Geriatrics and constipation

Long Term Care Columnist / Guide · Dec 10, 2003

Most elderly folks' "fixation" on their bowels comes from what they were taught from the cradle: if you didn't have at least one BM a day, you might get sick from the "poisons" in your system. I remember my own mother and grandmother believed it too and passed it on to me; so we Baby Boomers will probably be somewhat hung up on the BM thing too, although not to the degree our forbears were. I was in my late 30s before I myself realized that people have different bowel patterns, and that not all are unhealthy just because they might skip a day or two.

Unfortunately for the elderly, they tend to not drink enough water or other fluids, and thus they are often somewhat dry....which, of course, can lead to constipation. They forget to drink, or they don't like to drink because they're on diuretics and they have to go to the bathroom so often. If you can educate them as to the benefits of adequate fluid intake, this can help alleviate some of the problem. Other things to try could include increasing the amount of fiber in their diet, and of course exercise (walking is the best).

I wish you luck. It's never easy to "teach an old dog new tricks", and you really can't expect folks who have been worrying about their bowels for 80 or 90 years to STOP worrying. Just keep pushing fluids and fiber, and when all else fails, try CHOCOLATE---best-tasting natural laxative I know!

chris_at_lucas_RN, RN · Dec 10, 2003

when all else fails, try CHOCOLATE

Now I know why I never have a problem!!! LOL

I'm with mjlrn97--fiber. fluid and exercise.

I'm not sure what it is with little old people and their bowels, but I do think part of it is that as we get older we get more into taking care of ourselves (or into big time avoidance) because of our proximity to things going wrong.

The attention to BM's reminds me of toddlers at the potty training age--the focus seems very similar..... Just a thought, probably no connection.

And no, this (at least to me) is EXACTLY the reason for BB's like this one--to share ideas and resources.....

(congrats on new job! I envy you--it sounds wonderful.)

Noney · Dec 10, 2003

Constipation is a big deal with the elderly. Elderly patients can become very ill, if their bowels don'r move regularly. I agree with the other posts about exercise, water, and fiber. But alot of them need more, There are a lot of stool softners out there. Chronulac is good.

Noney

barb4575 · Dec 10, 2003

If they can tolerate it, warm it up in the microwave.

Barb

dragonfly954 · Dec 10, 2003

Thanks for the replies.I have heard LTC nurses refer to some magic remedies they use in the nursing homes besides prune juice.It is a mixture of 2 or 3 things(what they are I don't know)that they give to the little old people.I will have a lot of post ops I'm told.A lot have a tendency for chf and other cardiac problems an can't have a lot of fluids.I was just looking for some alternatives.I'm just getting started,but I really love the job(so far).This Medicare paperwork is for the birds though. :rolleyes:

debRNo1 · Dec 10, 2003

Originally posted by dragonfly954
I have heard LTC nurses refer to some magic remedies they use in the nursing homes besides prune juice.It is a mixture of 2 or 3 things(what they are I don't know)that they give to the little old people..

I think what you are referring to is: black and white

Its an oldie BUT a goodie !!! It is a mix of 30 cc MOM with a shot of cascara 5 cc. Unfortunately after all these years I hear now that cascara isnt available anymore ?? Somehow R/T cardiac difficulties in the elderly

The last 2 years at the LTC facility that I worked I spent doing "bowel audits" after a BAD survey and a huge problem with OUR bowel protocol.

Sometimes you cannot push fluids and some of them dont eat or drink too good anyway. Try colace-pericolace-MOM-lactalose-sennakot-Dulcolax supp or a dulcolax tab maybe.

Cant tell you how many impactions Ive seen in the hospital and in LTC facilities-not a good thing at all.

good luck

ktwlpn, LPN · Dec 10, 2003

Originally posted by dragonfly954
.I have heard LTC nurses refer to some magic remedies they use in the nursing homes besides prune juice.It is a mixture of 2 or 3 things(what they are I don't know)that they give to the little old people.

That could be "The Recipe" It is a mixture of bran,apple sauce and apple juice or prune puree-whatever combo your patient prefers...You can add lemom juice and zest for flavor or apricot puree....It is good on toast or a muffin...

jnette, ASN, EMT-I · Dec 10, 2003

Try the "Power Pudding" ! An effective NATURAL laxative... (remember the overuse of laxatives by the elderly actually produces the opposite affect of what they desire... it causes inhibition of the natural defecating reflex).

Here's something you might want to try with your elderly folks to keep them off the OTC's...

(A large homecare company in Va. launched this study to determine whether a NATURAL laxative therapy in the form of a good tasting pudding could relieve and prevent episodes of constipation ... and eliminate the need for stool softeners, cathartics, or laxatives.)

Power Pudding consists of equal portions of applesauce, wheat bran flakes, whipped topping (coolwhip) and canned, stewed prunes. You may add a small amt. of prune juice just to facilitate blending...

Those that participated in the study(and after discontinuing all laxatives) found that one quarter to one half cup of this pudding

developed acceptable stool consistency and elimination patterns.

One week of daily quarter to half cup servings of the pudding yielded 3-6 BMs p/wk. One cup portions resulted in 4 BMs p/wk... so more is not always better.

This might be a nice alternative and nonpharmacologic nursing intervention when doing home care with the elderly...

it would behoove you to take a bowel hx. first, and obtain a Dr.'s order, of course.

Worth a shot !

RNanne · Dec 10, 2003

Having worked Homehealth for a number of years, I know that constipation is a problem. I found it in the geriatric population as well as those on pain medication. Lots of the geriatrics have "institutional" bowels in that they have taken laxatives for so long that they have lost normal bowel function. I agree with those that have posted some wonderful natural aids to BMs. I have had folks that passed out on the toilet from Valsalva. had severe constipation, rectoceles, inability to defecate secondary to poor rectal muscle tone, etc. I developed a teaching model that I always used. Just take all that you know, add to it and teach away. I loved Homehealth in that you could do so much teaching. And I agree that the Medicare paperwork is a killer. It is the reason that I no longer work in Homehealth. It was tooo much.:chair:

Long Term Care Columnist / Guide · Dec 10, 2003

The Medicare paperwork is one of the main reasons I no longer work in LTC. :rolleyes: I laugh at my co-workers when they gripe about the amount of charting we do in the hospital.....I say, if you've never done Medicare/Medicaid documentation, you've never done paperwork.

RNanne · Dec 11, 2003

Yep, the medicare paperwork is awful. I would admit a client and do a 17 page assessment and write the goals and careplan. During assessment I would find that the client needed to be readmited to hospital. So I would write a hospital transfer (forget how many page), then readmit the client the next day with a 13 page readmittance, and then discharge paperwork in a day or two. Now that is simply unbelieveable. And all the paperwork has to be done in a short specified amount of time or medicare would lock it out. And that is just one client. Never mind the visit notes and new admits everyday and discharges about everyday. It drove me nuts. And I would have so many visits and admissions that most of the paperwork had to be done after work, before work and all weekend. I was only paid per visit and there were no benefits etc. I did love it though, the best nursing job that I ever had.

:)