以實證護理探討老人便秘之處置

Managing Constipation in the Elderly: An Evidence-Based Approach

便秘，在老人族群中是一個常見的問題。臨床上常依據老人便秘的主訴，使用輕瀉劑，未探討導致便秘的原因，因此非但無法解決老人便秘問題，反而造成更多的合併症，例如便秘與腹瀉交替出現、腹脹、食慾不振、甚至腸阻塞等。而目前臨床上對於便秘的處理方式缺乏科學實證，大部分依據個人經驗看法，專業人員間缺乏一致性。因此本文以實證的方式探討老人便秘處置。從瞭解便秘定義及造成老人便秘之導因，進而執行便秘完整病史評估、身體評估及理學檢查，介紹便秘之非藥物及藥物處理方式，最後發展便秘方案步驟的建議，以作為臨床處理老人便秘之參考，期望能減少老人便秘問題。

Constipation is a common problem afflicting the elderly. When elderly patients complain of constipation to their healthcare providers, they are typically prescribed laxatives rather than given a clinical examination to explore the specific causes. This approach not only does not resolve the long-term problem of constipation, but may also lead to further complications (e.g., constipation alternating with diarrhea, abdominal distention, poor appetite, and ileus). Effective management of constipation in the elderly should in many cases be tailored to the symptoms and conditions of individual patients rather than simply applying evidence-based treatment. There is a lack of consistency amongst specialists on how best to deal with the problem of constipation. The aim of this article was to explore evidence-based management approaches to constipation in the elderly. A definition of constipation is given and relevant causes are first given. Pharmacological and non-pharmacological treatment approaches are then introduced with regard to effective approaches to conducting physical examinations, assessing patient medical history, and performing laboratory tests. In addition, this article also developed a constipation protocol as a reference tool in the clinical management of constipation in the elderly. The authors hope results can help reduce the problem of constipation in the elderly population.