Anticholinergic Drug Use and Bowel Function in Nursing Home Patients

Monane, Mark; Avorn, Jerry; Beers, Mark H.; Everitt, Dan E.

doi:10.1001/archinte.1993.00410050067009

Cited by 69 publications

(38 citation statements)

References 22 publications

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“…15 Poor mobility is a known independent risk factor for FI in elderly persons, 16,17 although mobility is only 1 aspect of needing help to use the toilet. Other contributory factors in stroke patients include 18,19 by reducing contractility of the smooth muscle of the gut by an antimuscarinic effect at acetylcholine receptor sites; in some cases, long-term use may induce chronic colonic dysmotility. 18 -20 Constipation may lead to impaction and overflow incontinence in vulnerable people, such as stroke patients, 21,22 and as an underlying cause may contribute to the observed later onset and fluctuating course of FI.…”

Section: Discussionmentioning

confidence: 99%

New-Onset Fecal Incontinence After Stroke

Harari

Coshall

Rudd

et al. 2003

Stroke

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Background and Purpose-Fecal incontinence (FI) is a common complication after stroke, yet epidemiological research into this distressing condition is limited. The purpose of this study was to describe the prevalence, natural history, associations, and impact of new-onset FI after stroke. Methods-Stroke patients in the community-based South London Stroke Register (January 1995 to 2000) without preexisting FI were characterized regarding bowel continence at 7 to 10 days, 3 months, and 1 and 3 years after stroke. FI was defined as any degree of bowel leakage. Results-Prevalence of poststroke FI was 30% (7 to 10 days), 11% (3 months), 11% (1 year), and 15% (3 years). One third of patients with FI at 3 months were continent by 1 year; conversely, 63% incontinent at 1 year had been continent at 3 months. Characteristics of 91 patients with FI and 755 without FI at 3 months were compared using multiple logistic regression. Acute stroke associations of neglect (adjusted odds ratio [OR], 1.9; 95% CI, 1.0 to 3.5) and initial urinary incontinence (OR, 6.2; 95% CI, 3.2 to 11.9) were no longer significant after adjustment for clinical factors at 3 months. Final independent associations were anticholinergic drug use (OR, 3.1; 95% CI, 1.1 to 10.2) and needing help with toilet use (OR, 3.5; 95% CI, 1.4 to 17.3). FI at 3 months increased the risk of long-term placement (28% vs 6%) and death within 1 year (20% vs 8%). Conclusions-New-onset FI in stroke survivors is common but may be transient.

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Section: Discussionmentioning

confidence: 99%

New-Onset Fecal Incontinence After Stroke

Harari

Coshall

Rudd

et al. 2003

Stroke

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“…The therapeutic ecacy of these drugs needs to be balanced against the sideeects of medication such as Parkinsonism, akathisia (Bazire, 1996) and constipation (Monane et al, 1993). Long-term use is associated with tardive dyskinesia (Bazire, 1996), an increased risk of fractured neck of femur (Lauritzen et al, 1993) and a 36% greater risk of recurrent falls in residents on regular psychotropic medication (Thapa et al, 1995).…”

Section: Unwanted Eects Of Psychotropic Drug Usementioning

confidence: 99%

Medication use in nursing homes for elderly people

Furniss

Craig

Burns

1998

Int. J. Geriat. Psychiatry

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“…22,60 Polypharmacy may increase the risk of constipation, especially in older individuals, 34 and constipation as a drug side-e ect may be substantially under-reported in patients with SCI. Benzodiazepines have not previously been shown to increase the risk of constipation in non-injured subjects 33,37 and this study ®nding may be confounded by increased administration to individuals who are Frankel grade A or B. The ®nding that individuals with history of previous urinary outlet surgery had a greater risk of reporting di culty with evacuation may re¯ect the shared innervation between bladder and lower gut; hyperre¯exic volume-pressure abnormalities have been documented in both the colon and bladder in individuals with cervicothoracic lesions, 8,9,23 and persons with anorectal dyssynergia also tend to have concomitant bladder detrusorsphincter dyssynergia.…”

Section: Discussionmentioning

confidence: 99%

“…( 33 laxative use prior to SCI, current use of at least six medications, 34 and use of the following speci®c drug categories: calcium channel blockers, 35 iron supplements, 36 antidepressants, 37 neuroleptics, 38 baclofen (known to a ect gastric motility), 20 narcotics, 39 antidiarrheals (loperamide, kaopectate, and lomotil), aluminium-and calcium-containing antacids, 33 diuretics, angiotensin converting enzyme inhibitors, 40 and nonsteroidal antiin¯ammatory drugs. 41 Drugs with known anticholinergic properties were examined as a discrete pharmacological variable; this variable included drugs from within the categories of antidepressants (eg amitryptiline, imipramine, doxepin), neuroleptics (eg chlorpromazine, thioridazine, prochloperazine), as well as diphenhydramine, 37 and urological drugs oxybutynin and propantheline.…”

Section: Methodsmentioning

confidence: 99%

“…41 Drugs with known anticholinergic properties were examined as a discrete pharmacological variable; this variable included drugs from within the categories of antidepressants (eg amitryptiline, imipramine, doxepin), neuroleptics (eg chlorpromazine, thioridazine, prochloperazine), as well as diphenhydramine, 37 and urological drugs oxybutynin and propantheline. Chi-square tests were used to examine di erences in demographic, clinical and pharmacological characteristics between interview responders and non-participants.…”

Section: Methodsmentioning

confidence: 99%

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Constipation-related symptoms and bowel program concerning individuals with spinal cord injury

Harari

Sarkarati²,

Gurwitz

et al. 1997

Spinal Cord

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Purpose. To determine the prevalence of constipation-related symptoms in individuals with chronic spinal cord injury (SCI), to describe the bowel program as reported by patients and including use of bowel medications and evacuation techniques, and to examine the clinical, functional and pharmacological risks of di culty with evacuation. Patients and Methods. This is a cross-sectional study of all in-patients at least 3 months beyond acute injury, on the West Roxbury/Brockton VAMC SCI Service, during a 10 month period (n=197). Clinical, functional, and medication data were abstracted from medical and nursing records. Individual interviews were conducted with all available participants (n=161, 82%) regarding bowelrelated symptoms and treatment over the previous 1 month period. The study de®nition of di culty with evacuation was spending more than 1 h per episode of bowel evacuation. Results. Forty-one percent of the 161 interview responders spent more than 1 h on bowel evacuation, 50% reported abdominal distension and 38% reported abdominal pain, 27% reported headaches or sweats relieved by having a bowel movement, and 33% reported fecal incontinence at least once a month. The bisacodyl suppository was the most commonly used laxative agent, while docusate was the most popular oral agent. Subjects with di culty with evacuation (n=66) were compared with those who spent less than 1 h on evacuation (n=95). Factors associated with di culty with evacuation were tetraplegia, Frankel grade A/B, laxative use, polypharmacy, previous urinary outlet surgery, and symptoms of abdominal pain and distension. Conclusion. Constipation-related symptoms are highly prevalent in individuals with spinal cord injury, despite considerable laxative use. Our ®ndings suggest that di culty with evacuation can be predicted on the basis of a patient's clinical pro®le.

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Anticholinergic Drug Use and Bowel Function in Nursing Home Patients

Cited by 69 publications

References 22 publications

New-Onset Fecal Incontinence After Stroke

New-Onset Fecal Incontinence After Stroke

Medication use in nursing homes for elderly people

Constipation-related symptoms and bowel program concerning individuals with spinal cord injury

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