Constipation is casting a shadow over everyday life – a systematic review on older people's experience of living with constipation

Tvistholm, Nina; Munch, Lene; Danielsen, Anne Kjærgaard

doi:10.1111/jocn.13422

Cited by 27 publications

(25 citation statements)

References 33 publications

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“…In the general population of Europe, the mean value of the reported constipation prevalence is 17.1%, and its higher value is frequently associated with older age, female sex, less self-reported physical activity, and certain medications 1 , 2 . In general population, constipation is associated not only with worse health-related quality of life (HRQoL) 3 , 4 but also with higher risk of cardiovascular events and all-cause mortality 5 - 7 .…”

Section: Introductionmentioning

confidence: 99%

Constipation and the Quality of Life in Conservatively Treated Chronic Kidney Disease Patients: A Cross-sectional Study

Ruszkowski¹,

Heleniak²,

Król³

et al. 2020

Int. J. Med. Sci.

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Background: Constipation is a common gastrointestinal disorder that in general population is associated with worse health-related quality of life (HRQoL). The epidemiology of constipation has not been reliably determined in conservatively-treated CKD patients. We aimed to determine the prevalence of constipation and constipation-related symptoms in conservatively-treated CKD patients, to find factors associated with their altered prevalence ratio (PR), and to verify the associations between constipation and HRQoL. Methods: In this cross-sectional study, 111 conservatively-treated CKD outpatients fulfilled questionnaires that included questions addressing HRQoL (SF-36v2®), constipation-related symptoms (The Patient Assessment of Constipation‐Symptoms questionnaire), the Bristol stool form scale (BSFS), Rome III criteria of functional constipation (FC), and frequency of bowel movement (BM). Results: Depending on the used definition, the prevalence of constipation was 6.6-28.9%. Diuretics and paracetamol were independently associated with increased PR of BSFS-diagnosed constipation (PR 2.86, 95% CI 1.28-6.37, P = 0.01) and FC (PR 2.67, 95% CI 1.07-6.64, P = 0.035), respectively. The most commonly reported symptoms were bloating (50.9%) and straining to pass a BM (42.7%). Abdominal discomfort (37.3%) was independently associated with worse scores in all analyzed HRQoL domains. In multiple regressions, FC and having <7 BM/week, but not BSFS-diagnosed constipation, were associated with lower scores in several HRQoL domains. Conclusions: Constipation and related symptoms are prevalent in CKD patients. FC and decreased frequency of defecation, but not BSFS-diagnosed constipation, are associated with worse assessment of HRQoL in conservatively-treated CKD patients.

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Section: Introductionmentioning

confidence: 99%

Constipation and the Quality of Life in Conservatively Treated Chronic Kidney Disease Patients: A Cross-sectional Study

Ruszkowski¹,

Heleniak²,

Król³

et al. 2020

Int. J. Med. Sci.

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“…Evidence regarding the impact of constipation on patients is inconsistent and lacking within specialist palliative care. While a systematic review of four papers on older people’s experiences suggests physical, psychological and social impact, 11 data from an Australian Palliative Care database suggests that most palliative care patients were not unduly distressed by constipation. 12 Furthermore, underestimation of symptom intensity by healthcare professionals leads to increased risk of inadequate treatment, 13 and research in chronic pain has demonstrated incongruence between the patient experience and the healthcare professional’s assessment in the perceived importance and severity of constipation.…”

Section: Introductionmentioning

confidence: 99%

‘Take more laxatives was their answer to everything’: A qualitative exploration of the patient, carer and healthcare professional experience of constipation in specialist palliative care

et al. 2019

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Background: Constipation is a major problem for many older adults, more so for those who are receiving specialist palliative care. However, limited research reports the subjective experiences of constipation, despite evidenced differences between the healthcare professional and patient/carer perspective. Aim: The main aim of this study is to explore the experience of how constipation is assessed and managed within specialist palliative care from the patient, carer and healthcare professional perspective. Design: Exploratory, qualitative design, utilising focus groups and interviews, and analysed using thematic analysis. Setting/participants: Six focus groups with 27 healthcare professionals and semi-structured interviews with 13 patients and 5 family caregivers in specialist palliative care units across three regions of the United Kingdom. Results: Constipation impacted physically, psychologically and socially on patients and families; however, they felt staff relegated it on the list of importance. Lifestyle modifications implemented at home were not incorporated into their specialist palliative care plan within the hospice. Comparatively, healthcare professionals saw constipation solely as a physical symptom. Assessment focused on the physical elements of constipation, and management was pharmacologically driven. Healthcare professionals reported patient embarrassment as a barrier to communicating about bowel care, whereas patients wanted staff to initiate communication and discuss constipation openly. Conclusion: Assessment and management of constipation may not yet reflect the holistic palliative care model. A focus on the pharmacological management may result in lifestyle modifications being underutilised. Healthcare professionals also need to be open to initiate communication on bowel care and consider non-pharmacological approaches. It is important that patients and families are supported in self-care management, alongside standardised guidelines for practice and for healthcare professionals to facilitate this. KeywordsConstipation, symptom management, palliative care, hospice, quality of care, qualitative research

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“…2 While it is recognised that a co-ordinated multidisciplinary team approach may increase the survival of those with DMD and improve their quality of life (QoL) 3 adults are receiving less comprehensive and co-ordinated care compared with those in the paediatric service. 4 Aim To investigate QoL in adults with DMD living in the West of Scotland (WoS). Methods The SEIQoL-DW tool was used to assess the five most important elements that contribute to an individual's QoLthese were then used to guide qualitative interviews with six men in the WoS.…”

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29 Multi-disciplinary palliative care for men living with duchenne: a qualitative interview study

Laidlaw

Carduff

2018

BMJ Support Palliat Care

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BackgroundDuchenne muscular dystrophy (DMD) is an x-linked ultra-rare neuromuscular condition affecting 1 in 3600–6000 live male births.1 Individuals live with an exceptional illness trajectory of prolonged dwindling frailty and high symptom burden.2 While it is recognised that a co-ordinated multidisciplinary team approach may increase the survival of those with DMD and improve their quality of life (QoL)3 adults are receiving less comprehensive and co-ordinated care compared with those in the paediatric service.4 AimTo investigate QoL in adults with DMD living in the West of Scotland (WoS).MethodsThe SEIQoL-DW tool was used to assess the five most important elements that contribute to an individual’s QoL – these were then used to guide qualitative interviews with six men in the WoS. A thematic analysis was undertaken.ResultsMen living with DMD in the WoS described living good lives but feel ‘forgotten’ due to perceived gaps in their care: poorly co-ordinated and infrequent health care; lack of multi-disciplinary team input and holistic care; and poor or no access to allied health care professionals for example physiotherapy and psychological support.ConclusionsExisting guidelines rarely seem materialise as person-centred care. There are numerous opportunities to introduce palliative care gently as part of the MDT early in the illness trajectory and continue in a dynamic manner as time elapses and when trigger points arise. Better co-ordinated multi-disciplinary care with the inclusion of a palliative care specialist may be a solution allowing for an early introduction to palliative care and proactive advance care planning.References. Bushby K, et al. Diagnosis and management of duchenne muscular dystrophy part 1: Diagnosis and pharmacological and psychosocial managment. Lancet Neurol2010;9:77–93.. Landfeldt E, et al. The burden of duchenne muscular dystrophy. Neurology2014;83:529–36.. Bushby K, et al. Diagnosis and management of duchenne muscular dystrophy part 2: Implementation of multidisciplinary care. Lancet Neurol2010;9:177–89.. Rodger S, et al. Adult care for duchenne muscular dystrophy in the UK. J Neuro2015;262:629–41.

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Constipation is casting a shadow over everyday life – a systematic review on older people's experience of living with constipation

Cited by 27 publications

References 33 publications

Constipation and the Quality of Life in Conservatively Treated Chronic Kidney Disease Patients: A Cross-sectional Study

Constipation and the Quality of Life in Conservatively Treated Chronic Kidney Disease Patients: A Cross-sectional Study

‘Take more laxatives was their answer to everything’: A qualitative exploration of the patient, carer and healthcare professional experience of constipation in specialist palliative care

29 Multi-disciplinary palliative care for men living with duchenne: a qualitative interview study

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