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Constipation Treatment
Background
Constipation is the most common bowel problem in older adults. The definition varies by patients and health care providers, but generally it means less frequent bowel movements than usual, and those which are hard, dry, and difficult to pass. Constipation is a preventable and treatable problem. Changes that occur with normal aging, such as peristalsis in the gut slowing down or decreased physical activity, predispose older persons to constipation.
Risk Factors/Warning Signs
Constipation is often due to a combination of causes. Some of the risk factors include decreased activity, medications (such as certain pain pills, iron supplements, and calcium supplements), depression, neurological conditions (dementia, Parkinson’s disease, stroke, diabetes mellitus, and spinal cord injury), dehydration, low dietary fiber, metabolic disturbances (such as hypothyroidism), undergoing dialysis, obstruction, and decreased access to the toilet (Halter et al., 2009). The range of “normal” for bowel movements is three times per day to three times per week. A decrease in number of stools that is “normal” for the person and the occurrence of hard, dry stools that are difficult to expel are typical signs of constipation.
Diagnosis
If constipation is severe enough for the person to seek medical care, the patient may complain of abdominal pain and even have symptoms similar to other problems such as an appendicitis or diverticulitis. These more serious ailments can be ruled out through x-rays, CT scan or MRI. The diagnosis is based on clinical presentation, history, and physical examination. It is important to determine the onset and duration of the constipation, along with functional and nutritional status.
Treatments
Before starting a bowel program to prevent constipation, the existing problem should be dealt with. A physician may prescribe laxatives, suppositories, and/or enemas to get the stool moving and eliminated. Many such products can be obtained over the counter as home remedies, but severe and recurrent problems should be referred to the primary care provider for further examination of the cause. After starting with a clean bowel, interventions should focus on lifestyle and dietary modifications. All natural means should be tried first before adding medication to the regimen. This includes regular exercise, establishment of a regular routine for toileting (assure privacy), and encouragement of a high-fiber diet with adequate fluid intake (unless contraindicated)(Joanna Briggs Institute, 2008). Medications may be considered for those who do not respond to lifestyle changes. Residents of nursing homes appear to respond to stimulant laxatives (e.g., senna, bisacodyl) or Miralax. Enemas should not be used on a regular basis because they promote lazy bowel function. Most older persons can avoid constipation if they remain active, have proper nutrition high in fiber, and drink plenty of fluids.
Adapted from Mauk, K. L., Hanson, P., & Hain, D. (2014). Review of the management of common illnesses, diseases, or health conditions. In K. L. Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Sudbury, MA: Jones and Bartlett Publishers. Used with permission.
For more information on Constipation, visit The Mayoclinic at:
http://www.mayoclinic.com/
http://www.mayoclinic.com/
Peripheral Artery Disease
Background
Peripheral artery disease (PAD), the most common type of peripheral vascular disease (PVD), affects 8–12 million Americans, 12–20% of those over the age of 65, and could reach as many as 9.6 million Americans by the year 2050 (Cleveland Clinic, 2012).
Risk Factors/Warning Signs
The risk factors for PAD are the same as those for coronary heart disease (CHD), with diabetes and smoking being the greatest risk factors (AHA, 2005). Ac¬cord¬ing to the American Heart Association, only 25% of those older adults with PAD get treatment. PAD increases the risk of CHD, heart attack, and stroke.
Diagnosis
The most common symptoms of PAD are leg cramps that worsen when climbing stairs or walking, but dissipate with rest, commonly called intermittent claudication (IC). The majority of persons with PAD have no symptoms (AHA, 2005). PAD is a predictor of CHD and makes a person more at risk for heart attack and stroke. Left untreated, PAD may eventually lead to impaired function and decreased quality of life, even when no leg symptoms are present. In the most serious cases, PAD can lead to gangrene and amputation of a lower extremity.
Treatments
Most cases of PAD can be managed with lifestyle modifications such as those for heart-healthy living. This includes maintaining an appropriate weight, limiting salt intake, managing stress, engaging in physical activity as prescribed, quitting smoking, and eating a heart-healthy diet.
Patients with PAD should discuss their symptoms with both their healthcare provider and a physical therapist, because some patients find symptom relief through a combination of medical and therapy treatments (Aronow, 2007; Cleveland Clinic, 2012).
Adapted from Mauk, K. L., Hanson, P., & Hain, D. (2014). Review of the management of common illnesses, diseases, or health conditions. In K. L. Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Sudbury, MA: Jones and Bartlett Publishers. Used with permission.
For more information on PAD, visit NIH at:
www.nhlbi.nih.gov/health/health-topics/topics/pad/
www.nhlbi.nih.gov/health/health-topics/topics/pad/
Guest Blog: Tools to Make Your Shower Safer
Have you heard? A new government study has revealed that falls among adults over 65 rose over 30% in the past 10 years! While a fall every now and then may feel like no big deal, it is important for seniors to recognize that even seemingly harmless falls can lead to dangerous complications like hip fractures and head trauma.
If you or the person you care for hasn’t fall-proofed one of the most dangerous spots in the home, the shower, yet, don’t miss this essential list of helpful safety tools:
Toiletry Dispenser
Are you still struggling with slippery bars of soap and hard-to-grip shampoo and conditioner bottles in the shower? Get an easy-to-install toiletry dispenser instead which can stay fixed to the wall under your shower head and dole out toiletries in your hand as needed with the push of a button.
Grab Bars
Experts recommend installing grab bars both inside and outside the shower on walls that are easy to reach and can fully support your weight when you brace against them. Similar products like bathtub bars which sit fixed on the side of a bathtub and provide a raised support to hold and steady yourself are great too for notoriously hard-to-navigate tub showers.
Non-slip Shower Mat
Not all shower mats are created equal, and for seniors taking fall prevention measures in the shower, finding one that stays in place and offers a textured non-slip surface to stand on is critical. Additional features like being antimicrobial and machine-washable also prevent the buildup of contaminants and mildew which are common to humid areas like the shower.
Shower Chair
Even if you have no mobility issues at all, a shower chair may be a good investment if your space allows for it. Shower chairs make it easy to sit and rest in the shower if you suddenly feel weak or unbalanced. And specialty transfer chairs help caregivers easily get a loved one in and out of the shower without over-exerting themselves or putting their loved one’s safety at risk.
Handheld Shower Head
Quit trying to twist, turn, and contort your body when bathing yourself. A removable, handheld shower head is a must for easy, thorough washing that won’t leave you with a muscle strain in your back. Experts recommend getting one with at least 5 feet of maneuverable cord to allow for enough slack to raise and move it around your body with ease.
Outside of the shower, additional upgrades that can improve your safety and bathroom experience include automatic lights that provide consistent, bright lighting without having to flip a switch, non-slip bathroom mats, and raised toilet seats with handles.