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Constipation – No Trivial Matter
Constipation in older people is under-recognised in terms of the impact it has on physical health and quality of life, and is often not managed effectively. The International Longevity Centre (ILC-UK) in its recent publication The burden of constipation in our ageing society, reported an estimated cost to the NHS of £42 million. But the true cost of failing to effectively manage constipation in older people, in terms of both economic and societal burden to health services, as well in individual suffering and reduction in quality of life, may be much higher.
80 percent of care home residents experience constipation
Some 80 percent of care home residents aged over 65 are reported to experience chronic constipation. It can exacerbate symptoms in patients with conditions such as dementia and if left untreated, can have serious medical consequences, such as faecal impaction. Indeed annually more than 61,000 hospital admissions are recorded in England as a result of constipation.
Constipation can impact on health and quality of life
The contribution of nutritional and lifestyle factors, and the impact of constipation on health and quality of life was highlighted in a case study presented in the ILC report. This describes a series of changes experienced by a previously well 84 year old woman after her husband passed away. She became less active, stopped cooking for herself and lost weight. The lady was admitted to a nursing home with depression and constipation. Although treated with anti-depressants and referred for assessment of weight loss, her constipation was not treated effectively, and she went on to suffer faecal incontinence, requiring intensive nursing care.
Nutrition can be an important contributory cause
Nutrition can be an important contributory cause of constipation in the older person. Fluid and fibre intake may be reduced for fear of incontinence. An increased prevalence of swallowing difficulties can result in a requirement for thickened fluids and modified consistency diets, and this can also restrict adequate fibre and fluid intake. Less commonly recognised reasons may be poor dentition, which can impact on dietary intake, including fibre-containing foods and limited care assistance available for dependent individuals, which may hamper appropriate diet and fluid provision.
Health and care professionals should be aware of and monitor service users’ diet, hydration and mobility, so that measures to prevent constipation may be put in place. In general, the diet should be balanced and contain adequate fluid, whole grains, fruits, and vegetables. For low fibre consumers, fibre intake should be increased gradually (to minimise flatulence and bloating) and maintained.
Importantly, the taboo nature of constipation needs to be addressed such that older people start to feel more comfortable about self-reporting suspected constipation, knowing that they will be taken seriously and always treated with respect.