Management of Constipation in Residents With Dementia: Sorbitol Effectiveness and Cost

Objective The objective of this report is to describe a cost-effective strategy for management of constipation in nursing home residents with dementia. Design We conducted a prospective observational quality improvement study of 41 residents with chronic constipation and receiving an osmotic laxative. Sorbitol was substituted for lactulose. Setting The study was conducted at a dementia special care unit at a Veterans Administration hospital. Measurement We measured the number and amount of laxative use over a period of 4 weeks that were required to maintain regular bowel function. Results There was no difference in efficacy of lactulose and sorbitol. Use of additional laxatives was infrequent: Milk of Magnesia on approximately 10% of days/patient, bisacodyl suppository on 2% to 4% of days/patient, and Fleet enema only on 3 occasions. The cost of constipation management using routine administration of sorbitol and as-needed use of other laxatives was 27% to 55% lower than the cost of other constipation management strategies reported in the literature. Conclusion Substitution of sorbitol for lactulose does not change efficacy of the treatment and decreases cost. Regular use of an osmotic laxative avoids the costs and discomforts of rectal laxatives. The objective of this report is to describe a cost-effective strategy for management of constipation in nursing home residents with dementia. We conducted a prospective observational quality improvement study of 41 residents with chronic constipation and receiving an osmotic laxative. Sorbitol was substituted for lactulose. The study was conducted at a dementia special care unit at a Veterans Administration hospital. We measured the number and amount of laxative use over a period of 4 weeks that were required to maintain regular bowel function. There was no difference in efficacy of lactulose and sorbitol. Use of additional laxatives was infrequent: Milk of Magnesia on approximately 10% of days/patient, bisacodyl suppository on 2% to 4% of days/patient, and Fleet enema only on 3 occasions. The cost of constipation management using routine administration of sorbitol and as-needed use of other laxatives was 27% to 55% lower than the cost of other constipation management strategies reported in the literature. Substitution of sorbitol for lactulose does not change efficacy of the treatment and decreases cost. Regular use of an osmotic laxative avoids the costs and discomforts of rectal laxatives.