Abstract
Objectives
Laxatives are among the most prescribed medications to nursing home (NH) patients,
and we evaluated the hypothesis that laxative agents could be prescribed as a result
of a prescribing cascade. The aims of the study are (1) to investigate the use of
laxative drugs in a large sample of Italian NHs and (2) to assess the relationship
between medications that can induce constipation and laxative use.
Design
Retrospective cross-sectional multicenter study.
Setting and Participants
Individuals living in long-term care NHs.
Methods
Study conducted in a sample of Italian long-term care NHs distributed throughout the
country. Information on drug prescriptions, diseases and sociodemographic characteristics
collected 4 times during 2018 and 2019.
Results
Among the 2602 patients recruited from 27 NHs (mean age ± standard deviation: 88.4 ± 8.5;
women: 1994, 76.6%), 1248 were receiving laxatives (48%). Parkinson disease, cerebrovascular
disease, and hemiplegia were associated with laxative prescription, and diabetes was
associated with a decrease. Benzodiazepines, anti-Parkinson dopaminergic agents, and
antidepressants (tricyclic antidepressants and mirtazapine) were associated with laxative
treatment in univariate and adjusted models. Tricyclic antidepressants users were
3 times more likely to be taking laxatives than nonusers (odds ratio 2.98, 95% confidence
interval 1.31-6.77, P = .0093). A larger number of drugs that can induce constipation was associated with
laxative use (P = .0003). In all, 2002 individuals had at least 2 different prescription times: from
the first to the last visit laxative use rose from 46.1% to 49.9%. Time of stay was
also associated with laxative use (P = .016).
Conclusions and Implications
Laxatives are among the most prescribed medications in Italian NHs. Medications that
can induce constipation, such as antidepressants, anti-Parkinson dopaminergic agents,
and benzodiazepines, are often used together with laxatives, and combinations of these
drugs further increase the use of laxatives. Optimizing the prescription of psychotropic
drugs could help reduce the “prescribing cascade” with laxatives. The length of stay
in NHs is often proportional to laxative use and chronic treatment is very common.
Keywords
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Article info
Publication history
Published online: May 20, 2021
Footnotes
Data collection complied fully with Italian law on personal data protection, and the study was approved by the ethics committee of the IRCCS Carlo Besta Foundation.
This research did not receive any funding from agencies in the public, commercial, or not-for-profit sectors.
All data were anonymous and informed consent was not required for the purpose of this study.
All authors participated in drafting the manuscript or critical revision of the manuscript for important intellectual content and provided approval of the final submitted version. Individual contributions are as follows: CE and LP designed the study, interpreted data, and wrote the manuscript; AN did and interpreted statistical analyses; AN and AI made the final critical revision for important intellectual contents. All authors approved the final version of the manuscript.
The authors declare no conflicts of interest.
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