Laxative use and abuse in the older adult: Part I

Constipation is a challenging condition faced by clinicians in the every day care of elderly patients. Although it is not always possible to identify a single underlying cause, the initial approach to constipation in the elderly should involve a detailed investigation of associated risk factors, medications, dietary regimens, and bowel habits. The management of constipation in this population should focus on increasing dietary fiber (both soluble and insoluble), encouraging adequate fluid intake, and promoting physical activity. Only when these lifestyle modifications have failed should pharmacologic therapy be implemented. Lastly, it is important for clinicians to recognize the frequent association between constipation and opioid use in the older adult. Patients on long-term opioid therapy should be maintained on scheduled laxative regimens in order to improve their quality of life.