Chronic constipation in long stay elderly patients: a comparison of lactulose and a senna-fibre combination.
OBJECTIVE
To compare the efficacy and cost effectiveness of a senna-fibre combination and lactulose in treating constipation in long stay elderly patients.


METHODS
Randomised, double blind, cross over study.


METHODS
Four hospitals in Northern Ireland, one hospital in England, and two nursing homes in England.


METHODS
77 elderly patients with a history of chronic constipation in long term hospital or nursing home care.


METHODS
A senna-fibre combination (10 ml daily) or lactulose (15 ml twice daily) with matching placebo for two 14 day periods, with 3-5 days before and between treatments.


METHODS
Stool frequency, stool consistency, and ease of evacuation; deviation from recommended dose; daily dose and cost per stool; adverse effects.


RESULTS
Mean daily bowel frequency was greater with the senna-fibre combination (0.8, 95% confidence interval 0.7 to 0.9) than lactulose (0.6, 0.5 to 0.7; t = 3.51 p < or = 0.001). Scores for stool consistency and ease of evacuation were significantly higher for the senna-fibre combination than for lactulose. The recommended dose was exceeded more frequently with lactulose than the senna-fibre combination (chi 2 = 8.38, p or = 0.01). As an index of the standard daily dose, the dose per stool was 1.52 for lactulose and 0.97 for the senna-fibre combination, at a cost per stool of 39.7p for lactulose and 10.3p for senna-fibre. Adverse effects were no different for the two treatments.


CONCLUSIONS
Both treatments were effective and well tolerated for chronic constipation in long stay elderly patients. The senna-fibre combination was significantly more effective than lactulose at a lower cost.
Passmore
A P
AP
Department of Geriatric Medicine, Queen's University of Belfast.
Wilson-Davies
K
K
Stoker
C
C
Scott
M E
ME
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003248:Constipation / Q000188:drug therapy* / Q000191:economics; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D004338:Drug Combinations; D016527:Drug Costs; D005260:Female; D006760:Hospitalization; D006801:Humans; D007792:Lactulose / Q000191:economics / Q000627:therapeutic use*; D008134:Long-Term Care; D008297:Male; D012676:Senna Extract / Q000191:economics / Q000627:therapeutic use*
D004338:Drug Combinations; D007792:Lactulose; D012676:Senna Extract