Gastrointestinal Disorders in Long-Term Care

Goldberg, Roy J.; Jhurani, Mahesh

doi:10.1007/978-3-319-90761-1_95-1

Gastrointestinal Disorders in Long-Term Care

Roy J. Goldberg^3,4 &
Mahesh Jhurani⁴

Living reference work entry
First Online: 15 December 2019

330 Accesses
1 Citations

Abstract

Gastrointestinal (GI) symptoms are very common in older adults. Residents of long-term facilities face the typical problems of those patients in the community, but also have unique issues related to their multiple comorbidities and to the end of life. GI issues often present atypically, and may be iatrogenic, oftentimes due to prescribed medications. Recognizing symptoms early improves quality of life and helps avoid serious life-threatening complications. Goals of care conversations and an interdisciplinary approach are mandatory.

This is a preview of subscription content, log in via an institution.

References

Akhtar AJ. Lower gastrointestinal bleeding in elderly patients. J Am Med Dir Assoc. 2003;4:320–2.
Article PubMed Google Scholar
Akhtar AJ. Acute diarrhea in frail elderly nursing home patients. J Am Med Dir Assoc. 2008;9:476–85. 2003;4:34–9
Article Google Scholar
Alibhai SMH, Greenwood C, Payette H. An approach to the management of unintentional weight loss in elderly people. CMAJ. 2005;172(6):773–80. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC552892. Accessed 4 Jan 2019.
Article PubMed PubMed Central Google Scholar
Alkhatib AA, Alkhatib FA, Abubakr SM, et al. Acute upper gastrointestinal bleeding in elderly people: presentations, endoscopic findings, and outcomes. J Am Geriatr Soc. 2010;58(1):182–5.
Article PubMed Google Scholar
American Cancer Society. Key statistics for colorectal cancer. 2018. https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html. Accessed 4 Jan 2019.
American Medical Directors Association. LTC information series. Constipation and diarrhea in the long-term care setting. Columbia. 2018a. p. 1–31.
Google Scholar
American Medical Directors Association. Clinical practice guidelines. Gastrointestinal disorders in the long-term care setting. Columbia. 2018b. p. 1–25.
Google Scholar
Aoyama L, Weintraub N, Reuben DB. Is weight loss in the nursing home a reversible problem? J Am Med Dir Assoc. 2006;6(Suppl):S66–72.
Article Google Scholar
Bailey J, Carter NJ, Neher JO. Effective management of flatulence. Am Fam Physician. 2009;79(12):1098–100.
PubMed Google Scholar
Birrer RB, Vemuri SP. Depression in later life: a diagnostic and therapeutic challenge. Am Fam Physician. 2004;69(10):2375–82.
PubMed Google Scholar
Borum ML. Peptic-ulcer disease in the elderly. Clin Geriatr Med. 1999;15(3):457–71. https://www.ncbi.nlm.nih.gov/pubmed/10393735. Accessed 4 Jan 2019.
Article CAS PubMed Google Scholar
Bouras EP, Lange SM, Scolapio JS. Rational approach to patients with unintentional weight loss. Mayo Clin Proc. 2001;76:923–9.
Article CAS PubMed Google Scholar
Bromley SM. Smell and taste disorders: a primary care approach. Am Fam Physician. 2000;61(2):427–36.
CAS PubMed Google Scholar
Camilleri M. Diabetic gastroparesis. N Engl J Med. 2007;356:820–9.
Article CAS PubMed Google Scholar
Campbell-Taylor IC. Oropharyngeal dysphagia in long-term care: misperceptions of treatment efficacy. J Am Med Dir Assoc. 2008;9:523–31.
Article PubMed Google Scholar
Cappell MS, Friedel D. Initial management of acute upper gastrointestinal bleeding: from initial evaluation up to gastrointestinal endoscopy. Med Clin North Am. 2008;92(3):491–509.
Article PubMed Google Scholar
Centers for Disease Control and Prevention. Nursing homes and assisted living. 2017. https://www.cdc.gov/longtermcare/index.html. Accessed 4 Jan 2019.
Comparato G, Pilotto A, Franze A, Franceschi M, Di Mario F. Diverticular disease in the elderly. Dig Dis. 2007;25(2):151–9.
Article PubMed Google Scholar
Dev R, Wong A, Hui D, et al. The evolving approach to management of cancer cachexia. Oncology. 2017;31(1):23–32.
PubMed Google Scholar
DeVault KR, Castell DO. Guidelines for the prevention and treatment of gastroesophageal reflux disease. Practice Parameters Committee of the American College of Gastroenterology. Arch Intern Med. 1995;155(920):2165–73. https://www.ncbi.nlm.nih.gov/pubmed?term=7487238. Accessed 4 Jan 2019.
Article CAS PubMed Google Scholar
Ensrud KE, Ewing SK, Stone KL, et al. Intentional and unintentional weight loss increase bone loss and hip fracture risk in older women. J Am Geriatr Soc. 2003;51(12):1740–7.
Article PubMed Google Scholar
Farrell B, Merkley VF, Ingar N. Reducing pill burden and helping with medication awareness to improve adherence. Can Pharm J. 2013;146(5):262–9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3785195. Accessed 3 Jan 2019.
Article Google Scholar
Feeding Tube Awareness Foundation. 2018. https://www.feedingtubeawareness.org/tube-feeding-basics/tubetypes. Accessed 4 Jan 2019.
Finucane TE, Christmas C, Travis K. Tube feeding in patients with advanced dementia: a review of the evidence. JAMA. 1999;282(14):1365–70.
Article CAS PubMed Google Scholar
Firth M, Prather CM. Gastrointestinal motility problems in the elderly patient. Gastroenterology. 2002;122(6):1688–170.
Article PubMed Google Scholar
Fox CB, Treadway AK, Blaszczyk AT, et al. Megestrol acetate and mirtazapine for the treatment of unplanned weight loss in the elderly. Pharmacotherapy. 2009;29(4):383–97.
Article CAS PubMed Google Scholar
Gaddey HL, Holder K. Unintentional weight loss in older adults. Am Fam Physician. 2014;89(9):718–72.
PubMed Google Scholar
Glass RI, Parashar UD, Estes MK. Norovirus gastroenteritis. N Engl J Med. 2009;361:1776–85.
Article CAS PubMed Google Scholar
Goldberg RJ, Kaplan LA, Boucher LJ. Physician’s attentiveness to medication usage as etiology of weight loss. Long-term care. Interface. 2005;9:20–3.
Google Scholar
Herman, CM, McCarthy DM, Ramirez FC. Identifying and managing GERD in the elderly: optimizing therapy and improving outcomes. J Am Med Dir Assoc. 2001;Symposium Highlights:H30–3.
Google Scholar
Hoover DR, Siegel M, Lucas J, et al. Depression in the first year of stay for elderly long-term nursing home residents in the USA. Int Psychogeriatr. 2010;22(7):1161–71. https://www.ncbi.nlm.nih.gov/pubmed?term=20478100. Accessed 4 Jan 2019.
Article CAS PubMed Google Scholar
Hsieh C. Treatment of constipation in older adults. Am Fam Physician. 2005;72(11):2277–84.
PubMed Google Scholar
Huffman GB. Evaluating and treating unintentional weight loss in the elderly. Am Fam Physician. 2002;65:640–50.
PubMed Google Scholar
Jacob P, Kahrilis PJ, Herzon G. Proximal esophageal pH-metry in patients with ‘reflux laryngitis’. Gastroenterology. 1991;100(2):305–10. https://www.ncbi.nlm.nih.gov/pubmed?term=1985028. Accessed 4 Jan 2019.
Article CAS PubMed Google Scholar
Janssen I. The epidemiology of sarcopenia. Clin Geriatr Med. 2011;27(3):355–63. https://www.ncbi.nlm.nih.gov/pubmed?term=21824552. Accessed 4 Jan 2019.
Article PubMed Google Scholar
Kaiser MJ, Bauer JM, Ramsch C, et al. Validation of the Mini Nutritional Assessment Short-Form (MNA-SF): a practical tool for the identification of nutritional status. J Nutr Health Aging. 2009;13(9):782–8. https://www.ncbi.nlm.nih.gov/pubmed/19812868. Accessed 4 Jan 2019.
Article CAS PubMed Google Scholar
Kardinal CG, Loprinzi CL, Schaid DJ, et al. A controlled trial of cyproheptadine in cancer patients with anorexia and/or cachexia. Cancer. 1990;65(12):2657–62.
Article CAS PubMed Google Scholar
Katz PO. Gastroesophageal reflux disease. J Am Geriatr Soc. 1998;46:1558–65.
Article CAS PubMed Google Scholar
Kim BSM, Li BT, Engel A, Samra JS, Clarke S, Norton ID, Li AE. Diagnosis of gastrointestinal bleeding: a practical guide for clinicians. World J Gastrointest Pathophysiol. 2014;5(4):467–78.
Article PubMed PubMed Central Google Scholar
Kossioni AE, Hajto-Bryk J, Janssens B, et al. Practical guidelines for physicians in promoting oral health in frail older adults. J Am Med Dir Assoc. 2018;19(12):1039–46.
Article PubMed Google Scholar
Kotler DP. Cachexia. Ann Intern Med. 2000;133(8):622–34.
Article CAS PubMed Google Scholar
Kuo S, Rhodes RL, Mitchell SL, et al. Natural history of feeding tube use in nursing home residents with advanced dementia. J Am Med Dir Assoc. 2009;10(4):264–70.
Article PubMed PubMed Central Google Scholar
Landi F, Calvani R, Tosato M, et al. Anorexia of aging: risk factors, consequences, and potential treatments. Nutrients. 2016;8(2):69. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772033. Accessed 4 Jan 2019.
Article PubMed PubMed Central CAS Google Scholar
Lembo A, Camilleri M. Chronic constipation. N Engl J Med. 2003;348(14):1360–8.
Article Google Scholar
Lewko M, Chamseddin A, Zaky M, et al. Weight loss in the elderly: what’s normal and what’s not. PT. 2003;28:734–9.
Google Scholar
Little M. Treating and preventing Clostridium difficile infection in long-term care facilities. Ann Long Term Care. 2018;26(7):25–9.
Article Google Scholar
Liu CK, Hsu HH, Cheng SM. Colonic diverticulitis in the elderly. Int J Gerontol. 2009;3(1):9–15.
Article CAS Google Scholar
Lyketsos CG, Olin J. Depression in Alzheimer’s disease: overview and treatment. Biol Psychiatry. 2002;52(3):243–52. https://www.ncbi.nlm.nih.gov/pubmed?term=12182930. Accessed 4 Jan 2019.
Article PubMed Google Scholar
Makins R, Ballinger A. Gastrointestinal side effects of drugs. Expert Opin Drug Saf. 2003;4:421–9. https://www.ncbi.nlm.nih.gov/pubmed/12904098. Accessed 3 Jan 2019.
Article Google Scholar
Mayo Clinic. Fecal incontinence. https://www.mayoclinic.org/diseases-conditions/fecal-incontinence/symptoms-causes/syc-20351397. Accessed 4 Jan 2019.
Messinger-Rapport BJ, Morley JE, Thomas DR, et al. Clinical update on nursing home medicine: 2011. J Am Med Dir Assoc. 2011;12:615–26.
Article PubMed Google Scholar
Messinger-Rapport BJ, Cruz-Oliver DM, Thomas DR, Morley JE. Clinical update on nursing home medicine: 2012. J Am Med Dir Assoc. 2012;13:581–94.
Article PubMed Google Scholar
Mounsey A, Raleigh M, Wilson A. Management of older adults with constipation. Am Fam Physician. 2015;92(6):500–4. https://www.aafp.org/afp/2015/0915/p500.html. Accessed 4 Jan 2019.
PubMed Google Scholar
Nacci A, Ursino F, La Vela R, Matteucci F, Mallardi V, Fattori B. Fiberoptic endoscopic evaluation of swallowing: proposal for informed consent. Acta Otorhinolaryngol Ital. 2008;28(4):206–11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2644994. Accessed 4 Jan 2019.
CAS PubMed PubMed Central Google Scholar
National Caregivers Library. Toileting and incontinence. http://www.caregiverslibrary.org/caregivers-resources/grp-home-care/hsgrp-personal-care-activities/toileting-and-incontinence-article.aspx. Accessed 4 Jan 2019.
Nicolle LE. Catheter associated urinary tract infections. Antimicrob Resist Infect Control. 2014;3(23):1–8.
Google Scholar
Office of Disease Prevention and Health Promotion. Minimum data set. 2018. https://www.healthypeople.gov/2020/data-source/minimum-data-set. Accessed 4 Jan 2019.
Pankaj J, Pasricha PJ, Yates KP, et al. Aprepitant has mixed effects on nausea and reduces other symptoms in patients with gastroparesis and related disorders. Gastroenterology. 2018;154(1):65–76.e11. https://www.gastrojournal.org/article/S0016-5085(17)36066-3/fulltext. Accessed 4 Jan 2019.
Article CAS Google Scholar
Parkman HP, Hallinan EK, Hasler WL, et al. Early satiety and postprandial fullness in gastroparesis correlate with gastroparesis severity, gastric emptying, and water loading testing. Neurogastroenterol Motil. 2017;29(4):e12981. https://www.ncbi.nlm.nih.gov/pubmed/27781342. Accessed 4 Jan 2019.
Article Google Scholar
Payne MA, Morley JE. Dysphagia: a new geriatric syndrome. J Am Med Dir Assoc. 2017;18:555–7.
Article PubMed Google Scholar
Pearce C, Duncan H. Enteral feeding. Nasogastric, nasojejunal, percutaneous endoscopic gastrostomy, or jejunostomy: its indications and limitations. Postgrad Med J. 2002;78(918):198–204.
Article CAS PubMed PubMed Central Google Scholar
Ray BS, Neill CL. Abdominal visceral sensation in man. Ann Surg. 1947;126(5):709–23. https://www.ncbi.nlm.nih.gov/pubmed?term=17859026. Accessed 4 Jan 2019.
Article PubMed PubMed Central Google Scholar
Richter JE. Typical and atypical presentations of gastroesophageal reflux disease. The role of esophageal testing in diagnosis and management. Gastroenterol Clin North Am. 1996;25(1):75–102. https://www.ncbi.nlm.nih.gov/pubmed?term=8682579. Accessed 4 Jan 2019.
Article CAS PubMed Google Scholar
Ruiz Garcia V, López-Briz E, Carbonell Sanchis R, et al. Megestrol acetate for treatment of anorexia-cachexia syndrome. Cochrane Database Syst Rev. 2013; (3):CD004310.
Google Scholar
Schuster BG, Kosar L, Kamrul R. Constipation in older adults. Can Fam Physician. 2015;61(2):152–8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325863. Accessed 3 Jan 2019.
PubMed PubMed Central Google Scholar
Siegel JH, Kasmin FE. Biliary tract diseases in the elderly. Gut. 1997;41:433–5. https://gut.bmj.com/content/41/4/433. Accessed 4 Jan 2019.
Article CAS PubMed PubMed Central Google Scholar
Silver AJ. Aging and risks for dehydration. Cleve Clin J Med. 1990;57(4):341–4.
Article CAS PubMed Google Scholar
Simmons SF, Alessi C, Schnelle JF. Intervention to increase fluid intake in nursing home residents: prompting and preference compliance. J Am Ger Soc. 2001;49(7):926–33.
Article CAS Google Scholar
Simmons WK, Burrows K, Avery JA, et al. Depression related increases and decreases in appetite: dissociable patterns of aberrant activity in reward and interoceptive neurocircuitry. Am J Psychiatry. 2016;173(4):418–28. https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2015.15020162. Accessed 4 Jan 2019.
Article PubMed PubMed Central Google Scholar
Singh P, Yoon SS, Kuo B. Nausea: a review of pathophysiology and therapeutics. Ther Adv Gastroenterol. 2016;9(1):98–112. https://www.ncbi.nlm.nih.gov/pubmed?term=26770271. Accessed 3 Jan 2019.
Article CAS Google Scholar
Sloane PD, Ivey J, Helton M, et al. Nutritional issues in long-term care. J Am Med Dir Assoc. 2008;9:476–85.
Article PubMed Google Scholar
Sura L, Madhaven A, Carnaby G, Crary MA. Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging. 2012;7:287–98. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3426263. Accessed 3 Jan 2019.
PubMed PubMed Central Google Scholar
The Infectious Disease Society of America (IDSA) Clostridium difficile. 2018;66(7):e1–48. https://www.idsociety.org/practice-guideline/clostridium-difficile/. Accessed 12 Jan 2019.
Thomas DR, Morley JE. Regulation of appetite in older adults. Ann Long-Term Care. 2002; (Suppl):1–12.
Google Scholar
Thomas DR, Forrester L, Gloth MF, Gruber J, Krause RA, Prather C, et al. Clinical consensus: the constipation crisis in long-term care. Ann Long-Term Care. 2003; (Suppl):3–14.
Google Scholar
Unutzer J, Patrick DL, Simon G, Grembowski D, et al. Depressive symptoms and the cost of health services in HMO patients aged 65 years and older: a four-year prospective study. JAMA. 1997;277(20):1618–23. https://www.ncbi.nlm.nih.gov/pubmed?term=9168292. Accessed 4 Jan 2019.
Article CAS PubMed Google Scholar
Wald A. Fecal incontinence in adults. N Engl J Med. 2007;356(7):1648–55.
Article CAS PubMed Google Scholar
Waseem S, Moshiree B, Draganov PV. Gastroparesis: current diagnostic challenges and management considerations. World J Gastroenterol. 2009;15(1):25–37. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2653292. Accessed 4 Jan 2019.
Article PubMed PubMed Central Google Scholar
Weintraub JA, Zimmerman S, Ward K, et al. Improving nursing home residents’ oral hygiene: results of a cluster randomized intervention trial. J Am Med Dir Assoc. 2018;19:1086–91.
Article PubMed PubMed Central Google Scholar
Weizman AV, Nguyen GC. Diverticular disease: epidemiology and management. Can J Gastroenterol. 2011;7:385–9.
Article Google Scholar
White HK. Weight loss in advanced Alzheimer’s disease, part 1: contributing factors and evaluation. Ann Long Term Care. 2004;12:33–7.
Google Scholar
Wilcox CM, Alexander LN, Clark WS. Localization of an obstructing esophageal lesion. Is the patient accurate? Dig Dis Sci. 1995;40(10):2192–6. https://www.ncbi.nlm.nih.gov/pubmed?term=7587788. Accessed 3 Jan 2019.
Article CAS PubMed Google Scholar

Download references

Author information

Authors and Affiliations

Clinical Professor of Medicine-Division of Geriatrics, Albert Einstein College of Medicine, Bronx, NY, USA
Roy J. Goldberg
Kings Harbor Multicare Center, Bronx, NY, USA
Roy J. Goldberg & Mahesh Jhurani

Authors

Roy J. Goldberg
View author publications
You can also search for this author in PubMed Google Scholar
Mahesh Jhurani
View author publications
You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Roy J. Goldberg .

Editor information

Editors and Affiliations

Saint Peter's Healthcare System, New Brunswick, NJ, USA
C. S. Pitchumoni
Albert Einstein College of Medicine, Montefiore Medical Center, Wakefield Campus, Bronx, NY, USA
T.S. Dharmarajan

Rights and permissions

Reprints and permissions

Copyright information

About this entry

Cite this entry

Goldberg, R.J., Jhurani, M. (2020). Gastrointestinal Disorders in Long-Term Care. In: Pitchumoni, C., Dharmarajan, T. (eds) Geriatric Gastroenterology. Springer, Cham. https://doi.org/10.1007/978-3-319-90761-1_95-1

Download citation

DOI: https://doi.org/10.1007/978-3-319-90761-1_95-1
Received: 18 July 2019
Accepted: 28 July 2019
Published: 15 December 2019
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-90761-1
Online ISBN: 978-3-319-90761-1
eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics