الفهرس 
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Abstract
Introduction:
Constipation in elderly is very common, affect quality of life, and can generally be prevented through education, dietary changes and lifestyle modifications, which have few cost implications.
Aim of the study:
This study aimed to improve quality of life in elderly people with constipation, by assessing impact of constipation on quality of life of elderly, design and implement a health education program to elderly people with constipation, and evaluate effectiveness of health education program for constipation on symptom severity and quality of life of elderly people.
Subjects and methods:
This study is a pre-post intervention study was carried out in two elderly nursing homes in Ismailia city. It included 23 elders suffering from chronic constipation according to inclusion and exclusion criteria.
The study was conducted in three consecutive phases:
• Phase 1: pre-test phase.
The elders involved in the study were interviewed to assess them by questionnaires (pre-test).
• Phase 2: Health education program phase.
Design and implement the intervention program using group’s discussion approach of small groups of elderly persons on 3 sessions to reduce constipation symptoms and improve quality of life and booklet distribution.
• Phase 3: post-test phase.
This phase began by end of the health education program after 2 weeks of last session; each subject was re-interviewed using the same questionnaire of the first visit to assess the effectiveness of the program (post-test).
The results have shown the following:
About half (52.2%) of the sample was 70-80 years old. Female patients represented about two thirds (69.6%) of the sample. The great majority of the sample was divorced or widow (82.6%). The half of the sample (52.2%) has no formal education. About two thirds of the sample (65.2%) has crowding index of < 2 and sufficient income, while only 13% had history of previous abdominal surgery.
There was highly statistically significant improvement in post intervention intake of regular 3 meals which increased from 21.7% pre-intervention to 82.6% post-intervention, and elders intake of foods rich in fiber increased from 13% pre-intervention to 73.9% post-intervention, and elders with regular physical activity raised from 17.4% pre-intervention to 69.6% post-intervention. Also statistically significant difference in elders daily fluid intake of more than 1.5 liter/ day which increased from 39.1% pre-intervention to 87% post-intervention. Also elder’s intake of one cup or more of tea daily decreased from 82.6% pre-intervention to 47.8% post-intervention, while coffee decreased from 47.8% pre-intervention to 13% post-intervention.
There was statistically significant improvement regarding laxative intake, as elders’ intake of laxatives decreased from 82.6% in pre-intervention to 34.8% in post intervention.
There was statistically significant improvement in post intervention regarding constipation scoring grade as all cases became mild in post-intervention after it was 65.2% mild and 34.8%moderate, satisfaction as part of quality of life during last 2 weeks (good and excellent satisfaction) increased from no one to 82.6.
There was statistically significant improvement in all items of CSS (constipation scoring system) in post intervention.
There was highly statistically significant improvement in post intervention regarding symptom severity of constipation according to patient assessment of constipation symptoms (PAC-SYM) including total score and sub-scores. Also statistically significant improvement regarding patient quality of life in post intervention according to patient assessment of constipation quality of life (PAC-QOL) including total dissatisfaction and satisfaction scores and sub-scores except psychological domain improved but not statistically significant.
There was statistically significant association between constipation scoring system and increased age in pre intervention.
There was statistically significant association between constipation scoring system and no physical activity in pre intervention.
There was statistically significant association between constipation scoring system and increased age in post intervention. Also statistically significant association between constipation scoring system and divorced or widow elders in post intervention.
There was statistically significant relation between constipation scoring system and elders with no regular 3 meals intake, or no intake of foods rich in fiber in post intervention. However elders with no coffee intake have increased CSS score in post-intervention.
There was statistically significant relation between dissatisfaction score of quality of life and increased crowding index and insufficient income in pre intervention.
There was statistically significant relation between dissatisfaction score of quality of life and 1 or more daily cups of tea and more dissatisfaction with no coffee intake in pre intervention.
There was statistically significant relation between dissatisfaction score of quality of life and elderly people with no formal education, also highly statistically significant relation between dissatisfaction score of quality of life and elderly people with increased crowding index and insufficient income in post intervention.
There was highly statistically significant relation between dissatisfaction score of quality of life and no regular intake of 3 meals daily in post intervention.
There was no statistically significant relation between pre- intervention satisfaction score of quality of life and socio-demographic characteristics.
There was statistically significant relation between pre intervention satisfaction score of quality of life and no regular intake of foods rich in fibers, however elders with no intake of coffee cups daily have more satisfaction scores, also elderly people with regular physical activity have increased satisfaction score in pre-intervention which is highly statistically significant.
There was highly statistically significant relation between post intervention satisfaction score of quality of life and education of elderly people as more educated were more satisfied in post-intervention.
There was no statistically significant relation between post intervention satisfaction score of quality of life and dietary and exercise habits.
Age was correlated negatively with satisfaction score, but correlated positively with Constipation Scoring System (CSS). Also education correlated negatively with dissatisfaction score.
CSS score affect negatively on satisfaction score (p<0.01), but affect positively on dissatisfaction score and PAC-SYM (p<0.01). Also PAC-SYM affect negatively on satisfaction score, but affect positively on dissatisfaction score (p<0.01). There was inverse correlation between satisfaction and dissatisfaction scores (p<0.01).
Age, education, crowding index were statistically significant independent positive predictors of Constipation scoring system (CSS). Conversely intervention program was statistically significant independent negative predictor of CSS score.
Income and intervention program were statistically significant independent negative predictors of Patient assessment of constipation symptoms (PAC-SYM) score.
Female sex, education, crowding index and intervention program were statistically significant independent positive predictors of satisfaction score.
Age, education, crowding index were statistically significant independent positive predictors of dissatisfaction score. Conversely intervention program was statistically significant independent negative predictor of dissatisfaction score.
Conclusion:
In conclusion, constipation in elderly is very common, affects quality of life, and can generally be prevented through education, dietary changes and lifestyle modifications, which have few cost implications.
Recommendations:
It is recommended that policy makers improve education and income of elderly people as they affect quality of life. Health education programs should be done to responsible persons about nursing homes to make modifications in diet, add physical activity programs, and design modifications of toileting facilities which help elders to avoid constipation. Health care providers in nursing homes should rationalize their prescription of laxatives and instead describe lifestyle modifications. Diet with high fiber content should be available to elderly in nursing homes in suitable amount and consistency. They should give proper health education for elderly people about constipation and lifestyle modifications to prevent and relieve constipation.
Family physicians should screen for constipation in every elderly person as it is common in elderly persons and affect quality of life. Further research is needed to show effect of the health education program on the community level, and in primary care level to assess cost effectiveness of the program.
Minimal data are available regarding quality of life in patients with constipation. Effort should be expanded toward the study of this topic, particularly in the elderly. Family physicians should consider using the validated patient assessment of constipation symptom (PAC-SYM) and quality of life (PAC-QOL) questionnaires to constipated patients to evaluate severity and impact of constipation. There should be training of undergraduate and postgraduate about importance of health education and lifestyle modifications to be given to elderly about constipation.