Case study - an elderly customer
Case study: an elderly customer
Rita is asking about her husband, in his early 60s, who recently had an accident, so is resting and is less mobile than usual. He has been feeling constipated for a couple of days and says he wants something to help him go to the loo as he feels that his bowel isn't emptying fully. He has been taking painkillers (including codeine) for his hip pain and takes other medicines for his blood pressure and cholesterol. He has been using lactulose for a few days but is still not feeling quite right.
- Case notes
- Self-care advice
Step 1
Lifestyle assessment
The codeine could be causing constipation, as well as a lack of movement.
Constipation is also more common with increasing age.
Check fluid intake.
Warning signs that might need further investigation would be:6
- Weight loss
- Passing blood in the stools
- Symptoms persisting for more than 6 weeks with no apparent cause
- Family history of colon cancer or Crohn's disease.
He could be advised to check his position when trying to go to the loo - resting his feet on a low stool may help, as that raises the knees above the hips.2
A regular toilet routine may also help, which he may not be getting if he needs help to get to the toilet.
He should speak to a GP/pharmacist to discuss his pain relief options.
Product advice
Think about what you could recommend. Click below for a suggestion.
Step 4
Second-line treatment
In this case, as he is taking opioids, a bulk-forming laxative would not be appropriate. He has tried an osmotic laxative and still feels as though his bowel aren't emptying so in this case a stimulant laxative could help him to empty the bowels fully.
They should be used on a short-term basis. They generally start to work within 6-12 hours so are usually taken in the evening to produce a bowel movement in the morning. You could recommend that he stops using lactulose and instead tries Senokot, taking a dose in the evening.
Remember, sometimes the elderly may rely on stimulant laxatives to keep their bowel regular. This is not advised. Refer customers who regularly use laxatives to the pharmacist/GP.
