CONSTIPATION IN THE ELDERLY - INFLUENCE OF DIETARY, PSYCHOLOGICAL, AND PHYSIOLOGICAL FACTORS

OBJECTIVE: To identify dietary, psychological, and physiological chara cteristics of older individuals with chronic constipation, compared wi th a control group of individuals without constipation, and identify c orrelates of colonic transit time. DESIGN: Cohort study. SETTING: Univ ersity hospital and affiliated clinics. PARTICIPANTS: Eighteen constip ated and 18 control subjects who were nondemented, ambulatory, communi ty-dwelling outpatients over the age of 60 years. MEASURES: Measures i ncluded a 1-week food diary, diet questionnaire, bowel diary, the Hopk ins Symptom Checklist (SCL-90R), colonic transit study, and medical hi story, including queries about activity, medications, medical illnesse s, and bowel symptoms. MAIN RESULTS: Constipated subjects reported con suming fewer meals per day compared with control subjects (P < 0.01) a nd a tendency to consume fewer calories (P = 0.07). There were no diff erences between groups on fiber or fluid intake or any of the other di etary parameters. However, slow colonic transit was significantly rela ted to low caloric intake (P < 0.0001), higher percent of protein in t he diet (P < 0.05), low fluid intake (P < 0.05), and to psychological symptoms of somatization, obsessive-compulsiveness, depression, anxiet y, and the global severity index (P < 0.05). Transit times were unrela ted to crude or dietary fiber intake, activity level, or age. CONCLUSI ONS: The data suggest that constipation in this older population is re lated to caloric intake rather than fiber consumption or other dietary qualities. Psychological distress is associated with slowed colonic t ransit and should be investigated further as a possible etiologic fact or in constipation.