Effectiveness of Laxatives in the Elderly - NIHR Health Technology ...

effectiveness and high acceptability and
compliance have been claimed for some
of these simple treatments.
• Pattee and West (1988) supplemented the
diets of 24 nursing-home residents with a
dietary fibre product consisting of 75%
powdered cellulose (equivalent to 6–12 mg
of dietary fibre) over a 99-day period. Frequency
of bowel movement and laxative interventions
were monitored during the study, and the
rate of intervention was compared with that
in the month preceding the supplementation
programme. The majority of residents either
experienced significant reductions in the rate
of laxative intervention or maintained an
acceptable frequency of bowel movement.
The incidence of intervention with laxatives
was reduced from 72% of the observation
days pre-study to 3–7% during the study.
The powdered cellulose fibre supplement
was found to be convenient and palatable,
with only two residents withdrawing from
the trial.
• Hagberg and colleagues (1987) supplemented
the diets of 21 elderly nursing-home patients
(mean age 89 years) with bran. Fluid intake was
also increased. Bowel movement frequency was
improved with no adverse effects.
• Groth (1988) compared the effect of wheat
bran in preventing constipation in 22 orthopaedic
patients (mean age 69 years). Bran
supplementation increased frequency of
bowel movements and stool consistency.
• Odes (1993) studied the effects of a high
dietary fibre breakfast cereal containing
oats, wheat and soya bean and found
it improved frequency of bowel movement
and stool consistency, and use of laxatives
was reduced.
These and other observational studies report
that the addition of bulking agents such as fibre
to the diet of elderly patients is an effective
means of preventing constipation (Hull et al,
1980; Meier et al, 1990; Pringle et al, 1984;
Richards-Hall et al, 1995; Rodrigues-Fisher
et al, 1993).
Observational studies of the effect of fruit
mixtures have also been described. One comparative
study of the traditional Chinese treatment,
mulberry, found marked improvements
in both bowel movement frequency and
Health Technology Assessment 1997; Vol. 1: No. 13
consistency (Minghan & Zhu, 1989). Beverley
and Travis (1992) described the use of a “natural
laxative mixture” in 35 geriatric patients. The
mixture, which comprised prunes, currants,
figs, dates and prune concentrate, was shown
to be very effective. Frequency of bowel movement
and stool consistency improved and
laxative costs were reduced.
In a non-randomised comparative study,
Gibson and colleagues (1995) added a mixture
of Kellogg’s All Bran ® , apple sauce and prune
juice (2 tablespoons per day) to the diet of
45 patients on a geriatric ward and found that
treated patients were significantly less likely than
controls to require enemas or laxatives, with no
differences in side-effects. A laxative jam of dates
and prunes has also been reported to be effective
in preventing constipation in the hospitalised
elderly by Durand and colleagues (1991), and a
laxative pudding has been claimed to be effective
in a small study among the homebound elderly
(Neal, 1995). Behm (1985) also reported that
the addition of a ‘special recipe’ of bran, apple
sauce and prune juice to the diets of a sample of
nursing-home patients with physical and mental
disabilities resulted in improved stool consistency
and reduced laxative use.
Stewart and colleagues (1997) reported the use
of dietary strategy for preventing constipation
in a sample of UK psychogeriatric patients aged
68–102 years. This involved increased amounts
of cereals, fruit and vegetables, and soups and
other fluids. This added £0.20 per head to the
daily ward food bill but laxative use became
negligible. However, there is no quantitative
data in the study and few other details.
There is also one study in which a community
intervention aimed at reducing laxative sales and
promoting consumption of wholemeal/wholemeal
bread by the elderly is reported (Egger et al, 1991).
Small retirement communities in New South Wales,
Australia, were targeted using the theme, Bread:
It’s a Great Way to Go. There was a 49% decrease
in laxative sales and a 58% increase in sales of
wholemeal/wholegrain bread in the group at
which the community organisation strategy,
involving the media and social marketing,
was aimed.
Fluid intake
The role of fluid in the diet is also worth
mentioning in this context. It has been suggested
that fluid intake may play an important role in
influencing development of constipation
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