How to Treat Diarrhea in the Elderly with Ease

Learn how to treat diarrhea in the elderly effectively, from food choices to medications. Improve their comfort!

March 18, 2024

Understanding Diarrhea in the Elderly

Before delving into how to treat diarrhea in the elderly, it's beneficial to understand what diarrhea entails and its common causes, especially within the elderly population.

Defining Diarrhea

Diarrhea is characterized by loose or watery stools that occur more frequently than an individual's normal bowel pattern. Severe diarrhea consists of runny stools, frequent bowel movements, and stomach cramps. This condition can potentially lead to dehydration, hence the importance of promptly replacing lost fluids to prevent further complications. Anti-diarrhea medicines can be beneficial; however, their use should be discussed with a healthcare provider.

Common Causes of Diarrhea

Diarrhea in the elderly can be caused by a variety of factors, including infections, adverse effects of medications, and certain diseases. It's crucial to identify and address these underlying causes for effective treatment.

Medications are a common cause of diarrhea in the elderly. A thorough review of medications should be conducted to identify medication-associated causes of chronic diarrhea, which often include proton pump inhibitors (PPIs), non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, and laxatives, among others. Considering suitable alternatives is important if possible.

Chronic diarrhea, lasting over three weeks, could often be related to conditions like irritable bowel syndrome, celiac disease, or inflammatory bowel disease.

Understanding these causes paves the way for effective management and treatment of diarrhea in the elderly, ensuring the health and comfort of older adults.

Implications of Diarrhea in the Elderly

While diarrhea can be a discomforting issue for people of all ages, its implications are particularly significant among the elderly. The effects of diarrhea in this age group extend beyond the immediate physical discomfort, often leading to serious health risks like dehydration, and impacting the overall quality of life.

Dehydration Risks

Dehydration is a significant concern when treating diarrhea in the elderly. Older adults have lower reserves of fluid and electrolytes compared to younger individuals, making them more susceptible to dehydration. Severe diarrhea, characterized by runny stools, frequent bowel movements, and stomach cramps, can lead to the rapid loss of fluids.

It is crucial to replace lost fluids promptly to prevent dehydration, which, in severe cases, may require hospitalization. Anti-diarrhea medicines can be beneficial, but their use should be discussed with a healthcare provider [1].

Impact on Quality of Life

Diarrhea in the elderly, particularly when chronic, can severely impact the quality of life. The adverse consequences of chronic diarrhea can include electrolyte imbalances, dehydration, falls, pressure ulcers, malnutrition, and impairments in cognitive and functional status. These complications have the potential to exacerbate comorbid diseases, emphasizing the necessity for prompt and effective treatment [2].

Chronic diarrhea is a common problem affecting up to 5% of the general population at any given time. It poses challenges to clinicians due to its diverse etiology and multifactorial nature in individuals.

Moreover, medications are a common cause of diarrhea in the elderly. A thorough review of medications should be conducted to identify medication-associated causes of chronic diarrhea and consider suitable alternatives if possible. Common medications that can cause diarrhea in the elderly include proton pump inhibitors (PPIs), non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, and laxatives, among others.

Understanding the implications of diarrhea in the elderly is crucial for caregivers and healthcare providers. Ensuring proper hydration, monitoring the severity of symptoms, and being mindful of medication side effects can help in managing this condition effectively and enhancing the quality of life for elderly individuals.

Food and Drink Considerations

When managing diarrhea in the elderly, it's crucial to consider the impact of food and beverages. Certain items can exacerbate symptoms, while others can contribute to easing discomfort. Here are some guidelines on what to avoid and what to include in their diet.

Foods and Drinks to Avoid

A key part of managing diarrhea in the elderly involves avoiding certain foods and drinks. These include:

  • Sugar-free candies and gum: These products often contain sugar alcohols such as sorbitol and mannitol, which can worsen diarrhea.
  • Dairy products: Many older adults have lactose intolerance, which can exacerbate symptoms of diarrhea [4].
  • Caffeine and alcohol: These substances can irritate the gastrointestinal system and worsen symptoms of diarrhea.
  • Foods causing gas: Beans and raw vegetables, for instance, can exacerbate diarrhea [1].
  • Acidic and spicy foods: Citrus juices and spicy foods can worsen symptoms.
  • Fatty foods: Fatty meats and fried foods can exacerbate diarrhea.

It's worth noting that while generally dairy products should be avoided, there's an exception when it comes to yogurt. Despite being a dairy product, yogurt may aid in digestion due to its bacteria content and can generally be included in the diet.

Suitable Foods and Drinks

While dealing with diarrhea, it's important to maintain sufficient nutrition. Some suitable food options include:

  • Bananas
  • Rice
  • Applesauce
  • Toast
  • Potatoes
  • Smooth peanut butter
  • Skinless poultry
  • Yogurt

These foods can help to ease symptoms of diarrhea by providing easily digestible nutrients. They are mild, low in fiber, and unlikely to irritate the digestive system, making them ideal for consumption during a bout of diarrhea.

In terms of hydration, water remains the best option. It's crucial to maintain hydration levels when experiencing diarrhea, as the condition can lead to fluid and electrolyte loss. Opt for plain water, or if nausea is present, try taking small sips throughout the day to keep the body hydrated.

Medication Management

Medication management plays a pivotal role in addressing diarrhea in the elderly. This involves both over-the-counter remedies and prescription treatments, each tailored to the severity and underlying causes of the condition.

Over-the-counter Medications

Over-the-counter (OTC) anti-diarrheal medications, such as loperamide (brand name Imodium) and bismuth subsalicylate (brand name Pepto-Bismol), can be helpful for adults experiencing diarrhea. These medications help to decrease the frequency of bowel movements and make the stool less watery.

However, it's important to note that over-the-counter anti-diarrheal medications should be used cautiously in the elderly, as they can have adverse effects and potentially worsen underlying conditions.

Loperamide, for instance, is a synthetic opiate agonist that reduces peristaltic activity and inhibits secretion, leading to a decrease in fluid and electrolyte loss and an increase in stool consistency. While effective, it should be used judiciously due to its potential effects on the elderly [6].

Prescription Treatments

For persistent diarrhea related to conditions such as irritable bowel syndrome with diarrhea (IBS-D), prescription treatments include medications like rifaximin (brand name Xifaxan) and alosetron (brand name Lotronex). These medications are specifically for IBS-D and should only be used under the guidance of a healthcare provider [5].

Another viable prescription option is cholestyramine, a bile acid sequestrant considered the first-line treatment for bile acid diarrhea. It binds to bile acids in the intestine and increases their excretion in the feces. Cholestyramine can be used for the symptomatic control of bile acid-induced diarrhea and is effective in patients with IBS-D.

In conclusion, while medications can be effective in managing diarrhea in the elderly, they should always be used under the supervision of a healthcare provider. This ensures the safety and well-being of the elderly, taking into consideration their overall health status and potential interactions with other medications they may be taking.

Non-pharmaceutical Interventions

While medications can be effective in managing diarrhea in the elderly, there are also non-pharmaceutical interventions that can significantly help. These interventions focus on hydration and electrolyte replacement, and skincare and comfort measures.

Hydration and Electrolyte Replacement

Dehydration is a significant concern when treating diarrhea in the elderly, as older adults have lower reserves of fluid and electrolytes compared to younger individuals. Severe diarrhea, characterized by runny stools, frequent bowel movements, and stomach cramps, can lead to dehydration.

It is crucial to replace lost fluids promptly to prevent dehydration, which may require hospitalization. Frequent sips of water, broths, or oral rehydration solutions can help replace lost fluids and electrolytes. Avoid drinks high in sugar or caffeine, as they can exacerbate the condition.

Fluid Replacement Frequency
Water Frequent sips
Broths 1-2 cups every 2 hours
Oral Rehydration Solutions As directed on the package

Skincare and Comfort Measures

The adverse consequences of chronic diarrhea in the elderly can include electrolyte imbalances, dehydration, falls, pressure ulcers, malnutrition, impairments in cognitive and functional status, along with the potential to exacerbate comorbid diseases, emphasizing the necessity for prompt and effective treatment.

To increase comfort, the rectal area should be cleaned after each episode of diarrhea to prevent skin irritation. Applying warm water to the stomach and using soothing creams or astringent pads can help relieve discomfort and prevent complications like skin infection [1].

Comfort Measures Frequency
Clean rectal area After each episode
Warm water application As needed
Use soothing creams or astringent pads As needed

Remember, when caring for the elderly, it's crucial to maintain their dignity and comfort. These measures, combined with appropriate medical treatment, can help manage the symptoms of diarrhea and improve the quality of life of the elderly.

Chronic Diarrhea in the Elderly

When addressing how to treat diarrhea in the elderly, it's important to have a clear understanding of chronic diarrhea. This condition is common among the elderly, affecting up to 5% of the general population at any given time, and poses challenges due to its diverse etiology and multifactorial nature in individuals.

Identifying Chronic Diarrhea

The British Society of Gastroenterology (BSG) provides a definitive approach to the diagnosis and investigation of patients with chronic diarrhea. According to their guidelines, chronic diarrhea is defined as "the persistent alteration from the norm with stool consistency between types 5 and 7 on the Bristol stool chart and increased frequency greater than 4 weeks’ duration" [3].

It's also worth noting that fecal incontinence, which is common in the elderly population, may be mistaken or misrepresented as "diarrhea" by patients. It's crucial to distinguish between incontinence resulting from a structural or neurological condition affecting the anal sphincter complex and symptoms secondary to chronic diarrhea overwhelming the sphincter. Fecal incontinence may also be associated with fecal impaction or pelvic floor weakness in elderly women.

Addressing Chronic Diarrhea

A common cause of diarrhea in the elderly is medications. A thorough review of medications should be conducted to identify medication-associated causes of chronic diarrhea and consider suitable alternatives if possible. Common medications that can cause diarrhea in the elderly include proton pump inhibitors (PPIs), non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, and laxatives, among others.

Moreover, conditions like microscopic colitis and bile acid diarrhea (BAD) are frequently misdiagnosed as diarrhea-predominant irritable bowel syndrome (IBS-D) in the elderly. Microscopic colitis is more common in women and presents with chronic, non-bloody, secretory diarrhea. BAD may be diagnosed in up to 30% of patients previously diagnosed with IBS-D. Both conditions can be effectively treated and further investigations should be conducted if symptoms fail to settle following treatment [3].

By identifying the causes and factors contributing to chronic diarrhea in the elderly, one can implement effective strategies to manage the condition and improve the individual's quality of life.








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