The effect of lifestyle modification on severity of constipation and quality of life of elders in nursing homes at Ismailia city, Egypt LIFELAX - diet and LIFEstyle versus LAXatives in the management of chronic constipation in older people: randomised controlled trial. Effects of chicory inulin in constipated elderly people: a double-blind controlled trial Constipation--prevalence and incidence among medical patients acutely admitted to hospital with a medical condition. Complementary effects of auricular acupressure in relieving constipation symptoms and promoting disease-specific health-related quality of life: A randomized placebo-controlled trial. Stepped treatment of older adults on laxatives. The STOOL trial. Alleviating Constipation in the Elderly Improves Lower Urinary Tract Symptoms A double-blind, placebo-controlled study of prucalopride in elderly patients with chronic constipation.
Background : Constipation has a significant impact on the quality of life ( QOL ) .  Lifestyle modification is widely accepted and recommended by experts as first-line therapy . Aim : This study aim ed at using education on lifestyle modification to improve the QOL of the elderly in nursing homes suffering from functional constipation ( FC ) . Material s and Methods : This study was conducted in nursing homes in Ismailia city , Egypt . It involved 23 elderly patients suffering from FC , who were r and omly selected according to the sample equation . They fulfilled the inclusion criteria of being ≥60 years age and according to Rome II criteria . Participants completed personal characteristics and lifestyle question naire , the Patient Assessment of Constipation Symptom question naire ( PAC-SYM ) to assess the severity of symptoms , and the Patient Assessment of Constipation Quality of Life Question naire ( PAC-QOL ) to assess pre- and post-intervention . The intervention was conducted in three sessions , of 30 min each , 2 weeks apart using group discussion s to educate the sample about dietary pattern , fluid intake , regular physical activity , and the use of laxatives . Statistical analysis : Data were analyzed using a statistical package for social sciences ( SPSS version 20 ) . Results : The lifestyle modification education on constipation significantly reduced the severity of symptoms as measured by PAC-SYM , including its total score and subscores ( P < 0.001 ) . It also improved the QOL of elderly suffering from constipation as measured by PAC-QOL and reduced total scores of dissatisfaction ( P = 0.001 ) with the exception of the psychosocial subscale . It also significantly increased the satisfaction subscale of PAC-SYM ( P < 0.001 ) . Conclusion : Education on lifestyle modification leads to an improvement in the severity of the symptoms of constipation and the QOL of the elderly in nursing homes OBJECTIVES To investigate the clinical effectiveness and cost-effectiveness of laxatives versus dietary and lifestyle advice , and st and ardised versus personalised dietary and lifestyle advice . DESIGN A prospect i ve , pragmatic , three-armed cluster r and omised trial with an economic evaluation . SETTING General practice s in Engl and and Scotl and , UK . PARTICIPANTS People aged ≥ 55 years with chronic constipation , living in private households . Participants were identified as those who had been prescribed laxatives three or more times in the previous 12 months , or with a recorded diagnosis of chronic functional constipation . INTERVENTIONS Prescription of laxatives , with class of laxative and dose at the discretion of the GP and patient ( st and ard care control arm ) ; st and ardised , non-personalised dietary and lifestyle advice ; and , personalised dietary and lifestyle advice , with reinforcement . OUTCOME MEASURES The primary outcome was the constipation-specific Patient Assessment of Constipation-Symptoms (PAC-SYM)/Patient Assessment of Constipation- Quality of Life ( PAC-QOL ) . RESULTS The trial planned to recruit and retain 1425 patients from 57 practice s ( 19 per arm ) ; however , only 154 patients were recruited from 19 practice s. Due to these low recruitment rates it was not possible to report the conventional trial findings . Baseline characteristics of the sample from data gathered from both postal self-completion question naires and face-to-face interviews suggest that our sample experienced very few symptoms of constipation ( PAC-SYM ) and that the condition itself did not have a major impact upon their quality of life ( PAC-QOL ) . The low level of symptoms of constipation is most likely explained by 90 % of the sample using a laxative in the previous week . Most participants in our sample were satisfied with the performance of their laxatives , and levels of anxiety and depression were low . Their fibre consumption was classified as ' moderate ' but their average water consumption fell below the recommended guidelines . Daily diaries , completed each day for a period of 6 months , were analysed primarily in terms of overall response rate and item response rates , and the participants accepted this method of data collection . For the economic evaluation , all of the trial arms experienced a reduction in utility , as measured by EQ-5D . There was no statistical evidence to suggest that either the personalised intervention arm or the st and ardised intervention arm was associated with significant changes in utility at 3 months compared with the control arm . Data on related health-care costs show a cost saving of £ 13.34 for those in the personalised arm , compared with the control arm , and a smaller cost saving for the st and ardised arm . These savings primarily occurred because of reduced hospital costs . There was no significant change measured in utility , so the personalised arm appeared to be the preferred course , producing the greatest cost savings . CONCLUSIONS Due to the low number of participants in the trial , no firm conclusions could be drawn about the effectiveness of the interventions . However , a number of factors that contributed to the conduct and progress of the trial are highlighted , which may be relevant to others conducting research on a similar topic or population . TRIAL REGISTRATION IS RCT N73881345 . FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol . 14 , No. 52 . See the HTA programme website for further project information The impact of the daily consumption of 15 g chicory native inulin on fecal levels of bifidobacteria , stool parameters and quality of life of elderly constipated volunteers was investigated in a r and omized , double-blind , controlled versus placebo clinical trial . The impact of supplementation on constipation was assessed with question naires on bowel motor function parameters , visual analogue scales on bowel symptoms and quality of life . Fecal bacteria counts were determined at the beginning and at the end of the supplementation . Inulin supplementation led to a significant increase in total fecal bacteria ( P < 0.01 ) and bifidobacteria ( P < 0.001 ) concentrations after 28 days of consumption . Volunteers ( n = 25 ) in the inulin group reported increased satisfaction about digestion ( P < 0.01 ) and reduced defecation difficulties ( P < 0.001 ) during the supplementation . Slight gastrointestinal symptoms ( flatulence ) were reported but did not lead to discontinuation . Daily supplementation with 15 g inulin improves constipation and quality of life in an elderly population with constipation AIMS AND OBJECTIVES To examine the prevalence and incidence of  patient-reported symptoms of constipation in acutely hospitalised medical patients . BACKGROUND Constipation is a common medical problem with severe consequences , and most people suffer from constipation at some point in their lives . In the general population , constipation is one of the most common complaints and is a significant personal and public health burden . Alteration in patients ' patterns of elimination while in hospital has long been identified as either a potential or an actual problem that requires attention . Knowledge of the prevalence and incidence of constipation during hospitalisation is only sporadic . DESIGN The study was descriptive and a prospect i ve cohort design was chosen . METHODS The  Constipation Assessment Scale  was translated into Danish and was used for the assessment of patient-reported bowel function . Five nurses made the assessment s at admission to the acute medical ward and three days after admission . Three hundred and seventy-three patients participated in this study . RESULTS Thirty-nine percent of the patients showed symptoms of constipation at admission . Of the patients who did not have the symptoms at admission , 43 % developed the symptoms during the first three days of their stay in hospital . Significantly more of the older patients developed symptoms of moderate constipation . The incidence rate was 143 new cases per 1000 patient days . CONCLUSIONS In this study , symptoms of constipation were common among patients acutely admitted to hospital due to different medical conditions . Symptoms of constipation were also developed during the first three days of the stay in hospital . RELEVANCE TO CLINICAL PRACTICE The study highlights the need to develop both clinical guidelines towards treating constipation , and preventive measures to ensure that patients do not become constipated while staying in hospital 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 R and omized placebo-controlled trial . SETTING Elderly RCH . INTERVENTION Ninety-nine participants were r and omly 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 OBJECTIVES To investigate the clinical effectiveness and cost-effectiveness of bulk-forming , stimulant and osmotic laxatives , and also of adding a second type of laxative agent in the treatment of patients whose constipation is not resolved by a single agent . Additionally , to define the meaning of constipation in older people from the perspective of GPs and older patients , and to investigate the use of prescribed and non-prescribed treatments for constipation in older people together with their adherence to prescribed treatments . DESIGN A multicentre pragmatic , factorial r and omised controlled trial with economic evaluation and qualitative study using in-depth interviews and focus groups with older people , GPs and community nurses . SETTING General practice s in north-east Engl and . PARTICIPANTS People aged 55 years or over with chronic constipation living in private households . INTERVENTIONS Six stepped-treatment strategies using three classes of laxatives : bulk , stimulant and osmotic preparations , singly and in combination . MAIN OUTCOME MEASURES The primary outcome was the constipation-specific Patient Assessment of Constipation -- Symptoms/Patient Assessment of Constipation-- Quality of Life . Secondary outcomes included EuroQoL 5 Dimensions , reported number of bowel movements per week , the presence/absence of the other Rome II criteria for constipation , adverse effects of treatment and relapse rates . RESULTS Recruitment to the trial was difficult and the trial was closed after recruiting 19 participants . GP participants provided patient-centred definitions that focused on the idea of a change from the norm as defined by the individual patient and ' textbook definitions ' that focused on reduced frequency of defecation associated with a range of unpleasant sensations and other clinical symptoms . Nurses ' definitions of constipation included both a patient-centred perspective and the description of particular symptoms associated with constipation . Older participants defined constipation in terms of frequency of bowel movements and changes in normal bowel routine .  Older participants perceived constipation as follows : linked to specific diseases , medical conditions or health problems ; caused by the consumption of specific medications or surgical procedures ; caused by diet or eating habits ; part of the ageing process ; due to not going to the toilet when having the urge to defecate ; hereditary ; caused by stress or worry ; and caused by environmental exposure . GP participants suggested that constipation is due to changes in diet and lifestyle ; the physiology and degenerative processes of ageing ; and the iatrogenic impact of opiate medications . Nurse participants identified that constipation is linked to decreased mobility , decreased food intake , decreased fluid intake and consumption of certain medications . For many older people their constipation emerged as a problem over a period of time ; for some the ' condition ' had existed for many years .  Self-management of constipation had typically been their first response to the symptoms and continued once professional help had been sought . Older participants had a wide experience of different management strategies and treatments for constipation , and at the time of the study had firm preferences about the laxatives they would use . GP participants recognised the experience and use of laxatives of their patients . They exhibited strong personal preferences for different laxatives , often prescribing them in combination . Nurses were more likely than GPs to treat and prevent constipation using non-laxative measures ; these included providing advice on appropriate dietary changes , increasing fluid intake and , if possible , encouraging exercise and mobility . CONCLUSIONS There is little shared underst and ing between patients and professionals about ' normal ' bowel function with little consensus in general practice of the optimum management strategies for chronic constipation and the most effective strategies to use . Chronic constipation is seen as less important than other conditions prevalent in general practice ( e.g. diabetes ) because it is not an agreed management target within national frameworks . Consequently , practitioners had little interest in constipation as a research topic . Patient preferences and the absence of patient equipoise formed an enormous barrier to the recruitment of patients in the implementation of this trial . Studies are needed to investigate different methods of recruitment within the constraints of current ethical guidelines on ' opting in ' and to identify barriers and facilitators to recruitment to complex trials in general . Patient preference trials and natural cohort observational studies are also needed to investigate the effectiveness or cost-effectiveness of different laxatives and treatment strategies in the management of chronic constipation Background : Constipation and lower urinary tract symptoms ( LUTS ) very frequently occur in the elderly , and several reports have suggested that dysfunction in either one of these systems may affect the other . Most studies correlating rectal and bladder dysfunction , however , have been carried out in children or young women . Objective : To examine the effect of alleviating constipation on LUTS in the elderly . Methods : Fifty-two patients aged 65–89 ( mean 72 ± 13 ) years with chronic constipation and LUTS participated in this prospect i ve cohort study . Before treatment of constipation was initiated and on their monthly visits , patients completed a question naire regarding their constipation pattern , urinary symptoms , sexual function and mood , and underwent urinalysis . Urinary tract anatomy and residual urine were evaluated by abdominal ultrasound at the commencement and completion of the study . Patients were followed up for 4 months . Results : Treatment of constipation increased the number of weekly defecations from 1.5 ± 0.9 to 4.7 ± 1.2 ( p < 0.001 ) . Patients spent less time on the toilet ( 25 ± 2.1 versus 63 ± 1.9 min , p < 0.0001 ) . Fewer patients reported urgency ( 16 versus 34 , p < 0.001 ) , frequency ( 25 versus 47 , p < 0.001 ) and burning sensation during urination ( 6 versus 17 , p < 0.05 ) . There was improvement in the scoring of urgency , frequency and burning sensation ( from a baseline of 52 to 126 , 131 and 95 , respectively , p < 0.001 ) . Urinary stream disturbances improved in 32 of the 52 patients ( p < 0.001 ) . Residual urine volume decreased from 85 ± 39.5 to 30 ± 22.56 ml ( p < 0.001 ) . There was also a significant decrease in the number of patients with bacteriurial events ( 5 versus 17 , p < 0.001 ) , and an improvement in sexual activity and mood ( p < 0.05 ) . Conclusions : Our data demonstrated that medical relief of constipation significantly improves LUTS in the elderly which , in turn , improves the patient ’s mood , sexual activity and quality of life BACKGROUND Constipation affects up to 50 % of the elderly ; this study evaluates the efficacy , safety , and tolerability of the selective 5-HT(4 ) agonist prucalopride in chronically constipated elderly patients . METHODS Three hundred chronic constipation patients aged > or=65 years were r and omized to prucalopride ( 1 , 2 , or 4 mg once daily ) or placebo for 4 weeks . The primary endpoint was the percentage of patients with > or=3 spontaneous complete bowel movements ( SCBM ) per week . Secondary endpoints included the percentage with an increase of > or=1 SCBM per week , BM frequency , constipation-related symptoms , quality of life ( QoL ) , safety , and tolerability . KEY RESULTS More patients achieved > or=3 SCBM per week with prucalopride than with placebo . This difference was largest and significant during the first week of 4 mg prucalopride ( P < or= 0.05 ) . Significantly more patients in each prucalopride group achieved an increase of > or=1 SCBM per week from baseline vs placebo ( e.g. 60 % with 1 mg prucalopride vs 34 % with placebo at week 4 ; P < or= 0.05 ) . More patients had improvement in PAC-QOL satisfaction score of > or=1 with 1 mg prucalopride than with placebo ( P < or= 0.05 ) ; the same was true for PAC-SYM stool symptoms ( 1 and 4 mg prucalopride ; P < or= 0.05 ) . Treatment-emergent adverse events were similar between groups : the most frequently reported with prucalopride were headache and gastrointestinal events . There were no clinical ly significant differences between prucalopride and placebo for vital signs , laboratory assessment s , or ECG variables . CONCLUSIONS & INFERENCES Prucalopride , in the dose-range tested ( 1 - 4 mg once daily ) , has beneficial effects on bowel movements , symptoms , and QoL , and is safe and well-tolerated in elderly patients with chronic constipation
AIMS AND OBJECTIVES To explore and summarise best evidence of how constipation affects the daily living of older people from their own perspective .
Furthermore , to assess how interventions aim ed at treating constipation in older people affect patient-reported outcome such as quality of life .
BACKGROUND Constipation is a common and overlooked problem with an impact on everyday life , especially among older people .
Older people seem to have individual preconceptions on constipation which can influence the strategies used to prevent and treat constipation .