Management of Constipation in Aged Care

Constipation is a condition in which bowel movements occur less frequently than usual or consist of small or hard stools with or without straining. It is a very common complaint amongst the elderly population affecting as many as two out of three residents in aged care homes. Constipation can contribute to malnutrition as it leaves residents feeling uncomfortable, full and can reduce their appetite and therefore oral intake.

Normal stool frequency can vary greatly between people anywhere from three times a day to three times a week. Therefore constipation is usually diagnosed based on associated symptoms such as pain, stool hardness, straining or difficulty in passing a stool, rather than stool frequency.

Factors which can contribute to constipation include:

• some medications (eg, pain medications),

• irregular meal times/fluctuant oral intake,

• poor fibre intake

• reduced fluid intake

• reduced physical activity,

• relying on others for assistance to go to the toilet

• or lack of privacy and therefore delaying or ignoring the urge to open the bowels,

Ways to prevent constipation include:

• Eating a diet high in fibre: 25-30g of fibre per day

• Drinking plenty of fluids: aiming for at least 6-8 cups of fluid per day

• Exercise – chair/bed bound residents are at greater risk of constipation. Even a small amount of exercise such as walking to the toilet is better than no exercise at all.

Where is fibre found?

Fibre is found in plant foods such as wholemeal breads and cereals, fruit, vegetables, nuts, seeds and legumes. There are two types of fibre; insoluble and soluble. Both are beneficial for preventing constipation by acting as a fuel for bacteria in the large bowel to multiply and promote a healthy gut as well as attracting and holding water in the bowel to allow for the stool to pass through easier.

Many high fibre foods tend to be bulky or filling without providing many calories, e.g. fruits and vegetables. Eating these may lead to residents feeling full quicker. For residents with poor appetites it may be better to get fibre from more calorie dense foods such as breads, cereals and baked goods made with added wholemeal flour and wheat germ.

Residents of aged care homes often have low fibre intakes for a number of reasons:

• The menu does not contain sufficient high fibre foods.

• Poor menu choices by residents mean that low fibre foods are chosen over high fibre foods.

• Residents who have a poor appetite and skip/do not eat all meals may find it difficult to get enough fibre.

• Residents on texture modified diets tend to eat less fibre because they eat less breads, cereals and fresh fruits.

• Poor dentition may impact on the amount of fibrous fruit and vegetables that residents are able to eat.

In summary, constipation in aged care can be better managed/prevented by ensuring that residents are:

• Eating a diet high in fibre: 25-30g of fibre per day

• Drinking plenty of fluids: aiming for at least 6-8 cups of fluid per day

• Exercising regularly – chair/bed bound residents are at greater risk of constipation. Even a small amount of exercise such as walking to the toilet is better than no exercise at all.