Epidemiological study of elderly constipation in Beijing

Living with constipation and communication taboos surrounding constipation among older adults: An interpretive phenomenology analysis study

Chronic constipation is a prevalent problem that significantly impacts older adults' well-being. This study aimed to explore how older adults describe constipation symptoms and impacts and understand the perceived taboo surrounding discussions on related issues. Twenty older adults with constipation were interviewed using a semi-structured format in Taiwan. The Interpretive Phenomenology Analysis approach was utilized for data analysis. Five techniques recommended by Lincoln and Guba (1985) were implemented to ensure the study's trustworthiness. The primary themes encompassed comprehensive portrayals of fecal characteristics, the discomfort symphony of constipation, emotional turbulence in the struggle against constipation, daily activities shadowed by constipation, and underlying factors contributing to communication taboos. Most participants considered the discussion of constipation taboo due to its association with an embarrassing secret, an unacceptable social norm and stigma, and apprehensions of potential gossip. Geriatric caregivers need to consider individual perspectives, communication taboos, and sociocultural contexts when addressing older adults' constipation.

Global prevalence of constipation in older adults: a systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

Constipation is one of the most common functional disorders of the gastrointestinal tract in older adults. To date, no systematic review or previous meta-analysis has estimated the global prevalence of constipation in older adults. The prevalence of this disorder has been reported differently in different studies; therefore, this study aims to systematically review the publications and to perform a meta-analysis of the prevalence of constipation in older adults.

METHODS

The electronic databases PubMed, Google Scholar, Scopus, Web of Science, and ScienceDirect were systematically searched for studies reporting the prevalence of constipation in older adults up to February 2022. To perform the analysis, the random effects model was used, and heterogeneity was assessed by Cochran's Q test and expressed as I2.

RESULTS

Out of 5341 evaluated publications, 36 met the eligibility criteria. These studies included 58,405 older adults aged 60-93 years. The overall prevalence of constipation in older adults was 18.9% (95% confidence interval [95% CI]: 14.7-23.9%). The prevalence of constipation in older adults according to Rome II criteria was 16.2% (95% CI: 6.8-33.7), based on Rome III criteria was 19.2% (95% CI: 12.6-28.1), and based on Rome IV criteria was 10.3% (95% CI: 5.8-17.7). The highest prevalence of constipation was found in older adults in Africa at 32.3% (95% CI: 21.5-45.4), and the lowest in Asia at 13.6% (95% CI: 9.1-19.9). Concerning diagnostic tools, the highest prevalence of constipation was found if a self-reporting tool was applied with a value of 19.7% (95% CI: 15.8-24.3).

CONCLUSION

The results suggest that health policymakers should pay more attention to the prevention of constipation in older adults, including raising public awareness to the importance of nutrition and diet and physical activity in older adults.

Functional Constipation in Elderly and Related Determinant Risk Factors: Malnutrition and Dietary Intake

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.

Epidemiology of Constipation in Elderly People in Parts of China: A Multicenter Study

Purpose

To investigate the epidemiological characteristics of constipation in people aged 65 years and older in several regions of China.

Patients and Methods

A cross-sectional study based on a cluster sampling design was conducted in four cities of China: Tianjin, Xiamen, Cangzhou and Harbin. A total of 5,222 cases (age ≥ 65 years) were recruited, and the survey was conducted via centralized and household questionnaires that included the following: basic demographic characteristics such as sex, age, education, marital status, living status and occupation; social activities; duration of sleep at night; duration of menstruation and delivery times (in females); and if the participant had constipation symptoms, the severity of constipation. Constipation was diagnosed according to the Rome IV criteria.

Results

Of the 5,222 participants, 919 were diagnosed with constipation. The prevalence of constipation was 17.60% in elderly people ≥65 years old. Prevalence increased with age and was significantly higher in females than males (P < 0.05). Prevalence was lower in the manual compared to the non-manual worker group, and significantly increased with decreasing duration of night sleep (P < 0.05). Older age, female sex and shorter sleep duration at night were risk factors for constipation in elderly people.

Conclusion

The prevalence of constipation in the elderly people in four cities of China was 17.60%, and was significantly affected by age, sex and sleep duration at night.

Prevalence and Risk Factors of Functional Constipation According to the Rome Criteria in China: A Systematic Review and Meta-Analysis

BACKGROUND

Functional constipation (FC) is a common bowel disorder that prevails worldwide. In China, although a heterogeneous prevalence of constipation is expected, it is currently not demonstrated. In this study, we aimed to evaluate the prevalence and related risk factors of FC in the Chinese population, according to the Rome criteria.

METHODS

We searched the PubMed, the Embase, the Cochrane Library, the Web of Science, the China National Knowledge Infrastructure (CNKI), the Wanfang data knowledge service platform, the VIP information resource integration service platform, and the Chinese Biomedical Literature Service System (SinoMed) databases from the inception of database to July 2021. Population-based cross-section studies that enrolled adults with FC, diagnosed by the Rome criteria, were deemed eligible. We summarized the overall prevalence and detected the subgroup effect per the Rome I, Rome II, Rome III, and Rome IV criteria. We used the generalized linear mixed model (GLMM) with a random-effect intercept to pool the prevalence and performed pairwise meta-analyses for prevalence comparisons by risk factors.

RESULTS

We identified 3,213 records through our database search, and 39 studies from China, comprising 1,240,79 participants, met the eligibility criteria for our study. The pooled overall prevalence of FC using the Rome criteria was 8.5% in China. Heterogeneous prevalence was detected within the Rome criteria (Rome II: 10.6%, 95% CI: 7.2-15.4; Rome III: 6.5%, 95% CI: 3.4-12.0; Rome IV: 8.1%, 95% CI: 5.6-11.8). The prevalence increased between 1991 and 2020 (from 5.5% with 95% CI: 3.6-8.2 between 1991 and 2000 to 10.9% with 95% CI: 5.5-20.4 between 2011 and 2020). Higher prevalence was found in women [odds ratio (OR) = 1.53, 95% CI: 1.31-1.78] and the elderly (≥70 years vs. ≤ 29 years: OR = 3.38, 95% CI: 2.16-5.30) than in men and the younger population. A high-fiber diet was associated with lower prevalence (OR = 0.33, 95% CI: 0.15-0.75), whereas irregular bowel habit and inactivity were associated with higher prevalence (OR = 3.64, 95% CI: 2.64-5.03; OR = 1.97, 95% CI: 1.14-3.43). Unhealthy mental states, such as anxiety and depression, and poor sleep quality led to high prevalence (OR = 3.16, 95%C I: 1.96-5.11; OR = 2.74, 95% CI: 1.76-4.26; OR = 2.14, 95% CI: 1.69-2.72, respectively).

CONCLUSION

Various types of FC prevail in China based on the different Rome criteria, personal characteristics, and habits. The prevalence also increased over the past three decades. The FC should be included under the primary care setting with uniform diagnosis criteria in China.

SYSTEMATIC REVIEW REGISTRATION

http://www.crd.york.ac.uk/PROSPERO, CRD42021277172.

Prevalence, Symptoms, and Associated Factors of Chronic Constipation Among Older Adults in North-East of Peninsular Malaysia

This study aimed to determine the prevalence, symptoms, and associated factors of chronic constipation among older adults in the North-East of Peninsular Malaysia. A cross-sectional study was conducted among older patients from four health clinics. A total of 400 older patients participated, with a mean age of 68.7 (SD = 6.4) years. The prevalence of chronic constipation was 14.8%. The highest symptom reported was the inability to pass stool (98.3%). Chronic constipation was significantly associated with older age (OR = 2.97; 95% CI [1.17, 7.54]; p = .022), inadequate plain water intake per day (OR = 2.13; 95% CI [1.13, 4.02]; p = .020), hypertension (OR = 2.22; 95% CI [1.07, 4.61]; p = .033), and hyperlipidemia (OR = 2.52; 95% CI [1.24, 5.11]; p = .010). Identification of chronic constipation should be done as part of routine clinic visits, especially for older patients with cardiovascular disease.

Efficacy and safety of inulin supplementation for functional constipation: a systematic review protocol

Introduction

Functional constipation (FC) is a common digestive system disease, with an uptrend in morbidity and mortality, resulting in huge social and economic losses. Although the guidelines recommend lifestyle intervention as a first-line treatment, lifestyle intervention is not widely used in clinic. Inulin can be used as the basic material of functional food. Clinical studies have shown that inulin supplementation is associated with increased frequency of bowel movements, but has certain side effects. Therefore, the efficacy and safety of inulin in the treatment of FC need to be further evaluated.

Methods and analysis

We will search Medline, Web of Science, Embase, China National Knowledge Infrastructure Database, Wanfang Database and China Biomedical Literature Database. We will also search the China Clinical Trial Registry, the Cochrane Central Register of Controlled Trials and related conference summaries. This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RevMan V.5.3.5 will be used for analysis.

Ethics and dissemination

This systematic review will evaluate the efficacy and safety of inulin supplementation for the treatment of FC. All included data will be obtained from published articles, there is no need for the ethical approval, and it will be published in a peer-reviewed journal. Due to lack of a new systematic review in this field, this study will combine relevant randomised controlled trials to better explore the evidence of inulin supplementation in the treatment of FC and guide clinical practice and clinical research.

PROSPERO registration number

CRD42020189234.

Gastrointestinal discomforts and dietary intake in Chinese urban elders: A cross-sectional study in eight cities of China

BACKGROUND

Gastrointestinal (GI) discomforts are common in the elderly population; however, whether such discomforts are associated with dietary intake has not been studied.

AIM

To evaluate GI discomforts in Chinese urban elders and the associated factors.

METHODS

The gastrointestinal symptom rating scale (GSRS) was used to identify GI discomforts in 688 elders from eight cities of China. The semi-quantitative food frequency questionnaire and one time of 24 h dietary recall were used to access the food intake, identify dietary pattern, and calculate the nutrients intake.

RESULTS

About 83% of studied elders experienced at least one of GI discomforts in the past 6 mo; dyspepsia was the most commonly reported (66.7%), followed by reflux (44.8%), abdominal pain (35.9%), constipation (35.8%), and diarrhea (34.7%). Female gender, lower education level, and lower family income were associated with a higher GSRS score. Participants who were diagnosed with a GI-related disease had a higher score of constipation, but a lower score of reflux. Chronic diseases were positively associated with certain GI discomforts. Three dietary patterns were identified by the method of principal component analysis, which were characterized as high intake of salt and tea; more frequent intake of tubers, fruits, aquatic products, and soybeans; and high intake of cereal, vegetables, and meat, respectively. However, no associations between dietary patterns and GSRS score were found. The elders with a higher GSRS score had significantly lower intake of bean products. The elders whose GSRS score was ≥ 21 and 18-20 decreased their bean production intake by 7.2 (0.3, 14.3) g/d and 14.3 (1.2, 27.3) g/d, respectively, compared with those who had a GSRS score ≤ 17. There were no differences in other food categories, calories, or nutrients intake among elders with different GSRS scores.

CONCLUSION

GI discomforts are common in Chinese urban elders. GI discomforts might be associated with the choice of food.

Clinical features and treatment options among Chinese adults with self-reported constipation: An internet-based survey

OBJECTIVE

We aimed to investigate the clinical features, precipitating factors, bowel habits, bothersome symptoms and treatment strategies of individuals in China with self-reported constipation.

METHODS

An internet-based survey was conducted in China. The participants had self-reported chronic constipation (≥1 symptoms including straining, hard stools, time-consuming defecation, sensations of incomplete evacuation and anorectal blockage, using manual assistance, and fewer than three defecations per week, for over 6 months). Data on their sex, age and occupation, precipitating factors, bowel habit, main symptoms and treatment options were collected.

RESULTS

Overall, 6318 participants fulfilled the inclusion criteria for chronic constipation. More women (54.6%, n = 3450) than men reported constipation. The most common age group for constipation was 31 to 40 years (40.0%, n = 2520) and the most common occupation was office workers (43.6%, n = 2754). Disordered eating routines, consuming spicy food, and failure to defecate in time were the most common factors associated with constipation. Overall, 76.0% (n = 4804) participants did not defecate in the morning; 56.2% (n = 3548) spent 6 to 15 minutes in defecating. The most prevalent symptom was straining (39.4%, n = 2489). For preferred treatment options, 81.7% (n = 5160) selected changes in their lifestyle and diet, 51.1% (n = 3229) selected using traditional Chinese medicine, and 25.2% (n = 1590) selected using laxatives.

CONCLUSIONS

Constipation rates were higher in women, people aged 31 to 40 years old, and those working in offices. Having eating disorders, eating spicy food and withholding stools were the most common precipitating factors. Straining was the most prevalent symptom. Lifestyle changes were the most common action taken for managing constipation.

Initial Effects of Electroacupuncture for Chronic Severe Functional Constipation and the Potential Underlying Factors: Secondary Analysis of a Randomized Controlled Trial

Background

Electroacupuncture (EA) has been found to be effective for treating chronic severe functional constipation (CSFC). However, the initial effects of treatment usually affect the acceptability and compliance of patients with chronic disease in particular. Which class of CSFC patients will have a better initial response to EA remains uncertain and requires investigation.

Methods

This was a secondary analysis of an original multicenter randomized controlled trial in which patients with CSFC were randomly assigned to receive 28 sessions of EA or sham electroacupuncture (SA) over 8 weeks with 12 weeks of follow-up. The primary outcome, namely, response with complete spontaneous bowel movements (CSBMs), required participants to have ≥ 3 CSBMs and an increase of ≥ 1 CSBM from the baseline over the first week of treatment. Logistic regression analysis with bootstrapping techniques was performed to determine independent factors related to the response.

Results

A total of 1051 eligible patients were included in this study of whom 161 patients were classified as responders at week 1. The CSBM response rate was higher in the EA group (17.5%) than in the SA group (13.2%). And the proportion of these 1-week early responders remained to have higher clinical response at the end of 8-week treatment and 12 weeks after treatment. Age and higher baseline CSBMs were related to CSBM response within the first week: with every 1-year increase in age, the likelihood of clinical response was reduced by 1.7% (odds ratio [OR] 0.983, 95% confidence interval [CI] 0.972 to 0.993; P=0.001). The odds of a CSBM response in patients with 1< CSBMs ≤ 2 at baseline were 4.64 times higher than that in patients with CSBMs ≤ 1 (OR 4.64, 95%CI 4.01 to 5.27).

Conclusions

EA produced its initial effects within the first week of treatment. And the effects could last until week 8 and week 20. A younger age and higher number of CSBMs at baseline may increase likelihood of a response.

Effects of Lactobacillus plantarum CQPC01-fermented soybean milk on activated carbon-induced constipation through its antioxidant activity in mice

A newly found strain, Lactobacillus plantarum CQPC01 (LP-CQPC01), was used for soybean milk fermentation, and its effects against constipation were determined. LP-CQPC01-FSM (LP-CQPC01-fermented soybean milk) was found to have six kinds of soybean isoflavones; the isoflavones of LP-CQPC01-FSM were more than those of Lactobacillus bulgaricus-fermented soybean milk (LB-FSM) and unfermented soybean milk (U-FSM). Animal experiment showed that the MTL, Gas, ET, AchE, SP, VIP, and GSH levels in the constipated mice were increased; however, the SS, MPO, NO, and MDA levels in the constipated mice were reduced by soybean milk treatment. Further, LP-CQPC01-FSM increased the mRNA and protein expression of Cu/Zn-SOD, Mn-SOD, CAT, c-Kit, SCF, and GDNF and reduced the expression of TRPV1 and NOS relative to those of the mice with untreated constipation. LP-CQPC01 could be used as a new starter to produce high-quality soybean milk, which might be used as a functional drink.

Constipation in the elderly from Northern Sardinia is positively associated with depression, malnutrition and female gender

OBJECTIVES

Constipation is a common complaint in older adults. The rise in life expectancy may amplify the problem and increase social expenditure. We investigated the major risk factors associated with constipation in a large sample of elderly.

METHODS

Outpatients from Northern Sardinia attending a Geriatric Unit between 2001 and 2014 were enrolled. Demographic and anthropometric data, income, education and self-reported bowel function were collected. The presence of constipation was adjusted for cognitive status, assessed by the Mini-Mental State Examination (MMSE) test; single and cumulative illness rating scale (CIRS); current or past symptomatic depression and anxiety measured by the Geriatric Depression Scale (GDS); nutritional status, evaluated using the Mini-Nutritional Assessment (MNA); type and number of different medications used.

RESULTS

1328 elderly patients (mean age 77.7 ± 7.2 years) were enrolled. Constipation was present in 32.1%, more commonly in women (35.4% vs 28.3%) and increased with age. The multivariate analysis showed a significantly greater risk of constipation in patients with a risk of malnutrition (OR = 1.745, 95% CI: 1.043-2.022; p = .034), female gender (OR = 1.735, 95% CI: 1.068-2.820; p = .026) and depression (OR = 1.079, 95% CI: 1.022-1.140; p = .006). Other potential predisposing factors assessed such as MMSE, CIRS, body mass index, marital status, smoking habit, education, income and number of taken drugs did not show a statistically significant association. Aging was a risk for constipation also in patients free of medications.

CONCLUSIONS

Knowledge of risk factors associated with bowel alterations in elderly individuals may provide important clues for caregivers to prevent or reduce constipation.

Factors related to acupuncture response in patients with chronic severe functional constipation: Secondary analysis of a randomized controlled trial

Background

Acupuncture has been demonstrated to be effective and safe for chronic severe functional constipation (CSFC). However, which patients with CSFC will have a better response to acupuncture remains unclear.

Objective

To explore factors related to acupuncture response in patients with CSFC.

Methods

We performed a secondary analysis of a previous multicenter randomized controlled trial consisting of a 2-week run-in period, 8-week treatment, and 12-week follow-up without treatment in which patients with CSFC were randomly allocated to an electroacupuncture group or a sham electroacupuncture group. Responders were defined as participants with an increase of at least one complete spontaneous bowel movement (CSBM) in week 20 compared with the baseline period. The CSBM responder rate in both groups was described, and the baseline characteristics of participants potentially related to acupuncture response were mainly analyzed using logistic regression analysis with bootstrapping techniques.

Results

A total of 1021 participants were analyzed in this study, of whom 516 (50.5%) were classified as responders. The CSBM responder rate in week 20 was significantly greater in the electroacupuncture group than in the sham electroacupuncture group (62.9% vs. 37.9%, respectively; P<0.001). Both age and comorbidity were negatively associated with clinical response: with every one-year increase in age, the likelihood of clinical response was reduced by 1.2% (OR 0.988, 95%CI 0.980 to 0.996; P = 0.005), and patients with comorbidities were approximately 42% less likely to respond to treatment (OR 0.581, 95%CI 0.248 to 0.914; P = 0.001).

Conclusion

CSFC patients with increasing age and comorbidity may be less likely to respond to acupuncture. These findings contribute to guiding clinical practice in terms of pretreatment patient selection. Further research is needed to confirm the association.

Nurse-Led Self-Management Educational Intervention Improves Symptoms of Patients With Functional Constipation

This study aimed to evaluate the effects of self-management educational intervention on the symptoms of patients with functional constipation. From January 2014 to April 2015, 66 patients with functional constipation were randomly assigned into intervention group receiving intensive educational interventions and control group receiving routine nursing care. The constipation score of all clinical symptoms (Bristol stool form scale, defecation interval, incomplete evacuation, evacuatory difficulty) at 1 month postdischarge were all significantly lower in the intervention group than in the control group (all, p < .05). At 1 month postdischarge, the intervention group had a significantly higher proportion of patients with good health habits (reasonable diet, regular exercise, good defecation habits, proper use of laxatives) as compared with the control group (all, p < .05). These data suggest educational intervention can effectively improve constipation symptoms and compliance with treatment of patients, and lead to the development of good health habits.

Study on alterations of physiological functions in aged constipation rats with fluid-deficiency based on metabonomic and microbiology analysis

To clarify how constipation interferes with the normal physiological function of organisms,¹H NMR profiles combined with PCR-DGGE and 16s rRNA gene sequencing were used to investigate the relationship among constipation, metabolite and gut microbiota.