Constipation in an Elderly Community: A Study of Prevalence and Potential Risk Factors

Objective : The epidemiology of chronic constipation in the elderly remains poorly defined. We aimed to study the prevalence of, and potential risk factors for, constipation in a representative elderly community, using symptom-based diagnostic criteria. Methods: An age-and gender-stratified random sample of 1833 eligible residents of Olmsted County, Minnesota, aged 65 yr and over, was mailed a valid self-report questionnaire; 1375 responded (75%). Results : The overall age- and gender-adjusted prevalence (per 100) of any constipation was 40.1 (95% CI 38.9, 44.4); for functional constipation and outlet difficulty or delay, the prevalence rates were 24.4 (95% CI 22.0-26.9) and 20.5 (95% CI 18.2-22.8), respectively. Self-reported constipation did not reliably identify functional constipation or outlet delay. Outlet delay, but not functional constipation, was more frequent in women; functional constipation, but not outlet delay, was associated with advancing age. Nonsteroidal anti-inflammatory drugs and other medications were significant risk factors in subjects with functional constipation and outlet delay combined. Conclusions : In independently living, elderly persons, constipation is a common complaint; among these subjects, there appear to be symptom subgroups that can be identified.     

Development of constipation in nursing home residents

PURPOSE: Constipation is a common complaint among geriatric patients and may result in significant morbidity, especially among nursing home residents. The prevalence of constipation increases with advancing age and may be a result of the aging process, but the exact cause is unknown. The aim of this study was to describe the prevalence of constipation and to determine risk factors for the development of constipation in a large population of nursing home residents. METHODS: The Minimum Data Set is an assessment instrument used in nearly all Medicare-certified and Medicaid-certified nursing facilities. Nursing home residents who were at least 65 years of age and who had assessments at baseline and at three months were included in the study (N = 21,012). Baseline risk factors were included in a multivariate logistic regression to determine their association with the development of constipation. To allow causal implications, nursing home residents with constipation at baseline were excluded. The variables examined included medications, mobility, comorbid illness, and nutrition. RESULTS: The mean age (± standard deviation) of nursing home residents was 83±8 years, and the population was 70 percent female and 83 percent white. At baseline, the prevalence of constipation was 12.5 percent (N=2,627). By the three-month assessment, 7 percent (N=1,291) of nursing home residents had developed constipation. The factors associated independently with the development of constipation were, in order of magnitude, race, decreased fluid intake, pneumonia, Parkinson's disease, and the presence of allergies. Congestive heart failure and the use of a feeding tube were two factors identified as having a protective effect. CONCLUSION: The variables associated with the development of constipation may be used to identify geriatric nursing home residents at risk and to prevent constipation and its potential complications. Further study is needed to demonstrate a causal relationship between the risk factors and the development of constipation.Presented at the North American Gastroenterology Fellows Conference, Vancouver, British Columbia, August 27 to 30, 1999.     

Association between physical activity,fiber intake,and other lifestyle variables and constipation in a study of women

Because the risk factors for constipation in the general population are poorly defined, we examined the association between age, body mass index, and selected lifestyle and dietary factors with the prevalence of constipation in the Nurses' Health Study.A total of 62,036 women, aged 36-61 yr and free of cancer, responded to mailed questionnaires in 1980 and 1982, which assessed bowel movement frequency, dietary, and lifestyle factors. Constipation was defined as two or fewer bowel movements weekly.A total of 3327 women (5.4%) were classified as having constipation. Age and body mass index were inversely associated with constipation (p for trend < 0.0001). In multivariate analysis, women who reported daily physical activity had a lower prevalence of constipation (prevalence ratio [PR] = 0.56, 95% CI = 0.44-0.70). Women in the highest quintile of dietary fiber intake (median intake 20 g/day) were less likely to experience constipation (PR = 0.64, 95% CI = 0.57-0.73) than women in the lowest quintile (median intake 7 g/day). The PR for constipation for women who both reported daily physical activity and were in the highest quintile of fiber intake was 0.32 (95% CI = 0.20-0.54) compared with those with physical activity less than once weekly and those who were in the lowest quintile of fiber intake. Higher frequency of aspirin intake was associated with an increasing prevalence of constipation (PR = 1.38, 95% CI = 1.17-1.62). Current smoking and alcohol use were inversely associated with constipation.Our data suggest that moderate physical activity and increasing fiber intake are associated with substantial reduction in the prevalence of constipation in women.     

Constipation in the elderly living at home. Definition, prevalence, and relationship to lifestyle and health status

The prevalence of self-reported constipation and the factors which contribute to it were investigated in a door-to-door survey of 209 people aged 65 to 93. Thirty percent of men and 29% of women described themselves as constipated at least once a month. However, elderly people define constipation differently than do their physicians: only 3% of men and 2% of women in the community sample reported that their average stool frequency was less than three per week, the customary medical criterion for constipation. The primary symptom which elderly people used to define constipation was having to strain in order to defecate. Multiple factors were found to influence self-reports of constipation. The amount of liquids consumed was significantly related to longest period without a bowel movement in men, but fiber and liquids were not related to self-reported constipation in either sex. The number of chronic illnesses and the number of nonlaxative medications were significantly related to constipation in women but not men, and the number of psychological symptoms correlated significantly with self-reports of constipation in both men and women. Age was not significantly related to self-reported constipation in men or women over the age of 65.     

人体总摄氟量与氟骨症的剂量-效应关系

目的 探讨人体总摄氟量和氟骨症患病情况间的确切剂量-效应关系,为地方性氟中毒防治提供参考依据.方法 根据家庭手压井饮水含氟量的不同,分别从江苏省地方性氟中毒重病区村瓦庙村和非病区村新淮村抽取调查对象,观察日均总摄氟量和氟骨症患病情况,并把两村的调查对象作为一个整体,根据每个调查对象日均总摄氟量分为5个剂量组(＜2.00、2.00～、3.00～、4.00～、≥5.00 mg/d),分析日均总摄氟量和氟骨症患病情况的关系.结果 瓦庙村氟骨症检出率为31.06%(41/132),新淮村未发现氟骨症患者(0/35).调查对象随着日均总摄氟量的升高,氟骨症的检出率明显增加,有显著的剂量-效应关系(Quadriatic fit模型拟合曲线的回归方程为:y=2.624-6.855x+3.424x2,r=0.997).根据剂量-效应关系计算的总摄氟量的基准剂量95%可信限的下限值为2.50 mg/d,由此可得日均总摄氟量的参考剂量为2.50 mg/d.瓦庙村氟骨症患者[(5.09±1.20)mg/d]和非氟骨症者[(3.08±1.12)mg/d]的日均总摄氟量比较,差异有统计学意义(t=-9.32,P＜0.01).结论 在饮水型地方性氟中毒病区,日均总摄氟量和氟骨症检出率间呈正相关剂量-效应关系,日均总摄氟量的参考剂量(2.50 mg/d)低于<人群总摄氟量卫生标准>(WS/T 87-1996)的要求(3.50 mg/d).     

Study of the relationship between cigarette smoking,alcohol drinking and cognitive impairment among elderly people in China

OBJECTIVE: the incidence of cognitive impairment is increasing; however, little is known about the prevalence and risk factors for cognitive impairment of elderly people in China. This report focuses on investigating the relationship between cigarette smoking, alcohol drinking and cognitive impairment in elderly people. METHODS: 3012 participants aged 60 years old and over were enrolled from six communities of Chongqing. Cognitive function was measured by the Mini-Mental State Examination and Activities of Daily Living. The chi(2) test and logistic regression was used to find the relationship between cigarette smoking, alcohol drinking and cognitive impairment. RESULT: the rate of abnormal cognitive function in elderly people was 11.95%. Smoking was closely related to cognitive impairment (chi(2)=6.59, P=0.027). Alcohol drinking was also associated with cognitive impairment (chi(2)=6.31, P=0.025). In all smokers, current smoking was associated with a significantly increased risk of cognitive impairment (RR 2.33; 95% CI=1.37-5.82). In all people who drink every day, there was a significantly increased risk of cognitive impairment (RR 3.47; 95% CI=1.79-6.71). CONCLUSION: smoking and drinking are risk factors for cognitive impairment among elderly people. Cessation of smoking and reduction of drinking could be considered as part of a strategy to reduce the incidence of cognitive impairment.     

Risk factors for chronic constipation based on a general practice sample

OBJECTIVES: Many factors have been associated with the occurrence of constipation, particularly poor diet and lack of exercise. However, the importance of medications and general medical illnesses in constipation remains more uncertain. We aimed to identify risk factors for constipation from among patient clinical, therapeutic, and demographic characteristics. METHODS: The sample was composed of patients explicitly diagnosed with chronic constipation (n = 7251), those diagnosed with constipation of unspecified chronicity (n = 6441), and a sample of controls (n = 7103). All were drawn from a general practice research database representing more than 10 yr of data collection. RESULTS: A large number of clinical and therapeutic factors were independently associated with chronic constipation over and above age and gender. Primary neurological diseases were strongly associated with constipation but accounted for few cases. Opioids (OR = 1.6, population attributable risk [PAR] = 2.6%), diuretics (OR = 1.7, PAR = 5.6%), antidepressants (OR = 1.9, PAR = 8.2%), antihistamines (OR = 1.8, PAR = 9.2%), antispasmodics (OR = 3.3, PAR = 11.6%), anticonvulsants (OR = 2.8, PAR = 2.5%) and aluminum antacids (OR = 1.7, PAR = 3.0%) were associated with the highest risk among medications. CONCLUSIONS: Constipation is common in primary care, and multiple medications seem to be an important contributing factor. Concurrent diseases are also associated but at most are only contributing to a minority of cases.     

Correlates of Constipation in an Ambulatory Elderly Population

Constipation is a common and often perplexing problem for elderly people. The prevalence of self-reported constipation and factors associated with constipation were investigated in 3,166 people over age 65. Twenty-six percent of women and 15.8% of men reported recurrent constipation (p less than 0.0001). There was a significant increase in reported constipation with increasing age (p less than 0.0001). Multiple factors were found to correlate with self-reported constipation. A logistic regression model revealed 13 factors of significance in predicting constipation. The most important factors were age, sex, total number of drugs taken, pain in the abdomen, and hemorrhoids (p less than 0.0001). Specific drugs do not appear to be important factors in constipation in the elderly. Elderly people who report the use of multiple drugs, pain in the abdomen, and hemorrhoids are at increased risk for constipation.     

老年人脉压和脉压指数与代谢综合征的相关性和剂量反应关系

目的:探讨老年人脉压和脉压指数与代谢综合征及其组分的相关性和剂量反应关系。方法:横断面研究,选择2019年武进区65岁及以上健康体检老年人114 212例,代谢综合征患者40 388(35.4%)。调查内容包括问卷调查、体格检查和实验室检查。采用Logistic回归和限制性立方样条分析脉压和脉压指数与代谢综合征患病的相...     

Obesity and chronic gastrointestinal tract symptoms in young adults: a birth cohort study

BACKGROUND: An unexplained epidemic of obesity is occurring but the relationship between obesity and gastrointestinal (GI) tract function is unclear. We aimed to evaluate the association between body mass index (BMI) and specific GI symptoms. METHODS: A birth cohort in Dunedin, New Zealand, aged 26 yr (n = 980, 94% of total original sample) was evaluated using a validated GI symptom questionnaire. Categories of GI symptom complexes were defined a priori. The association of reported GI symptoms with BMI (kg/m(2)) was assessed adjusting for gender. RESULTS: The prevalence of obesity (BMI > or = 30 kg/m(2)) was 12%; 30% were overweight. There was a significant univariate positive association between increased BMI and diarrhea (>3 stools/day, loose stools, or urgency); the sex adjusted odds ratio for obese versus normal weight was 1.8 (95% CI 1.1, 2.9; p= 0.02). Abdominal pain associated with nausea or vomiting was positively associated with increased BMI (OR 2.0, 95% CI 1.0, 2.9; p= 0.04). Being overweight was negatively associated with abdominal pain and constipation (OR 0.4, 95% CI 0.2, 0.9; p= 0.02). Irritable bowel syndrome and reflux symptoms were not significantly associated with increased BMI. Waist-to-hip ratios were not significantly associated with GI symptoms. No study members were taking antiobesity medications. Hemoglobin A1c levels were not associated with any of the GI symptoms. CONCLUSIONS: In a general population sample of young adults, increasing BMI was associated with diarrhea and abdominal pain with nausea/vomiting.     

Is there any association between overweight,physical activity,fat and fiber intake with functional constipation in adolescents?

Abstract

Objectives: To assess the prevalence of functional constipation and its association with overweight, physical activity and the estimation of fat and fiber intake in adolescents.

Methods: In all, 386 adolescents aged 14–19?years from the city of Maceió (Alagoas, Northeast Brazil) were included in this study. Participants responded to standardized questionnaires that assessed bowel habits, physical activity and the estimation of fat and dietary fiber intake. Functional constipation was defined according to the Rome criteria. Weight and height were measured using standard methods. Body mass index (BMI) was used to evaluate whether a participant was overweight.

Results: The prevalence of constipation was 24.9%. The median BMI was higher in female adolescents with constipation (22.6) compared with female adolescents without constipation (20.0; p?=?.001). Physical inactivity (fewer than 300?min of physical activity per week) was more frequent in females (62.7%; 126/201) than in males (42.2%; 78/185; p?=?.000). No association was observed between physical inactivity and functional constipation. Excessive intake of fat in the diet was found in 45.3% (175/386) of participants, while poor dietary fiber intake was found in 84.2% (325/386) of participants. No association was found between a fat-rich diet and constipation. Low dietary fiber intake was associated with constipation in female adolescents (odds ratio = 3.42, 95% confidence interval: 1.08 and 12.06).

Conclusions: The prevalence of constipation was high among this group of adolescents. Constipation was not associated with physical inactivity but was associated with a low dietary fiber intake and higher BMI values in female adolescents.     

Constipation and fecal impaction in the long-term care patient

Constipation is a significant problem in the long-term care patient. There is a high prevalence of both primary and secondary causes of constipation in this population. Common primary causes include deficient dietary fiber, deficient fluid intake, and immobility. Common secondary causes include carcinoma, constipating medications, and neurologic and endocrine diseases. Moreover, complications of constipation such as fecal impaction, fecal incontinence, stercoral ulceration, and obstruction can be catastrophic in the debilitated elderly patient. Many cases of constipation can be treated by supplementing dietary fiber and fluid intake, with attention to nonmedical forms of intervention. In some patients, therapies such as bulk-forming agents, emollients, and periodic enemas may be necessary. In addition, there are some newer therapies available. Chronic stimulant laxative therapy should be reserved for patients with certain conditions that warrant their use.     

Constipation in the elderly from Northern Sardinia is positively associated with depression,malnutrition and female gender

Objectives: Constipation is a common complaint in older adults. The rise in life expectancy may amplify the problem and increase social expenditure. We investigated the major risk factors associated with constipation in a large sample of elderly.

Methods: Outpatients from Northern Sardinia attending a Geriatric Unit between 2001 and 2014 were enrolled. Demographic and anthropometric data, income, education and self-reported bowel function were collected. The presence of constipation was adjusted for cognitive status, assessed by the Mini-Mental State Examination (MMSE) test; single and cumulative illness rating scale (CIRS); current or past symptomatic depression and anxiety measured by the Geriatric Depression Scale (GDS); nutritional status, evaluated using the Mini-Nutritional Assessment (MNA); type and number of different medications used.

Results: 1328 elderly patients (mean age 77.7?±?7.2 years) were enrolled. Constipation was present in 32.1%, more commonly in women (35.4% vs 28.3%) and increased with age. The multivariate analysis showed a significantly greater risk of constipation in patients with a risk of malnutrition (OR?=?1.745, 95% CI: 1.043–2.022; p?=?.034), female gender (OR?=?1.735, 95% CI: 1.068–2.820; p?=?.026) and depression (OR?=?1.079, 95% CI: 1.022–1.140; p?=?.006). Other potential predisposing factors assessed such as MMSE, CIRS, body mass index, marital status, smoking habit, education, income and number of taken drugs did not show a statistically significant association. Aging was a risk for constipation also in patients free of medications.

Conclusions: Knowledge of risk factors associated with bowel alterations in elderly individuals may provide important clues for caregivers to prevent or reduce constipation.     

Prevalence, awareness, treatment, control and risk factors of hypertension in Korea: the Ansan study

OBJECTIVES: To determine prevalence, awareness, treatment, and control of hypertension, and its risk factors in an urban Korean population. DESIGN AND SETTING: A cross-sectional survey in Ansan-city, Korea. SUBJECTS AND METHODS: Population-based samples of people aged 18-92 years in Ansan-city, Korea, were selected, yielding 2278 men and 1948 women, and their blood pressures were measured using a highly standardized protocol. Hypertension was defined as a systolic BP > or = 140 mmHg or diastolic BP > or = 90 mmHg or reported treatment with antihypertensive medications, and subclassified according to 1999 WHO-ISH guidelines. Isolated systolic hypertension (ISH) defined as a systolic BP > or = 140 mmHg and diastolic BP < 90 mmHg was also examined. Data were stratified by age and sex. RESULTS: The overall prevalence of hypertension in this study was 33.7%. Among these, 64.9% had Grade 1 hypertension, 22.5% Grade 2, and 12.5% Grade 3. Age-specific prevalence of hypertension increased progressively with age, from 14.19% in 18 to 24 year-olds to 71.39% in those 75 years or older. Hypertension prevalence was significantly higher in men (41.5%) than in women (24.5%) (P < 0.001). Isolated systolic hypertension had significantly lower prevalence (4.33%) within the population, although in the elderly aged 55 years or more it rose by 11.13%. Overall, 24.6% of hypertensive individuals were aware that they had high blood pressure, as much as 78.6% were being treated with antihypertensive medications, and 24.3% were under control. Hypertension awareness as well as treatment and control rates varied by sex, with women higher in all three rates. Multivariate analysis revealed that age, body mass index and abdomen circumference were significantly associated with prevalence of hypertension both in men and women. CONCLUSIONS: Hypertension is highly prevalent in Korea. Despite the high rate of treatment, the rates of awareness and control are relatively low, suggesting the nationwide demand for preventing and controlling high blood pressure in Korea in order to avert an epidemic of cardiovascular disease.     

Risk factors for adverse drug events among older adults in the ambulatory setting

OBJECTIVES: To gather information on patient-level factors associated with risk of adverse drug events (ADEs) that may allow focus of prevention efforts on patients at high risk. DESIGN: Nested case-control study. SETTING: Large multispecialty group practice in New England. PARTICIPANTS: All Medicare enrollees cared for by a multispecialty group practice during 1 year (N=30,397 person-years from July 1, 1999, through June 30, 2000). For each patient with an ADE, a control was randomly selected. MEASUREMENTS: Data were abstracted from medical records on age, sex, comorbidities, and medication use at the time of the event. RESULTS: ADEs were identified in 1,299 older adults. Independent risk factors included being female and aged 80 and older. There were dose-response associations with the Charlson Comorbidity Index and number of scheduled medications. Patients taking anticoagulants, antidepressants, antibiotics, cardiovascular drugs, diuretics, hormones, and corticosteroids were at increased risk. In the analysis of preventable ADEs, the dose-response relationship with comorbidity and number of medications remained. Patients taking nonopioid analgesics (predominantly nonsteroidal antiinflammatory drugs and acetaminophen), anticoagulants, diuretics, and anti-seizure medications were at increased risk. CONCLUSION: Prevention efforts to reduce ADEs should be targeted toward older adults with multiple medical conditions or taking multiple medications, nonopioid analgesics, anticoagulants, diuretics, and antiseizure medications.     

Is a Type A behavior pattern associated with falling among the community-dwelling elderly?

The aim of this report is to investigate the relationship between Type A behavior patterns and the likelihood of falling among community-dwelling elderly, and to compare differences in the prevalence, reasons, locations, injuries and frequency of falls between Type A and non-Type A personalities. Persons aged 60 or older living in 3 communities of Nanjing, China participated in a baseline survey conducted in 2000 (n=879), and falling incidents were followed for 1 year. The survey employed a self-administered questionnaire designed to elicit demographic data, current health problems and medications taken, intake of alcohol, exercise habits, physical function, environmental hazards and Type A behavior patterns. Several factors associated with falling such as health condition, physical function and environmental factors did not differ between the Type A and non-Type A groups except in the male tendency toward heart disease and their inability to walk fast. The results of logistic regression analyses showed that a Type A behavior pattern was independently associated with falling in males but not in females. Findings in the present study suggest that a Type A behavior pattern might play an important role in the rate of falling incidents in elderly males, since some characteristics of this personality pattern might lead to risk-taking behavior. More studies are needed to evaluate the association of certain behavior patterns with falling incidents.     

Risk factors for alcohol-related liver injury in the island population of China: a population-based case-control study

AIM：To investigate the association of alcohol dose, duration of drinking and obesity with abnormal alcohol-related liver injury indicators, the prevalence of alcohol-related liver injury in the island population of China.METHODS：Randomized multistage stratified cluster sampling from the island population of China was used in the population-based case-control study. Then interview, physical examination, laboratory assessments and ultrasonography were done. RESULTS：Daily alcohol intake ≥ 20 g, duration of drinking ≥ 5 years and obesity were closely related to alcohol-related liver injury （P 〈 0.05）. The odds-ratio （OR） （95% CI） was 1.965 （1.122-3.442）, 3.412 （1.789-6.507） and 1.887 （1.261-2.824）, respectively. The prevalence rate of alcohol-related liver injury in ≥ 20 g daily alcohol intake group and 〈 20 g daily alcohol intake group was 37.14% and 12.06%, respectively. The prevalence rate of alcohol-related liver injury in ≥ 5 years drinking group and 〈 5 years drinking group was 34.44% and 8.53%, respectively. No significant dose-response relation was found between daily alcohol intake and abnormal alcohol-related liver injury indicators as well as between duration of drinking and abnormal alcohol-related liver injury indicators. There was no significant difference in the prevalence of alcohol-related liver injury between beer drinking group and yellow rice wine drinking group, hard liquor drinking group, multiple drinking group.CONCLUSION：The risk threshold of daily alcohol intake is 20 g and duration of drinking inducing alcohol-related liver injury 5 years in the island population of China. Liver injury induced by obesity should be concerned.     

Differential north to south gastric cancer-duodenal ulcer gradient in China

There are suggestions that duodenal ulcer protects individuals from gastric cancer and that rice is ulcerogenic while wheat is gastro-protective. We aimed to examine the relationship of gastric cancer, duodenal and gastric ulcers in different geographical regions in China and identified dietary risk factors for duodenal ulcer and gastric cancer. The prevalence of peptic ulcer and gastric cancer among symptomatic patients in eight major cities, four each from the north and the south representing all the six defined regions of China were studied. Endoscopy and case records over a 10 year period were reviewed and cases of confirmed duodenal and gastric ulcer and gastric cancer, together with the total number of endoscopies performed per year, were recorded. Rates were expressed as cases/1000 endoscopies. Results were compared to another epidemiological study on diet and mortality in the same regions in China conducted at the same time. Duodenal ulcer rates were 2.4-fold higher in southern China than northern China, whereas gastric cancer rates were 1.6-fold higher in the north than in the south. Correlation studies showed for the first time an inverse linear relationship between the gastric cancer rates and the duodenal ulcer rates (r=-0.8076, P=0.015), as well as the duodenal ulcer: gastric ulcer ratios (r=-0.9133, P=0.002). Gastric ulcer rates were higher in southern China but did not correlate with the gastric cancer rates (r=0.1455, P=0.731). Duodenal ulcer rates were found to be related to daily rice intake (r=0.8554, P=0.029) and inversely related to daily wheat flour intake (r=-0.8472, P=0.033). Gastric cancer rates were not related to any dietary risk factors tested. We concluded there was an inverse relationship between gastric cancer rates and duodenal ulcer rates. Although duodenal ulceration and gastric cancer are both linked to Helicobacter pylori infection, the findings of this study indicate independent additional aetiological factors for the pathogenesis of these conditions. Dietary factors such as rice or wheat intake may play a role.