Constipation in the Elderly

Written by: CDHF

Updated: February 28th, 2023

Startling Statistics about Constipation and the Elderly

Constipation is a term which refers to having difficulty during bowel movements and having incomplete and infrequent bowel movements over time. It can cause one to have stomach bloating, pain, gas, and poor appetite (Gallegos-Orozco, Foxx-Orenstein, Sterler, & Stoa 2012). Constipation is a common issue among the elderly with the prevalence differing based on social settings and circumstances. In the community, the prevalence among elderly aged 65 years and older is 26% for women and 16% for men. The prevalence increases as age progresses, and the rate among elderly aged 84 years and older is 34% for women and 26% for men (Schuster, Kosar, & Kamrul 2015). Among long-term care residents, the prevalence of constipation is depicted as high as 80%.

Why is Constipation a Specific Problem in the Elderly?

The foods people eat have a large effect on constipation – mostly related to fibre deficiency. Fibre is very important for bowel movements, yet often the food the elderly eat contains insufficient fibre (Gallegos-Orozco, Foxx-Orenstein, Sterler, & Stoa 2012). People with dental or chewing issues or loose-fitting false teeth or those with swallowing difficulties who eat soft low-fibre foods may have trouble obtaining fibre. A change of diet after moving into a long-term care home may cause fibre intake to decrease further (Schuster, Kosar, & Kamrul 2015). As we age, our taste bud sensitivity declines which could add to the disinterest in food (Hermann 2017). One factor that may particularly affect the elderly is a decreased fluid intake, which is vital to aiding fibre absorption (Schuster, Kosar, & Kamrul 2015).

Anxiety and depression are contributing factors leading to poor dietary habits in the elderly. Mood disorders in seniors can be caused by:

Uncertainty in life due to retirement
Loss of family members and friends
High level of dependence for regular day to day activities
Vulnerability to social isolation and lack of communication when living alone &
Poor health conditions due to physical disability and impairment (Hermann 2017)

All these factors can lead to reduced appetite and poor eating behaviours and decreased interest in shopping and cooking. Lack of physical activity, living a sedentary lifestyle or being restricted to bed or movement due to various medical conditions such as disability or physical impairment can also contribute to constipation (Schuster, Kosar, & Kamrul 2015).

On top of mental health, physical health factors such as cancer, diabetes and kidney disease can greatly affect the foods people eat (Fleming & Wade 2010). Treatments for these illnesses can influence dietary intake such as chemotherapy and surgeries and some antidepressants and other medicines require empty or full stomachs to ingest (Gustafsson, Lämås, Isaksson, Sandman & Lövheim, 2019).

Don’t overlook depression as a reason for low-fibre intake in the elderly.

More about Fibre

Dietary fibre, also known as roughage or bulk, includes parts of plant foods that the human body cannot absorb or digest. The fibre passes intact through one’s stomach and small intestine and into the colon which provides the bulk and fluids the stool requires (Mayo Foundation for Medical Education and Research 2022). The best way to increase fibre in the diet is through consuming whole foods. Foods with a higher fibre content are whole fruits, vegetables, grains, legumes, nuts and seeds (Mayo Foundation for Medical Education and Research, 2022). Fibre can be classified as soluble which is dissolvable in water and helps the heart and our digestive systems and insoluble which does not dissolve in water and helps digestion. Sources of soluble fibre are oats, peas, beans, apples, citrus fruits, barley, and psyllium. Sources of insoluble fibre are whole wheat flour, wheat bran, nuts and beans (Schuster, Kosar, & Kamrul 2015).

While incorporating a high fibre diet one needs to keep in consideration that fibre should be increased in diet very gradually over a few days so that the digestive system can get used to it. Consuming a diet rich in fibre along with enough fluids is important to prevent and treat constipation (Mayo Foundation for Medical Education and Research, 2022).

According to the recommendations for dietary fibre, elderly women require 21 grams/day and elderly men require 30 grams/day.

Here are some websites to help you find fibre in the foods an older person may enjoy:

The Encouragement to Eat

Wise use of fibre-rich ingredients is important. Fibrous ingredients are varied and can fill different roles in a meal – rather than endeavoring to have three servings of peas a day, for example, one can cook peas with brown rice and chia seeds for a more complete and varied meal, nutritionally fulfilling as well as being much more appealing to eat. Of course, if one cannot eat much either in one meal or throughout the day, choosing fibre-dense foods will help. Snacking on raspberries over strawberries in the same serving size packs much more fibre, for example.

Drinkable meals like smoothies loaded with fibre content helps as they are dense and smaller in amount. As elderly can have chewing issues, it will also be easier for them to just drink their meals. Also, drinkable meals can include more colors and seem more appealing on a low appetite.

The time when people eat is important as well. Any medicines that elderly patients may take, whether they directly affect fibre or appetite, can get in the way of eating. It helps to plan meals around whenever seniors take medicine, as appetites may either be lowered by their medicine, or their medicine ingestion may be dependent on the times that they eat (Gustafsson, Lämås, Isaksson, Sandman & Lövheim, 2019).

Stimulate appetite by encouraging physical activity. Physical activity plays a crucial part in prevention and treatment of constipation and in stimulating appetite. Engaging in physical activity like walking or morning stretches would also ensure that seniors have something to look forward to in a day. This could also be seen as a socializing activity where they get to meet more people engaged in similar activities, and the more you move, the more your body feels the need for energy and encourages hunger (Schuster, Kosar, & Kamrul 2015).

Smaller meals dense in nutrients and fibre, would prevent seniors from feeling overwhelmed from large portion sizes and giving up on eating. They would receive higher amounts of nutrients by consuming smaller portions when the meal is nutrient dense, and they would not have to spend a long time consuming it. Smaller meals or snacks could also be carried with them which would help them meet their nutritional requirements.

Fibre packed smoothies are wonderful when appetite is low. Blend in raspberries, chia seeds, or cooked frozen spinach for example.

Glass of refreshing raspberry smoothie with fibre for elderly for breakfast

Finding Fibre on Few Funds

Having access to an array of high-fibre foods is not always an option. The availability of fibrous foods may be limited by one’s local options or one’s budget. That doesn’t mean there isn’t a way to increase fibre intake with little options, and with these ideas, one can also elevate their cooking.

When it comes to buying food, money can be saved by either buying in bulk or buying seasonal ingredients. In the case of buying in-season ingredients, they are not only cheaper but also fresher and last longer. An example of seasonally cycling fibre-rich fruits depending on the season is using avocados during the summer and apples during the autumn. Many high-fibre foods are cheap, such as beans and oats. Coupled with them lasting long in dried or canned forms, these cheaper fibrous options can form the backbone of a fibre-rich diet.

For less perishable fibrous foods, pickling them can keep them available for far longer. Pickling carrots, beets, and okra not only preserves them, but adds new taste profiles to break up monotonous cooking and encourages cooking among the elderly. This is particularly handy for buying in bulk if one is trying to save money. Vegetables can be stretched even further – food scraps usually thrown out such as peels, roots, skins, and off-cuts can be saved to make fibrous vegetable stock.

Practising growing your own vegetables and fruits even on a smaller scale. Growing your own food may sound tedious but doing it for one’s own personal use on a smaller scale is more rewarding. It is a very hands-on process, and you know exactly what goes into it. It can be higher in nutrients as picked fresh daily and help in cutting costs. One could also join community gardens where this can be practiced in more space, where tips and tricks for gardening can be learned as well. Gardening has also been shown to improve mood.

Incorporate sprouting as a method of preparation for legumes, grains, nuts. Sprouting is a natural process where the grains, legumes, nuts when soaked in water, produce sprouts (germination), which increases their nutrient content and makes them easily digestible. It does not require time or money and can be done with basic ingredients already available at home. Sprouts increase in nutritional content e.g. protein, vitamins and fibre, even after they have been harvested (National Nutrition 2022).

Using whole grains in homemade breads instead of processed, store bought, items can increase fibre and save money. Refined breads bought in stores have less nutrients, including fibre, as the processing removes them. While making bread at home different grains and ingredients can be added based on personal interests to increase its nutritional content (Mayo Foundation for Medical Education and Research 2022).

Pickling carrots, beets or okra, not only preserves them, but adds new taste profiles to break up monotonous cooking and encourages eating among the elderly.

Summary

Constipation may have adverse effects on the health of elderly as it increases the stress on their bodies, lowers their appetite, and this could indirectly have many health consequences. To prevent and treat constipation increase fluid intake, consume a diet rich in good sources of fiber and make physical activity a part of life. Make smart and maintain healthy eating behaviors.

Recipes

High-Fibre Overnight Oats

High-Fibre Pasta

CDHF is thrilled to have partnered with The Culinary Management Nutrition Program at George Brown College to create this much needed science-based information on constipation in the elderly population!

Students from the Food and Nutrition Management Program at George Brown College Chef School participated in an academic writing content to create a Constipation in the Elderly article or video for CDHF. The course, called Nutrition Analysis, is taught by nutrition professor, Dr. Linda Gillis. Students focused on the elderly who often have issues with their mental health, finances and appetite which makes consuming a high fibre diet difficult.

Their experience in planning meals using creative ideas and recipes is highlighted in this article and these videos. Yasmin Jinna and Eunsu Yun were the article winners. Kenneth Au and Chante Grant were the winners for the video contest. George Brown College provides students with real world applications and opportunities for learning.