Dr. Shruthi Ananthram 19pgdg036 Abstract


Procedure of collection of data



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Dr.Shruthi-PGDG36-constipation
Procedure of collection of data:
Patients were administered the above questionnaire and the answers recorded by the interviewer during the course visits to the old age home. Each interview took approximately 35 minutes.

Results

A total of 52 patients were enrolled in this study, out of which 23 were suffering from constipation. Of the 52 respondents, 21 were male and 31 were female. The age ranged from 65 years to 84 years, with a median age of 75 years.


Table 1 shows the demographic profile of the subjects of the study such as age, sex, education, marital status, body-mass index and behavioral parameters such as diet and water intake. It also displays the co-morbidities suffered by the patients.

Table 1: Distribution of demographic profile of study subjects.

Demographic features:

n (%)

Total

52 (100)

Sex

Male

21 (40.38)

Female

31 (59.61)

Age Groups

65-69

11 (21.15)

70-74

12 (23.08)

75-79

17 (32.69)

80-84

14 (26.92)

Mean ± SD = 13.5

Median (IQR) = 75

Range60-84

Educational Level

None

17 (32.69)

<10 standard

22 (42.30)

>10 standard

10 (19.23)

Graduate

03 (05.77)

Marital Status

Married

0

Widowed

52 (100%)

Single

0

Co-morbidities

Diabetes

34 (65.38)

Hypertension

27 (51.92)

Asthma

01 (01.92)

Chronic kidney disease

03 (05.77)

CVA

04 (07.69)

Osteo-arthritis

30 (57.69)

Body Mass Index

Under-weight (<18.5)

21 (40.38)

Normal (18.6-22.9)

12 (23.08)

Over-weight (23-24.9)

19 (36.54)

Obese (>25)

0

Dietary Factors

Adequate water intake (>1.5l/day)

37 (71.15)

Vegetables < 3 spoons/day

42 (80.77)

Fruits >2 pieces/day

35 (67.30)

Table 2 shows the constipation symptoms in the study group. These symptoms include Rome IV criteria for functional constipation that included straining, lumpy or hard stools (Bristol stool form type 1 or 2), incomplete evacuation, anorectal blockage, manual maneuvers to facilitate defecation, and reduced stool frequency (less than three bowel movements per week, which was assessed by asking the respondents “On average, how often do you empty your bowels?”). In order to meet the criteria for constipation the respondents had to suffer from at least two of the above complaints, plus rarely having loose stools without prior use of laxatives. Furthermore, we enquired about additional symptoms of constipation that we often encountered in clinical practice: failure to defecate, duration of straining, abdominal bloating, anal pain, abdominal pain, and re-defecation within 1 hour of stool passage. In accordance with the Rome IV criteria, respondents with abdominal pain and/or bloating were not excluded from being constipated.


Respondents who drank less than 1.5 L water and ate less than 3 spoons vegetables per day, had a significant higher prevalence of constipation, compared to the ones with more fluid and vegetable intake. We found no significant difference between the prevalence of constipation in respondents with different levels of education, or BMI classifications.

Table 2: Constipation symptoms in total study group:

Constipation symptoms in total study group:




Overall

Males

Females

Total

52

21 (40.38)

31 (59.61)

Constipation symptoms included in the Rome IV criteria for functional constipation

Straining

23 (44.23)

07 (13.46)

16 (30.77)

Incomplete defecation

04 (07.69)

0

04 (07.69)

Anal blockage

01 (01.92)

0

01 (01.92)

Hard stool

20 (38.56)

07 (13.46)

13 (25.00)

Stool frequency <3 times/week

09 (17.30)

02

07 (13.46)

Using hands to assist defecation

04 (07.69)

01 (01.92)

3

Other constipation symptoms

Daily failure to defecate

09 (17.30)

02 (03.84)

07 (13.46)

Average straining duration of more than 5 min

20 (38.46)

07 (13.46)

13 (25.00)

Abdominal bloating

04 (07.69)

01 (01.92)

3

Anal pain

02 (03.84)

0

02 (03.84)

Abdominal pain

08 (15.38)

01 (01.92)

07 (13.46)


Discussion:

This study demonstrates that not only the prevalence and likelihood of constipation, but also the clinical picture of constipated individuals living in a charitable old age home. The prevalence of severe constipation was found to be 44% in our study participants. It more prevalent among the females as compared to males. A significantly higher proportion of the constipated had physical impairments, physical restraints, problems with nutrition, and higher numbers of drugs for regular use.


Sex and age were found to influence the likelihood of constipation independently of each other. Women were more than twice as likely to suffer from constipation as men. Women suffered from almost all constipation symptoms more often than men. Prevalence of constipation also increased with age. Symptoms like a hard stool consistency, anal blockage, and using the hands during defecation were reported more frequently in the oldest age group. A significantly higher proportion of the constipated had cognitive and/or physical impairments, physical restraints, impaired speech, problems with nutrition, and higher numbers of drugs for regular use.

Conclusion

This study was conducted to study the prevalence of constipation among the elderly living in a special setting – the charitable old age home.


As expected, it was found that constipation is a common problem. Women were more than twice as likely to suffer from constipation as men. Symptom were more severe in the older age groups. Co-morbidities and increased number of drugs consumed increased the likelihood of constipation.
Some finding peculiar to this settings were

  • inadequate food intake due to food not being to the patients choice

  • limited mobility even among the physically fit due to lack of space for walking

  • inadequate food intake due to dental issues

  • lack of privacy and time constraints while using the community toilets

  • general atmosphere of emotional neglect, though inmates are physically well-looked after

Recommendations
Management of constipation in the elderly is always challenging, but it is especially so in the setting of a charitable old age home. The world’s population is rapidly aging, and our economy may not grow enough to keep up with the care of the elderly. Hence, charitable old age homes play a vital role and these inmates while requiring medical care, also require other facilities such as community involvement in their well-being, dietary modifications, dental hygiene and care, resources for developing hobbies, facilities for exercise etc. While this study is too limited to draw any concrete conclusions and make recommendations, care-givers should keep in mind the peculiar requirements of constipated patients in such settings.

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