Title : Exploring the correlation between constipation and delirium
Abstract:
Constipation is a common problem in hospitalized patients, especially among those who are 65 years and older. Constipation is affected by advanced age, decreased physical activity, poor nutritional status, and polypharmacy (Lim, J. et al., 2021). The American College of Gastroenterology defines constipation based upon symptoms that include substandard defecation which consist of sporadic stools, a difficult time in passing stool or both (American College of Gastroenterology, 2024). Delirium is a common condition that also affects older hospitalized patients (Mei, et al. 2023). Delirium is a considered a geriatric, medical condition, not explained by a pre-existing neurocognitive disorder (American Psychological Association, 2013). Delirium has consistently been shown to be linked to poor health outcomes, higher hospital-related complications, prolonged hospital stays and increased readmission rates (Al Huraizi et al., 2023). Delirium occurs as a result of both predisposing and controllable factors (Mei, et al, 2023). Almost all of the controllable factors occur as a result of acute conditions or hospitalization. These factors include brain function changes, sepsis, infection, hypoglycemia, drug use, sleep pattern changes, electrolyte imbalances, 24-hour light environment, and pain management medications or anesthesia. This retrospective chart review study examined patients admitted to the Acute Care of Elderly (ACE) Unit in a North Texas hospital. Its aim was to investigate the potential association between constipation and delirium among inpatients aged 65 and above. In the study, constipation is defined as no bowel movement in 48 hours or more and delirium as Positive 4AT (Rapid Clinical Test for Delirium Detection). The study found a strong correlation between delirium, constipation and race. Additionally, the study investigated the relationship between constipation and delirium with other variables, including length of stay, inpatient falls, sitter usage, and the use of opioids, smoking, and alcohol before admission.
Audience Take Away:
- The study highlighted the bidirectional relationship between delirium and constipation. Shared risk factors like opioids, comorbidities, life style contribute to their co-occurrence especially among elderly patients.
- Preventing or intervening early in cases of delirium is crucial to mitigate patient harm events such as falls, infections, and pressure injuries, as well as to prevent physical and cognitive decline. Delirium can prolong hospital stays and necessitate increased sitter usage, resulting in elevated medical costs.
- Clinicians should assess and manage constipation in delirious patients and vice versa to improve clinical outcomes.
- Further research on evaluating the efficiency of interventions targeting constipation to prevent or intervene early delirium among hospitalized elderly populations.