Many patients in nursing homes experience constipation, which is difficult to manage for both patients and nursing home staff. Constipation is not a clearly defined disease, but a general term describing the discomforts someone experiences due to their bowel movements. The prevalence of constipation is higher with age, with the greatest increase in prevalence after 70 years of age. Women are an estimated 2 to 3 times more likely to experience constipation than men. Up to 72% of nursing home patients suffer from constipation.
Nursing home patients with constipation commonly experience impaired health-related quality of life, are more physically aggressive, and have greater psychological distress. Chronic constipation can cause fecal impaction, and in critical cases, faecal impaction can lead to stercolar ulcerations, intestical obstruction, or bowel perforation. Constipation should not be regarded as an age-related condition, since most older adults who are healthy experience normal bowel function. Nursing home staff often report that management of constipation is difficult due to busy work schedules with many tasks, so that adequate bowel management is low in priority. Moreover, low staff levels and a high number of unskilled nursing aides among the staff lead to poor management of the patients’ bowels.
Dietary fiber, appropriate intake of fluids, physical activity, and laxatives are the most commonly used treatments for constipation. An estimated 50 to 70% of nursing home patients use laxatives on a regular basis. A recent study sought to analyze the prevalence and associations of constipation and use of laxatives among nursing home patients. The study also investigated the impact of residing in different nursing home units on the prevalence of constipation and use of laxatives.
The study had 261 participants who were nursing home patients. 23.4% of the participants had constipation and 67.1% used laxatives on a regular basis. The study found that difficulties with balance, urinary incontinence, Parkinson’s disease, and hypothyroidism were significantly associated with constipation. Furthermore, diminished communication ability and number of drugs were related to the use of laxatives.
Factors that were protective for laxative use were anti-dementia drugs and being engaged in activities one-third to two-thirds of the day.
The study concluded that constipation and use of laxatives is very common among the nursing home population. Variance exists due to differences in patient characteristics and health inadequacies. Therefore, elderly patients may respond positively to individualized care to make up for deficiencies. Nursing home staff must provide every patient with the best quality of care and deliver good constipation management no matter how demanding their workload is. It is the nursing home’s responsibility to ensure that staffing levels are adequate to meet patient needs efficiently.