'Fiber 7' supplement as an alternative to laxatives in a nursing home

Is Fibre an Effective Strategy to Improve Laxation in Long-Term Care Residents?

The high prevalence of constipation in long-term care (LTC) residents has been a long-standing issue for caregivers, attending health professionals, and the residents themselves. The traditional medical response has been to utilize pharmaceutical laxatives, enemas, and suppositories for treatment. The purpose of this review was to determine if fibre supplementation (including fibre added to foods) is effective in increasing stool frequency, improving stool consistency, and decreasing laxative use in LTC residents. A systematic search was conducted using PubMed and CINAHL databases, inclusive to March 2017. Search terms included: "long-term care" or "nursing home" AND "fiber (fibre)," "bran," "psyllium," "inulin," or "prebiotic." Intervention trials of fibre supplementation with ≥5 LTC residents were included. The search generated 456 articles following removal of duplicates; 8 studies met the inclusion criteria. Three additional trials were identified through a hand search of references of pertinent articles. Current evidence suggests that added fibre may be effective in increasing stool frequency and/or decreasing laxative use in LTC residents and, thus, may lessen the burden of constipation. However, randomized controlled trials are needed to clearly demonstrate the effects of adding fibre to foods, particularly insoluble and less fermentable sources, on constipation in LTC residents.

Perceived Barriers to Increased Whole Grain Consumption by Older Adults in Long-Term Care

Many older adults fail to consume adequate amounts of dietary fiber from food sources, including whole grains. Little information is available about consumption of dietary fiber and whole grains by residents of long-term care facilities. Surveys were mailed to 3,000 randomly selected US members of the Academy of Nutrition and Dietetics who worked in practice groups related to elder care. Net response rate was 22.7% (n = 681). Cost was a barrier to whole grain use for 27.1% of respondents, followed by dietary needs (22.1%), contracts in place (20.3%), and overall nutritional content (20.1%). Over 75% of respondents stated their patients require dietary fiber supplementation. Nutrition professionals most frequently (23.6%) reported spending $11-20 monthly per patient on dietary fiber supplements. Although a majority of facilities served whole grain foods daily, 89.5% of respondents would like to serve more whole grains. Ready-to-eat cereals, bread, bagels, and hot cereals were the most common whole grain products served at the facilities where survey respondents worked. An economic analysis of the benefits of increased consumption of whole grains and other high-fiber foods versus the use of laxative supplements may be helpful to administrators of long-term care facilities.

Meeting the nutritional needs of elderly residents in aged-care: are we doing enough?

OBJECTIVES

[corrected] Institutionalized elderly are at high risk of malnutrition, including those residing in low-level aged-care and able to self-feed. We used comprehensive dietary intake assessments to determine the nutritional adequacy of food served to residents and if food waste contributed to insufficient nutrient intakes.

DESIGN

Cross sectional.

SETTING

18 low-level aged care facilities.

PARTICIPANTS

199 residents (mean age 86.7 yrs, 76% females).

MEASUREMENTS

Dietary data using 3-6 day weighed food records. Foods were categorized into main food groups (grains, fruit, vegetables, meats, dairy and 'extra') and quantified based on recommended serving sizes. Chi squared test was used to determine sex differences in proportion of residents below recommended intake levels.

RESULTS

Residents were provided with sufficient serves of fruit (>2) and meats (>1), but not dairy (<3), vegetables (<5) and grain foods (women only, <4), and excess serves of 'extra' foods (>2). Mean dietary intakes did not meet recommendations for calcium, zinc, magnesium, potassium, folate and dietary fibre with many residents not meeting energy and protein requirements. Sodium intake was up to 3 times higher than recommended, and sugars consumed in excess. Food waste was 0-15% and resulted in men not consuming recommended serves of grain foods. 'Extra' foods contributed substantially to energy intake but provided few of the required nutrients.

CONCLUSION

Substituting some 'extra' foods for serves of dairy, vegetables and wholegrain foods would improve the nutritional quality of foods, without altering food volume, so is feasible to improve nutritional status in elderly aged-care residents.

A controlled trial of an intervention to improve urinary and fecal incontinence and constipation

OBJECTIVES

To evaluate effects of a multicomponent intervention on fecal incontinence (FI) and urinary incontinence (UI) outcomes.

DESIGN

Randomized controlled trial.

SETTING

Six nursing homes (NHs).

PARTICIPANTS

One hundred twelve NH residents.

INTERVENTION

Intervention subjects were offered toileting assistance, exercise, and choice of food and fluid snacks every 2 hours for 8 hours per day over 3 months.

MEASUREMENTS

Frequency of UI and FI and rate of appropriate toileting as determined by direct checks from research staff. Anorectal assessments were completed on a subset of 29 residents.

RESULTS

The intervention significantly increased physical activity, frequency of toileting, and food and fluid intake. UI improved (P=.049), as did frequency of bowel movements (P<.001) and percentage of bowel movements (P<.001) in the toilet. The frequency of FI did not change. Eighty-nine percent of subjects who underwent anorectal testing showed a dyssynergic voiding pattern, which could explain the lack of efficacy of this intervention program alone on FI.

CONCLUSION

This multicomponent intervention significantly changed multiple risk factors associated with FI and increased bowel movements without decreasing FI. The dyssynergic voiding pattern and rectal hyposensitivity suggest that future interventions may have to be supplemented with bulking agents (fiber), biofeedback therapy, or both to improve bowel function.

Fecal incontinence in the elderly

Fecal incontinence affects up to 20% of community-dwelling adults and more than 50% of nursing home residents, and is one of the major risk factors for elderly persons in the nursing home. Institutionalization itself is a risk factor (eg, immobility due to physical restraints). Management should focus on identifying and treating underlying causes, such as diet- or medication induced diarrhea, constipation, and fecal impaction. Use of absorbent pads and special undergarments is useful. Anorectal physiologic testing of nursing home residents has revealed an association between constipation, stool retention, and fecal incontinence. Impaired sphincter function (risk factor for fecal incontinence), decreased rectal sensation, and sphincter dyssynergia (risk factor for constipation and impaction) are found in a high proportion of incontinent nursing home residents. Biofeedback and sacral nerve stimulation may be useful in refractory patients and should be considered before colostomy in community-dwelling adults. Despite appropriate management, nursing home residents may remain incontinent because of dementia and health or restraint related immobility.

Use of fiber instead of laxative treatment in a geriatric hospital to improve the wellbeing of seniors

INTRODUCTION

Constipation is a common problem in the elderly population, especially in geriatric wards. Laxatives are the most preferred solution but current studies link constipation and laxative use to weight-loss and malnutrition in nursing homes. Dietary fibers also affect stool weight and transit time. So, oat-bran effectiveness in reducing the need for bowel medication and weight-loss for geriatric care patients was examined in a geriatric hospital.

AIM

To determine whether the addition of oat-bran to common oral diet can reduce the use of laxatives and improve the wellbeing and bodyweight of the inhabitants of a long-term-care facility.

METHODS

The study was designed as a controlled blind intervention trial among 30 frail inhabitants of a geriatric hospital aged 57-100 years with laxative use. Including criteria were: oral food intake and laxatives as therapy and excluding criteria were: parenteral and enteral feeding, surgeries in the gastro- intestinal tract, drugs that shorten or lengthen the passage through the gut, risk of aspiration, swallowing troubles. An intervention and a control group were formed. 15 of them received 7-8 g oat-bran/d for 12 weeks (fiber group) mixed up in the daily common diet of the ward and 15 served as control (control group).

DATA COLLECTION

Bodyweight was taken at baseline, after 6 weeks and at the end of the supplementation. Data on laxative use, stool frequency and the eating habits of the elderly were recorded.

RESULTS

Laxatives were successfully discontinued by 59% (p < 0.001) in the fiber-group; in the control-group there was an increase of 8% (p=0.218). Bodyweight remained constant in the fiber-group and decreased in the control-group (p=0.002). The oat-fiber supplementation in the introduced form was well tolerated.

CONCLUSIONS

Use of oat-fiber allowed discontinuation of laxatives by 59% while improving body-weight and wellbeing of the seniors. Fiber supplementation is a safe and convenient alternative to laxatives in a geriatric hospital.

Urinary and fecal incontinence in nursing home residents

Urinary and fecal incontinence are comorbid conditions affecting over 50% of nursing home residents. Management should focus on identifying and treating underlying causes. Despite appropriate management, residents may remain incontinent because of dementia and health- or restraint-related immobility. This article reviews the results of studies that have documented how prompted voiding programs can significantly reduce urinary and fecal incontinence, particularly if the intervention includes dietary and exercise components. Documentation of noninvasive and efficacious interventions by randomized, controlled trials and the labor costs of implementing these measures can lead to changes in how nursing home care is provided and funded.