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Constipation is a common cause of general practice consultations in elderly people, and laxative use is common among this group of patients. However, there appears to be little evidence to guide laxative treatment in this population. This paper reports the results of a systematic review of randomized controlled trials of the efficacy of laxatives in the treatment of constipation in the elderly. While the results of the review suggest that laxatives can improve bowel movement frequency, stool consistency, and symptoms of constipation, with a few exceptions, the relevant trials have serious methodological shortcomings. However, the review finds little evidence of marked differences in effectiveness between laxatives and, in particular, there appears to be no evidence to support the current National Health Service (NHS) trend towards prescribing the more expensive stimulant laxatives. This is an area where good quality trial evidence is now needed.