1. Doron Garfinkel, M.D., Svetlana Zludkov, M.D., Sameira Jamal, R.N., Ronit Har-Noy, R.N. Doron Garfinkel, M.D., Svetlana Zludkov, M.D., Sameira Jamal, R.N., Ronit Har-Noy, R.N. The Shoham Geriatric Medical Center, Pardes-Hanna, ISRAEL The Shoham Geriatric Medical Center, Pardes-Hanna, ISRAEL The effects of Stopping Enemas in Disabled Elderly Patients Suffering from Constipation in Nursing Departments

2. Shoham Geriatric Medical Center Owned by the Government The largest geriatric campus in Israel 360 square Km of land 800 patient ’ s patient ’ s beds

5. מ ש ר ד ה ב ר י א ו ת מ ד י נ ת י ש ר א ל המרכז הגריאטרי המשולב ע”ש שוהם פרדס חנה

6. BACKGROUND :   Constipation is a very common age - associated problem in elderly people.   The incidence of Constipaion increases with Age, Co-morbidities, Drugs, Disability and Immobility.   The incidence is higher in Nursing Homes (NH) and particularly in Nursing Departments (ND).   Constipation can be relieved by diet, several types of Laxatives and Enemas. The effects of Stopping Enemas in Disabled Elderly Patients Suffering from Constipation in Nursing Departments

7. BACKGROUND :  In September 2004, supply of Fleet Enemas (FE) ( Sodiumbiphosphate 16g/ Sodiumphosphate 6g/ 10cc, ) ( Sodiumbiphosphate 16g/ Sodiumphosphate 6g/ 10cc, ) was unexpectedly stopped and we had to use our was unexpectedly stopped and we had to use our Reserve or give Lactulose instead. Reserve or give Lactulose instead.  The influence of Discontinuation of Enemas (DoE) in our ND patients was evaluated. in our ND patients was evaluated.   In many disabled patients in ND, Constipation can be relieved only by enemas.

8. METHODS  270 disabled patients in 10 ND were evaluated.  Begining September 1, in all patients teated with FE, an attempt of DoE was made FE, an attempt of DoE was made and they were all given Lactulose. and they were all given Lactulose.  Using medical and nursing follow up notes, several parameters were compared in all patients several parameters were compared in all patients between July-August and October-November of between July-August and October-November of 2004 (before and after DoE, respectively). 2004 (before and after DoE, respectively).

9. R E S U L T S 270 patients NO treatment 16 (6%) Lactulose 60 (22%) Fleet Enema 194 (72%) DoE Attempt FAILUE 120 (62%).SUCCESSFUL 74 (38 74 (38%). Control Group 196 Pt. DoE Group 74 Pt. LATE EFFECTS Unbearable Symptoms Requiring Readministration of FE Unbearable Symptoms Requiring Readministration of FE Comparing parameters parameters before & after DoE

10.  Urinary symptoms  Sleep  Appetite  Irritability  Urinary or Respiratory Infections  Number of sedatives/tranquilizers prescribed  Referrals to Hospitals before and after DoE  Findings of Rectal Examination were comparable in both groups in both groups RESULTS LATE EFFECTS OF DoE RESULTS LATE EFFECTS OF DoE Following 3 months of DoE, There was No difference between the Doe and controls in:

11. RESULTS LATE EFFECTS OF DoE RESULTS LATE EFFECTS OF DoE  A significantlly increased number of Physical Examinations by physician (123 before 226 after Examinations by physician (123 before 226 after DoE, no significant change in controls, P< 0.01). DoE, no significant change in controls, P< 0.01).  A higher prevalence of increase in body weight (35% compared to 15% in the controls, p < 0.001). (35% compared to 15% in the controls, p < 0.001). Following 3 months, The DoE group Did Have:

12. CONCLUSIONS  In Nursing Departments, stopping Enemas and starting Lactulose with NO significant and starting Lactulose with NO significant adverse effects, can be accomplished in adverse effects, can be accomplished in less than 40%. less than 40%.  However, in most disabled patients in ND, Stopping Enemas is Inpractical and has Stopping Enemas is Inpractical and has No Clinical or Financial Benefits. No Clinical or Financial Benefits.

13. The Shoham Geriatric Medical Center, Pardes-Hanna, ISRAEL The Shoham Geriatric Medical Center, Pardes-Hanna, ISRAEL Thank You ! Doron Garfinkel, M.D.