title: Risk factors associated with lower defecation frequency in hospitalized older adults: a case control study.
abstract: BACKGROUND
  Constipation is highly prevalent in older adults and may be associated with greater frequency of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). We investigated the prevalence of lower defecation frequency (DF) and risk factors (including AECOPD) associated with lower DF among hospitalized elderly patients.
  
  
  METHODS
  We conducted a retrospective case-control study in a community hospital of Southeast Ohio. Adults aged 65 years or older admitted during 2004 and 2006 were reviewed (N = 1288). Patients were excluded (N = 212) if their length of stay was less than 3 days, discharge diagnosis of Clostridium difficile-associated diarrhea, death or ventilator- dependent respiratory failure during hospitalization. Lower DF was defined as either an average DF of 0.33 or less per day or no defecation in the first three days of hospitalization; cases (N = 406) and controls (N = 670) were included for the final analysis.
  
  
  RESULTS
  Approximately 38% had lower DF in this patient population. Fecal soiling/smearing of at least two episodes was documented in 7% of the patients. With the adjustment of confounders, AECOPD (adjusted odds ratio [AOR] =1.47, 95% confidence interval [CI] =1.01-2.13) and muscle relaxant use (AOR =2.94; 95% CI =1.29-6.69) were significantly associated with lower DF. Supplementation of potassium and antibiotic use prior to hospitalization was associated with lower risk of lower DF.
  
  
  CONCLUSIONS
  Approximately 38% of hospitalized older adults had lower DF. AECOPD and use of muscle relaxant were significantly associated with lower DF; while supplementation of potassium and antibiotic use were protective for lower DF risk after adjusting for other variables.
authors.affiliation: Department of Geriatric Medicine/Gerontology, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, 45701, USA. gau@ohio.edu.
authors.forename: Jen-Tzer
authors.initials: JT
authors.lastname: Gau
authors.affiliation: Division of Hematology-Oncology, Department of Internal Medicine, University of Arizona Cancer Center, Tucson, AZ, 85724, USA. uacharya@email.arizona.edu.
authors.forename: Utkarsh H
authors.initials: UH
authors.lastname: Acharya
authors.affiliation: Division of Pulmonary, Critical Care, Sleep Medicine & Allergy, University of Nebraska Medical Center, Omaha, NE, 68198, USA. MSKhanDO@gmail.com.
authors.forename: M Salman
authors.initials: MS
authors.lastname: Khan
authors.affiliation: Division of Epidemiology and Biostatistics, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD, 20814, USA. tkao@usuhs.edu.
authors.forename: Tzu-Cheg
authors.initials: TC
authors.lastname: Kao
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003672:Defecation / Q000502:physiology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016017:Odds Ratio; D029424:Pulmonary Disease, Chronic Obstructive / Q000503:physiopathology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents