A longitudinal study of constipation and laxative use in a community-dwelling elderly population Barry L. Werth a, *, Kylie A. Williams b , Lisa G. Pont a a Sydney Nursing School, University of Sydney, Sydney, NSW, Australia b Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia 1. Background Like most developed countries, the Australian population is aging with the majority of the elderly population residing in the community (Luszcz et al., 2007). Constipation is a relatively common condition which is particularly prevalent in the elderly and usually self-managed with laxatives (Gallagher & O’Mahony, 2009; McCrea, Miaskowski, Stotts, Macera, & Varma, 2009). Over $100 million is spent annually in Australia on laxatives but this is only one cost consequence of constipation. The costs of doctor consultations, hospitalisations and lost productivity due to constipation represent a significant additional economic burden (Dennison et al., 2005; Locke, Pemberton, & Phillips, 2000; Sonnenberg & Koch, 1989a, 1989b). In addition to the financial costs associated with constipation, the impact on the quality of life of those who suffer with constipation is a further consequence which cannot be ignored (Belsey, Greenfield, Candy, & Geraint, 2010; Dennison et al., 2005; Johanson & Kralstein, 2007; Talley, 2004; Wald et al., 2007). International studies have reported a wide range in the prevalence of constipation in community-dwelling elderly popu- lations (Campbell, Busby, & Horwath, 1993; Chaplin, Curless, Thomson, & Barton, 2000; Hammond, 1964; Wong, Wee, Pin, Gan, & Ye, 1999). Depending on the definition of constipation used, prevalences between 11% and 55% have been reported. Studies using self-defined constipation where participants are free to define constipation themselves without any constraints usually report higher prevalence rates than those using a specified definition or criteria (Wald et al., 2008). A recent US longitudinal study of the general adult population over a period of 20 years Archives of Gerontology and Geriatrics xxx (2015) xxx–xxx A R T I C L E I N F O Article history: Received 10 August 2014 Received in revised form 27 January 2015 Accepted 9 February 2015 Available online xxx Keywords: Longitudinal survey Aged Community Constipation Risk factors Laxatives A B S T R A C T Background: Little is known about laxative use, the association of constipation with laxative use, risk factors for constipation and how each of these changes over time in the community-dwelling elderly. Objective: The aim was to explore the prevalence of laxative use and of self-reported constipation, and identify risk factors (including age) associated with constipation, in a cohort of community-dwelling elderly residents. Methods: Data from the Australian Longitudinal Study of Ageing (ALSA) was used to compare differences in constipation and laxative use in the community-dwelling elderly between 1992–1993 and 2003– 2004. Results: Relevant data was available for 239 ALSA participants. The prevalence of self-reported constipation increased from 14% in 1992–1993 to 21% in 2003–2004. There was a corresponding increase in the prevalence of laxative use from 6% to 15% over the same period. At both time points, females reported a higher prevalence of both constipation and laxative use however the female:male prevalence ratios decreased over time indicating higher increases in the prevalence of each among males. Persistent chronic constipation occurred in 9% of the cohort. The association between laxative use and self-reported constipation was poor and laxative use was associated with self-reported constipation in less than a third of cases. Conclusion: The prevalence of both constipation and laxative use increases with age in the elderly, and these increases are greater for males than for females. Discrepancies between self-reported constipation and laxative use may suggest sub-optimal management of constipation in the community-dwelling elderly and further work is needed to fully understand this. ß 2015 Elsevier Ireland Ltd. All rights reserved. * Corresponding author. Tel.: +61 428 115 866. E-mail address: bwer8557@uni.sydney.edu.au (B.L. Werth). G Model AGG-3131; No. of Pages 7 Please cite this article in press as: Werth, B.L., et al., A longitudinal study of constipation and laxative use in a community-dwelling elderly population. Arch. Gerontol. Geriatr. (2015), http://dx.doi.org/10.1016/j.archger.2015.02.004 Contents lists available at ScienceDirect Archives of Gerontology and Geriatrics jo ur n al ho mep ag e: www .elsevier .c om /lo cate/ar c hg er http://dx.doi.org/10.1016/j.archger.2015.02.004 0167-4943/ß 2015 Elsevier Ireland Ltd. All rights reserved.