1 Internal Medicine, Herlev, Herlev and Gentofte Hospital, The Capital Region of Denmark
The prevalence of self-reported chronic constipation is high in old age, affecting grossly one out of four older subjects, although solid consistent epidemiological data are lacking for many countries. It is more prevalent in frail elders and in those living in nursing homes, usually associated with a high burden of comorbid problems and the use of drugs that may cause this side effect. Constipation is a significant health problem that impairs function and quality of life. Faecal impaction is a feared complication that may require hospitalization. However, it is not a very popular geriatric syndrome, and care usually relies on patients by the use of over the counter laxatives or herbal remedies, with little or no physician control except for the most severe cases. This paper explores the epidemiology, screening, diagnosis and management of chronic constipation in old age in four very different European countries. Constipation is not usually screened for, except in hospital admissions and some nursing homes, where nurses usually supervise bowel movements; when constipation is present, there is no standard threshold to transfer this information to attending physicians. It may go undiagnosed in community dwelling individuals. The diagnostic workup usually relies on a non-structured medical history and physical exam, and there is a high variability in the use of diagnostic tests. Access to specialists (mostly gastroenterologists) is limited to a few patients, and geriatricians are rarely involved in the care of such patients, except for acute patients for constipation being part of a complex list of geriatric problems. Constipation is usually treated symptomatically, with variable rates of success. Physicians usually recommend non-pharmacologic approaches, but compliance with them is unknown. The choice of laxatives lies more on patients, with osmotic laxatives (lactulose and macrogol) being the most widely used group. The use of herbal remedies is highly variable and in many cases concealed.
European Geriatric Medicine, 2013, Vol 4, Issue 6, p. 421-26