Constipation is a common problem in the elderly population, especially in care homes, and laxatives are usually the first line treatment. The cause of constipation in this population group is often multifactorial, and, as a result, its management is often difficult leading to several different laxatives being prescribed at once.
Laxative prescriptions are common
Residents that are cognitively impaired or physically disabled often have reduced fluid and food intake and reduced mobility and/or a lack of fibre containing foods in their diet, all factors that contribute to constipation and prescription of laxatives.
A dietary intervention was undertaken by Central London Community Healthcare NHS Trust to determine whether a smoothie could have a similar effect to laxatives on improving bowel frequency and stool consistency. Such an intervention, if successful, could result in the reduced prescription of laxatives and a cost saving to GP budgets, and would further have the benefit of increasing the fluid, fibre, vitamin and mineral intake of residents.
Increased fibre, fluid and vitamins
The results of a five month programme of introducing smoothies in one care home have been reported recently in Complete Nutrition Magazine. A choice of smoothies was offered to the residents, with both high calorie and low calorie alternatives to cater for residents’ individual needs. Higher fibre smoothies were provided on alternate days to ensure increased fibre was introduced gradually, preventing any adverse gastrointestinal symptoms. Examples of smoothies included Prune and Pear (prune juice, tinned pears, drinking chocolate; 207 kcals, 2.3g protein, 3.6g fibre; cost of £1.03); Apricot Delight (tinned apricots, orange juice, ice cream, honey; 155 kcal, 2.6g protein, 1.7g fibre; cost of £0.25) and Power Shake (whole milk, banana, oats, powdered supplement; 247kcal, 11.4g protein, 2.5g fibre; cost of £0.40).
After 1 month it was noted that 48% of residents showed a clinical improvement to warrant a reduction in laxative prescriptions. Results after 4 months included a reduction in PRN laxative prescription (laxatives taken as needed) cost of 76% and complete elimination of enema prescriptions, which was also reported as an improvement in quality of life.
The level of dietetic input for such an audited intervention may not be feasible in all care homes. Nonetheless, the introduction of smoothies is an avenue that may be worth exploring on a wider level in reducing the need for, and cost of, numerous laxative prescriptions, whilst providing essential vitamins, fluid and fibre to residents of care homes, where the food provision can often lack such nutrients.