The incidence of and risk factors for inadequate bowel preparation in elderly patients: A prospective observational study

Abstract

Background/Aim:We conducted a prospective observational study to identify the incidence of and risk factors for inadequate bowel preparation in elderly Chinese patients.Patients and Methods:We enrolled 240 outpatients over 60 years of age scheduled for elective colonoscopy at our university hospital between November 2016 and April 2017. We recorded patient demographics, bowel preparation data, and clinical characteristics. Factors associated with inadequate bowel preparation were identified by multivariate logistical regression analysis.Results:The rate of inadequate bowel preparation was 34.6%. Factors associated with inadequate bowel preparation were a history of abdominal surgery (OR, 2.617; CI, 1.324–5.174; P = 0.006), chronic constipation (OR, 3.307; CI, 1.551–7.054; P = 0.002), non-compliance with dietary instructions (OR, 2.239; CI, 1.122–4.471; P = 0.022), non-compliance with polyethylene glycol (PEG) dosage (OR, 4.576; CI, 1.855–11.287; P = 0.001), walking <30 minutes during preparation (OR, 2.474; CI, 1.261–4.855; P = 0.008), interval between PEG ingestion and the onset of bowel activity (OR, 1.025; CI, 1.010–1.040; P = 0.001), and a last stool that was not clear and watery (OR, 4.191; CI, 1.529–11.485; P = 0.005).Conclusion:The incidence of adequate bowel preparation in elderly patients is not optimal. Walking <30 minutes during the PEG ingestion period may be a surrogate for bowel preparation failure. Future studies should identify elderly patients at risk for poor bowel preparation and develop interventions to improve outcomes in this population.

Factors affecting bowel preparation adequacy and procedural time

“…This study found that patients 50 years or younger and nondiabetic patients had a statistically higher frequency of adequate bowel preparation (rated 0, 1, or 2 on Ottawa Preparation Scale overall) as rated by endoscopists. This reinforces existing literature, which lists both older age and diabetic status as risk factors for poor bowel preparation adequacy . Aging causes degeneration of the autonomic nervous system that controls enteric smooth muscles.…”

“…This reinforces existing literature, which lists both older age and diabetic status as risk factors for poor bowel preparation adequacy. [10][11][12] Aging causes degeneration of the autonomic nervous system that controls enteric smooth muscles. Furthermore, older patients tend to be more immobile.…”

“…Patients with comorbidities, such as diabetes and smoking, have also been associated with poorer bowel adequacy prior to colonoscopy. [9][10][11][12] A small study (n = 99) of diabetic patients showed that only 64% had good or better bowel preparation compared to 97% of nondiabetic patients. 13 Previous surgical history has been associated with unsatisfactory bowel preparation.…”

Bowel preparation: The elderly, the hospitalized, and the colonoscope

“…looked at incidence and risk factors for inadequate bowel preparation among elderly patients. [ 8 ] In this prospective trial, the rate of inadequate bowel preparation among ambulatory patients above the age of 60 was 34.6%. In a unique aspect of the study, subjects were required to walk at least 30 min while taking the laxative.…”

Evaluation of pH and residual gastric volume after colon preparation with mannitol: prospective randomized study comparing procedure performed after 3 hours versus 6 hours

“…Insufficient cleansing or preparation is associated with a low diagnostic yield, a higher rate of canceled procedures, corresponding increased costs, lengthy procedures, and a higher risk of complications. The existing literature has identified multiple factors contributing to suboptimal bowel preparation, including comorbidities, age, gender, use of antidepressants, education level, history of abdominal surgery, non-compliance with preparation instructions, and the timing of bowel preparation before the colonoscopy (2,3). Recent studies suggest that the time interval between the last intake of bowel preparation medication and the start of colonoscopy, is a significant factor in determining the efficacy of cleansing (4).…”