Management of Constipation in Residents With Dementia: Sorbitol Effectiveness and Cost

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Abstract

Objective:

The objective of this report is to describe a cost-effective strategy for management of constipation in nursing home residents with dementia.

Design:

We conducted a prospective observational quality improvement study of 41 residents with chronic constipation and receiving an osmotic laxative. Sorbitol was substituted for lactulose.

Setting:

The study was conducted at a dementia special care unit at a Veterans Administration hospital.

Measurement:

We measured the number and amount of laxative use over a period of 4 weeks that were required to maintain regular bowel function.

Results:

There was no difference in efficacy of lactulose and sorbitol. Use of additional laxatives was infrequent: Milk of Magnesia on approximately 10% of days/patient, bisacodyl suppository on 2% to 4% of days/patient, and Fleet enema only on 3 occasions. The cost of constipation management using routine administration of sorbitol and as-needed use of other laxatives was 27% to 55% lower than the cost of other constipation management strategies reported in the literature.

Conclusion:

Substitution of sorbitol for lactulose does not change efficacy of the treatment and decreases cost. Regular use of an osmotic laxative avoids the costs and discomforts of rectal laxatives.

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