CONSTIPATION - ASSESSMENT AND MANAGEMENT IN AN INSTITUTIONALIZED ELDERLY POPULATION

OBJECTIVES: To examine prescribing and utilization patterns of laxativ es, stool softeners, and enemas in a large, long-term care facility, t o compare self-reports of constipation with specific, bowel-related sy mptoms in residents of this facility, and to examine concordance betwe en bowel symptoms reported:by residents and the assessments of the nur sing staff. DESIGN: Cross-sectional study. SETTING AND SUBJECTS: All i ndividuals residing in an academically oriented long-term care facilit y in the United States for at least 1 month (n = 694). MEASUREMENTS: C linical, functional, and medication data were abstracted from the medi cal and nursing records. Individual interviews regarding bowel-related symptoms were conducted with all able participants (n = 456 (66%)) an d their respective primary nurses, and concordance was determined. The study definition of symptom-specific constipation was no more than 2 bowel movements per week and/or straining on more than 1 in 4 bowel mo vements. RESULTS: Fifty percent (n = 367) of all residents used at lea st 1 daily laxative, stool softener or enema during a 1-month study pe riod. Over half of all laxative users (it = 200) took more than 60 dos es per month. Stool softeners were most commonly prescribed, followed by saline laxatives, stimulant laxatives, hyperosmolar laxatives, and bulk laxatives. Forty-seven percent (n = 213) of the 456 interview res ponders reported constipation (''self-reporters''), but only 62% of se lf-reporters met the study criteria for symptom-specific constipation. Concordance between resident's and nurse's report regarding specific bowel symptoms was only fair to slight (kappa 0.12-0.38). Self-reporte rs of constipation took almost twice as many laxatives, stool softener s, and enemas as residents who did not report constipation. CONCLUSION : Our findings emphasize the need for a more systematic approach to th e assessment of constipation in the long-term care setting, particular ly when pharmacologic treatment is being considered.