CHRONIC CONSTIPATION IN LONG-STAY ELDERLY PATIENTS - A COMPARISON OF LACTULOSE AND A SENNA-FIBER COMBINATION

Objectives-To compare the efficacy and cost effectiveness of a senna-f ibre combination and lactulose in treating constipation in long stay e lderly patients.Design-Randomised, double blind, cross over study. Set ting-Four hospitals in Northern Ireland, one hospital in England, and two nursing homes in England. Subjects-77 elderly patients with a hist ory of chronic constipation in long term hospital or nursing home care . Intervention-A senna-fibre combination (10 ml daily) or lactulose (1 5 ml twice daily) with matching placebo for two 14 day periods, with 3 -5 days before and between treatments. Main outcome measures-Stool fre quency, stool consistency, and ease of evacuation; deviation from reco mmended dose; daily dose and cost per stool; adverse effects. Results- Mean daily bowel frequency was greater with the senna-fibre combinatio n (0.8, 95% confidence interval 0.7 to 0.9) than lactulose (0.6, 0.5 t o 0.7; t = 3.51 p less-than-or-equal-to 0.001). Scores for stool consi stency and ease of evacuation were significantly higher for the senna- fibre combination than for lactulose. The recommended dose was exceede d more frequently with lactulose than the senna-fibre combination (chi 2 = 8.38, p less-than-or-equal-to 0.01). As an index of the standard d aily dose, the dose per stool was 1.52 for lactulose and 0.97 for the senna-fibre combination, at a cost per stool of 39.7p for lactulose an d 10.3p for senna-fibre. Adverse effects were no different for the two treatments. Conclusions-Both treatments were effective and well toler ated for chronic constipation in long stay elderly patients. The senna -fibre combination was significantly more effective than lactulose at a lower cost.