Use of laxatives in institutions for the mentally retarded

Objective: To study, in institutionalized mentally retarded patients, the p revalence of regular laxative use, and to identify its correlates. Methods: Twenty-one of the 22 institutions for the mentally retarded in Fla nders (Belgium) provided the setting for the study, which included a popula tion of 3712 residents with an IQ of < 50. This was a descriptive cross-sec tional study of a random sample of 20 patients per institution, consisting of a structured interview of the personnel responsible for daily care of th e selected patients. The study population consisted of 420 mentally retarde d patients. Their median age was 29 years (range 2-72 years). Twenty-six pe rcent of patients had an IQ of 35-49, 40% an IQ of 20-34 and 34% an IQ of < 20. Sixteen percent of the patients were non-ambulant. Results: Regular laxative use was found in 26.4% (111/ 420) of the resident s. In addition, occasional laxative use was found in 2% (10/420) of the res idents. Oral laxatives were used daily by 13% (56/420) and oral laxative!; daily in combination with enemas were used by 9% (391/420). Enemas but no o ral laxatives were used by 3% (11/420); manual evacuation in combination wi th oral laxatives and enemas was used by 1% (5/420). Seventy-eight percent (78/100) of the oral laxative users used them for more than 1 year. Seventy -one percent (71/100) used one laxative, 23% two and 6% three. Thirty diffe rent brands of oral laxatives were used. Sixty-seven percent (67/100) used osmotic laxatives alone or in combination, 30% used stimulant laxatives, 19 % used bulk forming laxatives and 19% mineral oil. Oral laxatives were alwa ys prescribed by attending physicians, while enemas were also initiated by nurses in 35% (18/52). Laxative use was positively and independently correl ated with female gender, with being non-ambulant, with oral motor dysfuncti on and with the use of medication other than laxatives. It did not correlat e with age. Within the institutions, laxative use varied from one to 15 use rs out of the 20 randomly selected patients (median 4/20). Conclusion: Laxative use is frequent in institutions for the mentally retar ded, with a large inter-institution variation, indicating that constipation is an important problem and underlining the need for research into cost-ef fective treatment.