Effective Alternative to Constipation Medication in Nursing Home Residents: Libera Study
DOI:
https://doi.org/10.14306/renhyd.21.2.355Keywords:
Constipation, Dietary Fiber, Sorbitol, Laxatives, Aged, Nursing HomesAbstract
Introduction: The aim of this study is to ascertain the impact of administering a dessert rich in fibre and sorbitol on the prescription of laxatives in nursing home residents with constipation.
Material and methods: Single-centre, interventional prospective study in elderly nursing home residents diagnosed with constipation and treated with laxatives, in which each patient is his/her own comparator. A dessert rich in fibre and sorbitol (high-fibre Resource® Fruit Purée) was given for 7 weeks. The main variable was the difference in days of pharmacological treatment with laxatives between the week before the start of the study and the last week of the study.
Results: 40 patients were studied with a median age of 88.5 years (range: 72–101). After 7 weeks, the residents required a mean of 3.5 fewer days per week of treatment with laxatives. Patients receiving pharmacological medication decreased by 40%. Weekly bowel movements increased by a mean of 2 while gastrointestinal discomfort decreased. The intervention did not change previous intake. Adherence to the prescribed regimen was over 94%. A decrease in the number of days with laxative therapy was associated with: consuming 5 or more desserts a week, being over 85, having poor oral health and not suffering from malnutrition or food disorders.
Conclusions: Dispensing a dessert rich in fibre and sorbitol may be an effective and safe alternative to laxatives in elderly nursing home residents with constipation, and may help to reduce polymedication in these patients.
References
(1) Wald A. Constipation: Advances in Diagnosis and Treatment. JAMA. 2016;315(2):185-91.
(2) Navarro MS, Llanos C, García E, Moreno L, Flores M, Chávez K, et al. Frecuencia de estreñimiento en pacientes de Atención Primaria. Rev Clin Med Fam. 2015;8(1):4-10.
(3) Garrigues V, Gálvez C, Ortiz V, Ponce M, Nos P, Ponce J. Prevalence of constipation: agreement among several criteria and evaluation of the diagnostic accuracy of qualifying symptoms and self-reported definition in a population-based survey in Spain. Am J Epidemiol. 2004;159(5):520-6.
(4) Quinten C, Coens C, Ghislain I, Zikos E, Sprangers MAG, Ringash J, et al. The effects of age on health-related quality of life in cancer populations: A pooled analysis of randomized controlled trials using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 involving 6024 cancer patients. Eur J Cancer. 2015;51(18):2808-19.
(5) Schmier JK, Miller PE, Levine JA, Perez V, Maki KC, Rains TM, et al. Cost savings of reduced constipation rates attributed to increased dietary fiber intakes: a decision-analytic model. BMC Public Health. 2014;14:374.
(6) Fundación Española de Aparato Digestivo, editor. Guía práctica de actuación diagnóstico-terapéutica en estreñimiento crónico. Madrid, España: FEAD;
(7) Toner F, Claros E. Preventing, assessing, and managing constipation in older adults. Nursing. 2012;42(12):32-9.
(8) Blekken LE, Nakrem S, Vinsnes AG, Norton C, Mørkved S, Salvesen Ø, et al. Constipation and Laxative Use among Nursing Home Patients: Prevalence and Associations Derived from the Residents Assessment Instrument for Long-Term Care Facilities (interRAI LTCF). Gastroenterol Res Pract. 2016;2016:1215746.
(9) Jiang Y, Tang Y-R, Xie C, Yu T, Xiong W-J, Lin L. Influence of sleep disorders on somatic symptoms, mental health, and quality of life in patients with chronic constipation. Medicine (Baltimore). 2017;96(7):e6093.
(10) Bove A, Bellini M, Battaglia E, Bocchini R, Gambaccini D, Bove V, et al. Consensus statement AIGO/SICCR diagnosis and treatment of chronic constipation and obstructed defecation (part II: treatment). World J Gastroenterol. 2012;18(36):4994-5013.
(11) 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(2):136-9.
(12) Micka A, Siepelmeyer A, Holz A, Theis S, Schön C. Effect of consumption of chicory inulin on bowel function in healthy subjects with constipation: a randomized, double-blind, placebo-controlled trial. Int J Food Sci Nutr. 2017;68(1):82-9.
(13) Lever E, Cole J, Scott SM, Emery PW, Whelan K. Systematic review: the effect of prunes on gastrointestinal function. Aliment Pharmacol Ther. 2014;40(7):750-8.
(14) Leung L, Riutta T, Kotecha J, Rosser W. Chronic constipation: an evidence-based review. J Am Board Fam Med. 2011;24(4):436-51.
(15) Sanchez MIP, Bercik P. Epidemiology and burden of chronic constipation. Can J Gastroenterol. 2011;25(Suppl B):11B-15B.
(16) Xin HW, Fang XC, Zhu LM, Xu T, Fei GJ, Wang ZF, et al. Diagnosis of functional constipation: agreement between Rome III and Rome II criteria and evaluation for the practicality. J Dig Dis. 2014;15(6):314-20.
(17) Wisten A, Messner T. Fruit and fibre (Pajala porridge) in the prevention of constipation. Scand J Caring Sci. 2005;19(1):71-6.
(18) 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(2):104-11.
(19) Andy UU, Vaughan CP, Burgio KL, Alli FM, Goode PS, Markland AD. Shared Risk Factors for Constipation, Fecal Incontinence, and Combined Symptoms in Older U.S. Adults. J Am Geriatr Soc. 2016;64(11):e183-8.
(20) Dent E, Chapman I, Piantadosi C, Visvanathan R. Screening for malnutrition in hospitalised older people: Comparison of the Mini Nutritional Assessment with its short-form versions. Australas J Ageing [Internet]. 2017;[ahead of print]. Disponible en: doi: 10.1111/ajag.12402
(21) Peña EA, Slate EH. Global Validation of Linear Model Assumptions. J Am Stat Assoc. 2006;101(473):341-54.
(22) Yang J, Wang H-P, Zhou L, Xu C-F. Effect of dietary fiber on constipation: a meta analysis. World J Gastroenterol. 2012;18(48):7378-83.
(23) Bliss DZ, Savik K, Jung H-JG, Whitebird R, Lowry A, Sheng X. Dietary fiber supplementation for fecal incontinence: a randomized clinical trial. Res Nurs Health. 2014;37(5):367-78.
(24) Chutkan R, Fahey G, Wright WL, McRorie J. Viscous versus nonviscous soluble fiber supplements: mechanisms and evidence for fiber-specific health benefits. J Am Acad Nurse Pract. 2012;24(8):476-87.
(25) Escudero E, González P. La fibra dietética. Nutr Hosp. 2006;21(Suppl. 2):61-72.
This journal 