Constipation In Older Adults Research Articles

A review of laxative therapies for treatment of chronic constipation in older adults

Background: Multiple studies have addressed the treatment of chronic constipation in adults in general; however, less guidance is available for treating this condition in older patients. Objective: The aim of this paper was to review the effectiveness of laxatives for chronic constipation in the elderly. Methods: Medline, Web of Science, international Pharmaceutical Abstracts, and the Cochrane database of Systematic Reviews were searched for english-language articles evaluating the treatment of chronic constipation in older individuals from the inception of the databases until October 2010. Search terms included constipation, treatment, laxative, elderly, and geriatric. Articles were excluded if the mean age was <65 years. Results: Thirty-one trials were identified. These studies varied widely in terms of methodology, quality, sample size, efficacy end points, and duration. Mean stool frequency was 9.08 bowel movements per week with psyllium and 8.29 per week with calcium polycarbophil (P = 0.04). docusate sodium daily, docusate sodium q12h, and docusate calcium daily for 3 weeks produced a mean stool frequency of 1.95 bowel movements per week versus 1.50 for placebo ( P = NS), 2.29 versus 1.76 ( P = NS), and 2.83 versus 1.75 ( P<0.02), respectively. Mean stool frequency with lactulose versus placebo was 0.7 and 0.5 bowel movements per day ( P<0.02). in patients receiving polyethylene glycol or lactulose, mean stool frequency was 1.3 and 0.9 bowel movements per day ( P = 0.005). in a study comparing senna plus a bulking agent with lactulose, mean stool frequency was 4.5 per week for the combination product versus 2.2 per week for lactulose ( P<0.001). A study comparing sodium picosulfate with senna reported a mean stool frequency of 0.71 and 0.63 per day ( P value not reported). Lubiprostone was associated with 5.69 spontaneous bowel movements per week versus 3.46 per week for placebo ( P = 0.001). Conclusions: Higher-quality trials evaluating the treatment of constipation in older patients are needed to create a basis for more definitive recommendations in this population. The approach to older adults with constipation should be individualized.

Effectiveness of Non-Surgical Management Strategies for Constipation in Adults with Stroke: A Systematic Review

Effectiveness of Non-Surgical Management Strategies for Constipation in Adults with Stroke: A Systematic Review

The prevention and management of constipation in older adults in a residential aged care facility

The need to implement programs for developing leadership and practice improvement skills using an evidence-based practice approach to practice change is becoming more apparent in the health and aged care services. This is no more apparent than in high care residential health and aged care services, where health professionals are increasingly required to provide care for older people with multifocal and complex healthcare needs. This paper describes one of the projects undertaken as part of the Joanna Briggs Institute Commonwealth Department of Health and Ageing Clinical Aged Care Fellowship program from February 2005 to June 2005. This purpose of this particular project was twofold. First it sought to improve the local practice in the prevention and management of constipation and that this practice was performed according to the best available evidence. Second to use the Joanna Briggs Institute Practical Application of Clinical Guidance (PACES) program to implement a process of audit and feedback as a strategy to improve practice. The project was designed to link in with the facility's existing quality improvement program and better practice continence management project. The project was conducted over 6 months and was divided into six stages involving the identification of evidence-based standards of care, an initial audit to determine appropriate sample size, a clinical audit across the facility, planning of the implementation process, implementation of the action plan and re-audit to assess practice change. Overall, the results were extremely positive and demonstrated a real improvement in practice relating to constipation in the project facility. This success, however, needs to be seen in the context of the benefits of having the support of senior management, an existing quality improvement and continence management better practice project, and a culture of clinical review. Although there will always be more work to be done, the success of this project can be viewed in terms of the improvements gained and the long-term benefits for the facility and the organisation using the time-efficient audit and feedback strategy.

The prevention and management of constipation in older adults in a residential aged care facility

The prevention and management of constipation in older adults in a residential aged care facility

Preventing constipation in older adults

Preventing constipation in older adults

Dietary fiber for constipation in older adults: a systematic review

Objective: The purpose of this systematic review is to describe and evaluate the quality and results of published trials of dietary fiber for constipation in older adults, and summarize the evidence for the effectiveness of this treatment.Methods: Published trials of dietary fiber treatment for constipation in older adults were included if they presented quantified outcomes for at least one measure of bowel function. Methodological quality was critically appraised according to defined criteria. The clinical results of randomized, controlled and/or double-blinded studies were analyzed and summarized.Results: Of 20 studies, 19 were conducted in institution-dwelling samples. Eight studies met review criteria. There were two double-blinded randomized controlled trials. Their results were contradictory. Declines in laxative use were observed in five of six studies, three of the five were unblinded. Contradictory results were reported for fecal incontinence and comfort with defecation.Conclusion: There is not strong or consistent evidence for the effectiveness of treating constipation in institution-dwelling older adults with dietary fiber. This is partly due to weak study design.