Priorities and recommendations

The Burden of Constipation in our Ageing Population – Working Towards Better Solutions report, unveils the current unmet need for improved recognition, appropriate prevention, diagnosis, management and monitoring of constipation in older adults.

Six key priorities were identified based on the conclusions of the research, with suggested recommendations for achieving each goal:

  1. Functional constipation should not be underestimated or trivialised and should not simply be considered as an inevitable consequence of ageing or frailty.
    • Raise awareness of the key messages and issues raised within the report amongst all healthcare professionals and other healthcare providers, as well as at a policy level
    • Support the development of policy and guidelines to support appropriate prevention, diagnosis and management of constipation as a separate condition to continence
  2. Constipation should be classified and recognised as a condition in its own right, not just a set of symptoms associated with other disorders.
    • Develop an internationally-agreed, clear and simple definition for constipation
    • Highlight constipation within established continence guidance as a separate but related issue
    • Develop clear and simple guidance for older people in care homes to help prevent, report and promptly manage constipation in older adults
  3. Recognition and awareness of the typical symptoms and causes of constipation, as well as understanding how to effectively prevent and treat it, should be a training priority across the whole multi-disciplinary team and social care professionals working with older people.
    • Increase information about constipation as an issue across training materials and resources to improve attitudes of the whole multi-disciplinary care team towards the condition. Specific focus on nursing staff who have more frequent patient contact
    • Develop on- and off-line resources, for example e-learning modules, risk assessment tools, template training packs, care home resources, to offer easy access to practical resources
    • Support measures to encourage the review of medicines to avoid unnecessary poly-pharmacy
    • Include evidence-based preventative measures into globally accepted best practice care pathways and ensure endorsement by key multi-disciplinary professional bodies and dissemination throughout membership
  4. Constipation needs to be better diagnosed so it can be promptly treated and managed more effectively in-line with agreed best practice and recognised standards.
    • Increase proactive case-finding of constipation in care homes through monitoring and screening programmes
    • Encourage prompt treatment to avoid complications, including faecal impaction and worsening of symptoms of neurological disease such as dementia
    • Develop clear guidelines and care pathways for constipation
    • Implement strategies for guidance to ensure this is accepted in daily practice
    • Evaluate existing diagnostic tools and promote best practice in using them
  5. The taboo nature of constipation needs to be addressed amongst the general public such that older people start to feel more comfortable and less embarrassed about self-reporting suspected constipation, knowing that they will be taken seriously and always treated with respect.
    • Encourage greater open discussion about constipation as a common health issue through campaigning and information provision
    • Develop information resources for patients/carers
    • Support better self-reporting through sensitive questioning techniques
  6. Highlight the true cost of failing to effectively manage constipation in older people, in terms of economic and societal burden to health services, as well as the cost in terms of individual suffering and reduction in quality of life.
    • Gather economic data to target health service providers and commissioners/payers to highlight the cost of complicated constipation, in terms of hospitalisations etc.
    • Develop communication tools to highlight the impact on quality of life
    • Encourage routine prevention and treatment of constipation in a hospital and care setting
    • Challenge inaction amongst healthcare providers – how can they afford NOT to deal with this preventable condition?