以整合照護指引與文獻回顧為基礎的老年人慢性便秘非藥物照護建議

Non-pharmacologic care for chronic constipation in the elderly based on intergraded guidelines and literature review

陳雅莉(Ya-Li Chen) ； 林文絹(Wen-Chuan Lin)

《台灣公共衛生雜誌》 35卷3期 (2016/06) Pp. 248-259

https://doi.org/10.6288/TJPH201635104088

摘要

老年人因老化、生理功能改變、咀嚼能力減弱、罹患各種慢性疾病及用藥等多重因素影響下，使便秘成了老年人常見的健康問題，便秘的盛行率隨著年紀增長而增加。長期便秘引起腹部脹痛、食慾不振、噁心、嘔吐等不適；此外，若因便秘致使排便用力，也易誘發心肌梗塞、中風猝死等危險，影響老年人的生理及心理健康，降低生活品質，因此便秘的預防和處置是照護者均需面對的重要課題。本文整合現今國內外老年人慢性便秘非藥物照護指引與文獻，提出慢性便秘照護上的實證建議，內容包括護理人員及主要照顧者在評估老年人便秘時應留意的重點，於便秘的預防及處置上，如何適當的攝取膳食纖維、益生菌及水分等，並配合腹部按摩與活動來改善便秘問題，可適用於無特殊疾病(如慢性腎衰竭、神經性便秘)之居家、社區、機構及醫療院所有慢性便秘困擾的老年人，提供照護人員之參考，以提升老年人之生活品質。

關鍵字

便秘 ； 老年人 ； 膳食纖維 ； 益生菌

並列摘要

Constipation is a common medical disorder in the elderly, and results from aging, physiologic changes, co-existing chronic diseases, and the administration of multiple drugs. The prevalence of constipation increases with advancing age. Chronic constipation may lead to significant gastrointestinal discomfort. In addition, defecating with force induces myocardial infarction and death from stroke, which affect physiologic and psychological health, thus impairing the quality of life. It is therefore of paramount importance for caregivers to prevent and manage constipation. Herein we provide evidence-based suggestions for chronic constipation care on the basis of guidelines and a literature review pertaining to the non-pharmacologic care of chronic constipation. The themes derived from the guidelines and a literature review are intended to aid nurses and primary health caregivers focus on the prevention and the treatment of constipation, and consists of an adequate intake of dietary fiber, probiotics, and fluids, together with interventions, such as abdominal massage and physical activity, to improve constipation while taking care of these elderly patients. Evidence-based suggestions provided herein are useful for the management of chronic constipation in the elderly free of other specific diseases (e.g. chronic renal failure and neurotic constipation) dwelling at home or institutions.

並列關鍵字

constipation ； the elderly ； dietary fiber ； probiotics

參考文獻

Rao SS, Talley NJ, Schmader KE, Grover S. Constipation in the older adult. http://www.uptodate.com/contents/constipation-in-the-olderadult?source=search_result&search=constipation&selectedTitle=3%7E150. Accessed November 28, 2014

The Merk Manual of Geriatrics.

Centre for Evidence-Based Medicine (CEBM). Oxford centre for evidence-based medicine levels of evidence. Available at: http://www.cebm.ne t/?s=ht tp%3A%2F%2Fwww.c ebm.ne t%2F. Accessed July 1, 2014

World Gastroenterology Organisation (WGO). World Gastroenterology Organisation global guidelines: constipation: a global perspective. Available at: http://www.worldgastroenterology.org/assets/export/userfiles/05_constipation.pdf. Accessed December 8, 2014

National Guideline Clearinghouse (NGC). Prevention of constipation in the older adult population. Available at: http://www.guideline.gov/content.aspx?id=47565&search=constipation. Accessed July 20, 2014