An evidence-based dietary fiber enrichment programme for relieving constipation in elderly orthopaedic patients

Abstract

Constipation is a multifactorial digestive disorder highly prevailing among the hospitalized elderly Orthopaedic patients. Unlike Western countries, laxative therapy is used to be the first line remedy for constipation in many hospitals of Hong Kong although fiber-rich diet has been proven by numerous studies as the best alternative with low cost and less complications.

This dissertation is a translational nursing research which aims at formulating a programme of using fiber-rich food products for relieving constipation in elderly Orthopaedic patients, based on the best available research evidences.

It was started with an integrated and systematic review of papers studying the dietary interventions for relieving constipation and reducing laxative consumption in elderly with ADL dependency. Seven relevant studies were identified and critically appraised using the methodology checklist for RCTs designed by Scottish Intercollegiate Guidelines Network (SIGN). After summarizing and synthesizing the data, three dietary interventions with 1+ level of evidence were concluded as the most effective strategies for eradicating the clinical issue.

Following assessment of the implementation potential of the proposed innovation in designated clinical setting in terms of transferability, feasibility and cost-benefit ratio, an evidence-based dietary fiber enrichment programme was developed with recommendations for patient recruitment, intervention and evaluation. Furthermore, to assure a smooth change of practice and to determine the effectiveness of the programme, comprehensive plans of communication with different stakeholders, pilot study and evaluation were also subsequently established.

With this evidence-based programme, the prevalence of functional constipation and laxative consumption are hoped to be reduced in elderly Orthopaedic patients.