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Findings From the National Health Interview Survey and Clinical Implications

Danielle Harari, MB, ChB, MRCP; Jerry H. Gurwitz, MD; Jerry Avorn, MD; Rhonda Bohn, MPH; Kenneth L. Minaker, MD, FRCP

Arch Intern Med. 1996;156(3):315-320.

Abstract
Background
Constipation is widely considered to be a common problem among the elderly, as evidenced by the high rate of laxative use in this population. Yet, age-related prevalence studies of constipation generally do not distinguish between actual alteration in bowel movement frequency and subjective self-report of constipation.

Objective
To determine the relationship between advancing age and bowel habit.

Methods
We employed data collected on 42375 subjects who participated in the National Health Interview Survey on Digestive Disorders based on interviews with a random nationwide sample of US households. We examined the following characteristics reported by this population according to selected age groupings by decade: constipation, levels of laxative use, and two bowel movements per week or less.

Results
Contrary to conventional wisdom, there was no age-related increase in the proportion of subjects reporting infrequent bowel movements. Nonetheless, the prevalence of self-report of constipation increased with advancing age, with a greater proportion of women reporting this symptom than men across all age groups. Laxative use also increased substantially with aging; while women were more likely to use laxatives than men, this effect attenuated with advancing age. A U-shaped relationship was observed between advancing age and bowel habit in men and women; 5.9% of individuals younger than 40 years reported two bowel movements per week or less compared with 3.8% of those aged 60 to 69 years and 6.3% of those aged 80 years or older. This relationship persisted after adjusting for laxative use.

Conclusion
These findings suggest that a decline in bowel movement frequency is not an invariable concomitant of aging. In elderly patients who report being constipated, it is essential to take a careful physical, Psychological, and bowel history rather than to automatically assume the need for laxative use.

(Arch Intern Med. 1996;156:315-320)

Author Affiliations
From the Division on Aging, Harvard Medical School, and the Massachusetts General Hospital/Beacon Hill Geriatric Medicine Unit and General Medicine Unit, Boston (Drs Harari and Minaker); Geriatric Research Education and Clinical Center, Veterans Affairs Medical Center, Brockton/West Roxbury, Mass (Drs Harari, Gurwitz, and Minaker); and Program for the Analysis of Clinical Strategies, Gerontology Division, Brigham and Women's Hospital and Harvard Medical School, Boston (Drs Gurwitz and Avorn and Ms Bohn).

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