Constipation in the Older Adult
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Accreditation
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.
Credit Designation Statement
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1.0 category 1 credit toward the AMA Physician’s Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. Valid December 1, 2004 - February 28, 2005. Estimated time: 1 hour
FULL DISCLOSURE POLICY AFFECTING CME ACTIVITIES
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or provider has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The presenting faculty reported the following: Dr. Cole has indicated that he has not received financial support for consultation, research or evaluation or has a financial interest relevant to this article. Dr. Lacy has indicated that he has received grants/research support from Novartis Phamaceuticals, AstraZeneca, and GlaxoSmithKline. No faculty member has indicated that their presentation will include information on off-label products.
DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combination of drugs, including indications, contraindications, warnings and adverse effects before administering pharmacologic therapy to patients.
Educational Objectives
1. To understand the prevalence and natural history of chronic constipation in the older patient
2. To review the current definition of constipation and understand differences in patient and physician perceptions of this disorder
3. To review the common etiologies and the underlying patho- physiologies of constipation in the older patient
4. To review current treatment options using an evidence-based approach
Constipation is a heterogeneous disorder with a wide spectrum of symptoms and complaints. Constipation results in 2.5 million office visits each year,1 leads to a significant reduction in quality of life,2 and is expensive to treat.3,4 This review describes the difficulties in defining constipation in clinical practice, the epidemiology and natural history of constipation in the older adult, normal and abnormal colonic physiology, the effects of aging on the colon, and provides recommendations on cost-effective methods of evaluating and treating this common disorder.
Definition
Physicians and patients differ dramatically in their definition of constipation. Clearly defining what is meant by the term constipation is critical to accurately diagnose the problem, review the natural history, and assess response to treatment. Physicians tend to use objective measures to define constipation, and this typically involves measuring stool frequency. Several large population studies have shown that most individuals have from 3 bowel movements per day to 3 bowel movements per week.5,6 As such, many physicians define constipation as less than 3 bowel movements per week.
References
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