Policy and guidance

There is a lack of official evidence-based guidance to support the diagnosis and management of constipation in adults over the age of 65 years. Care standards and quality frameworks exist across Europe, however the focus is usually on urinary or faecal incontinence, not constipation.1,2

A robust structural framework is needed to integrate recommendations into day-to-day care. Without this, sub-optimal management of constipation will continue.

Tools to support effective diagnosis of constipation include:

  • Rome III diagnostic tool;
  • Bristol Stool Form Scale;
  • Template forms for monitoring food and fluid intake;
  • Lists of sensitive diagnostic questions;
  • Flow chart of effective care pathway.

Prevalence of constipation in care homes and institutions is high, as is the associated distress it causes.3,4,5 However, quality care indicators for the health and welfare of those living in long term care across Europe do not include constipation as a quality indicator to be measured or monitored.

Germany6 Guideline for urinary incontinence in care homes, but no equivalent for chronic constipation
The Netherlands1,7 Constipation guideline for GPs outlining best practice diagnosis and management
Czech Republic8 No mention of bowel care of any kind
Italy9 No official guidelines for diagnosis or management of constipation or faecal incontinence
France10 Practical, evidence-based recommendations focusing on diagnosis of constipation and impact on quality of life
UK2,11,12 No specific national level guidance for the management of constipation in adults, however, national guidance exists for constipation in children and young people. Also references to constipation in guidelines on faecal incontinence and nutritional health
Switzerland13 Comprehensive best-practice guideline for palliative care (2010-2012)

Useful resources to support the management of constipation around the world include:

  • World Gastroenterology Organisation (WGO) guidelines on constipation14
  • World Health Organisation (WHO) report15
  • American Gastroenterological Association (AGA) technical review on constipation3

Diet and lifestyle changes are often the first course of action for patients. However, there is limited evidence to support this approach.16,17 A broad range of treatments are also available to manage constipation.18

References

Click to view full reference list

  1. ActiZ, Organisation of care entrepeneurs; LOC, National Organisation of clients’ councils; NVVA, Professional Association for Nursing Home Doctors and Social Geriatricians; Sting, National Professional Care Association; IGZ, Health Inspectorate; VWS, Ministry of Health, Welfare and Sports; ZN, Dutch Care Insurers, Quality Framework Responsible Care, 2007, retrieved 3 September 2013, http://www.crncc.ca/knowledge/related_reports/pdf/Kwaliteitskader%20Verantwoorde%20Zorg%20(english).pdf.

  2. NICE, Faecal incontinence: The management of faecal incontinence in adults, 2007, retrieved 3 September 2013, http://www.nice.org.uk/CG49.

  3. American Gastroenterological Association, ‘Technical Review on Constipation’, Gastroenterology, 2013, vol. 114, pp. 218-238.

  4. Potter J and Wagg A, ‘Management of bowel problems in older people: an update’, Clin Med, 2005, vol. 5, no. 3, pp. 289-95.

  5. Norton C, ‘Constipation in older patients’, Brit J Nurs, 2006, vol. 15, no. 4, pp. 188-92.

  6. Füsgen I, ‘Konsesusstatement ‘Chronische Obstipation in der stationären Altenhilfe – (K)ein Problem?’, European Journal of Geriatrics, 2010, vol. 12, no. 4, pp. 153-244.

  7. Diemel J, Van den Hurk A, Muris J et al. ‘NHG-Standaard Obstipatie’, Huisarts Wet, 2010, vol. 53, no. 9, pp. 484-98.

  8. Ministry of Labour and Social Affairs, Standards for Quality in Social Services, 2002, retrieved 19 August 2013, http://www.mpsv.cz/files/clanky/2057/standards.pdf.

  9. Federazione Nazionale Collegi Infermieri (IPASVI), La gestione della stitichezza, retrieved 19 August 2013, http://www.ipasvi.it/ecm/percorsi-guidati/la-gestione-della-stitichezza-id17.htm

  10. Piche T, Dapoigny M, Bouteloup, C, et al. ‘Recommandations pour la pratique clinique dans la prise en charge et le traitement de la constipation chronique de l’adulte’, Gastroenterol Clin Biol, 2007, vol. 31, pp. 125-35.

  11. NICE, Constipation in children and young people, 2010, retrieved 19 August 2013, http://www.nice.org.uk/nicemedia/live/12993/48741/48741.pdf

  12. Social Care Institute for Excellence, Nutritional care and hydration, in Adults’ Service SCIE Guide 15 – Dignity in Care, 2009, retrieved 19 August 2013, http://www.scie.org.uk/publications/guides/guide15/files/guide15-nutrition.pdf.

  13. Swiss Confederation, National Strategy for Palliative Care 2010-2012, 2009, retrieved 2 January 2014, http://www.bag.admin.ch/themen/gesundheitspolitik/13764/index.html?lang=en.

  14. World Gastroenterology Organisation, Practice Guidelines: Constipation, 2007, retrieved 3 September 2013, http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/05_constipation.pdf.

  15. World Health Organisation, Keep fit for life: meeting the nutritional needs of older people, 2002, retrieved 3 September 2013, http://www.who.int/nutrition/publications/en/nut_older_persons_1.pdf.

  16. Zizza C, Ellison K, Wernette C. ‘Total Water Intakes of Community-Living Middle-Old and Oldest-Old Adults’, J Gerontol A Biol Sci Med Sci, 2009, vol. 64, no. 4, pp. 481-6.

  17. Joanna Briggs Institute. ‘Management of constipation in older adults’, Best Practice, 2008, vol 12, no. 7, pp. 1-4.

  18. Tack J, Müller-Lissner S, Stanghellini V et al. ‘Diagnosis and treatment of chronic constipation – a European perspective’, Neurogastroenterol Motil, 2011, vol. 23, pp. 697-710.