The progressive increase in life expectancy in developed countries has led to a corresponding rise in the proportion of elderly population. In the United States, the population aged 65 and older was 40.2 million in 2010 and is projected to be 88.5 million in 2050.1
This exponential increase poses a number of challenges, as diseases and conditions that are more prevalent in elderly patients will need a much greater allocation of resources and expertise in health care systems in future years.
Chronic constipation (CC) is a common disorder, with an estimated prevalence of 12%–19% in the general population (depending on the area and the criteria used for the diagnosis).2
A multinational survey published in 2008 that included 13,879 adults from seven different countries (United States, United Kingdom, Germany, France, Italy, Brazil, and South Korea) found a prevalence of constipation symptoms of 12.3% in the adult population (range 5%–18%), with odds ratios for constipation in women and elderly of 2.43 (95% CI: 2.18–2.71) and 1.5 (95% CI: 1.25–1.73), respectively.3
This same study reported a prevalence of use of laxatives among those with constipation between 16%–40%. Increasing age, symptom frequency, and lower income and education were individual factors associated with laxative use.
A survey performed in Olmsted (Minnesota, USA), specifically designed for elderly responders (≥65 years old, mean age 76), found a constipation prevalence of 40.1% (95% CI: 38.9–44.4). Functional constipation, the most frequent category encountered in this study, had a prevalence of 24.4% (95% CI: 22.0–26.9).4
In another study, performed using face-to-face interviews with frail elderly individuals who were not institutionalized, constipation was spontaneously mentioned by 45% of participants and was considered by 11% to be a major burden to their quality of life.5
CC affects the majority of long-term patients in hospitals and residents in nursing homes,6
and often, with exorbitant prevalence (reported up to 50%–79%) in the long-term institutionalized elderly.7
Although CC can be seen as a trivial medical problem, its impact on quality of life can be substantial and may result in considerable additional utilization of health care resources, including specialist visits, gastrointestinal diagnostic procedures, and medical treatment modalities.6
Using both disease-specific and generic quality of life measurement instruments, studies suggest constipation is associated with impaired health-related quality of life,9
with CC patients exhibiting lower scores for physical functioning, mental health, general health perception, and bodily pain when compared with individuals without constipation.11
Medical relief of constipation in a group of 52 CC patients aged 65–89 years resulted in improvement of patient’s mood, sexual activity, and quality of life.12
In the United States, CC accounts for more than 2.5 million visits to physicians and for laxative sales of several hundred million dollars a year.13
In England and Wales, constipation generated some 450,000 general practice consultations per year in 1991 and 1992, at an estimated cost of £4.5 million per year.8
Data from the UK National Survey of morbidity data in general practice showed an age-dependent increase in the consultation rates for constipation, from 75/100,000 person-year for the 45–64 age group, to 400/100,000 person-year for the 77–84 age group.14
Lubiprostone (Amitiza®, Sucampo Pharmaceuticals) was approved in the United States in 2006 for the treatment of chronic idiopathic constipation (CIC) in men and women, and in 2008 for women with irritable bowel syndrome with predominance of constipation (IBS-C). Since then, several studies focusing on lubiprostone efficacy and use have been published. Aims of this review were: (1) to review the current available treatments of CC in the elderly population; (2) to summarize the pharmacological properties of lubiprostone and data on its effects on constipation, based on studies in the general population; (3) to evaluate the data supporting the use of lubiprostone in the elderly; and (4) to discuss the studies performed using lubiprostone in specific situations occurring more frequently in older people, including Parkinson’s disease (PD) and opioid-induced constipation (OIC).
For the purpose of the present review, publications in abstract form and full papers on lubiprostone clinical studies were searched from 1995 to October 2012 on the PubMed electronic database and from proceedings of gastroenterology international meetings, using combinations of the following keywords: constipation, chronic, idiopathic, elderly, lubiprostone, Amitiza, opioid-induced, and Parkinson’s.