Elderly constipation

Adverse effects consist mainly of gastrointestinal intolerance such as nausea, epigastric pain and diarrhea and, especially in the elderly constipation with continued therapy. All ferrous salts may cause a black coloration of the faeces. Children are particularly susceptible to potentially lethal iron intoxications. Oral iron preparations should not be administered concurrently with tetracyclines as mutual interference with absorption will occur. 

That initial assessment should consider whether diarrhoea is watery, or sugar or fat malabsorptive, or whether there is active bleeding or significant abdominal pain suggesting inflammatory disease. In the elderly constipation with overflow may be the real problem, and the possibilities of partial mechanical obstruction and neoplasia must be born in mind. 

Kleessen, B., Sykura, B., Zunft, H.-J., and Blaut, M., Effects of inulin and lactose on fecal micro flora, microbial activity, and bowel habit in elderly constipated persons, Am. J. Clin. Nutr., 65, 1397-1402, 1997. 

Antagonists of muscarinic acetylcholine receptors had widely been used since 1860 for the treatment of Parkinson s disease, prior to the discovery of l-DOPA. They block receptors that mediate the response to striatal cholinergic interneurons. The antiparkinsonian effects of drugs like benzatropine, trihexyphenidyl and biper-iden are moderate the resting tremor may sometimes respond in a favorable manner. The adverse effects, e.g., constipation, urinary retention, and mental confusion, may be troublesome, especially in the elderly. 

Because many elderly persons experience constipation, laxative use is sometimes viewed as a normal part of daily life. However, mineral oil can be a special hazard in bedridden elderly persons because it can lead to pneumonia through inhalation of oil droplets into the lungs. Lactulose may be a better choice in this situation. Regular use of any laxative that affects fluid and electrolytes may result in significant unwanted adverse effects. 

On the other hand, constipation may occur in some patients receiving tube feedings, especially the elderly. Increased provision of fluid or fiber may be useful in attaining bowel regularity. As with diarrhea, constipation maybe drug-related, in which case discontinuation or replacement of the offending drug may help to alleviate the problem. 

Cathartic. Elder has a history of being used as a remedy for acute constipation. Parts used leaves, inner bark. 

Elderberry is not only nourishing, it also promotes a healthy metabolism. It helps break up mucus congestion, helps prevent free radicals from damaging healthy cells, treats constipation by loosening old fecal matter lodged in the colon and helps to stimulate natural peristaltic movement. Elder also helps eliminate water and fat that is unnecessarily stored in the body. 

Ouwehand AC, Lagstrom H, Suomalainen T, Salminen S Effect of probiotics on constipation, fecal azoreductase activity and fecal mucin content in the elderly. Ann Nutr Metab 2002 46 159-162. 

Anti muscarinics Hyperthermia due to blockage of sweating mechanisms, decreased salivation and lacrimation, acute-angle-closure glaucoma in the elderly, urinary retention, constipation, blurred vision, delirium, and hallucinations... 

Lactulose is a disaccharide that causes an osmotic effect retained in the colon. It is generally not recommended as a first-line agent for the treatment of constipation because it is costly and not necessarily more effective than agents such as milk of magnesia. It may be justified as an alternative for acute constipation and has been found to be particularly useful in elderly patients. 

The most frequently reported side effects are dizziness, nausea, headache, diarrhea, vomiting, upper respiratory tract infections, constipation, dyspepsia, ataxia, and nervousness. It generally has fewer side effects than pheny-toin, valproic add, or carbamazepine. Hyponatremia has been reported in up to 25% ofpatients and is more likely in the elderly. About 25% to 30% of patients who have had a rash with carbamazepine will have a cross-reaction with oxcarbazepine. 

Anticholinergic side effects include dry mouth, blurred vision, constipation, and urinary retention. More serious reactions include forgetfulness, sedation, depression, and anxiety. Patients with preexisting cognitive deficits and the elderly are at greater risk for central anticholinergic side effects. 

With long-term use, the most problematic side effect is weight gain. However, many antihistamines including diphenhydramine also possess potent anticholinergic effects. This can cause dry mouth, blurred vision, constipation, confusion, and urinary retention. Because anticholinergic effects are especially problematic for the elderly, we advise against the routine use of antihistamines to treat elderly patients with insomnia. 

Digoxin (cardiac glycoside) and trihexyphenidyl (antimuscarinic drug) must be used with caution in elderly patients. Low doses are recommended in elderly patients to avoid toxicity. Lactulose may be safely administered to elderly patients with constipation. 

Elderly Advanced age was associated with a decrease of tiotropium renal clearance, which may be explained by decreased renal function. In the placebo-controlled studies, a higher frequency of dry mouth, constipation, and urinary tract infections was observed with increasing age in the tiotropium group. Pregnancy Category C. 

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. 

Anticholinergic side-effects are dry mouth, urinary retention and constipation. Confusion and drowsiness occur especially in the elderly and because of their poor risk-benefit ratio old age is a relative but serious contraindication for the use of these agents. 

As for all opioids common adverse effects are constipation, slowed gastric emptying and biliary spasm. Urinary retention may occur. There is an increased risk of respiratory depression in young children and in the elderly. Allergic reactions are rare, but wheals and pain at the injection site due to histamine release may occur. CNS depressants will potentiate the depressant effects of morphine and that of other opioids. 

The common side effects seen in chronic therapy (Table 19.3) are mostly related to vasodilation—headaches, dizziness, facial flushing, hypotension, and so forth. High doses of verapamil in elderly patients are known to cause constipation. Serious side effects, especially following the intravenous use of verapamil, include marked negative inotropic effects and depression of preexisting sick sinus syndrome, A-V nodal disease, and... 

PO031 Passmore, A. P., K. Wilson-Davies, C. Stoker, and M. E. Scott. Chronic constipation in long stay elderly patients a comparison of lactulose and a senna-fiber combination. Brit Med J 1993 307(6907) 769-771. 

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