Chronic Constipation in the Elderly Patient: Updates in Evaluation and Management

Area of Science:

• Geriatrics
• Gastroenterology
• Primary Care Medicine

Background:

• Chronic constipation (CC) is a prevalent global health issue in the elderly, significantly impacting their quality of life.
• Prevalence estimates for CC in individuals over 60 years range from 15% to 30%, with diagnosis often complicated by varied criteria.
• Aging populations and increased prevalence necessitate effective management strategies by primary care physicians.

Purpose of the Study:

• To provide primary care physicians with updated knowledge on the approach and management of chronic constipation in elderly patients.
• To summarize current understanding of CC pathogenesis, diagnosis, and treatment options tailored for the geriatric population.

Main Methods:

• Review of current literature on chronic constipation in the elderly.
• Discussion of diagnostic tools including anamnesis, physical examination, laboratory tests, colonoscopy, and physiologic tests.
• Outline of a stepwise, individualized treatment approach, including lifestyle modifications, medication adjustments, laxatives, and biofeedback.

Main Results:

• CC pathogenesis in the elderly involves factors like physical inactivity, polypharmacy, comorbidities, rectal hyposensitivity, and defecatory disorders.
• Diagnosis can be aided by detailed history, digital rectal examination, blood tests, colonoscopy, and physiologic assessments.
• Treatment follows a stepwise strategy, starting with lifestyle changes and laxatives, with biofeedback being effective for specific defecatory disorders.

Conclusions:

• An individualized, stepwise approach is crucial for managing chronic constipation in elderly patients.
• Primary care physicians play a vital role in the diagnosis and management of CC, requiring up-to-date knowledge.
• Effective management strategies encompass lifestyle adjustments, medication review, pharmacotherapy, and specialized therapies like biofeedback.