title: Assessment of constipation management in long-term care patients.
abstract: OBJECTIVE
  To determine the prevalence of diagnosed constipation among nursing home patients; to assess the prevalence of routine (at least one time per week for 4 consecutive weeks) laxative use; and to investigate prescribing practices.
  
  
  METHODS
  A retrospective multi-center medical record evaluation.
  
  
  METHODS
  Any one of 25 nursing facilities representative of a long-term care pharmaceutical provider's geographical coverage.
  
  
  METHODS
  All patients under the age of 65, and/or who had resided in the facility for less than 4 weeks, and/or who were placed in a specialty care bed (eg, Alzheimer's disease, hospice, HIV/AIDS) were excluded.
  
  
  RESULTS
  A total of 712 resident charts meeting initial inclusion criteria were screened, 392 (55%) of which had a documented diagnosis of constipation and/or routine laxative use. Approximately 28% (CI +/- 3.3) of residents had a documented diagnosis of constipation. The rate of laxative use within the same sample population of 712 patients was 53.8% (CI +/- 3.7). Of the 392 patients with a diagnosis of constipation and/or routine laxative use, over 72% had at least one diagnosis or medication known to precipitate constipation. The most commonly prescribed laxatives were stool softeners (26.2%), saline laxatives (18.4%) and stimulant/irritant laxatives (15.6%). Almost half of the laxative users were prescribed more than one agent.
  
  
  CONCLUSIONS
  This study supports the concern that there is often a gap between documentation of symptoms and constipation treatment decisions. No correlation was found between the specific laxative prescribed and the presence or absence of a documented diagnosis of constipation. Treatment decisions should be based on thorough examination and individualized patient needs. Furthermore, there is a need to increase monitoring for drug effectiveness.
authors.affiliation: Long Term Care Services, Sutter Health, Sacramento, CA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Phillips
authors.forename: D
authors.initials: D
authors.lastname: Polakoff
authors.forename: S K
authors.initials: SK
authors.lastname: Maue
authors.forename: R
authors.initials: R
authors.lastname: Mauch