Effectiveness of laxatives in elderly--a cross sectional study in nursing homes

A Decrease in the Hardness of Feces with Added Glucosylceramide Extracted from Koji In Vitro-A Working Hypothesis of Health Benefits of Dietary Glucosylceramide

Skin barrier function, prevent colon cancer, head and neck cancer, and decrease liver cholesterol. However, the mechanism of action has not yet been elucidated. In this study, we propose a new working hypothesis regarding the health benefits and functions of glucosylceramide: decreased fecal hardness. This hypothesis was verified using an in vitro hardness test. The hardness of feces supplemented with glucosylceramide was significantly lower than that of the control. Based on these results, a new working hypothesis of dietary glucosylceramide was conceived: glucosylceramide passes through the small intestine, interacts with intestinal bacteria, increases the tolerance of these bacteria toward secondary bile acids, and decreases the hardness of feces, and these factors synergistically result in in vivo effects. This hypothesis forms the basis for further studies on the health benefits and functions of dietary glucosylceramides.

Continuous laxative use and its relationship to defecation among residents of nursing homes: A longitudinal observational study using the interRAI

AIM

To clarify the association between constipation, diarrhea, and long-term laxative use in Japanese nursing home residents.

METHODS

Data from 306 residents with chronic constipation aged over 75 years for basic characteristics, medication use, activities of daily living, and concurrent illness were collected via two consecutive 6-monthly surveys conducted using the Japanese interRAI assessment tool. We used bivariate and multivariate analyses to examine the associations between chronic constipation, diarrhea, and continuous laxative use.

RESULTS

Chronic constipation persisted in 74.5% of residents despite their continuous use of laxatives. Additionally, 14.4% experienced chronic diarrhea while on laxatives. Residents using salt laxatives had significantly lower chronic constipation than those not using salt laxatives (adjusted odds ratio [AOR] 0.52), while residents using novel laxatives had significantly higher chronic diarrhea than those not using novel laxatives (AOR 4.28).

CONCLUSIONS

Our findings reveal that bowel movement-related problems remain a concern and highlight the need for further research on the use of novel laxatives in nursing home residents. Geriatr Gerontol Int 2024; 24: 133-139.

Assessing Gastrointestinal Tolerance in Healthy Adults: Reliability and Validity of a Weekly Questionnaire

When examining gastrointestinal tolerance to nondigestible carbohydrates, a weekly vs. daily symptoms questionnaire may lessen participant burden. This secondary analysis examined the reliability and validity of the Gastrointestinal Symptom Rating Scale (GSRS) in healthy adults. The internal consistency reliability of the GSRS syndromes and a daily questionnaire (DQ) comparator were determined. The GSRS syndromes prediction of slow transit stool form was assessed by ROC analysis. The DQ (α = 0.76) and GSRS syndromes of constipation (α = 0.73; ω = 0.74), and diarrhea (α = 0.76; ω = 0.77) exhibited acceptable reliability, as did the GSRS overall (α = 0.76; ω = 0.87) but not the syndromes of abdominal pain (α = 0.54; ω = 0.54), reflux (α = 0.69; ω = 0.67), or indigestion (α = 0.64; ω = 0.67). The GSRS syndromes predicted slow transit stools (AUC = 0.855), and the GSRS items of stomach pain, nausea, flatus, constipation, and diarrhea were moderately correlated (ρ = 0.55-0.64; P < 0.001) with the corresponding DQ items. The GSRS may be useful to assess gastrointestinal tolerance and efficacy of nondigestible carbohydrates given its performance at predicting slow transit stools, suggestive of constipation.

The effect of Cassia fistula L. syrup in geriatrics constipation in comparison with the lactulose: A randomized clinical trial

ETHNOPHARMACOLOGICAL RELEVANCE

Cassia fistula is widely used in traditional Persian Medicine as a mild laxative. The rate of chronic constipation increases above the age of 60.

AIM OF THE STUDY

This study aimed to investigate the effect of Cassia fistula syrup (CFS) on geriatric constipation.

MATERIALS AND METHODS

This clinical trial study was performed on 70 aged patients who were referred to the clinic of gastroenterology of Rouhani Hospital, Babol, North of Iran. Patients were randomly divided into two groups of CFS or Lactulose with a dose of 30 ccs/day. Patients were visited two weeks after entering the study to evaluate the frequency of defecation, feeling of incomplete emptying after defecation, manual maneuver, consistency of stool, and also the quality of life.

RESULTS

The frequency of defecation per week varied from 1.82 ± 1.16 to 8.36 ± 3.44 in the CFS group after 2 weeks of intervention that was significantly more than the Lactulose that changed from 2.16 ± 1.46 to 5.66 ± 2.96 (P-value = 0.023, partial eta square = 0.079, NNT = 4). The quality of life, the percent of straining, lumpy or hard stool, pain during defecation, and the consistency of stool based on VAS were significantly better in the CFS group. The sensation of incomplete defecation, anorectal obstruction, and manual maneuvering were not different significantly between groups.

CONCLUSION

CFS can be more effective than Lactulose on geriatric constipation.

Management of constipation in long-term care hospitals and its ward manager and organization factors

Background

Studies examining organizational factors that may influence constipation management in long-term care (LTC) hospitals are lacking. This study aimed to clarify the practice of constipation management in LTC hospitals and to explore its factors, including ward manager’s perception, organizational climate, and constipation assessment.

Methods

In this cross-sectional questionnaire survey of ward managers and staff nurses working in LTC wards, we determined daily assessment and practices regarding constipation management. We also conducted multivariate analyses to examine factors related to constipation management.

Results

There was a 20% response rate to the questionnaire. Nearly all LTC wards routinely assessed bowel movement frequency; other assessments were infrequent. Laxatives were used, but the use of dietary fiber and probiotic products was implemented in only 20–30% of wards. The implementation of non-pharmacological management and adequate use of stimulant laxatives were positively associated with the ward manager’s belief and knowledge, organizational climate, the existence of nursing records for constipation assessment, planned nursing care for constipation, and organized conferences and in-hospital study sessions on constipation management.

Conclusion

Areas to improve constipation management in LTC hospitals include altering the ward manager’s perception, improving hospital’s organizational climate, and introducing standardized assessment/care planning systems.

Laxative use among older adults with intellectual disability: a cross-sectional observational study

BACKGROUND

Chronic constipation is a prevalent issue in older people with intellectual disabilities and may have a significant negative impact on quality of life. The use of laxatives have not been adequately studied in this population.

OBJECTIVE

To examine laxatives in relation to prevalence, pattern, dosage, reported indication and correlates.

SETTING

Older people with intellectual disabilities who live independently, in community group homes or residential care in Ireland.

METHOD

Data was extracted from wave 2 (2013/2014) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). Descriptive statistics, bivariate analyses and multiple logistic regression were carried out. Laxative use was analysed using two indicators for chronic constipation, reported doctor's diagnosis of constipation and Rome III criteria.

MAIN OUTCOME MEASURE

Laxative use.

RESULTS

Among the cohort n = 677, chronic constipation was reported by 38.5% (n = 257). In total 41.5% (n = 281) reported 431 laxatives (mean ± 1.53 ± 0.74), with 74.3% (n = 209) of those with laxative use reporting chronic constipation. There were 40% (n = 113) who took 2 + laxatives, within which, 60% (n = 67) were using a combination from same laxative class. Reporting chronic constipation, living in residential care, exposure to anticholinergics and receiving soft/liquidized food were significantly associated with laxative use.

CONCLUSION

Chronic constipation and laxative use were highly prevalent in this study of older adults with intellectual disabilities. The treatment of constipation appeared to be unsystematic. Intra-class laxative use was frequent. There is a need for evidence-based treatment guidelines developed especially for people with intellectual disabilities to provide effective, quality care.

[Determining the Prevalence of Constipation and Relating Factors in Elderly People: A Nursing Home Study]

Amaç

Bu çalışma, huzurevinde kalan yaşlılarda Roma II konstipasyon tanılama kriterlerine göre konstipasyon görülme sıklığını ve ilişkili faktörleri belirlemek amacıyla yapılmıştır.

Yöntem

Kesitsel tipteki bu çalışma Ankara’da bir huzurevinde yaşayan ve araştırmaya dahil edilme kriterlerine uyan 160 yaşlı birey ile gerçekleştirilmiştir. Veriler tanıtıcı özellikler bilgi formu ve Roma II Konstipasyon Tanılama Kriterleri formu ile yüz yüze görüşülerek toplanmıştır. Verilerin analizinde tanımlayıcı istatistikler ile Ki-Kare testi kullanılmıştır.

Bulgular

Yaşlı bireylerin yaş ortalaması 78±8.1 (min: 65, max: 95) olup, %53.1’i erkektir. Yaşlı bireylerin %51.9’u Roma II konstipasyon tanılama kriterlerine göre konstipasyon sorunu yaşamaktadır. Roma II konstipasyon tanılama kriterleri incelendiğinde yaşlı bireylerin, %44.4’ünün defekasyon yaparken zorlanma/yoğun ıkınma yaşadığı, %29.4’ünün dışkı kıvamının sert olduğu, %53.8’inin yetersiz dışkılama hissi/tam boşalamama problemi olduğu, %30.2’sinin bağırsak hareketinin haftada 2 kez ve daha az olduğu belirlenmiştir. Düzenli fiziksel aktivite yapmayan, günlük 2 litreden az su tüketen ve huzurevinde kalma süresi 11 yılın üzerinde olan yaşlı bireylerde konstipasyon sorununun daha fazla olduğu belirlenmiştir (p<0.05).

Sonuç

Huzurevinde yaşayan yaşlı bireylerin yarısından biraz fazlasının konstipasyon sorunu yaşadığı belirlenmiştir. Yaşlı bireylerde konstipasyon ve risk faktörlerinin erken dönemde belirlenmesi, düzenli olarak egzersiz yapmalarının desteklenmesi önem taşımaktadır.

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.

Complementary and alternative medicine use for constipation: a critical review focusing upon prevalence, type, cost, and users' profile, perception and motivations

OBJECTIVES

Complementary and alternative medicine (CAM) is increasingly used by those suffering from constipation. This paper reports the first critical integrative review of CAM use for people with constipation focusing upon the prevalence, type and cost of CAM use, as well as CAM users' profile, perception and motivations.

METHODS

A comprehensive search of international literature was conducted in MEDLINE, Academic Search Complete (EBSCO), and Allied and Complementary Medicine Database (AMED). The search was limited to original research peer-reviewed English language articles concerning CAM use for constipation published with an abstract and full text between 2005 and 2015.

RESULTS

A total of 35 papers met the inclusion criteria and were included in the review. The review shows approximately one in every three people suffering from constipation use CAM with herbal medicine the most commonly used CAM treatment for constipation and a large proportion of CAM use occurring concurrent with or in addition to conventional medical treatments. While early investigation suggests the cost of herbal medicine use in constipation care may be lower than that associated with the use other CAM modalities and conventional medications, this issue requires further research.

CONCLUSIONS

Although a high percentage of people with constipation using CAM consider these treatments effective, there remains a need for further in-depth examination of both patient and provider perspectives as well as communication and decision-making around CAM use for constipation to inform safe, effective and coordinated care for patients with constipation.

Constipation in Elderly Patients with Noncancer Pain: Focus on Opioid-Induced Constipation

Constipation is a common and often debilitating condition in the elderly, which may be caused by underlying disease conditions, structural abnormalities in the bowel, and a variety of medications such as anticholinergics, antidepressants, and opiates. In this review, we focus on opioid-induced constipation (OIC), which is often underrecognized and undertreated in the elderly. When opioid therapy is initiated, healthcare providers are encouraged to evaluate risk factors for the development of constipation as part of a thorough patient history. To this end, the patient assessment should include the use of validated instruments, such as the Bristol Stool Scale and Bowel Function Index, to confirm the diagnosis and provide a basis for evaluating treatment outcomes. Healthcare providers should use a stepwise approach to the treatment of OIC in the elderly. Conventional laxatives are a first-line option and considered well tolerated with short-term use as needed; however, evidence is lacking to support their effectiveness in OIC. Moreover, because of the risk of adverse events and other considerations, such as chewing difficulties and swallowing disorders, conventional oral laxatives may be inappropriate for the treatment of OIC in the elderly. Thus, the availability of new pharmacologic agents such as the peripherally acting µ-opioid receptor antagonists methylnaltrexone and naloxegol, which target the underlying causes of OIC, and the secretagogue lubiprostone may provide more effective treatment options for elderly patients with OIC.

Constipation and Laxative Use among Nursing Home Patients: Prevalence and Associations Derived from the Residents Assessment Instrument for Long-Term Care Facilities (interRAI LTCF)

Introduction. Constipation is a common, bothersome, and potentially dangerous condition among nursing home (NH) patients. Between 50 and 74% of NH patients use laxatives. Objective. To study prevalence and associations of laxative use and constipation using the comprehensive Norwegian version of the Resident Assessment Instrument for Long-Term Care Facilities. Methods. Cross-sectional study. Patients from 20 NH units were included. Logistic regression was used to analyze the results. Data collected in NHs might be clustered. Consequently, the multivariable models were tested against a mixed effects regression model to investigate variance both on the level of patients and on the level of NH units. Results. In all, 261 patients were included. The prevalence of constipation was 23.4%, and 67.1% used laxatives regularly. Balance problems, urinary incontinence, hypothyroidism, and Parkinson's disease were associated with constipation. Reduced ability to communicate and number of drugs were associated with laxative use. Antidementia-drugs and being involved in activities 1/3 to 2/3 of daytime were protective factors for laxative use. Mixed effects analyses identified variance on the level of NH units as nonsignificant. Conclusion. Constipation and laxative use are common. Variance is mainly explained by different patient characteristics/health deficiencies. Hence, patients might benefit from individualized care to compensate for deficiencies.

Geriatric management in medieval Persian medicine

In Iran, a large group of patients are elderly people and they intend to have natural remedies as treatment. These remedies are rooted in historical of Persian and humoral medicine with a backbone of more than 1000 years. The current study was conducted to draw together medieval pharmacological information related to geriatric medicine from some of the most often manuscripts of traditional Persian medicine. Moreover, we investigated the efficacy of medicinal plants through a search of the PubMed, Scopus and Google Scholar databases. In the medieval Persian documents, digestible and a small amount of food such as chicken broth, honey, fig and plum at frequent intervals as well as body massage and morning unctioning are highly recommended. In the field of pharmacotherapy, 35 herbs related to 25 families were identified. Plants were classified as tonic, anti-aging, appetizer, memory and mood enhancer, topical analgesic and laxative as well as health improvement agents. Other than historical elucidation, this paper presents medical and pharmacological approaches that medieval Persian practitioners applied to deal with geriatric complications.

Prevalence and Effectiveness of Laxative Use Among Elderly Residents in a Regional Hospital Affiliated Nursing Home in Hsinchu County

Background:

Long-term care residents are susceptible to constipation and one-half to three quarter of older nursing home residents receive laxatives regularly.

Objectives:

The purpose of this study was to evaluate the factors related to abnormal bowel function and explore the effectiveness of laxative treatment among the elderly residents of a nursing home.

Patients and Methods:

A total of 110 residents older than 65 years old was enrolled in this study. The following variables were gathered: age, gender, body mass index (BMI), length of stay, daily fluid intake, type of food, functional level, cognitive ability, physical therapy status, somatic and psychiatric diseases, number of medications, and medication use. The use and dosage of laxatives were recorded by means of Anatomical Therapeutic Chemical (ATC) classification system. Normal bowel function was defined as defecation frequency from three defecations per day to three defecations per week and stool consistency score of three to five on Bristol Stool Form Scale. A comparison between groups with normal and abnormal bowel function was drawn.

Results:

Low BMI, increased fluid intake, liquid food intake, poor functional level, poor cognition, and a history of stroke were significantly associated with altered bowel function (P < 0.05). The most frequently used laxatives were glycerol, senna glycoside, and magnesium oxide. There were significant differences in laxative regimens between residents with normal and altered bowel function; those with altered bowel function tended to take more laxatives than those with normal bowel function.

Conclusions:

This study suggested that treatment of constipation in the nursing home was unsatisfactory. To improve treatment outcomes in those susceptible to altered bowel function, a coordinated approach with involvement of physicians, nursing staff, and other professionals including dieticians and pharmacists seems necessary.

Bowel movement: the sixth vital sign

Bowel movements provide vital information on how the body is functioning, and constipation among older adults is especially problematic. Although we do not like hearing the details of someone else's bowel movement, it is a function that nurses need to assess, support, and treat with the same attitude as when caring for patients with pain.