Constipation is under-estimated, under-treated and overlooked. Yet chronic constipation affects as much as 80 per cent of the older adult population living in care homes. If left untreated, it can result in serious medical consequences, such as faecal impaction, a condition where retention of solid faeces prevents normal evacuation. Faecal impaction can affect up to 50 per cent of older adults in hospital wards or care homes and can lead to faecal incontinence.
Constipation adversely impacts on quality of life
The impact of constipation on quality of life is significant and comparable to that of more recognised conditions such as diabetes, osteoarthritis or osteoporosis in terms of physical and psychological impact. Constipation not only results in a reduced quality of life of older adults, but is also associated with significant economic costs relating to nursing time, investigation, intervention, medication and on-going management.
Factors associated with an increased risk of constipation include a low fibre diet, as well as low fluid intake and reduced mobility – all factors highly prevalent in the care home environment.
A method to increase fibre consumption is to increase wholegrains in the diet. Research published recently in the British Journal of Nutrition showed that people who ate more wholegrains not only had a higher intake of fibre, but were also eating more key vitamins and minerals, and less salt. It also revealed that almost one in five of us is not eating any at all, and 80 per cent may not be eating enough wholegrains to have a health benefit.
In a recent draft report from the Scientific Advisory Committee on Nutrition that looked at the evidence for dietary fibre intake and health outcomes, there was moderate evidence of an association between increased wholegrain consumption and decreased risk of cardiovascular disease and type 2 diabetes. There was also some evidence, although limited, to link increased wholegrain consumption with lower energy intake and lower risk of stroke, hypertension and colon cancer.
Increasing wholegrain intake in care homes
Current Government guidelines, including those for care home catering, are that starchy foods should make up around a third of residents’ daily diet wholegrain varieties should be offered where possible. But what is a wholegrain? Essentially this is the entire grain, including a fibre rich outer layer (bran), a nutrient-rich inner part (germ) and a central starchy part (endosperm). Wholegrains include whole wheat, whole-wheat flour, wheat flakes, bulgur wheat, whole and rolled oats, oatmeal, oat flakes, brown rice, whole rye and rye flour and whole barley. Breads, pasta and breakfast cereals made from these will therefore be classified as wholegrain foods.
Tips to increase wholegrain consumption include:
- Bread: choose a variety, including wholemeal. Use a combination of white and wholemeal in sandwiches to encourage consumption
- Flour: wholemeal flour can be used for some recipes or used to replace some of the white flour
- Breakfast: serve porridge, wholemeal toast and low sugar/salt wholegrain breakfast cereals
It’s important to remember to increase any fibre consumption gradually in the diet, for instance, by mixing brown and white varieties, and to ensure adequate fluid consumption. Also, importantly, wholegrains are not the only source of fibre; the fibre found fruit and vegetables and pulses are also important in a healthy diet, so these should also be included both in care home menus and in the diet of the general population.
