Constipatin in Long.doc

Constipation in Long-Term Care ISSN: 1524-7929 VOLUME: 16 PUBLICATION DATE: Dec 10 2008 author:? Syed H. Tariq, MD, FACP Author Affiliations: Dr. Tariq is former Associate Professor of Internal Medicine and Geriatrics, Medical Director of the Acute Care of Elderly (ACE Unit), Division of Geriatric Medicine, Saint Louis University; and currently a Fellow, Division of Gastroenterology Hepatology, St. Louis University School of Medicine, MO. The intestine tends to become sluggish with age. —Hippocrates No organ in the body is so misunderstood, so slandered and maltreated as the colon. —Sir Arthur Hurst, 1935 Constipation is reported in over 33 million adults, which makes it one of the most common problems in the United States. It accounts for 2.5 million physician visits and 92,000 hospitalizations each year. Constipation is seen in 25% of older persons. The term constipation can be very confusing. While patients describe constipation as passing hard stool or straining to have a bowel movement, physicians, on the other hand, describe constipation as fewer than three bowel movements per week. Thus, both patient and physician are likely to be talking about two different sets of symptoms. For this very reason, there is little correlation between self-reported constipation and number of bowel movements in epidemiologic surveys. The diagnostic criteria for constipation was created by a consensus conference in Rome, Italy, with the most recent updated information known as the Rome III Diagnostic Criteria. Epidemiology Frailty in older persons is very common and is associated with immobility, poor intake, and dehydration.1,2 It is, therefore, not surprising that constipation has been reported in 45% of frail elderly persons.3 The use of laxatives in the nursing home (NH) is reported in 50% to 65% of residents.4-8 Half of these older persons took a daily laxative, yet only 62% of them actually met the criteria for constipation. Hence, there was minimal concordance betw