Drugs and constipation in elderly in nursing homes: what is the relation?

Gunvor S Fosnes, Stian Lydersen, Per G Farup, Gunvor S Fosnes, Stian Lydersen, Per G Farup

Abstract

Introduction. Constipation is a common adverse drug reaction. Objective. Study associations between drugs and constipation in nursing home residents. Design. Cross-sectional study. Material and Methods. Nursing home residents above 60 years of age were included. Demographics, diet, physical activity, activity of daily living, nutritional status, use of drugs, and diseases were recorded. Constipation was defined as functional constipation or constipation-predominant IBS according to the Rome III criteria and/or regular use of laxatives. Drugs were classified according to the Anatomical-Therapeutic-Chemical Classification System (ATC), and anticholinergic effect was noted. Results. In all, 79 men and 188 women with a mean age of 85.4 (SD 7.1) years were included. The prevalence of constipation was 71.5%. Use of drugs in general, including polypharmacy, was not associated with constipation. Reduced activity of daily living (OR = 0.71, 95% CI : 0.60-0.84, P < 0.001), other antidepressants (N06AX) (OR 3.08, 95% CI : 1.09-8.68, P = 0.03), and benzodiazepine derivatives (N05BA) (OR = 2.80, 95% CI : 1.12-7.04, P = 0.03) were significantly associated with constipation; drugs with markedly anticholinergic effect (OR = 3.7, 95% CI : 0.78-17.53, P = 0.10), natural opium alkaloid (N02AA) (OR = 5.01, 95% CI : 0.95-25.94, P = 0.06), and propionic acid derivatives (M01AE) (OR = 7.00, 95% CI : 0.75-65.08, P = 0.09) showed a trend. Conclusion. In elderly with constipation, focus should be on specific groups of drugs and nonpharmacological factors, not on drugs in general.

Figures

Figure 1
Figure 1
A flow chart of the participants in the study.

References

    1. O’Keefe EA, Talley NJ, Zinsmeister AR, Jacobsen SJ. Bowel disorders impair functional status and quality of life in the elderly: a population-based study. Journals of Gerontology—Series A. 1995;50(4):M184–M189.
    1. Higgins PDR, Johanson JF. Epidemiology of constipation in North America: a systematic review. American Journal of Gastroenterology. 2004;99(4):750–759.
    1. Belsey J, Greenfield S, Candy D, Geraint M. Systematic review: impact of constipation on quality of life in adults and children. Alimentary Pharmacology and Therapeutics. 2010;31(9):938–949.
    1. Gallagher P, O’Mahony D. Constipation in old age. Best Practice and Research. 2009;23(6):875–887.
    1. Hosia-Randell H, Suominen M, Muurinen S, Pitkälä KH. Use of laxatives among older nursing home residents in Helsinki, Finland. Drugs and Aging. 2007;24(2):147–154.
    1. van Dijk KN, ve Vries CS, van den Berg PB, Dijkema AM, Brouwers JRBJ, de Jong-van Den Berg LTW. Constipation as an adverse effect of drug use in nursing home patients: an overestimated risk. British Journal of Clinical Pharmacology. 1998;46(3):255–261.
    1. Rao SS, Go JT. Update on the management of constipation in the elderly: new treatment options. Clinical Interventions in Aging. 2010;5:163–171.
    1. Gurwitz JH, Field TS, Judge J, et al. The incidence of adverse drug events in two large academic long-term care facilities. American Journal of Medicine. 2005;118(3):251–258.
    1. Locke GR, Pemberton JH, Phillips SF. Aga technical review on constipation. Gastroenterology. 2000;119(6):1766–1778.
    1. Milton JC, Hill-Smith I, Jackson SHD. Prescribing for older people. BMJ. 2008;336(7644):606–609.
    1. Ruths S, Straand J, Nygaard HA. Multidisciplinary medication review in nursing home residents: what are the most significant drug-related problems? The Bergen District Nursing Home (BEDNURS) study. Quality and Safety in Health Care. 2003;12(3):176–180.
    1. Halvorsen KH, Ruths S, Granas AG, Viktil KK. Multidisciplinary intervention to identify and resolve drug-related problems in Norwegian nursing homes. Scandinavian Journal of Primary Health Care. 2010;28(2):82–88.
    1. Doshi JA, Shaffer T, Briesacher BA. National estimates of medication use in nursing homes: findings from the 1997 medicare current beneficiary survey and the 1996 medical expenditure survey. Journal of the American Geriatrics Society. 2005;53(3):438–443.
    1. McLean AJ, Le Couteur DG. Aging biology and geriatric clinical pharmacology. Pharmacological Reviews. 2004;56(2):163–184.
    1. Field TS, Gurwitz JH, Avorn J, et al. Risk factors for adverse drug events among nursing home residents. Archives of Internal Medicine. 2001;161(13):1629–1634.
    1. Hajjar ER, Hanlon JT, Artz MB, et al. Adverse drug reaction risk factors in older outpatients. American Journal Geriatric Pharmacotherapy. 2003;1(2):82–89.
    1. MNA—Mini Nutritional Assessment, 2010, .
    1. Longstreth GF, Thompson WG, Chey WD, Houghton LA, Mearin F, Spiller RC. Functional bowel disorders. Gastroenterology. 2006;130(5):1480–1491.
    1. WHO Collaborating Centre for Drug Statistics Methodology, 2010,
    1. Carnahan RM, Lund BC, Perry PJ, Pollock BG, Gulp KR. The anticholinergic drug scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity. Journal of Clinical Pharmacology. 2006;46(12):1481–1486.
    1. van Buuren S, Boshuizen HC, Knook DL. Multiple imputation of missing blood pressure covariates in survival analysis. Statistics in Medicine. 1999;18(6):681–694.
    1. Wong RK, Palsson OS, Turner MJ, et al. Inability of the Rome III criteria to distinguish functional constipation from constipation-subtype irritable bowel syndrome. American Journal of Gastroenterology. 2010;105(10):2228–2234.
    1. Digesu GA, Panayi D, Kundi N, Tekkis P, Fernando R, Khullar V. Validity of the Rome III Criteria in assessing constipation in women. International Urogynecology Journal and Pelvic Floor Dysfunction. 2010;21(10):1185–1193.
    1. Gage H, Goodman C, Davies SL, et al. Laxative use in care homes. Journal of Advanced Nursing. 2010;66(6):1266–1272.
    1. Tune LE. Anticholinergic effects of medication in elderly patients. Journal of Clinical Psychiatry. 2001;62(22):11–14.
    1. Talley NJ, Jones M, Nuyts G, Dubois D. Risk factors for chronic constipation based on a general practice sample. American Journal of Gastroenterology. 2003;98(5):1107–1111.
    1. Pilotto A, Franceschi M, Vitale D, et al. The prevalence of diarrhea and its association with drug use in elderly outpatients: a multicenter study. American Journal of Gastroenterology. 2008;103(11):2816–2823.
    1. Harari D, Gurwitz JH, Avorn J, Choodnovskiy I, Minaker KL. Correlates of regular laxative use by frail elderly persons. American Journal of Medicine. 1995;99(5):513–518.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться