Constipation in Patients Requiring Long-Term Care
Constipation is a common ailment for long-term care (LTC) patients, and laxatives are the most prescribed medications by LTC facilities. In the elderly long-term care population, up to 74% of patients receive at least one laxative per day. Over the age of 65, the number of LTC patients dealing with constipation is estimated to be at 50%.
Despite the prevalence of constipation at LTC facilities, the true cost of constipation – both in terms of patient wellness and financial cost to institutions – can be overlooked.
Constipation can exact substantial costs, especially if a facility’s bowel care management program isn’t as effective as it could be.
The Financial Costs of Constipation to Long-Term Care Facilities
Constipation causes both financial and wellness costs to LTC facilities and their patients. In a 2002 study, researchers evaluated the cost of constipation to LTC facilities. The study considered the following factors:
● Care time
● Medication cost
● Age
● Gender
● Length of stay
● Functional status
Nursing staff performance of constipation care related tasks is time consuming and costly. The average cost per task occurrence ranged from $0.72 for enema administration to $1.74 for oral medication administration (based on 2002 data in the study).
The frequency of constipation in LTC residents, the total amount of care needed to treat constipation, and the number of supplies needed led to an average facility cost per long-term care resident with constipation of $2253 per year in 2002. According to the Consumer Price Index and Medical Care inflation calculators, that cost could be $3,500 – $4,000 per year now.
In fact, it is estimated that over $1 billion annually is spent treating constipation when both direct and indirect costs are considered.
The Health Costs of Constipation to Long-term Care Patients
The cost exacted by constipation isn’t only financial. The high rate of constipation in the LTC population reduces patient quality of life and increases the risk of several complications including fecal incontinence and impaction.
Constipation also has a negative impact on long-term care residents’ productivity, independence, and mental health.
When the frequency and severity of constipation in LTC residents is improved through an effective bowel care management program, studies show that facilities report:
● Fewer urinary symptoms
● Better sexual function
● Improved mood
● Reduction in depression and other mental health disorders
Common Causes of Constipation in Long-term Care Patients
Long-term care patients are especially susceptible to constipation for a variety of reasons, including:
● Medications
● Endocrine and Metabolic
● Diseases
● Neurologic Disorders
● Myopathic Disorders
● Depression
● General disability
● Poor mobility
● Diet and Fluid Intake
● Abuse/overuse of laxatives
Effective Bowel Care Programs for Long-term Care Patients
To reduce both the health and financial costs of constipation, it is important for long-term care facilities to establish an effective bowel care program. Bowel care programs need to include:
● A thorough and accurate assessment of a patient’s bowel history, overall health, and current bowel function
● Regular times for bowel care for each patient
● Prompt response to patient urge to defecate
● Protocols for patients who need assistance getting to the toilet
● The effective use of laxatives
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Sources:
1. Basson, M.D. (2011). Constipation. http://emedicine.medscape.com/article/184704-overview
2. Rao, S.S.C, & J.T. Go. (2010). Update on the management of constipation in the elderly: new treatment options. Clinical Interventions on Aging: 5, p 163-171.
3. Tack, J. (2011). Current and future therapies for chronic constipation. Best Practice & Research Clinical Gastroenterology:25, p. 151-158.
4. Holson, D.A. (2010). Constipation in Emergency Medicine.
5. Frank, L. et al. (2002). Time and economic cost of constipation care in nursing homes. J Am Med DirAssoc. Jul-Aug;3(4):215-23
6. Ginsberg, D. A. et al (2007). Evaluating and Managing Constipationin the Elderly.UrolNurs.;27(3):191-200, 212
7. https://www.bls.gov/data/inflation_calculator.htm
8. https://www.in2013dollars.com/Medical-care/price-inflation
