IBS Articles

A new report The Burden of Constipation in our Ageing Population – Working Towards Better Solutions uncovers for the first time, the true scale of the problem of chronic constipation in adults over the age of 65. A group of experts has analysed all publicly available European evidence and the alarming results show how this condition is under-estimated, under-treated and overlooked.

The report reveals how chronic constipation, be it functional or secondary to identifiable causes, affects as much as 80 per cent of the older adult population living in care homes and one in five adults aged over 65 years in the community.^1-3 If left untreated, it can result in serious medical consequences, such as faecal impaction, a condition where retention of solid faeces prevents normal evacuation. Faecal impaction can affect up to 50 per cent of older adults in hospital wards or care homes and can lead to faecal incontinence.^4-6 The research included in the report clearly highlights how the absence of preventative strategies for constipation has a significant impact on quality of life of older people. It also illustrates the unnecessary ill-health caused through sub-optimal management of this condition and the clear unmet need to address this unacceptable problem.

The impact of constipation on quality of life is significant and comparable to that of more recognised conditions such as diabetes, osteoarthritis or osteoporosis in terms of physical and psychological impact.⁷ Constipation not only results in a reduced quality of life of older adults, but is also associated with significant economic costs relating to nursing time, investigation, intervention, medication and on-going management by health and social services.^8-11 With the proportion of over-65s rising and estimated to reach 29.5 per cent of the total population in the European Union by 2060, this situation is only set to get worse.¹²

The experts reached and issued a six key priority consensus with practical recommendations that they believe will make a positive and immediate difference to the way chronic constipation in older adults living in care homes or the community is diagnosed and treated:

1. Functional constipation should not be underestimated or trivialised and should not simply be considered as an inevitable consequence of ageing or frailty

2. Chronic constipation should be classified and recognised as a condition in its own right, not just a set of symptoms associated with other disorders

3. Recognition and awareness of the typical symptoms and causes of constipation, as well as understanding how to effectively prevent and treat it, should be a training priority across the whole multi-disciplinary team and for social care professionals working with older people

4. Constipation needs to be better diagnosed so it can be promptly treated and managed more effectively in line with agreed best practice and recognised standards

5. The taboo nature of constipation needs to be addressed amongst the general public such that older people start to feel more comfortable and less embarrassed about self-reporting suspected constipation, knowing that they will be taken seriously and always treated with respect

6. Highlight the true cost of failing to effectively manage constipation in older people, in terms of economic and societal burden to health services, as well as the cost in terms of individual suffering and reduction in quality of life.

Another important finding that emerged is the lack of agreement among healthcare professionals, other healthcare providers, policy makers and also patients on the appropriate diagnosis and management of constipation, as well as distinct gaps in the availability of guidance and guidelines across Europe. Evidence-based guidance does exist, for example, from The Netherlands, Great Britain, Italy and Germany; however, these either focus only on children and young people or incontinence rather than constipation specifically.

David Sinclair, Assistant Director, Policy & Communications, ILC-UK comments: “Despite estimated figures of 80 per cent of care home residents suffering from constipation, this is a problem in older adults that is clearly not being taken seriously enough. We hope this report will provide a lever to improve earlier recognition of constipation and, importantly, to encourage all those involved in the care of older adults to take the positive and immediate steps outlined in this report that will lead to improved care.”

Professor Enrico Corazziari, Professor of Gastroenterology, University “La Sapienza”, Rome, Italy comments on the report: “Constipation can be a source of real mental and physical distress for older adults. The lack of evidence-based guidance on the management of constipation in older adults across Europe means that management is sub-optimal; patients are suffering unnecessary ill-health and failing to receive appropriate or timely treatment. We hope that the calls to action outlined in this new report generate urgent impetus for a wholesale review of how we manage this common and preventable condition.”

Peter Martin, Chief Operating Officer at Norgine comments: “As a company with long standing expertise in gastroenterology, we are committed to improving the quality of life of patients who suffer from constipation. By funding this report, in collaboration with the ILC-UK, we want to work with healthcare systems across Europe to find cost effective solutions to improve outcomes for patients.”

A full copy of the report can be downloaded at http://www.ilcuk.org.uk/index.php/publications, http://www.ilc-alliance.org/index.php/reports

References

1. Potter J and Wagg A, ‘Management of bowel problems in older people: an update’, Clin Med, 2005, vol. 5, no. 3, pp. 289-95.

2. Talley N, ‘Definitions, epidemiology, and impact of chronic constipation’ Rev Gastroenterol Disord, 2004, 4 Suppl 2:S3-S10.

3. Bosshard W, Dreher R, Schnegg J et al. ‘The treatment of chronic constipation in elderly people. An update’, Drugs Aging, 2004, vol. 21, no. 14, pp. 911-30.

4. Barcelo M, Garcia-Sanchez R, Diaz-Rubio M, et al. ‘Prevalence of fecal impaction among residents in nursing homes in Spain and associated factors’, Gastroenterology, 2012, vol. 142, no. 5, pp. 445-46.

5. Spinzi G, ‘Bowel care in the elderly’, Dig Dis, 2007, vol. 25, pp. 160-65.

6. Stevens T, Soffer E and Palma R, ‘Fecal incontinence in elderly patients: Common, treatable, yet often undiagnosed’, Cleveland Clinic J Med, 2003, vol. 70, no. 5, pp. 441-8.

7. Belsey J, Greenfield S, Candy D et al. ‘Systematic review: impact of constipation on quality of life in adults and children’, Aliment Pharmacol Ther, 2010, vol. 31, pp. 938-49.

8. Norton C, ‘Constipation in older patients’, Brit J Nurs, 2006, vol. 15, no. 4, pp. 188-92.

9. Addison R, Davies C, Haslam D et al. ‘A national audit of chronic constipation in the community’, Nursing Times, 2003, vol. 99, no. 11, pp. 34-35.

10. Larkin P, Sykes N, Centeno C, et al. ‘The management of constipation in palliative care: clinical practice recommendations’ Palliat Med, 2008, vol. 22, no. 7, pp. 796-807.

11. Hosia-Randell H, Suominen M, Muurinen S et al. ‘Use of laxatives among older nursing home residents in Helsinki, Finland’, Drugs Aging, 2007, vol. 24, no. 2, pp. 147-54.

12. EUROSTAT European Commission, Population structure and ageing, 2012, retrieved 19 April 2013, http://epp.eurostat.ec.europa.eu/statistics_explained/index.php/Population_structure_and_ageing#Future_trends_in_population_ageing.