Literature review

2

EBP Quality Improvement Group Paper and Poster

Abigail Pomares, Dayagnis Rodriguez, Julia Gomes Pinto Da Silva, Ashley Hinds

Miami-Dade College Benjamin Leon School of Nursing

Medical Campus

NUR 3165

Dr. Violeta Aguilar-Figuly

September 15, 2021

PICOT Question

Background/Problem

Constipation is one of the common health challenges among the elderly population aged above 60 years. The prevalence of the condition increases with an individual’s age and tends to differ in distinct settings. The individuals above 60 years and above in a community have prevalence rates of up to 16% among men and 26% among women (Schuster et al., 2015). Such indicates an alarming prevalence rate that requires intervention. The rates increase with age as the patients aged 84 years and above have 26% for men and 34% for women (Schuster et al., 2015). Besides, the increment rate becomes high among the long-term care residents, with most patients having a high prevalence of 80%. However, the condition can be treated through standard lifestyle modification or medications such as laxatives. In this regard, the following PICOT question provides an avenue for exploring the health condition and the potential difference between the existing intervention measures, right from lifestyle changes to medication.

PICOT Question

In elderly patients aged above 60 years (P), do lifestyle modifications, including scheduled toileting, increased fluid and dietary fiber intake (I), as compared to use of osmotic laxative (C), reduce constipation (O), over three months? (T)

Patient/population (P): The population of interest in this research are the elderly aged 60 and above. The elderly are targeted for this research in that constipation is more common among this population despite also affecting the general population. Statistics show that up to 65% of the population aged above 60 tends to experience straining during bowel movement as the most reported symptom (Gandell et al., 2013). In this regard, the condition associates with age and affects the adult population living in community and care institutions.

Intervention (I): The current intervention practice that will be of interest in this research is lifestyle modification. In this regard, the treatment for most of the elderly patients presenting constipation symptoms is lifestyle changes. The approach involves focusing on scheduling toileting for the patients after meals, increasing their fluid intake and dietary fiber (Gandell et al., 2013). Besides, fiber intake usually involves focusing on the psyllium or the polycarbophil to help with symptom improvement. The intake is also regulated to ensure it is slow enough and gradually increasing over weeks to help lower the risk of adverse effects.

Compare/control (C): The intervention to be compared with the lifestyle modification is osmotic laxatives. In this case, the study is expected to reveal the comparable variables when osmotic agents are used instead of lifestyle changes. Some of the agents to consider in this case include polyethylene glycol, lactulose, and sorbitol (Gandell et al., 2013). The intervention works by drawing extra water from the system into the stool to help in softening and improving bowel movement. In this case, the variable to observe is whether the intervention reduces constipation faster and effectively within the timeframe set.

Outcome (O): The before observation includes the elderly patient not experiencing a regular bowel movement. This includes showing symptoms such as less consistent bowel movement, straining, hard stool, and a sense of incomplete bowel movement (Schuster et al., 2015). However, the current observation after an intervention should be reduced constipation. In this regard, the elderly patient should feel better with improved, frequent softer and easy bowel movements.

Time (T): The timeframe for which the lifestyle modifications are evaluated and compared to medication to establish effectiveness in managing constipation is three months.

References

Gandell, D., Straus, S. E., Bundookwala, M., Tsui, V., & Alibhai, S. M. (2013). Treatment of constipation in older people. CMAJ: Canadian Medical Association Journal, 185(8), 663–670. https://doi.org/10.1503/cmaj.120819

Schuster, B. G., Kosar, L., & Kamrul, R. (2015). Constipation in older adults: stepwise approach to keep things moving. Canadian Family Physician, 61(2), 152–158.