment of constipation in frail elderly is insufficient and the treatment poses extra challenges in this population [3,9]
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