Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 526

Complaints of constipation and the use of laxatives remain common in older people. When controlling for comorbidities, constipation is no more common in elderly than in younger people. Stool frequency remains unchanged with ageing. Elders more commonly complain of straining and hard stools. Risk factors for constipation include medication use, chronic medical illness, and psychological distress. Healthy elders are no more likely to develop constipation than younger people. Constipation adversely affects elders’ sense of well‐being and quality of life. The economic impact is also significant due to the cost of laxatives alone. In patients with up‐to‐date colorectal cancer screening who lack worrisome symptoms such as bleeding or weight loss, empirical treatment is appropriate.

A step‐wise approach should be taken in the management of constipation. First, review medications causing constipation, and increase dietary fibre and fluid intake. There is limited evidence that making lifestyle changes resolves constipation, but it is universally accepted as an initial approach. Bulking agents can be added first‐line, then an osmotic laxative, and then a stimulant laxative if required. The safest, best‐tolerated and, least expensive laxatives should be implemented before prescribing the more expensive second‐line laxatives. Avoid bulking agents in the context of faecal impaction. A paucity of evidence is available to support the use of stool softeners. Patients who fail to respond require a more detailed evaluation.

Identifying the most effective treatment strategy for constipation in elders, whether in the community or long‐term care setting, remains unclear due to the lack of high‐quality therapeutic trials for most laxatives. Improved research in this area is needed to identify the most effective, economically viable therapeutic agents.