Laxative use and chronic diarrhoea in older adults living in residential care

Chronic diarrhoea in older adults in residential care is underreported. This study examined its prevalence, contributing factors, and impacts on the quality of life of older adults living in care throughout New Zealand.

This study had two components: (1) a retrospective observational study of resident clinical, medication, bowel chart and health care data from 36 residential care facilities electronically entered by nursing or care staff, and (2) an observational study in six facilities where residents completed validated gastrointestinal and quality of life questionnaires. Residents were categorised by bowel pattern (normal, constipation, and diarrhoea) using Rome IV criteria. Chi-square tests compared bowel patterns with quality of life outcomes. Associations between bowel symptom reporting in parts one and two were assessed using contingency tables.

The retrospective data of 2411 residents revealed that 26% (618/2411) experienced chronic diarrhoea, most of whom were taking laxatives (402/618), presumably for constipation. The prevalence of chronic diarrhoea in non-laxative users was 8.8% (214/2411). Proportions were similar in part two: 21% (23/110) of residents experienced chronic diarrhoea, half of whom were also charted laxatives (12/23). Chronic diarrhoea was negatively associated with quality of life (p < 0.001) and associated with an increased risk of pressure injuries (n = 80, 12.9%) compared to having normal bowel motions (n = 20, 7%) (p < 0.001).

Chronic diarrhoea commonly affects older adults living in residential care, with laxative use appearing a significant contributor. Living with chronic diarrhoea can negatively impact quality of life and may be associated with an increased risk of pressure injury.