Use of laxatives among older nursing home residents in Helsinki, Finland

Background and objective: Constipation and, as a consequence, the use of laxatives are common among frail older people. The causes of and factors associated with laxative use, however, have undergone surprisingly little study. The objectives of our study were to (i) assess the prevalence of regularly administered laxatives, (ii) identify factors associated with regular use of laxatives, and (iii) determine which drug classes or medications are associated with regular laxative use in an older nursing home population in Helsinki. Methods: This study was a cross-sectional assessment of all long-term nursing home residents aged :65 years in Helsinki, Finland. In February 2003, the health status of these residents was assessed and data on their demographic characteristics, health and medication use were collected from medical charts. Results: Of all nursing home residents in Helsinki, 82% (n = 1987, mean age 83.7 years) participated in the study. Of all residents, 55.3% received laxatives regularly. Factors associated with regular laxative use in univariate analysis included age < 80 years, stroke, Parkinson's disease, inability to move independently, poor Mini Nutritional Assessment (MNA) score (< 17), fluid intake less than five glasses per day, and chewing problems. Drugs associated with laxative use included opioids, antacids, diuretics, tricyclic antidepressants, lipid-lowering drugs other than HMG-CoA reductase inhibitors (statins), histamine H-2 receptor antagonists, nonselective NSAIDs, anticholinergic drugs for urine incontinence, and calcium channel antagonists other than verapamil and nifedipine. In logistic regression analysis, age < 80 years (odds ratio [OR] 1.29; 95% CI 1.03, 1.60), inability to move independently (OR 1.80; 95% CI 1.42, 2.28), poor MNA score (< 17) [OR 1.51; 95% CI 1.19, 1.93], chewing problems (OR 1.27; Cl 95% 1.00, 1.61), Parkinson's disease (OR 1.63; 95% CI 1.01, 2.64), and concomitant use of a high number (> 7) of drugs other than laxatives and constipation-inducing drugs found in univariate analysis (OR 1.06; 95% CI 1.03, 1.09) were associated with use of laxatives. Having snacks between meals (OR 0.74; 95% CI 0.60, 0.90) was associated with lower risk of laxative use. Conclusions: Regular laxative use in older nursing home residents in Helsinki is very common. Offering snacks between meals and regular evaluation of medication use may influence laxative use.