1
|
Eguchi T, Inatomi O, Shintani S, Momose K, Sako T, Takagi M, Fumihara D, Inoue K, Katayama N, Morisawa T, Ota T, Tsuji Y. Efficacy and safety of elobixibat in combination with or switched from conventional treatments of chronic constipation: A retrospective observational study. JGH Open 2024; 8:e70019. [PMID: 39193138 PMCID: PMC11347617 DOI: 10.1002/jgh3.70019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/07/2024] [Accepted: 08/07/2024] [Indexed: 08/29/2024]
Abstract
Background and Aim Elobixibat is a triple mode of action laxative that increases water secretion into the colon, promotes colonic motility, and reestablishes the defecation desire. This study aims to evaluate the effectivity and safety of elobixibat in chronic constipation (CC) patients refractory to conventional laxatives. Methods A single-center retrospective observational study was conducted in refractory CC patients diagnosed according to the Rome IV criteria and received elobixibat between April 2018 and June 2022 at Osaka Saiseikai Nakatsu Hospital. Data were collected for spontaneous bowel movement (SBM), Bristol stool form scale (BSFS) scores, abdominal symptoms, and adverse events. Results Eligible 311 patients were selected for the analysis. Two-week Elobixibat treatment significantly increased SBM (times/week) from 2.9 ± 1.9 to 4.3 ± 1.9 (P < 0.0001). The BSFS score improved significantly from 3.2 ± 1.7 to 4.4 ± 1.4 (P < 0.0001). The percentages of patients with hard stool were decrease and that with normal stools were increase. Improvements in abdominal symptoms (sensation of incomplete bowel evacuation, straining, abdominal pain and distention, and difficulty defecating) were also significant (P < 0.05). These constipation symptoms were improved irrespective of patient characteristics or previous laxatives. The 43.9% of previous laxatives were discontinued at the start of or after starting elobixibat treatment. A few adverse events were observed, elobixibat was well tolerated. Conclusion Elobixibat was effective in patients who were refractory to other laxatives, irrespective of previous therapy or patient characteristics. Elobixibat may contribute to resolving polypharmacy with single mode of action laxatives.
Collapse
Affiliation(s)
- Takaaki Eguchi
- Department of Gastroenterology and HepatologyOsaka Saiseikai Nakatsu HospitalOsakaJapan
- Department of General MedicineShiga University of Medical Science HospitalShigaJapan
| | - Osamu Inatomi
- Division of Gastroenterology, Department of MedicineShiga University of Medical ScienceShigaJapan
| | - Shuhei Shintani
- Division of Gastroenterology, Department of MedicineShiga University of Medical ScienceShigaJapan
| | - Kenji Momose
- Department of Gastroenterology and HepatologyOsaka Saiseikai Nakatsu HospitalOsakaJapan
| | - Tomoya Sako
- Department of Gastroenterology and HepatologyOsaka Saiseikai Nakatsu HospitalOsakaJapan
| | - Megumi Takagi
- Department of Gastroenterology and HepatologyOsaka Saiseikai Nakatsu HospitalOsakaJapan
| | - Daiki Fumihara
- Department of Gastroenterology and HepatologyOsaka Saiseikai Nakatsu HospitalOsakaJapan
| | - Kazuki Inoue
- Department of Gastroenterology and HepatologyOsaka Saiseikai Nakatsu HospitalOsakaJapan
| | - Norio Katayama
- Department of Gastroenterology and HepatologyOsaka Saiseikai Nakatsu HospitalOsakaJapan
| | - Toshiyuki Morisawa
- Department of Gastroenterology and HepatologyOsaka Saiseikai Nakatsu HospitalOsakaJapan
| | - Takumi Ota
- Medical Affairs DepartmentMochida Pharmaceutical Co., Ltd.TokyoJapan
| | - Yoshihisa Tsuji
- Department of General MedicineShiga University of Medical Science HospitalShigaJapan
| |
Collapse
|
2
|
Bishop R, Laugharne R, Burrows L, Ward S, Eustice S, Branford D, Wilcock M, Lamb K, Tavare A, Annesley C, Lewis S, Voulgaropoulos V, Sleeman F, Sargent B, Shankar R. Laxative use in adults with intellectual disabilities: development of prescribing guidelines. BJPsych Open 2024; 10:e84. [PMID: 38634310 PMCID: PMC11060064 DOI: 10.1192/bjo.2024.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/25/2024] [Accepted: 03/11/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Constipation is overrepresented in people with intellectual disabilities. Around 40% of people with intellectual disabilities who died prematurely were prescribed laxatives. A quarter of people with intellectual disabilities are said to be on laxatives. There are concerns that prescribing is not always effective and appropriate. There are currently no prescribing guidelines specific to this population. AIMS To develop guidelines to support clinicians with their decision-making when prescribing laxatives to people with intellectual disabilities. METHOD A modified Delphi methodology, the RAND/UCLA Appropriateness Method, was used. Step 1 comprised development of a bespoke six-item, open-ended questionnaire from background literature and its external validation. Relevant stakeholders, including a range of clinical experts and experts by experience covering the full range of intellectual disability and constipation, were invited to participate in an expert panel. Panel members completed the questionnaire. Responses were divided into 'negative consensus' and 'positive consensus'. Members were then invited to two panel meetings, 2 weeks apart, held virtually over Microsoft Teams, to build consensus. The expert-by-experience group were included in a separate face-to-face meeting. RESULTS A total of 20 people (ten professional experts and ten experts by experience, of whom seven had intellectual disability) took part. There were five main areas of discussion to reach a consensus i.e. importance of diagnosis, the role of prescribing, practicalities of medication administration, importance of reviewing and monitoring, and communication. CONCLUSIONS Laxative prescribing guidelines were developed by synthesising the knowledge of an expert panel including people with intellectual disabilities with the existing evidence base, to improve patient care.
Collapse
Affiliation(s)
- Ruth Bishop
- Cornwall Intellectual Disability Equitable Research (CIDER), Cornwall Partnership NHS Foundation Trust, Truro, UK; and CIDER, University of Plymouth Peninsula School of Medicine, Truro, UK
| | - Richard Laugharne
- CIDER, Cornwall Partnership NHS Foundation Trust, Truro, UK; and CIDER, University of Plymouth Peninsula School of Medicine, Truro, UK
| | - Lisa Burrows
- Knowledge Spa Library, Royal Cornwall Hospital Trust, Truro, UK; and The Southwest Clinical School, University of Plymouth, Truro, UK
| | - CHAMPS Team
- The Cornwall Intellectual Disability and Autism Support Team, Cornwall Council, Truro, UK
| | - Sandra Ward
- Independent expert with lived experience, Truro, UK
| | - Sharon Eustice
- CIDER, Cornwall Partnership NHS Foundation Trust, Truro, UK
| | - David Branford
- CIDER, University of Plymouth Peninsula School of Medicine, Truro, UK
| | | | - Kirsten Lamb
- CIDER, University of Plymouth Peninsula School of Medicine, Truro, UK
| | | | - Charlotte Annesley
- Learning Disability Liaison Service, North Middlesex University Hospital NHS Trust, London, UK
| | - Stephen Lewis
- Gastroenterology Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | | | | | | | - Rohit Shankar
- CIDER, Cornwall Partnership NHS Foundation Trust, Truro, UK; and CIDER, University of Plymouth Peninsula School of Medicine, Truro, UK
| |
Collapse
|
3
|
Laugharne R, Sawhney I, Perera B, Wainwright D, Bassett P, Caffrey B, O'Dwyer M, Lamb K, Wilcock M, Roy A, Oak K, Eustice S, Newton N, Sterritt J, Bishop R, Shankar R. Chronic constipation in people with intellectual disabilities in the community: cross-sectional study. BJPsych Open 2024; 10:e55. [PMID: 38425039 PMCID: PMC10951845 DOI: 10.1192/bjo.2024.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND One-third to half of people with intellectual disabilities suffer from chronic constipation (defined as two or fewer bowel movements weekly or taking regular laxatives three or more times weekly), a cause of significant morbidity and premature mortality. Research on risk factors associated with constipation is limited. AIMS To enumerate risk factors associated with constipation in this population. METHOD A questionnaire was developed on possible risk factors for constipation. The questionnaire was sent to carers of people with intellectual disabilities on the case-loads of four specialist intellectual disability services in England. Data analysis focused on descriptively summarising responses and comparing those reported with and without constipation. RESULTS Of the 181 people with intellectual disabilities whose carers returned the questionnaire, 42% reported chronic constipation. Constipation was significantly associated with more severe intellectual disability, dysphagia, cerebral palsy, poor mobility, polypharmacy including antipsychotics and antiseizure medication, and the need for greater toileting support. There were no associations with age or gender. CONCLUSIONS People with intellectual disabilities may be more vulnerable to chronic constipation if they are more severely intellectually disabled. The associations of constipation with dysphagia, cerebral palsy, poor mobility and the need for greater toileting support suggests people with intellectual disabilities with significant physical disabilities are more at risk. People with the above disabilities need closer monitoring of their bowel health. Reducing medication to the minimum necessary may reduce the risk of constipation and is a modifiable risk factor that it is important to monitor. By screening patients using the constipation questionnaire, individualised bowel care plans could be implemented.
Collapse
Affiliation(s)
- Richard Laugharne
- Cornwall Partnership NHS Foundation Trust, Truro, UK; and Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth, Truro, UK
| | - Indermeet Sawhney
- Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
| | - Bhathika Perera
- Department of Psychiatry, University College London, London, UK
| | | | | | | | - Maire O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Republic of Ireland
| | - Kirsten Lamb
- Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth, Truro, UK
| | | | - Ashok Roy
- Coventry and Warwickshire Partnership NHS Trust, Birmingham, UK
| | - Katy Oak
- Royal Cornwall Hospitals Trust, Truro, UK
| | | | - Nick Newton
- Cornwall Partnership NHS Foundation Trust, Truro, UK
| | | | - Ruth Bishop
- Cornwall Partnership NHS Foundation Trust, Truro, UK; and Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth, Truro, UK
| | - Rohit Shankar
- Cornwall Partnership NHS Foundation Trust, Truro, UK; and Cornwall Intellectual Disability Equitable Research (CIDER), University of Plymouth, Truro, UK
| |
Collapse
|
4
|
Todhunter-Brown A, Booth L, Campbell P, Cheer B, Cowie J, Elders A, Hagen S, Jankulak K, Mason H, Millington C, Ogden M, Paterson C, Richardson D, Smith D, Sutcliffe J, Thomson K, Torrens C, McClurg D. Strategies used for childhood chronic functional constipation: the SUCCESS evidence synthesis. Health Technol Assess 2024; 28:1-266. [PMID: 38343084 PMCID: PMC11017632 DOI: 10.3310/pltr9622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background Up to 30% of children have constipation at some stage in their life. Although often short-lived, in one-third of children it progresses to chronic functional constipation, potentially with overflow incontinence. Optimal management strategies remain unclear. Objective To determine the most effective interventions, and combinations and sequences of interventions, for childhood chronic functional constipation, and understand how they can best be implemented. Methods Key stakeholders, comprising two parents of children with chronic functional constipation, two adults who experienced childhood chronic functional constipation and four health professional/continence experts, contributed throughout the research. We conducted pragmatic mixed-method reviews. For all reviews, included studies focused on any interventions/strategies, delivered in any setting, to improve any outcomes in children (0-18 years) with a clinical diagnosis of chronic functional constipation (excluding studies of diagnosis/assessment) included. Dual reviewers applied inclusion criteria and assessed risk of bias. One reviewer extracted data, checked by a second reviewer. Scoping review: We systematically searched electronic databases (including Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature) (January 2011 to March 2020) and grey literature, including studies (any design) reporting any intervention/strategy. Data were coded, tabulated and mapped. Research quality was not evaluated. Systematic reviews of the evidence of effectiveness: For each different intervention, we included existing systematic reviews judged to be low risk of bias (using the Risk of Bias Assessment Tool for Systematic Reviews), updating any meta-analyses with new randomised controlled trials. Where there was no existing low risk of bias systematic reviews, we included randomised controlled trials and other primary studies. The risk of bias was judged using design-specific tools. Evidence was synthesised narratively, and a process of considered judgement was used to judge certainty in the evidence as high, moderate, low, very low or insufficient evidence. Economic synthesis: Included studies (any design, English-language) detailed intervention-related costs. Studies were categorised as cost-consequence, cost-effectiveness, cost-utility or cost-benefit, and reporting quality evaluated using the consensus health economic criteria checklist. Systematic review of implementation factors: Included studies reported data relating to implementation barriers or facilitators. Using a best-fit framework synthesis approach, factors were synthesised around the consolidated framework for implementation research domains. Results Stakeholders prioritised outcomes, developed a model which informed evidence synthesis and identified evidence gaps. Scoping review 651 studies, including 190 randomised controlled trials and 236 primary studies, conservatively reported 48 interventions/intervention combinations. Effectiveness systematic reviews studies explored service delivery models (n = 15); interventions delivered by families/carers (n = 32), wider children's workforce (n = 21), continence teams (n = 31) and specialist consultant-led teams (n = 42); complementary therapies (n = 15); and psychosocial interventions (n = 4). One intervention (probiotics) had moderate-quality evidence; all others had low to very-low-quality evidence. Thirty-one studies reported evidence relating to cost or resource use; data were insufficient to support generalisable conclusions. One hundred and six studies described implementation barriers and facilitators. Conclusions Management of childhood chronic functional constipation is complex. The available evidence remains limited, with small, poorly conducted and reported studies. Many evidence gaps were identified. Treatment recommendations within current clinical guidelines remain largely unchanged, but there is a need for research to move away from considering effectiveness of single interventions. Clinical care and future studies must consider the individual characteristics of children. Study registration This study is registered as PROSPERO CRD42019159008. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 128470) and is published in full in Health Technology Assessment; Vol. 28, No. 5. See the NIHR Funding and Awards website for further award information.
Collapse
Affiliation(s)
- Alex Todhunter-Brown
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Lorna Booth
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Pauline Campbell
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Brenda Cheer
- ERIC, The Children's Bowel and Bladder Charity, Bristol, UK
| | - Julie Cowie
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Suzanne Hagen
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | | | | | - Charlotte Paterson
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, University of Stirling, Stirling, UK
| | | | | | | | - Katie Thomson
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
- Department of Occupational Therapy, Human Nutrition and Dietetics, Glasgow Caledonian University, Glasgow, UK
| | - Claire Torrens
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, University of Stirling, Stirling, UK
| | - Doreen McClurg
- Nursing, Midwifery and Allied Health Professions (NMAHP) Research Unit, Glasgow Caledonian University, Glasgow, UK
| |
Collapse
|
5
|
Waninge A, Van der Putten A, Wagenaar M, Van der Schans C. Towards criteria and symptoms of constipation in people with severe or profound intellectual and multiple disabilities: A Delphi study. Heliyon 2023; 9:e16446. [PMID: 37303519 PMCID: PMC10250576 DOI: 10.1016/j.heliyon.2023.e16446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 04/29/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023] Open
Abstract
Background Chronic constipation is common in people with intellectual disabilities, and seems to be highly prevalent in people with severe or profound intellectual and multiple disabilities (SPIMD). However, there is no current widely accepted definition for the constipation experienced by these individuals. Aim This Delphi study aims to compile a list of operationalized criteria and symptoms of constipation in people with SPIMD based on practical experiences of and consensus between experts supporting them. Methods A two-round Delphi study with an intermediate evaluation and analyses was conducted. Parents and relatives of persons with SPIMD and support professionals were included. The panel answered statements and open questions about symptoms and criteria of constipation. They were also requested to provide their opinion about classifying criteria and symptoms into domains. Answers to statements were analysed separately after both rounds with regard to consensus rate and displayed qualitatively; answers to open questions were analysed deductively. Results In the first Delphi round (n = 47), consensus was achieved on criteria within the domains 'Defecation' and 'Physical features', that were assigned to broader categories. Symptoms retrieved within the domain 'Behavioural/Emotional' were brought back to the panel as statements. After the second Delphi round (n = 38), consensus was reached on questions about domains, and for eight criteria (domain 'Defecation' n = 5; domain 'Physical features n = 3). Within the domain 'Behavioural/Emotional', consensus was achieved for five symptoms. Criteria and symptoms with consensus >70% were considered 'generic' and <70% as 'personal'. Symptoms mentioned in the text boxes were used to operationalize categories. Discussion and conclusion It was possible to compile a list of generic criteria related to the domains 'Defecation' (n = 5) and 'Physical features' (n = 3) supplemented with generic symptoms related to the domain 'Behavioural/Emotional' (n = 5). We propose using both generic as well as personal criteria and symptoms resulting in a personal profile for an individual with SPIMD. Based on the current results, we recommend follow-up research to develop a screening tool to be used by relatives and professional caregivers, and a definition of constipation. This may support reciprocal collaboration and lead to timely identification of constipation in people with SPIMD.
Collapse
Affiliation(s)
- A. Waninge
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, the Netherlands
- Health Psychology Research, University of Groningen, Groningen, the Netherlands
| | - A.A.J. Van der Putten
- Department of Inclusive and Special Needs Education and Youth Care, University of Groningen, Groningen, the Netherlands
| | - M.C. Wagenaar
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, the Netherlands
| | - C.P. Van der Schans
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences Groningen, Groningen, the Netherlands
- Health Psychology Research, University of Groningen, Groningen, the Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
6
|
Abdominal massage: A review of clinical and experimental studies from 1990 to 2021. Complement Ther Med 2022; 70:102861. [PMID: 35907436 DOI: 10.1016/j.ctim.2022.102861] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 06/10/2022] [Accepted: 07/20/2022] [Indexed: 12/09/2022] Open
Abstract
OBJECTIVE To systematically review the current state and holistic application of abdominal massage (AM). DESIGN A systematic review of qualitative evidence was conducted. All English articles exploring the topic of AM that had been published until the end of June 2021 were retrieved. DATA SOURCES The PubMed, Cochrane library, and Embase databases were accessed. Some original texts were obtained from Google Scholar. DATA EXTRACTION AND SYNTHESIS Two authors independently evaluated all search data to identify relevant studies. Disagreements were settled by discussion with a third author. Results were independently extracted into standardized sheets and checked for accuracy. MAIN RESULTS A total of 107 full-text reports were eligible for inclusion. Adult digestive disorders, pediatric disorders, gynecological disorders, obstetric disorders, metabolic disorders, psychological disorders, the side effects of AM, and animal experiments accounted for 49.53%, 14.02%, 7.48%, 7.48%, 4.67%, 4.67%, 5.61%, and 6.54% of all these papers, respectively, with most reports focusing on clinical studies. CONCLUSION The variety of diseases treated with AM is gradually increasing, and the treatment programs of AM for many diseases are being gradually optimized. Different forms of AM, especially mechanical AM, have been widely studied; the side effects of AM have also been considered; and the possible mechanisms of AM therapy continue to be discovered. In general, AM is an effective and safe therapy and can be widely used in various diseases, but further studies are necessary to clarify the mechanism of AM for different diseases. In the future, AM could become an even safer, more popular, and more modern therapy.
Collapse
|
7
|
|
8
|
A Primary Care Approach to Constipation in Adults with Intellectual and Developmental Disabilities. Adv Med 2021; 2021:3248052. [PMID: 34820456 PMCID: PMC8608534 DOI: 10.1155/2021/3248052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/17/2021] [Accepted: 10/13/2021] [Indexed: 01/20/2023] Open
Abstract
Constipation is a condition that is very prevalent and is reported in up to 40 percent of individuals with intellectual and developmental disabilities (IDD). Constipation in this patient population is most commonly secondary to neuromuscular abnormalities, immobility, suboptimal diet, and medication side effects. History taking is frequently limited in adults with IDD due to communication barriers, often leading to a missed diagnosis of constipation. Inadequately treated constipation may lead to adverse effects including behavioral disturbances, fecal impaction, intestinal obstruction, and even death from intestinal perforation and sepsis. As a result, a high index of suspicion must exist for this patient population. Treatment in these patients requires an individualized approach, to reduce the constipation and its associated health complications.
Collapse
|
9
|
Laxative use among older adults with intellectual disability: a cross-sectional observational study. Int J Clin Pharm 2019; 42:89-99. [PMID: 31792735 DOI: 10.1007/s11096-019-00942-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 11/16/2019] [Indexed: 01/07/2023]
Abstract
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.
Collapse
|
10
|
Sappok T, Diefenbacher A, Winterholler M. The Medical Care of People With Intellectual Disability. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:809-816. [PMID: 31888794 PMCID: PMC6947689 DOI: 10.3238/arztebl.2019.0809] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 05/22/2019] [Accepted: 09/13/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND An estimated 1.5 million persons in Germany are intellectually disabled. Persons with intellectual disability (ID) are especially vulnerable to somatic and mental illnesses. METHODS This review is based on pertinent literature retrieved by selective searches in PubMed and the Cochrane Library. RESULTS Genetic abnormalities are a frequent cause of diseases that affect multiple organs and need interdisciplinary treatment. A number of somatic diseases are more common in persons with ID than in the general population, including epilepsy (30-50% in persons with severe or very severe ID, vs. 0.5% in the general popu- lation) and dementia (five times more common than in the general population). Patients with Down syndrome are 20 times more likely than the general population to develop acute lymphoblastic leukemia. Some mental illnesses, too, are more common in persons with ID, e.g., autism spectrum disorders (7.5-15% vs. 1% in the general population). The history and the findings of the physical and psychiatric examination are assessed in accordance with the biopsychosocial model of disease, and in the light of the patient's mental developmental age. Structured instruments for behavioral evaluation and diagnosis are an important additional component of the diagnostic assessment. A holistic approach is required that takes multiple life areas into account and involves the patient's familial and social environment, while obeying the rules of simple language. Psychotherapeutic and psychosocial measures must be adapted to the patient's cognitive abilities and mental developmental age. CONCLUSION Intellectually disabled persons can be treated in a multimodal, multiprofessional approach. As of early 2019, there were 38 medical centers for adults with intellectual disability or severe multiple disabilities in Germany (Medizinische Behandlungszentren für Erwachsene mit geistiger Behinderung oder schweren Mehrfachbehinderungen, MZEB), where they can be cared for with due attention to their special needs.
Collapse
Affiliation(s)
- Tanja Sappok
- Berlin Treatment Center for adults with intellectual disabilities (ID) and mental disorders, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin
| | - Albert Diefenbacher
- Department of Psychiatry, Psychotherapy and Psychosomaticsk, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin
| | | |
Collapse
|
11
|
O'Dwyer C, McCallion P, Henman M, McCarron M, O'Leary E, Burke E, O'Connell J, O'Dwyer M. Prevalence and patterns of antipsychotic use and their associations with mental health and problem behaviours among older adults with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 32:981-993. [PMID: 31038275 DOI: 10.1111/jar.12591] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/03/2019] [Accepted: 02/14/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND There are concerns that antipsychotics may be used inappropriately in adults with intellectual disability for problem behaviours in the absence of a diagnosed mental health condition. The aim was to examine the prevalence and patterns of antipsychotic use and their association with problem behaviours and mental health conditions in older adults with intellectual disability. METHODS Cross-sectional data were drawn from Wave 2 (2013/2014) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA). Medication data were available for 95.6% (n = 677). Those who reported antipsychotic use and reported psychotic or other mental health conditions and those who reported problem behaviours were compared. RESULTS In total, 45.1% (n = 305) had antipsychotics, and of those with antipsychotic use and diagnosis information (n = 282), 25.9% (73) had a psychotic disorder. 58% of those exposed to antipsychotics reported problem behaviours. CONCLUSION Reported use of antipsychotics significantly exceeded reported doctor's diagnosis of psychotic conditions in this study.
Collapse
Affiliation(s)
- Claire O'Dwyer
- IDS-TILDA, School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Philip McCallion
- School of Social Work, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Martin Henman
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | - Mary McCarron
- Dean of the Faculty of Health Sciences, Trinity College, Dublin, Ireland
| | - Eva O'Leary
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | - Eilish Burke
- IDS-TILDA, School of Nursing and Midwifery, Trinity College, Dublin, Ireland
| | - Juliette O'Connell
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | - Máire O'Dwyer
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| |
Collapse
|
12
|
Martínez-Ochoa MJ, Fernández-Domínguez JC, Morales-Asencio JM, González-Iglesias J, Ricard F, Oliva-Pascual-Vaca Á. Effectiveness of an Osteopathic Abdominal Manual Intervention in Pain Thresholds, Lumbopelvic Mobility, and Posture in Women with Chronic Functional Constipation. J Altern Complement Med 2018; 24:816-824. [PMID: 29782181 DOI: 10.1089/acm.2018.0081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To assess the effect of an osteopathic abdominal manual intervention (AMI) on pressure pain thresholds (PPTs), mobility, hip flexibility, and posture in women with chronic functional constipation. DESIGN Randomized, double-blind placebo-controlled trial. SETTING/LOCATION Subjects were recruited for the study by referral from different gastroenterology outpatient clinics in the city of Madrid (Spain). SUBJECTS Sixty-two patients suffering from chronic functional constipation according to the guidelines of the Congress of Rome III. INTERVENTIONS The experimental group (n = 31) received an osteopathic AMI, and the control group (n = 31) received a sham procedure. OUTCOME MEASURES PPTs at different levels, including vertebral levels C7, T3, T10, T11, and T12, trunk flexion range of motion (ROM), hip flexibility, and posture, were measured before and immediately after the intervention. A comparison between the difference between the pre- and postintervention values using the Student's t test for independent samples or nonparametric U-Mann-Whitney test depending on the distribution normality of the analyzed variables was perfomed. RESULTS In the intergroup comparison, statistically significant differences were found in PPT at T11 (p = 0.011) and T12 (p = 0.001) and also in the trunk flexion ROM (p < 0.05). Moreover, women showed no adverse effects with acceptable pain tolerance to the intervention. CONCLUSION The application of an osteopathic AMI is well tolerated and improves pain sensitivity in areas related to intestinal innervation, as well as lumbar flexion.
Collapse
Affiliation(s)
| | | | - Jose Miguel Morales-Asencio
- 3 Faculty of Nursing, Physical Therapy, Podiatry and Occupational Therapy, University of Málaga , Málaga, Spain
| | | | - François Ricard
- 1 Escuela de Osteopatía de Madrid, Alcalá de Henares , Madrid, Spain
| | - Ángel Oliva-Pascual-Vaca
- 1 Escuela de Osteopatía de Madrid, Alcalá de Henares , Madrid, Spain .,4 Department of Physiotherapy, University of Seville , Seville, Spain
| |
Collapse
|