Constipation is a common disorder in long-term care patients and can occur as it’s own bowel disorder or due to common medications such as anticholinergic agents or opioid pain medications. Previous research has shown that approximately 75% of long-term care patients are chronically taking at least one medication that can cause constipation. Bowel regimens are typically initiated and remain part of these patient’s medication plans long term. The goal of this review is to identify efficacy in terms of frequency of bowel movement, need for escalated regimen medication use, and occurrence of adverse drug reactions. Bowel regimens are a typical part of long-term care patient medication profiles as well as hospitalized patients in acute care, so the research to identify safety and efficacy of these regimens is useful and fills a need in clinical practice.
The studies included were conducted in the UK, USA, Finland, and Taiwan, which increases external validity based on the wide variety of research location but may introduce a confounding variable since all four countries have different cultural foods, typical dining plan, and lifestyle factors. These variables may interact with the need for and efficacy of bowel regimens as well as causative agents. The most studied laxatives were senna and lactulose. It is interesting that commonly used medications in the USA such as docusate and Miralax were only analyzed as “other laxatives”, leaving question into what should be used first line and what is applicable to patients in the USA.
Based on this research, senna with a bulking agent had better long term efficacy than lactulose in long-term care patients. This data seemed to be different than community dwelling patients which have more efficacy with polyethylene glycol substances. Safety was assessed by occurrence of adverse drug events, in which gastrointestinal symptoms where most commonly noted but more data with a longer timeline would be needed to make a conclusion.
Article link: https://onlinelibrary.wiley.com/doi/10.1111/jcpt.12721