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

1. 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

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

5. 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

6. 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.

7. 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.

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 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).

9. 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

10. 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

11. 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).

12. 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.

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