TREATMENT OF ELDERLY BENZODIAZEPINE - USERS WITH CONTROLLED - RELEASE MELATONIN : IMPROVEMENT OF SLEEP QUALITY - PowerPoint PPT Presentation

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TREATMENT OF ELDERLY BENZODIAZEPINE - USERS WITH CONTROLLED - RELEASE MELATONIN : IMPROVEMENT OF SLEEP QUALITY

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The effects of Stopping Enemas in Disabled Elderly Patients Suffering from Constipation in Nursing Departments Doron Garfinkel, M.D., Svetlana Zludkov, M.D., – PowerPoint PPT presentation

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Title: TREATMENT OF ELDERLY BENZODIAZEPINE - USERS WITH CONTROLLED - RELEASE MELATONIN : IMPROVEMENT OF SLEEP QUALITY


1
The effects of Stopping Enemas in Disabled
Elderly Patients Suffering from Constipation in
Nursing Departments
Doron Garfinkel, M.D., Svetlana Zludkov, M.D.,
Sameira Jamal, R.N., Ronit Har-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 patients beds

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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, Plt
    0.01).
  • A higher prevalence of increase in body weight
  • (35 compared to 15 in the controls, p lt
    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 !
Doron Garfinkel, M.D.
The Shoham Geriatric Medical Center,
Pardes-Hanna, ISRAEL
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