Abstract
Constipation is a common cause of general practice consultations in elderly people, and laxative use is common among this group of patients. However, there appears to be little evidence to guide laxative treatment in this population. This paper reports the results of a systematic review of randomized controlled trials of the efficacy of laxatives in the treatment of constipation in the elderly. While the results of the review suggest that laxatives can improve bowel movement frequency, stool consistency, and symptoms of constipation, with a few exceptions, the relevant trials have serious methodological shortcomings. However, the review finds little evidence of marked differences in effectiveness between laxatives and, in particular, there appears to be no evidence to support the current National Health Service (NHS) trend towards prescribing the more expensive stimulant laxatives. This is an area where good quality trial evidence is now needed.
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Selected References
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- Camilleri M., Thompson W. G., Fleshman J. W., Pemberton J. H. Clinical management of intractable constipation. Ann Intern Med. 1994 Oct 1;121(7):520–528. doi: 10.7326/0003-4819-121-7-199410010-00008. [DOI] [PubMed] [Google Scholar]
- Cheskin L. J., Kamal N., Crowell M. D., Schuster M. M., Whitehead W. E. Mechanisms of constipation in older persons and effects of fiber compared with placebo. J Am Geriatr Soc. 1995 Jun;43(6):666–669. doi: 10.1111/j.1532-5415.1995.tb07203.x. [DOI] [PubMed] [Google Scholar]
- Ewerth S., Ahlberg J., Holmström B., Persson U., Udén R. Influence on symptoms and transit-time of Vi-SiblinR in diverticular disease. Acta Chir Scand Suppl. 1980;500:49–50. [PubMed] [Google Scholar]
- Fain A. M., Susat R., Herring M., Dorton K. Treatment of constipation in geriatric and chronically ill patients: a comparison. South Med J. 1978 Jun;71(6):677–680. doi: 10.1097/00007611-197806000-00022. [DOI] [PubMed] [Google Scholar]
- Finlay M. The use of dietary fibre in a long-stay geriatric ward. J Nutr Elder. 1988;8(1):19–30. doi: 10.1300/j052v08n01_03. [DOI] [PubMed] [Google Scholar]
- Glukhen'kii T. T., Novitskii V. S. K epidemiologii koronarnoi bolezni serdtsa. Vrach Delo. 1974 Sep;0(9):9–11. [PubMed] [Google Scholar]
- Hyland C. M., Foran J. D. Dioctyl sodium sulphosuccinate as a laxative in the elderly. Practitioner. 1968 May;200(199):698–699. [PubMed] [Google Scholar]
- Kamm M. A. Constipation. Br J Hosp Med. 1989 Mar;41(3):244-5, 248-50. [PubMed] [Google Scholar]
- Kinnunen O., Salokannel J. Constipation in elderly long-stay patients: its treatment by magnesium hydroxide and bulk-laxative. Ann Clin Res. 1987;19(5):321–323. [PubMed] [Google Scholar]
- Kinnunen O., Winblad I., Koistinen P., Salokannel J. Safety and efficacy of a bulk laxative containing senna versus lactulose in the treatment of chronic constipation in geriatric patients. Pharmacology. 1993 Oct;47 (Suppl 1):253–255. doi: 10.1159/000139866. [DOI] [PubMed] [Google Scholar]
- Lederle F. A., Busch D. L., Mattox K. M., West M. J., Aske D. M. Cost-effective treatment of constipation in the elderly: a randomized double-blind comparison of sorbitol and lactulose. Am J Med. 1990 Nov;89(5):597–601. doi: 10.1016/0002-9343(90)90177-f. [DOI] [PubMed] [Google Scholar]
- Lennard-Jones J. E. Clinical management of constipation. Pharmacology. 1993 Oct;47 (Suppl 1):216–223. doi: 10.1159/000139861. [DOI] [PubMed] [Google Scholar]
- Marchesi M., Marcato M., Silvestrini C. Esperienze cliniche con un preparato contenente cascara sagrada e boldo nella terapia della stipsi semplice nell'anziano. G Clin Med. 1982 Nov-Dec;63(11-12):850–863. [PubMed] [Google Scholar]
- O'Keefe E. A., Talley N. J., Zinsmeister A. R., Jacobsen S. J. Bowel disorders impair functional status and quality of life in the elderly: a population-based study. J Gerontol A Biol Sci Med Sci. 1995 Jul;50(4):M184–M189. doi: 10.1093/gerona/50a.4.m184. [DOI] [PubMed] [Google Scholar]
- Passmore A. P., Davies K. W., Flanagan P. G., Stoker C., Scott M. G. A comparison of Agiolax and lactulose in elderly patients with chronic constipation. Pharmacology. 1993 Oct;47 (Suppl 1):249–252. doi: 10.1159/000139865. [DOI] [PubMed] [Google Scholar]
- Passmore A. P. Economic aspects of pharmacotherapy for chronic constipation. Pharmacoeconomics. 1995 Jan;7(1):14–24. doi: 10.2165/00019053-199507010-00003. [DOI] [PubMed] [Google Scholar]
- Pers M., Pers B. A crossover comparative study with two bulk laxatives. J Int Med Res. 1983;11(1):51–53. doi: 10.1177/030006058301100111. [DOI] [PubMed] [Google Scholar]
- Probert C. S., Emmett P. M., Heaton K. W. Some determinants of whole-gut transit time: a population-based study. QJM. 1995 May;88(5):311–315. [PubMed] [Google Scholar]
- Rajala S. A., Salminen S. J., Seppänen J. H., Vapaatalo H. Treatment of chronic constipation with lactitol sweetened yoghurt supplemented with guar gum and wheat bran in elderly hospital in-patients. Compr Gerontol A. 1988 Jun;2(2):83–86. [PubMed] [Google Scholar]
- Read N. W., Celik A. F., Katsinelos P. Constipation and incontinence in the elderly. J Clin Gastroenterol. 1995 Jan;20(1):61–70. doi: 10.1097/00004836-199501000-00016. [DOI] [PubMed] [Google Scholar]
- Read N. W., Timms J. M. Constipation: is there light at the end of the tunnel? Scand J Gastroenterol Suppl. 1987;129:88–96. doi: 10.3109/00365528709095858. [DOI] [PubMed] [Google Scholar]
- Rouse M., Chapman N., Mahapatra M., Grillage M., Atkinson S. N., Prescott P. An open, randomised, parallel group study of lactulose versus ispaghula in the treatment of chronic constipation in adults. Br J Clin Pract. 1991 Spring;45(1):28–30. [PubMed] [Google Scholar]
- Sanders J. F. Lactulose syrup assessed in a double-blind study of elderly constipated patients. J Am Geriatr Soc. 1978 May;26(5):236–239. doi: 10.1111/j.1532-5415.1978.tb01967.x. [DOI] [PubMed] [Google Scholar]
- Stern F. H. Constipation--an omnipresent symptom: effect of a preparation containing prune concentrate and cascarin. J Am Geriatr Soc. 1966 Nov;14(11):1153–1155. doi: 10.1111/j.1532-5415.1966.tb02869.x. [DOI] [PubMed] [Google Scholar]
- Thompson W. G., Heaton K. W. Functional bowel disorders in apparently healthy people. Gastroenterology. 1980 Aug;79(2):283–288. [PubMed] [Google Scholar]
- Tramonte S. M., Brand M. B., Mulrow C. D., Amato M. G., O'Keefe M. E., Ramirez G. The treatment of chronic constipation in adults. A systematic review. J Gen Intern Med. 1997 Jan;12(1):15–24. doi: 10.1046/j.1525-1497.1997.12103.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wesselius-De Casparis A., Braadbaart S., Bergh-Bohlken G. E., Mimica M. Treatment of chronic constipation with lactulose syrup: results of a double-blind study. Gut. 1968 Feb;9(1):84–86. doi: 10.1136/gut.9.1.84. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Whitehead A., Whitehead J. A general parametric approach to the meta-analysis of randomized clinical trials. Stat Med. 1991 Nov;10(11):1665–1677. doi: 10.1002/sim.4780101105. [DOI] [PubMed] [Google Scholar]
- Williamson J., Coll M., Connolly M. A comparative trial of a new laxative. Nurs Times. 1975 Oct 23;71(43):1705–1707. [PubMed] [Google Scholar]
- Wolfsen C. R., Barker J. C., Mitteness L. S. Constipation in the daily lives of frail elderly people. Arch Fam Med. 1993 Aug;2(8):853–858. doi: 10.1001/archfami.2.8.853. [DOI] [PubMed] [Google Scholar]