The effects of Stopping Enemas in Disabled Elderly Patients Suffering from Constipation in Nursing D...
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Doron Garfinkel , M.D., Svetlana Zludkov , M.D ., Sameira Jamal, R.N., Ronit Har-Noy , R.N . PowerPoint PPT Presentation


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The effects of Stopping Enemas in Disabled Elderly Patients Suffering from Constipation in Nursing Departments. 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.

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Doron Garfinkel , M.D., Svetlana Zludkov , M.D ., Sameira Jamal, R.N., Ronit Har-Noy , R.N .

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Doron garfinkel m d svetlana zludkov m d sameira jamal r n ronit har noy r n

The effects of Stopping Enemas in Disabled Elderly Patients Suffering from Constipation in Nursing Departments

DoronGarfinkel, M.D., Svetlana Zludkov, M.D.,

Sameira Jamal, R.N., RonitHar-Noy, R.N.

The Shoham Geriatric Medical Center, Pardes-Hanna,

ISRAEL


Shoham geriatric medical center

Shoham Geriatric Medical Center

  • Owned by the Government

  • The largest geriatric campus

    in Israel

  • 360 square Km of land

  • 800 patient’s beds


Doron garfinkel m d svetlana zludkov m d sameira jamal r n ronit har noy r n

מ ד י נ ת י ש ר א ל

מ ש ר ד ה ב ר י א ו ת

המרכז הגריאטרי המשולב ע”ש שוהם

פרדס חנה


Doron garfinkel m d svetlana zludkov m d sameira jamal r n ronit har noy r n

The effects of Stopping Enemas in Disabled Elderly Patients Suffering from Constipation in Nursing Departments

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.


Doron garfinkel m d svetlana zludkov m d sameira jamal r n ronit har noy r n

BACKGROUND :

  • In many disabled patients in ND,

    Constipation can be relieved only by enemas.

  • In September 2004, supply of Fleet Enemas (FE)

    ( Sodiumbiphosphate 16g/ Sodiumphosphate 6g/ 10cc, )

    was unexpectedly stopped and we had to use our

    Reserve or give Lactulose instead.

  • The influence of Discontinuation of Enemas (DoE)

    in our ND patients was evaluated.


Doron garfinkel m d svetlana zludkov m d sameira jamal r n ronit har noy r n

METHODS

  • 270 disabled patients in 10 ND were evaluated.

  • Begining September 1, in all patients teated with

    FE, an attempt of DoE was made

    and they were all given Lactulose.

  • Using medical and nursing follow up notes,

    several parameters were compared in all patients

    between July-August and October-November of

    2004 (before and after DoE, respectively).


Doron garfinkel m d svetlana zludkov m d sameira jamal r n ronit har noy r n

R E S U L T S

270 patients

Fleet Enema

194 (72%)

NO treatment

16 (6%)

Lactulose

60 (22%)

DoE Attempt

Unbearable Symptoms

Requiring Readministration of FE

FAILUE

120 (62%).

SUCCESSFUL

74 (38%).

LATE EFFECTS

Control Group

196 Pt.

DoE Group

74 Pt.

Comparing

parameters

before & after DoE


Doron garfinkel m d svetlana zludkov m d sameira jamal r n ronit har noy r n

RESULTS

LATE EFFECTS OF DoE

Following 3 months of DoE,

There was No difference between the Doe and controls in:

  • 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


Doron garfinkel m d svetlana zludkov m d sameira jamal r n ronit har noy r n

RESULTS

LATE EFFECTS OF DoE

Following 3 months,

The DoE group Did Have:

  • A significantlly increased number of Physical

    Examinations by physician (123 before 226 after

    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).


Doron garfinkel m d svetlana zludkov m d sameira jamal r n ronit har noy r n

CONCLUSIONS

  • In Nursing Departments, stopping Enemas

    and starting Lactulose with NO significant

    adverse effects, can be accomplished in

    less than 40%.

  • However, in most disabled patients in ND,

    Stopping Enemas is Inpractical and has

    No Clinical or Financial Benefits.


Doron garfinkel m d svetlana zludkov m d sameira jamal r n ronit har noy r n

Thank You !

DoronGarfinkel, M.D.

The Shoham Geriatric Medical Center, Pardes-Hanna,

ISRAEL


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