Dietary Fiber Nursing Intervention

Abstract

Constipation is a major complaint of older adults. Approximately 30% of older adults use laxatives at least once weekly, and laxatives account for 1% of physician prescriptions in addition to approximately 700 over-the-counter preparations. This study evaluated the efficacy of a fiber and fluid nursing intervention on the maintenance of bowel movements and elimination aid withdrawal in residents of a long-term health care facility. The findings indicated that the number of bowel movements reached a peak at 3 months and returned to baseline values at the 6-month point while the use of both laxatives and stool softeners decreased significantly. Enema and suppository use was so infrequent at baseline and throughout the study that changes in these variables were statistically insignificant. The results demonstrate that a natural means of maintaining bowel movements using a fiber and fluid nursing intervention can significantly decrease the number of laxatives and stool softeners needed by residents of a long-term facility.

Development of a constipation risk assessment scale

“…To ensure that the desirable daily fluid intake is achieved to prevent constipation, 10 or more cups/glasses would need to be consumed, therefore this was scored 'zero'. A fluid intake of a minimum of 1.5 l/day was considered adequate for constipation prevention (Meza et al, 1984;Rodrigues-Fisher et al, 1993;Gibson et al, 1995;Armstrong-Esther et al, 1996;Ouellet et al, 1996;Duffy and Zernike, 1997) and would measure at 6 cups/glasses per day (Wilson, 1999). The sub-category of '6-9 cups/glasses consumed daily' was then included, which was scored as 'one'.…”

Review of the literature on constipation to enable development of a constipation risk assessment scale

“…Research examining risk factors in an elderly population (n = 36) concluded that fibre and fluid intake was not significantly different in constipated versus non-constipated individuals (Towers et al, 1994). Values provided for fluid intake in the two groups indicate that ''3.4 glasses (8 oz) of fluid'' were consumed on average daily, which is lower than the recommended minimum fluid intake (Alford, 1991;Rodrigues-Fisher et al, 1993;Gibson et al, 1995). Values provided for fluid intake in the two groups indicate that ''3.4 glasses (8 oz) of fluid'' were consumed on average daily, which is lower than the recommended minimum fluid intake (Alford, 1991;Rodrigues-Fisher et al, 1993;Gibson et al, 1995).…”

“…This rationale has been proved by many research studies which have reported increased colonic activity with a diet high in fibre, measured by transit times of food through the gut (Burkitt et al, 1972;Harvey et al, 1973;Burkitt et al, 1974;Cummings et al, 1978;Graham et al, 1982;Kelsay and Clark, 1984;Preston and Lennard-Jones, 1985;Davies et al, 1986;Muller-Lissner, 1988;Rodrigues-Fisher et al, 1993;Cheskin et al, 1995;Cameron et al, 1996;Voderholzer et al, 1997). This rationale has been proved by many research studies which have reported increased colonic activity with a diet high in fibre, measured by transit times of food through the gut (Burkitt et al, 1972;Harvey et al, 1973;Burkitt et al, 1974;Cummings et al, 1978;Graham et al, 1982;Kelsay and Clark, 1984;Preston and Lennard-Jones, 1985;Davies et al, 1986;Muller-Lissner, 1988;Rodrigues-Fisher et al, 1993;Cheskin et al, 1995;Cameron et al, 1996;Voderholzer et al, 1997).…”

“…In long-term tube-fed patients, Shankardass et al (1990) found that an enteral formula containing 12.8 g of fibre improved bowel function in 57.1% of the experimental group (n = 28). A repeated measures design, using a small convenience sample (n = 15) in a long-term care facility, demonstrated that a fluid and fibre dietary regime significantly increased bowel movements and reduced the need for laxative therapy in subjects over a six month period (Rodrigues-Fisher et al, 1993).…”

“…A value of 1.5 litres/day appears to be the minimum fluid intake recommended within the research literature for prevention of constipation (Meza et al, 1984;Rodrigues-Fisher et al, 1993;Gibson et al, 1995;Armstrong-Esther et al, 1996;Ouellet et al, 1996;Duffy and Zernike, 1997) and for treatment of chronic functional constipation (Anti et al, 1998). Benton et al (1997) would actually suggest that 1.5-2.0 litres/day is marginal and only volumes in excess of 2 litres are adequate for constipation prevention.…”