A new stoma for an older person—An association with quality of life and physical function: A systematic review

Abstract

Background: Older people are more likely to have a stoma postabdominal surgery than younger people. Few studies have examined the effect of a stoma on older people. The aim of this review was to explore the effect of a stoma on functional independence of an older person. We explored secondary outcomes of poststoma formation length of hospital stay, quality of life and factors affecting stroma independence. Methods: An exploratory systematic review was developed by our multidisciplinary group including an expert patient, colorectal surgeon, stoma nurse, physiotherapist, geriatrician, and methodologist. Four databases were searched including studies with participants 60 years old or older, who had undergone abdominal surgery for any pathology resulting in an abdominal stoma. Results:We identified 857 studies, of which we included 25 in the final review incorporating 6972 participants (average age 67.4 years). There was a strong association between presence of stoma and (1) worse physical function (standardized MD = 0.7; 95% CI 0.21-1.19; I 2 = 95) and (2) worse quality of life (standardized MD = 1.61; 95% CI 0.5-2.72, I 2 = 98). The same effect was seen in fecal ostomy and urinary diversion. Few studies measured stoma independence and only one examined factors affecting this. No studies examined length of stay. Conclusions: Stoma have a negative association with the physical function and quality of life of older people. Future studies should focus on identifying modifiable factors that may affect physical function, quality of life, and stoma independence.

Functional outcome and frailty in colorectal surgery patients

“…Stoma care is challenging in older persons, with a negative impact on quality of life and function that may result in loss of independence and institutionalization. 31,32 To our knowledge, there is a paucity of information regarding frailty and stoma-self management. In our study, 63 patients had stoma formation as part of their colorectal surgery.…”

Transanal endoscopic microsurgery versus radical resection for early-stage rectal cancer: a systematic review and meta- analysis

“…In terms of quality of life, we concluded that the rate of stoma is significantly higher in both temporary and permanent stoma in RS than in TEM. Postoperative stoma can significantly impair physiological function and reduce quality of life [ 35 ]. The extensive and invasive nature of RS not only significantly impairs patients’ quality of life and social functioning, but also promotes health anxiety and affects family social relationships.…”

Defecation Dysfunction and Exercise Habits among Survivors of Rectal Cancer: A Pilot Qualitative Study

“…In a systematic review of 25 cases, Neuberger et al [ 9 ] concluded that stoma insertion negatively affects physical function and quality of life in older people. In our study, the EORTC QLQ-30 survey results indicated that the non-stoma group had a higher QoL than the stoma group.…”

“…These findings suggests that exercise intervention is necessary to prevent a decline in physical function. Furthermore, Neuberger et al [ 9 ] reported that appropriate exercise patterns and regular walking alleviated defecatory dysfunction. Therefore, additional studies of defecatory dysfunction and exercise habits in survivors with and without stomas are warrented.…”