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Yurtdaş Depboylu G, Acar Tek N, Akbulut G, Günel Z, Kamanlı B. Functional Constipation in Elderly and Related Determinant Risk Factors: Malnutrition and Dietary Intake. JOURNAL OF THE AMERICAN NUTRITION ASSOCIATION 2022:1-7. [PMID: 35833672 DOI: 10.1080/27697061.2022.2096150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/31/2022] [Accepted: 06/26/2022] [Indexed: 06/15/2023]
Abstract
AIM The objective of this study was to evaluate the relationship between FC and physical activity, dietary intake and malnutrition in the elderly. METHOD A cross-sectional study was conducted on 883 adults aged >65 years from nursing homes and community health centers in Turkey. Constipation status was evaluated according to Rome IV criteria and Bristol Stool Form Scale. Dietary intake was assessed using a food consumption record (24-hour food recall). The dietary energy and nutrients were analyzed using the "Nutrition Information Systems Package Program". The nutritional status of participants was evaluated using the Mini-Nutritional Assessment (MNA) test. The International Physical Activity Questionnaire (IPAQ, short form) was used to assess physical activity status. RESULTS Among the 883 participants, 29.6% were classified into the FC group (32.2% of females, 25.8% of males). The FC group had significantly lower total energy, fluid, water, protein, carbohydrate, magnesium, zinc, phosphorus, potassium, soluble fiber, insoluble fiber, total fiber, and fiber (g)/1000 kcal intake than the non-FC group (p < 0.05). The multivariate logistic regression analysis showed that total dietary fiber intake was significantly associated with a lower prevalence of FC (OR: 0.98, 95% Cl: 0.96-0.99). According to MNA, participants at risk of malnutrition (OR: 5.21, 95% Cl: 3.09-9.77) and malnourished participants (OR: 3.03, 95% Cl: 1.62-5.68) had a greater likelihood of FC compared with normal participants. Participants in the middle lower quartile of water intake (OR: 0.63, 95% CI: 0.42-0.95) had a decreased likelihood of FC compared with participants in the lowest quartile. CONCLUSION FC is a common gastrointestinal disorder among the elderly in Turkey. Low dietary fiber intake, low water intake and malnutrition were important risk factors associated with FC in the elderly.
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Affiliation(s)
| | - Nilüfer Acar Tek
- Department of Nutrition and Dietetics, Gazi University, Ankara, Turkey
| | - Gamze Akbulut
- Department of Nutrition and Dietetics, Gazi University, Ankara, Turkey
| | - Zerin Günel
- Department of Nutrition and Dietetics, Muğla Sıtkı Koçman University, Muğla, Turkey
| | - Betül Kamanlı
- Department of Nutrition and Dietetics, Muğla Sıtkı Koçman University, Muğla, Turkey
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Dahl WJ, Mendoza DR. Is Fibre an Effective Strategy to Improve Laxation in Long-Term Care Residents? CAN J DIET PRACT RES 2017; 79:35-41. [PMID: 28971691 DOI: 10.3148/cjdpr-2017-028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
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.
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Affiliation(s)
- Wendy J Dahl
- a Food Science and Human Nutrition Department, University of Florida, Gainesville, FL
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Koo JP, Choi JH, Kim NJ. The effects of maitland orthopedic manual therapy on improving constipation. J Phys Ther Sci 2016; 28:2857-2861. [PMID: 27821950 PMCID: PMC5088141 DOI: 10.1589/jpts.28.2857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/27/2016] [Indexed: 12/17/2022] Open
Abstract
[Purpose] This study aimed to examine the effects of interventions on constipation and to
provide basic data for physical therapy in internal medicine. [Subjects and Methods] The
colon transit times of 30 subjects were measured and after the interventions. Fifteen
subjects were assigned to a Maitland orthopedic manual therapy group, and 15 subjects were
assigned to a dietary fiber group. [Results] The analysis of changes in colon
transit time showed statistically significant differences in left colon transit time,
rectosigmoid colon transit time, and total colon transit time for the Maitland orthopedic
manual therapy group and statistically significant differences in rectosigmoid colon
transit time and total colon transit time for the dietary fiber group. An analysis of
group differences in the effects of Maitland orthopedic manual therapy and dietary fiber
showed that the Maitland orthopedic manual therapy group achieved statistically
significantly larger declines in rectosigmoid colon transit time and total colon transit
time compared with the dietary fiber group. [Conclusion] This study confirmed that
Maitland orthopedic manual therapy can be an effective treatment method for internal
conditions such as functional constipation by almost normalizing the colon transit time,
not only by improving the symptoms of constipation but also by facilitating intestinal
movements.
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Affiliation(s)
- Ja-Pung Koo
- Department of Physical Therapy, Pohang University, Republic of Korea
| | - Jung-Hyun Choi
- Department of Physical Therapy, Institute for Elderly Health and Welfare, Namseoul University, Republic of Korea
| | - Nyeon-Jun Kim
- Department of Physical Therapy, Pohang University, Republic of Korea
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Li MK, Lee TFD, Suen KPL. Complementary effects of auricular acupressure in relieving constipation symptoms and promoting disease-specific health-related quality of life: A randomized placebo-controlled trial. Complement Ther Med 2014; 22:266-77. [PMID: 24731898 DOI: 10.1016/j.ctim.2014.01.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 10/23/2013] [Accepted: 01/30/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Constipation has been identified as a worldwide health problem among elderly people. Currently, it is not effectively relieved by the use of laxatives and lifestyle modification. Previous studies reported promising results in managing constipation with auricular acupressure (AA), although its effectiveness was not affirmed. This study is to evaluate the complementary effects of AA in relieving constipation symptoms and in promoting disease-specific health-related quality of life (HRQOL) among elderly residential care home (RCH) residents in Hong Kong. DESIGN Randomized placebo-controlled trial. SETTING Elderly RCH. INTERVENTION Ninety-nine participants were randomly assigned to either experimental group (AA using auricular plasters with magnetic pellets), placebo-controlled group (AA using auricular plasters with Semen Vaccariae), or usual care group (AA using auricular plasters only). AA was applied onto seven auricular acupoints for 10 days. MAIN OUTCOME MEASURES Constipation symptoms and disease-specific HRQOL were measured before AA, at the completion of AA (D10), and at the 10th-day follow-up time (D20). RESULTS Significant group×time interaction effect was found in the change of satisfaction subscale between the experimental group and placebo-controlled group at D10 (p=0.016) and D20 (p=0.016) relative to the baselines. For both constipation symptoms and disease-specific HRQOL, the experimental group demonstrated the greatest improvement after receiving AA at both D10 and D20 compared with the other two groups. CONCLUSION The current findings indicated positive clinical value of AA with magnetic pellets in managing constipation in elderly RCH residents. AA was also found to be a safe and acceptable intervention.
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Affiliation(s)
- M K Li
- Division of Nursing and Health Studies, The Open University of Hong Kong, Hong Kong.
| | - T F Diana Lee
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong
| | - K P Lorna Suen
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
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Chen CY, Ke MD, Kuo CD, Huang CH, Hsueh YH, Chen JR. The Influence of Electro-Acupuncture Stimulation to Female Constipation Patients. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2013; 41:301-13. [DOI: 10.1142/s0192415x13500225] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study aims to examine electro-acupuncture stimulation (EA) assisted therapy with analysis of heart rate variability to understand autonomic nervous activity variability (ANAV) and to track the changes in female patients with constipation. The average ages were 42±12 years old. The participants were divided by a single-blind and randomized trial into two groups: the electro-acupuncture-point group, and the non-electro-acupuncture-point group. Both of the groups had eight treatments, once a week. For the electro-acupuncture (EA) group, needles were inserted into their Zusunli (ST36), Shangiuxu (ST37), Tiensu (ST25), Shueidao (ST28), Guanyuan (CV4) and Qihai (CV6) points. For the sham electro-acupuncture (SA) group, needles were inserted into acu-points that were not the ones mentioned for the EA group. While inserting needles, needles were inserted lightly into the participants' skin and removed quickly (mock Transcutaneous Electrical Nerve Stimulation, TENTS). After an eight-week treatment period, the autonomic nervous system activities of the SA group did not show significant differences in their heart rate variability. However, the autonomic nervous system activities of the EA group had continuously increased after each session. The normalized high frequency powers (nHFP) of their autonomic nervous system activities were 26.79 in the first week, and they increased to 32.28 in the fourth week. In the eighth week, their nHFP had increased to 37.60 (p < 0.05). The normalized low frequency power (nLFP) was 30.81 in the first week. However, it decreased to 25.98 after three weeks of treatment. After the eight-week treatment period, the nLFP decreased to 24.84 (p < 0.05). After the eight-week treatment, the control group did not appear to undergo any physiological change, while the constipation had been improved for the experimental group. It was found that the activation of parasympathetic nervous system in the experimental group increased after the eight-week treatment. The effects of such a result on the enhancement of the activation of parasympathetic nervous system and the improvement of constipation should be further discussed.
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Affiliation(s)
- Chien-Yue Chen
- Institute of Electronic Engineering, National Yunlin University of Science and Technology, Taiwan
| | - Ming-Da Ke
- Graduate School of Engineering Science and Technology, National Yunlin University of Science and Technology, Taiwan
| | - Cheng-Deng Kuo
- Laboratory of Biophysics, Taipei Veterans General Hospital Medical Research and Education, Taipei, Taiwan
| | - Chien-Hsun Huang
- Department of Community and Family Medicine, National Taiwan University Hospital, Yun-Lin Branch, Taiwan
| | - Ya-Hsin Hsueh
- Institute of Electronic Engineering, National Yunlin University of Science and Technology, Taiwan
| | - Jing-Rhong Chen
- Graduate Optoelectronic, National Yunlin University of Science and Technology, Taiwan
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Gordon AL, Logan PA, Jones RG, Forrester-Paton C, Mamo JP, Gladman JRF. A systematic mapping review of randomized controlled trials (RCTs) in care homes. BMC Geriatr 2012; 12:31. [PMID: 22731652 PMCID: PMC3503550 DOI: 10.1186/1471-2318-12-31] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 06/25/2012] [Indexed: 01/02/2023] Open
Abstract
Background A thorough understanding of the literature generated from research in care homes is required to support evidence-based commissioning and delivery of healthcare. So far this research has not been compiled or described. We set out to describe the extent of the evidence base derived from randomized controlled trials conducted in care homes. Methods A systematic mapping review was conducted of the randomized controlled trials (RCTs) conducted in care homes. Medline was searched for “Nursing Home”, “Residential Facilities” and “Homes for the Aged”; CINAHL for “nursing homes”, “residential facilities” and “skilled nursing facilities”; AMED for “Nursing homes”, “Long term care”, “Residential facilities” and “Randomized controlled trial”; and BNI for “Nursing Homes”, “Residential Care” and “Long-term care”. Articles were classified against a keywording strategy describing: year and country of publication; randomization, stratification and blinding methodology; target of intervention; intervention and control treatments; number of subjects and/or clusters; outcome measures; and results. Results 3226 abstracts were identified and 291 articles reviewed in full. Most were recent (median age 6 years) and from the United States. A wide range of targets and interventions were identified. Studies were mostly functional (44 behaviour, 20 prescribing and 20 malnutrition studies) rather than disease-based. Over a quarter focussed on mental health. Conclusions This study is the first to collate data from all RCTs conducted in care homes and represents an important resource for those providing and commissioning healthcare for this sector. The evidence-base is rapidly developing. Several areas - influenza, falls, mobility, fractures, osteoporosis – are appropriate for systematic review. For other topics, researchers need to focus on outcome measures that can be compared and collated.
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Affiliation(s)
- Adam L Gordon
- Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK.
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Li MK, Lee TFD, Suen KPL. A review on the complementary effects of auriculotherapy in managing constipation. J Altern Complement Med 2010; 16:435-47. [PMID: 20423213 DOI: 10.1089/acm.2009.0348] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Constipation is a common health problem that adversely affects an individual's general health and quality of life. Constipated people usually manage the problem by taking laxatives and by modifying their lifestyle even if such have questionable therapeutic effects. Auriculotherapy, a safe treatment modality in Chinese medicine, has been reported to be effective in managing constipation. Despite previous studies reported encouraging results in using auriculotherapy, its effectiveness in managing constipation has not been systematically reviewed. This review, therefore, examines previous studies that have investigated the effectiveness of auriculotherapy in managing constipation. METHOD A search in the databases of MEDLINE EMBASE, AMED, and China Academic Journals Full-text Database and manual searching were performed to identify relevant clinical studies. RESULTS A total of 29 relevant clinical studies conducted from 1994 to 2008 were identified. All of the studies reported that auriculotherapy was effective in managing constipation. However, generalization of their findings was limited because of two significant methodological flaws: (1) uncertainty in accurate acupoints identification and subjects' compliance to instructions resulted in varied doses of intervention received; and (2) inconsistent intervention protocols and therapeutic outcome criteria made comparison among different studies difficult. CONCLUSIONS The findings of this review could provide pertinent information for researchers in terms of study designs and methodologies that may be used for future studies. The use of randomized controlled trials on a sample of sufficient size and of standard intervention protocol is recommended to provide empirical evidence that will support auriculotherapy as a complementary strategy in managing constipation.
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Affiliation(s)
- Mei-Kuen Li
- School of Science and Technology, The Open University of Hong Kong, Hong Kong, China.
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Schnelle JF, Leung FW, Rao SSC, Beuscher L, Keeler E, Clift JW, Simmons S. A controlled trial of an intervention to improve urinary and fecal incontinence and constipation. J Am Geriatr Soc 2010; 58:1504-11. [PMID: 20653804 DOI: 10.1111/j.1532-5415.2010.02978.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
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.
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Affiliation(s)
- John F Schnelle
- Division of General Internal Medicine and Public Health, Center for Quality Aging, School of Medicine, Vanderbilt University, Nashville, Tennessee, USA.
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Sturtzel B, Dietrich A, Wagner KH, Gisinger C, Elmadfa I. The status of vitamins B6, B12, folate, and of homocysteine in geriatric home residents receiving laxatives or dietary fiber. J Nutr Health Aging 2010; 14:219-23. [PMID: 20191257 DOI: 10.1007/s12603-010-0053-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Vitamin B12 deficiency as a digestive disorder and constipation as a gastro motility disorder are common in the elderly. Laxative treatment is often chosen without regard for gut health. OBJECTIVE To investigate whether the addition of oat-bran to the common oral diet for 12 weeks is able to reduce constipation and laxative use and improve gut health. It is assumed that this will lead to improved plasma levels of vitamins B6, B12, folate, and of homocysteine in nursing home residents. METHODS A controlled, parallel intervention trial. 30 frail patients with multiple chronic diseases, aged 57-98 years, receiving laxative therapy were included. Patients were randomized into a fiber (n=15) and a control group (n=15). The intervention group received 5.2g/d oat-bran for 84 days mixed into the daily common meals. The control group received the ward's habitual diet. Food intake and laxative use were documented and blood samples (on day 01, day 42 and day 84) were collected. Vitamin B12 and folate were analyzed by radioimmunoassay, B6 and homocysteine by RP-HPLC with fluorescence detection, in addition to the routine lab test of albumin and CRP. RESULTS In the fiber group, the intervention was well tolerated and laxative use decreased significantly (p < 0.001). In the control group, plasma B12 decreased faster (p < 0.05). In both groups, B6 and folate status remained unchanged. Plasma homocysteine decreased in both groups (p < 0.05). General mean energy intake was low (4861.4 kJ/d). CONCLUSION Oat-bran helps to improve constipation management and B12 bioavailability in elderly, with multiple chronic diseases who live in nursing homes.
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Affiliation(s)
- B Sturtzel
- Department of Nutritional Sciences, University of Vienna, Althanstrasse 14, A-1090 Vienna, Austsria.
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Sturtzel B, Mikulits C, Gisinger C, Elmadfa I. Use of fiber instead of laxative treatment in a geriatric hospital to improve the wellbeing of seniors. J Nutr Health Aging 2009; 13:136-9. [PMID: 19214342 DOI: 10.1007/s12603-009-0020-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
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.
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Affiliation(s)
- B Sturtzel
- Department of Nutritional Science, University of Vienna, Vienna, Austria
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Hale EM, Smith E, St James J, Wojner-Alexandrov AW. Pilot Study of the Feasibility and Effectiveness of a Natural Laxative Mixture. Geriatr Nurs 2007; 28:104-11. [PMID: 17430744 DOI: 10.1016/j.gerinurse.2006.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We sought to determine the effect of a natural laxative mixture compared with daily prescribed laxatives on bowel movement frequency in elderly long-term care residents. Secondary endpoints included ease of administration and costs of the natural laxative. A randomized controlled trial comparing the effect of the Beverley-Travis natural laxative mixture to prescribed laxatives was conducted over an 8-week period. Subjects were randomized to treatment and control groups; control subjects continued on regularly prescribed laxatives, and treatment group subjects discontinued prescribed laxatives and received 2 tablespoons of the natural laxative mixture twice a day for the remaining 4-week period. Bowel movement frequency and consistency were collected, and ease of natural laxative administration as well as costs associated with use of the natural or prescribed laxatives were calculated. The study included 45 residents, with 34 completing the 8-week study period (16 treatment group subjects and 18 control subjects). Treatment group subjects had a significant increase in average number of bowel movements from 15.5 to 22.2 (P = .007) following initiation of the natural laxative, and no difference in bowel movement frequency was observed among control subjects (P = NS). The natural laxative mixture was rated as "easy" or "very easy" to administer by 90%-92% of nurses, and cost savings of $103.04 was estimated. The Beverley-Travis natural laxative mixture, given at a dosage of 2 tablespoons twice daily, is easy to use, cost-effective, and more effective than daily prescribed laxatives at producing normal bowel movements.
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Khaja M, Thakur CS, Bharathan T, Baccash E, Goldenberg G. 'Fiber 7' supplement as an alternative to laxatives in a nursing home. Gerodontology 2005; 22:106-8. [PMID: 15934353 DOI: 10.1111/j.1741-2358.2005.00061.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Chronic constipation is a common and bothersome problem in elderly nursing home patients. Although fibre has a known role in the treatment of constipation, laxatives are still widely used in nursing home patients. OBJECTIVE To determine whether the addition of a fibre supplement to oral diet can reduce the use of laxatives in a long-term care facility. PARTICIPANTS AND METHODS Oral diet of 92 nursing home residents (all older than 65) on chronic laxatives (docusate, milk of magnesia with Cascara, psyllium) was supplemented with 'Fiber 7', a natural powder fibre (7 g per meal twice a day). During the next 2.5 years discontinuation of laxatives was attempted. RESULTS Laxatives were successfully discontinued in 63 of the 92 patients (68.5%, 95% confidence interval 59-78%). The fibre supplement was well tolerated. The cost of care was decreased by dollar 3.5 per patient every month or by dollar 220/month for the 63 patients. CONCLUSIONS Use of 'Fiber 7' allowed discontinuation of laxatives in 63 of 92 nursing home residents. The fibre supplement was a safe and convenient alternative to laxatives and decreased the cost of medical care.
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Affiliation(s)
- M Khaja
- New York Methodist Hospital, Brooklyn, New York, NY, USA
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Abstract
BACKGROUND AND AIMS Constipation is a common problem in geriatric wards and in the elderly population. Although high-fibre diets can help relieve constipation non-pharmacologically in many patients, traditional laxatives still remain the standard treatment. A fibre supplement in the form of raw bran is not always well tolerated. We wanted to study the effects of a daily consumption of a fruit- and fibre-rich porridge on stool frequency, perceived well-being and the costs for laxatives, when compared with traditional treatment with laxatives, in geriatric patients. METHODS Twenty patients in secondary geriatric wards (hospital rehabilitation wards) were randomized into an intervention group (porridge group) and a control group (standard diet without porridge) for a 1-week run-in and 2-week study, with registration of clinical data, e.g. medical treatment, laxative consumption, stool frequency and perceived well-being. RESULTS The patients in the porridge group had a daily defaecation without laxatives on average 76% of the time (10.7/14 days) compared with 23% of the time (3.3/14 days) in the non-porridge group (p = 0.003). The discomfort was less in the porridge group (2.5 vs. 6.5 on a 10-degree visual analogue scale, p = 0.008) when compared with the control group. The cost for laxatives was 93% lower in the intervention group (2.5 vs. 37.5) for the 2-week study. CONCLUSIONS A fibre-rich porridge was effective, well liked and tolerated and reduced the need for laxatives in geriatric patients. We conclude that a daily fibre-rich meal ought to be included in the treatment strategies of constipation in hospital wards.
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Affiliation(s)
- Aase Wisten
- Section of Geriatrics and Rehabilitation, Department of Internal Medicine, Sunderby Hospital, Luleå, Sweden.
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Abstract
Symptoms of urgency and increased frequency of micturition and nocturia, with or without urge incontinence, are the hallmarks of a condition that afflicts millions of Americans. Several new drug therapies, as well as behavioral approaches, provide keys to management.
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Affiliation(s)
- Diane Kaschak Newman
- Penn Center for continence and Pelvic Health, Division of urology, University of Pennsylvania Health System, Philadelphia, USA.
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Affiliation(s)
- M Petticrew
- MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK NHS Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK
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Affiliation(s)
- M Petticrew
- MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK NHS Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK
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