title: Constipation: assessment and management in an institutionalized elderly population.
abstract: OBJECTIVE
  To examine prescribing and utilization patterns of laxatives, stool softeners, and enemas in a large, long-term care facility, to compare self-reports of constipation with specific, bowel-related symptoms in residents of this facility, and to examine concordance between bowel symptoms reported by residents and the assessments of the nursing staff.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  All individuals residing in an academically oriented long-term care facility in the United States for at least 1 month (n = 694).
  
  
  METHODS
  Clinical, functional, and medication data were abstracted from the medical and nursing records. Individual interviews regarding bowel-related symptoms were conducted with all able participants (n = 456 (66%)) and their respective primary nurses, and concordance was determined. The study definition of symptom-specific constipation was no more than 2 bowel movements per week and/or straining on more than 1 in 4 bowel movements.
  
  
  RESULTS
  Fifty percent (n = 367) of all residents used at least 1 daily laxative, stool softener or enema during a 1-month study period. Over half of all laxative users (n = 200) took more than 60 doses per month. Stool softeners were most commonly prescribed, followed by saline laxatives, stimulant laxatives, hyperosmolar laxatives, and bulk laxatives. Forty-seven percent (n = 213) of the 456 interview responders reported constipation ("self-reporters"), but only 62% of self-reporters met the study criteria for symptom-specific constipation. Concordance between resident's and nurse's report regarding specific bowel symptoms was only fair to slight (kappa 0.12-0.38). Self-reporters of constipation took almost twice as many laxatives, stool softeners, and enemas as residents who did not report constipation.
authors.affiliation: Division on Aging, Harvard Medical School.
authors.forename: D
authors.initials: D
authors.lastname: Harari
authors.forename: J H
authors.initials: JH
authors.lastname: Gurwitz
authors.forename: J
authors.initials: J
authors.lastname: Avorn
authors.forename: I
authors.initials: I
authors.lastname: Choodnovskiy
authors.forename: K L
authors.initials: KL
authors.lastname: Minaker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002400:Cathartics / Q000627:therapeutic use*; D003248:Constipation / Q000175:diagnosis / Q000628:therapy*; D003430:Cross-Sectional Studies; D004733:Enema / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007326:Institutionalization; D008134:Long-Term Care; D008297:Male; D009735:Nursing Homes
chemical_list: D002400:Cathartics