Answer

Literature Review

                There is a dramatic increase in constipation with age. Gandell, Straus, Bundookwala, Tsui, and Alibhai (2013) note that the estimated prevalence of the condition among geriatrics is approaching 50% which is a public health concern. Some of the key elements associated with the condition are medication use, low socioeconomic status, the non-white race, gender where the prevalence is higher among women, and related mental disorders such as depression and anxiety. Constipation management is described by the effective alleviation of the adverse symptoms including straining during defecation, hard and lumpy stools, incomplete evacuation, anorectal obstruction, manual manoeuvres, and reduced defecations per week (Lamas, Karlsson, Nolen, Lovheim, and Sandman, 2017). Various approaches have been developed which aid in constipation management. These include osmotic agents, bulk agents, stool softeners, prokinetic agents, and lifestyle modification. This paper, therefore, entails a literature review of examining the variation between medication therapy and diet and fluid intake.

The understanding of constipation’s etiology and its management has evolved. For the elderly, however, there is more than a single etiologic mechanism which prompts the use of a multifactorial management strategy. De Giorgio et al. (2015) in this regard points out that among most aged patients, the response to lifestyle modification and diet combined with bowel training approaches is effective in managing the comorbid conditions. With more than 30% of the total elderly population experiencing constipation at a point in their lifetime, there is a need to develop alternative approaches especially with the rise in the herbalists and pharmacies. Nebhinani and Suthar (2017) on the other hand notes that the most effective management approach is one that takes a combination of various factors. In a literature review, Nebhinani and Suthar (2017) noted that healthcare providers must demonstrate competence in developing a combination of approaches that will profoundly relieve the patient’s symptoms. Among the combined approaches of managing the condition include medication therapy, lifestyle and behavioural modification, and the use of laxatives.

                The type of management strategy depends on the patient and environmental factors. In a qualitative exploratory study by Munch, Tvistholm, Trosborg, and Konradsen (2016), it was established that the management approach for a patient is dependent on a number of individual factors including other conditions, social activities, and hospitalization. The consideration of these issues is critical in preventing further complications and patient issues especially in using multiple medications. The study illuminated the need for medical practitioners to pay attention to the patient factors which aid in developing a profound intervention plan. This aspect was further supported by Nebhinani and Suthar (2017) who added that a number of steps have to be followed to manage the condition among the elderly. These phases have to include identifying the constipation diagnosis which considers the existence of one or more symptoms, a physical examination which considers a thorough inspection of the anal-rectal, and establishing the different treatment approaches, especially on the reversible issues. Based on these steps, the management strategy can be developed which is a consideration of different issues including laxative therapy and lifestyle modification which is a combination of taking fibres and plenty of water.

                The use of medication therapy is associated with other challenges including adverse side effects and high costs. In a descriptive study by Yilmaz and Asiret (2017), it was established that the use of laxatives among other pharmacological approaches is discouraged based on the high costs and side effects which prompt the consideration of the non-pharmacological strategies. According to these authors, the implementation of the behavioural and lifestyle modification such as taking a diet that is rich in fibre and increasing the intake of fluids is associated with better patient outcomes. This contradicted the systematic review performed by Martinez-Martinez, Calabuig-Tolsa, and Cauli (2017) who espouse that the use of medication therapy is effective although the duration of use should be carefully selected. However, the key issue is that the use of drugs should be combined with diet and lifestyle modification to enhance the quality of patient outcome and profoundly relieve the symptoms.

Research Gap Problem

                Drawing from the literature analysis above, it is apparent that both pharmacotherapy and non-pharmacological approaches are effective in managing constipation. However, it is not clear which strategy between diet and fluid intake and the use of drugs is effective in managing the condition especially among the hospitalized patients for one month. The study by Martinez-Martinez et al. (2017) for instance considers the use of pharmacotherapy as more effective. However, these authors point a concern when the drugs are used in the long term which therefore demonstrates the importance of diet and fluid intake. Yilmaz and Asiret (2017) counters the use of drug therapy based on the cost and side effects grounds and point out on the importance of considering the lifestyle modification such as fluid intake and consuming foods rich in fibre and vegetables. However, there is still no study that specifies the duration of stay at the hospital for these patients and which strategies are therefore essential in addressing the patient’s symptoms especially between diet and fluid intake and the use of drugs.

Summary Table

                In summary, the above literature analysis demonstrates the research gap in constipation management among the elderly. With the condition prevalence being high among the aged, it is imperative to identify the specific patient and environmental conditions that may affect the intervention strategy. Although the use of drugs is considered effective, their long-term application remains a challenge based on the side effects and costs. Therefore, diet and fluids intake are critical in the management plan. The research gap identified is that among hospitalized patients, it is not clear which strategy between drugs and diet and fluid intake is essential in managing the condition especially in the short-term which is the foundation of the change project and research.