Fecal distribution changes using colorectal ultrasonography in older people with physical and cognitive impairment living in long-term care facilities: A longitudinal observational study

Shiho Tanaka, Koichi Yabunaka, Masaru Matsumoto, Nao Tamai, Hiroshi Noguchi, Mikako Yoshida, Gojiro Nakagami, Junko Sugama, Hiromi Sanada

Research output: Contribution to journalArticlepeer-review

Abstract

Nurses encounter difficulties evaluating constipation in elderly people with physical and cognitive impairment. Transabdominal ultrasonography (US) has been used to evaluate fecal impaction or fecal quality. However, it is unclear whether colorectal US can evaluate constipation symptoms in older people. Using colorectal US, we continuously observed the elderly and clarified the relationship between patterns of fecal distribution changes and constipation symptoms in older people with physical and cognitive impairment at long-term care facilities. This study included patients aged ≥65 years with oral intake. US was performed once a day until the next defecation, and fecal hardness was assessed. US images were extracted and categorized. Then, patterns of fecal distribution changes in the colorectum were classified. Multiple logistic regression analysis was performed to examine related factors associated with a constipation pattern. Among 101 patients, US images of 95 patients were analyzed. In 74.4% of the patients, US showed continuation of reflection with acoustic shadow in the rectum, which was significantly associated with defecation on the bed. Of the patients with a continuous crescent-shaped reflection pattern (R3), 92.9% had hard stool. R3 was found to be significantly associated with a Mini-Mental State Examination score of ≤10. In most of the patients, US detected a continuation of reflection with acoustic shadow in rectal patterns, indicating fecal retention in the rectum. Point-of-care US can be used by nurses to visualize rectal fecal retention as constipation patterns in the older people with physical and cognitive impairment at long-term care facilities.

Original languageEnglish
Article number55
JournalHealthcare (Switzerland)
Volume6
Issue number2
DOIs
Publication statusPublished - 2018 Jun

Keywords

  • Bowel-related nursing care
  • Cognitive dysfunction
  • Constipation
  • Elderly
  • Long-term care
  • Nursing
  • Ultrasonography

ASJC Scopus subject areas

  • Health Informatics
  • Health Policy
  • Health Information Management
  • Leadership and Management

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