Gallagher Paul F, O'Mahony Denis, Quigley Eamonn M M
Department of Geriatric Medicine, Cork University Hospital, Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland.
Drugs Aging. 2008;25(10):807-21. doi: 10.2165/00002512-200825100-00001.
Constipation is a significant healthcare problem in the elderly. However, while undoubtedly common in the elderly, data on the prevalence of constipation in general and of its subtypes vary considerably, depending on the nature of the study population and their location. Furthermore, the complexity of the pathophysiology of constipation in this age group is little appreciated. Assumptions regarding 'age-related changes in colorectal physiology' are, for the most part, not supported by scientific evidence and may serve to distract the clinician from uncovering the contributions of co-morbid diseases and the impact of iatrogenic factors. The evidence base from which one can develop recommendations on the management of constipation in the elderly is, for the most part, slim. This becomes most starkly apparent when one attempts to critically assess specific approaches to management. There is insufficient evidence to support the use of many commonly used laxatives both in the general population and in the elderly. Lifestyle interventions have value for some patients but data are lacking on the benefits of these interventions for patients with chronic constipation. Data in the elderly do not exist for most new pharmacological approaches to constipation. Pending the availability of good data, management of constipation in the elderly should be tailored to each individual's needs and expectations, regardless of age or place of residence. In certain situations, constipation may be complicated by the development of impaction; preventive strategies are important in this context. We urge enrolment of many more elderly individuals with chronic constipation in clinical trials designed to address their particular needs.
便秘是老年人面临的一个重大健康问题。然而，尽管便秘在老年人中无疑很常见，但关于便秘总体患病率及其亚型的数据差异很大，这取决于研究人群的性质及其所在位置。此外，这个年龄组便秘病理生理学的复杂性鲜为人知。关于“结肠直肠生理学的年龄相关变化”的假设在很大程度上没有科学证据支持，可能会使临床医生无法发现合并症的影响以及医源性因素的作用。目前，能够为老年人便秘管理制定建议的证据基础十分薄弱。当人们试图严格评估具体的管理方法时，这一点就变得最为明显。没有足够的证据支持在普通人群和老年人中使用许多常用的泻药。生活方式干预对一些患者有价值，但缺乏这些干预措施对慢性便秘患者益处的数据。对于大多数新的便秘药物治疗方法，尚无针对老年人的数据。在获得充分数据之前，老年人便秘的管理应根据每个人的需求和期望进行调整，无论其年龄或居住地点如何。在某些情况下，便秘可能会因粪便嵌塞而变得复杂；在这种情况下，预防策略很重要。我们敦促让更多患有慢性便秘的老年人参加旨在满足他们特殊需求的临床试验。
