Intractable Constipation in the Elderly

Baffy, Noemi; Foxx‐Orenstein, Amy E.; Harris, Lucinda A.; Sterler, Susan M

doi:10.1007/s11938-017-0142-2

Cited by 22 publications

(15 citation statements)

References 88 publications

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“…In addition to ONS and SAB, laxatives and paracetamol were the other commonly introduced drugs during hospitalization, which is consistent with the fact that malnutrition [ 18 ], pain [ 21 ] and constipation [ 22 ] are major problems in the elderly. Except for ONS, which was not analyzed, our results are similar to those of a French study that assessed drug modifications among geriatric inpatients [ 8 ].…”

Section: Discussionsupporting

confidence: 55%

Changes in Treatment of Very Elderly Patients Six Weeks after Discharge from Geriatrics Department

Dipanda

Barben

Nuemi³

et al. 2020

Geriatrics

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We assessed the prescriptions of patients hospitalized in a geriatric unit and subsequently discharged. This prospective and observational study was conducted over a two-month period in the geriatrics department (acute and rehabilitation units) of a university hospital. Patients discharged from this department were included over a two-month period. Prescriptions were analyzed at admission and discharge from the geriatrics department (DGD), and six weeks after DGD. We included 209 patients, 63% female, aged 86.8 years. The mean number of medications prescribed was significantly higher at DGD than at admission (7.8 vs. 7.1, p = 0.003). During hospitalization, 1217 prescriptions were changed (average 5.8 medications/patient): 52.8% were initiations, 39.3% were discontinuations, and 7.9% were dose adjustments. A total of 156 of the 209 patients initially enrolled completed the study. Among these patients, 81 (51.9%) had the same prescriptions six weeks after DGD. In univariate analysis, medications were changed more frequently in patients with cognitive impairment (p = 0.04) and in patients for whom the hospital report did not indicate in-hospital modifications (p = 0.007). Multivariate analysis found that six weeks after DGD, there were significantly more drug changes for patients for whom there were changes in prescription during hospitalization (p < 0.001). A total of 169 medications were changed (mean number of medications changed per patient: 1.1): 52.7% discontinuations, 34.3% initiations, and 13% dosage modifications. The drug regimens were often changed during hospitalization in the geriatrics department, and a majority of these changes were maintained six weeks after DGD. Improvements in patient adherence and hospital-general practitioner communication are necessary to promote continuity of care and to optimize patient supervision after hospital discharge.

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Section: Discussionsupporting

confidence: 55%

Changes in Treatment of Very Elderly Patients Six Weeks after Discharge from Geriatrics Department

Dipanda

Barben

Nuemi³

et al. 2020

Geriatrics

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“…GI motility disorders, in particular, are prevalent amongst the elderly, and cause significant physical, emotional, and financial burdens due to chronic constipation, fecal incontinence, even GI tumors. Among them, the incidence of constipation is striking, about 20% of old people experience chronic constipation, which results in failure to absorb nutrients and eliminate harmful metabolites, as well as increasing incidence of infection, and so being involved in the etiology of GI diseases [1,2]. It is believed that the deeper understanding on the pathological proceeding of GI motility disorders will provide a special “window of opportunity” for the early intervention and delay disease progression in the elderly.…”

Section: Introductionmentioning

confidence: 99%

Aging-dependent decrease in the numbers of enteric neurons, interstitial cells of Cajal and expression of connexin43 in various regions of gastrointestinal tract

Sun

et al. 2018

Aging

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Aging is a significant risk factor for gastrointestinal dysmotility, but aging-associated differences between different organs and the exact time to start degenerating have remained obscure. Here we evaluated alterations of interstitial cells of Cajal, enteric neurons and connexin43 expression in the stomach, jejunum and colon in 2-, 12-, 16-, 20- and 24-month-old mice, as well as in aged human colon. Interstitial cells of Cajal, cholinergic and nitrergic neurons within the whole digestive tract were reduced over time, but their loss first appeared in stomach, then in intestine, helping to understand that gastric function was first impaired during aging. The decrease of connexin43 expression occurred before interstitial cells of Cajal and neurons loss, suggesting that connexin43 might be the major target influenced during senescence. Furthermore, changes in expressions of pro-inflammatory cytokines (tumour necrosis factor-α, interleukin-1β, interleukin-6) and apoptosis-related proteins (B-cell lymphoma-2, caspase-3) which indicated “inflammaging”, might contribute to the loss of enteric neurons and interstitial cells of Cajal in aged gastrointestinal tract. Our results provide possible therapeutic time window for beneficial intervention for geriatric patients with gastrointestinal motility disorders.

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“…Moreover, this finding derives from a chi-square test and constipation is not exclusively a medication-related problem in the ID population [ 37 ]. On the other hand, the finding that the use of laxatives in our sample was significantly higher in people treated with antipsychotics and antiepileptics and in (psychotropic) polypharmacy (2+ psychotropics) treatment suggests that medications with or without AC activity plays an important role in chronic constipation in older adults both with [ 12 , 30 ] and without ID [ 37 , 38 , 39 ].…”

Section: Discussionmentioning

confidence: 72%

Anticholinergic burden in adult and elderly people with intellectual disabilities: Results from an Italian multicenter cross-sectional study

Vreese

Mantesso²,

Bastiani³

et al. 2018

PLoS ONE

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BackgroundAdults and older people with intellectual disabilities (ID) frequently receive anti-cholinergic drugs in chronic use, but no studies in Italy to date have investigated cumulative anticholinergic exposure and factors associated with high anticholinergic burden in this frail population.AimTo probe the cumulative exposure to anticholinergics and the demographic, social and clinical factors associated with high exposure.MethodsThe 2012 updated version of the Anticholinergic Burden Score (ACB) was calculated for a multicentre sample of 276 adult and older people over 40 years with ID and associations with factors assessed.ResultsOverall, antipsychotics, antiepileptics, anxiolytics, and antidepressants were the most frequent classes contributing to the total ACB score. People living in residential care were more likely exposed to high anticholinergic burden (an ACB score of 3+): both community housing (odds ratio [OR] 4.63, 95%CI 1.08–19.95) and nursing home facility ([OR] 9.99, 95%CI 2.32–43.04). There was also a significant association between an ACB score of 3+ and reporting mental health conditions ([OR] 25.56, 95% CI 8.08–80.89) or a neurological disease ([OR] 4.14, 95%CI 1.32–12.94). Neither demographic characteristics (age and gender) nor other clinical conditions (somatic comorbidity, levels and typology of ID) were associated with higher anticholinergic load. A high burden of anticholinergic was significantly more frequent in laxative users (22.6% ACB3+ vs. 5.1% ACB 0) (p = 0.003).ConclusionsPsychotropic drugs were the highest contributors to the anticholinergic burden in adult and old age ID, especially in those people living in institutional settings with mental health and/or neurological conditions. High anticholinergic load has shown to be associated with the use of laxatives.

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Intractable Constipation in the Elderly

Cited by 22 publications

References 88 publications

Changes in Treatment of Very Elderly Patients Six Weeks after Discharge from Geriatrics Department

Changes in Treatment of Very Elderly Patients Six Weeks after Discharge from Geriatrics Department

Aging-dependent decrease in the numbers of enteric neurons, interstitial cells of Cajal and expression of connexin43 in various regions of gastrointestinal tract

Anticholinergic burden in adult and elderly people with intellectual disabilities: Results from an Italian multicenter cross-sectional study

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