Is Fibre an Effective Strategy to Improve Laxation in Long-Term Care Residents?
Publication: Canadian Journal of Dietetic Practice and Research
3 October 2017
Abstract
The high prevalence of constipation in long-term care (LTC) residents has been a long-standing issue for caregivers, attending health professionals, and the residents themselves. The traditional medical response has been to utilize pharmaceutical laxatives, enemas, and suppositories for treatment. The purpose of this review was to determine if fibre supplementation (including fibre added to foods) is effective in increasing stool frequency, improving stool consistency, and decreasing laxative use in LTC residents. A systematic search was conducted using PubMed and CINAHL databases, inclusive to March 2017. Search terms included: “long-term care” or “nursing home” AND “fiber (fibre),” “bran,” “psyllium,” “inulin,” or “prebiotic.” Intervention trials of fibre supplementation with ≥5 LTC residents were included. The search generated 456 articles following removal of duplicates; 8 studies met the inclusion criteria. Three additional trials were identified through a hand search of references of pertinent articles. Current evidence suggests that added fibre may be effective in increasing stool frequency and/or decreasing laxative use in LTC residents and, thus, may lessen the burden of constipation. However, randomized controlled trials are needed to clearly demonstrate the effects of adding fibre to foods, particularly insoluble and less fermentable sources, on constipation in LTC residents.
Résumé
La forte prévalence de la constipation chez les résidents recevant des soins de longue durée constitue, depuis longtemps, un problème pour les fournisseurs de soins, les professionnels de la santé et les résidents eux-mêmes. Traditionnellement, le milieu médical se tourne vers les laxatifs pharmaceutiques, les lavements et les suppositoires à titre de traitement. L’objectif de cette étude était de déterminer si la supplémentation alimentaire en fibres (dont l’ajout de fibres à la nourriture) est efficace pour augmenter la fréquence des selles, améliorer leur consistance et décroître l’utilisation de laxatifs par les résidents. Une recherche systématique a été effectuée, en utilisant les bases de données PubMed et CINAHL, sur une période allant jusqu’à la fin mars 2017. Les critères de recherche comprenaient : « soins de longue durée » ou « centre d’hébergement et de soins de longue durée » ET « fibre », « son », « psyllium », « inuline » ou « prébiotique. » Des essais sur le terrain de supplémentation en fibres auprès de ≥ 5 résidents ont été inclus. Après retrait des doublons, la recherche a ciblé 456 articles, et 8 études respectaient le critère d’inclusion. Une recherche manuelle parmi les références d’articles pertinents a permis de trouver trois autres essais. Les données probantes actuelles suggèrent que l’ajout de fibres pourrait constituer un moyen efficace pour augmenter la fréquence des selles et/ou diminuer l’usage de laxatifs chez les résidents, ce qui pourrait ainsi alléger le fardeau que représente la constipation. Cependant, des essais randomisés sont nécessaires pour démontrer clairement les effets de l’ajout de fibres aux aliments sur la constipation chez les résidents, particulièrement lorsque ces fibres proviennent de sources insolubles ou qui fermentent moins facilement.
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Financial support: Graduate student funding provided by SENESCYT (Secretaría Nacional de Educacion Superior, Ciencia y Tecnología) Ecuador.
Conflict of interest: The authors declare no conflicts of interest.
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Canadian Journal of Dietetic Practice and Research
Volume 79 • Number 1 • March 2018
Pages: 35 - 41
Editor: Newton Lupwayi
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Version of record online: 3 October 2017
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Wendy J.DahlPhD and Daniela RiveroMendozaMS. 2018. Is Fibre an Effective Strategy to Improve Laxation in Long-Term Care Residents?. Canadian Journal of Dietetic Practice and Research.
79(1): 35-41. https://doi.org/10.3148/cjdpr-2017-028
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