Critical mistakes in managing chronic constipation in the older person and how to avoid them: A narrative review

Abstract

OBJECTIVES: This narrative review identifies pitfalls in managing constipation in older adults and provides evidence-based recommendations to avoid them. METHODS: A selective literature search was conducted across electronic databases (PubMed, MEDLINE, Embase, and Cochrane Library) to identify relevant publications on constipation management in older adults. Randomized controlled trials, meta-analyses, systematic reviews, evidence-based clinical practice guidelines, and selected expert consensus statements and narrative reviews were included. RESULTS: Constipation significantly impacts quality of life and healthcare costs in older adults. It is not a consequence of normal aging but results from decreased mobility, medications, underlying diseases, and pelvic floor dysfunction. A stepwise diagnostic and therapeutic approach is recommended, recognizing that multiple etiologic mechanisms often coexist in elderly patients. Before pharmacological interventions, initial management should include thorough history-taking, physical examination, medication review, and dietary and lifestyle modifications. CONCLUSIONS: Common management mistakes include inadequate assessment, overlooking underlying conditions, insufficient diagnostic workup, ignoring multifactorial causes, premature medication use, and neglecting patient education. Effective management requires systematic evaluation and personalized interventions. CLINICAL IMPLICATIONS: Clinicians should adopt a stepwise approach, from clinical assessment to diagnostic testing or medications. Patient education and individualized treatment based on comorbidities and preferences are essential, with regular efficacy reassessment.