Constipation older patients

Iron preparations tend to cause gastrointestinal irritation resulting in nausea, epigastric pain and altered bowel habit (constipation or diarrhoea). In older patients there is a risk that constipation may lead to faecal impaction. Side-effects tend to be dose related. 

Assessment and treatment of older patients with constipation. The Nursing Standard 46 November 1 (21) 8. Available at http //www.nursing-standard.co.uk/archives/ns/ vol21-08/pdfs/v21 n08p4146.pdf [Accessed 27 July 2008]... 

Opioid-induced constipation is more troublesome in older patients, and it should be anticipated by instituting laxative therapy along with the narcotic. A typical laxative regimen consists of psyllium and a stool softener. A mild stimulant laxative such as bisacodyl (Dulcolax) can be added if constipation becomes problematic. 

Eideriy In 2 studies, the incidence of commonly reported anticholinergic adverse events in patients treated with trospium (including dry mouth, constipation, dyspepsia, UTI, and urinary retention) was higher in patients 75 years of age and older as compared with younger patients. This effect may be related to an enhanced sensitivity to anticholinergic agents in this patient population. 

Elderly Patients 65 years of age and older who received tegaserod for chronic idiopathic constipation experienced a higher incidence of diarrhea and discontinuations because of diarrhea than patients younger than 65 years of age. Pregnancy Category B. Use during pregnancy only if clearly needed. 

Because of effects on smooth muscle, the calcium channel blockers (particularly verapamil (96) but also diltiazem) can cause constipation. This may be due to colonic motor activity inhibition (97). Gastroesophageal reflux can also occur, and the calcium channel blockers should be avoided in patients with symptoms suggestive of reflux esophagitis (98). Calcium channel blockers (verapamil, diltiazem, and nifedipine) can also be associated with an increased incidence of gastrointestinal bleeding, as reported in a prospective cohort study in 1636 older hypertensives, with a relative risk of 1.86 (95% Cl = 1.22, 2.82) compared with beta-blockers (7). However, this finding was not confirmed in other retrospective studies (13,99,100). 

The safety, tolerability, and efficacy of risperidone have been assessed in 103 patients with schizophrenia (52 men and 51 women) aged 65 years or older in an open, multicenter, 12-week study (141). The mean risperidone dose at end-point was 2.4 mg/day. Adverse events occurred in 91 patients and included dizziness (n = 23), insomnia (n = 17), agitation (n = 15), somnolence (n = 15), injury (n = 12), constipation (n = 11), and extrapyramidal disorders (n = 10) 11 patients withdrew because of adverse events. Among the 91 patients with normal baseline QTc intervals (below 450 ms), 9 had a prolonged QTc interval during the study (range 450-516 ms). 

As many as 40% of patients older than 65 years of age report experiencing constipation. The results from 42,375 participants of the National Health Interview Survey on Digestive Disorders demonstrated that there is not an age-related increased incidence of infrequent bowel movements however, there is an age-related increased incidence of laxative use. The frequency of subjects reporting two or fewer bowel movements per week was 5.9% for those younger than 40 years of age 3.8% for subjects 60 to 69 years of age and 6.3% for subjects older than 80 years of age. In a prospective study of 3166 people... 

In patients older than 65 years of age, drugs that correlate most often with constipation are anticholinergics, aspirin, furosemide, ni-... 

Typhoid fever is an illness caused by infection with Salmonella typhi. Typhoid is spread via the fecal-oral route. Clinical illness in its severe form is characterized by gradually rising fever that reaches 39 to 41°C (102.2 to 105.8°F) and persists for up to 2 weeks. Headaches, abdominal discomfort, malaise, myalgia, and anorexia usually are present. Older children and adults usually have constipation, whereas diarrhea is common in infants. Complications include intestinal perforation and hemorrhage. Between 2% and 5% of patients become chronic gallbladder carriers of S. typhi. 

There are many antihistamines available and they differ in their duration of action, anticholinergic effects (dry mouth, blurred vision, urinary retention and constipation) and incidence of drowsiness. Older antihistamines are the most likely to cause drowsiness. Newer ones, for example acrivastine, are preferred because they penetrate the blood-brain barrier less easily and cause less sedation. Nevertheless, all antihistamines should be labelled with a warning that they may cause drowsiness and patients should not drive or operate machinery when taking them. 

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