Doron Garfinkel, M.D., Svetlana Zludkov, M.D., Sameira Jamal, R.N., Ronit Har-Noy, R.N.

Doron Garfinkel, M.D., Svetlana Zludkov, M.D., Sameira Jamal, R.N., Ronit Har-Noy, R.N.

The Shoham Geriatric Medical Center, Pardes-Hanna, ISRAEL

The Shoham Geriatric Medical Center, Pardes-Hanna, ISRAEL

The effects of Stopping Enemas in Disabled Elderly Patients

Suffering from Constipation in Nursing Departments

The effects of Stopping Enemas in Disabled Elderly Patients

Suffering from Constipation in Nursing Departments

Shoham Geriatric Medical CenterShoham Geriatric Medical Center

Owned by the GovernmentOwned by the Government

The largest geriatric campusThe largest geriatric campus

in Israelin Israel

360 square Km of land360 square Km of land

800 patient800 patient’’s bedss beds

LONG TERM CARE DEPARTMENTSLONG TERM CARE DEPARTMENTS

FRAILFRAIL

66

NURSINGNURSING1111

DEMENTIA UNITSDEMENTIA UNITS

44

מ ש ר ד ה ב ר י א ו תמ ש ר ד ה ב ר י א ו תמ ד י נ ת י ש ר מ ד י נ ת י ש ר

א לא ל

המרכז הגריאטרי המשולב ע”ש שוהםהמרכז הגריאטרי המשולב ע”ש שוהם

פרדס חנהפרדס חנה

BACKGROUND :BACKGROUND :

Constipation is a very common age - associated

problem in elderly people.

The incidence of Constipaion increases with Age,

Co-morbidities, Drugs, Disability and Immobility.

The incidence is higher in Nursing Homes (NH)

and particularly in Nursing Departments (ND).

Constipation can be relieved by diet,

several types of Laxatives and Enemas.

The effects of Stopping Enemas in Disabled Elderly Patients

Suffering from Constipation in Nursing Departments

The effects of Stopping Enemas in Disabled Elderly Patients

Suffering from Constipation in Nursing Departments

BACKGROUND :BACKGROUND :

In September 2004, supply of Fleet Enemas (FE) In September 2004, supply of Fleet Enemas (FE)

( Sodiumbiphosphate 16g/ Sodiumphosphate 6g/ 10cc, ) ( Sodiumbiphosphate 16g/ Sodiumphosphate 6g/ 10cc, )

was unexpectedly stopped and we had to use our was unexpectedly stopped and we had to use our

Reserve or give Lactulose instead. Reserve or give Lactulose instead.

The influence of Discontinuation of Enemas (DoE) The influence of Discontinuation of Enemas (DoE)

in our ND patients was evaluated.in our ND patients was evaluated.

In many disabled patients in ND, Constipation can be relieved only by enemas.

METHODSMETHODS

270 disabled patients in 10 ND were evaluated. 270 disabled patients in 10 ND were evaluated.

Begining September 1, in all patients teated with Begining September 1, in all patients teated with

FE, an attempt of DoE was made FE, an attempt of DoE was made

and they were all given Lactulose. and they were all given Lactulose.

Using medical and nursing follow up notes, Using medical and nursing follow up notes,

several parameters were compared in all patients several parameters were compared in all patients

between July-August and October-November of between July-August and October-November of

2004 (before and after DoE, respectively).2004 (before and after DoE, respectively).

R E S U L T SR E S U L T S

270 patients270 patientsNO treatmentNO treatment

16 (6%)16 (6%)LactuloseLactulose60 (22%)60 (22%)

Fleet EnemaFleet Enema

194 (72%)194 (72%)

DoE AttemptDoE Attempt

FAILUE

120 (62%).

SUCCESSFUL SUCCESSFUL

74 (3874 (38%).

Control GroupControl Group

196 Pt.196 Pt.

DoE GroupDoE Group

74 Pt.74 Pt.

LATE EFFECTSLATE EFFECTS

Unbearable Symptoms Requiring Readministration

of FE

Unbearable Symptoms Requiring Readministration

of FE

Comparing Comparing parametersparameters

before & after DoEbefore & after DoE

Urinary symptoms Urinary symptoms Sleep Sleep AppetiteAppetite Irritability Irritability Urinary or Respiratory InfectionsUrinary or Respiratory Infections Number of sedatives/tranquilizers prescribedNumber of sedatives/tranquilizers prescribed Referrals to HospitalsReferrals to Hospitals

before and after DoEbefore and after DoE Findings of Rectal Examination were comparable Findings of Rectal Examination were comparable in both groups in both groups

RESULTS

LATE EFFECTS OF DoE

RESULTS

LATE EFFECTS OF DoEFollowing 3 months of DoE,Following 3 months of DoE,

There was No difference between the Doe and controls in:There was No difference between the Doe and controls in:

RESULTS

LATE EFFECTS OF DoE

RESULTS

LATE EFFECTS OF DoE

A A significantlly increased number of Physical significantlly increased number of Physical Examinations by physician (123 before 226 afterExaminations by physician (123 before 226 after DoE, no significant change in controlsDoE, no significant change in controls, P< 0.01)., P< 0.01). A higher prevalence of increase in body weight A higher prevalence of increase in body weight (35% compared to 15% in the controls, p < 0.001).(35% compared to 15% in the controls, p < 0.001).

Following 3 months,Following 3 months,

The DoE group Did Have:The DoE group Did Have:

CONCLUSIONSCONCLUSIONS In Nursing Departments, stopping Enemas In Nursing Departments, stopping Enemas and starting Lactulose with NO significant and starting Lactulose with NO significant adverse effects, can be accomplishedadverse effects, can be accomplished in in

less than 40%.less than 40%.

However, in most disabled patients in ND, However, in most disabled patients in ND, Stopping Enemas is Inpractical and has Stopping Enemas is Inpractical and has No Clinical or Financial Benefits.No Clinical or Financial Benefits.

The Shoham Geriatric Medical Center, Pardes-Hanna, ISRAEL

The Shoham Geriatric Medical Center, Pardes-Hanna, ISRAEL

Thank You !Thank You !

Doron Garfinkel, M.D.Doron Garfinkel, M.D.