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At least 80% of seniors living in care suffer from constipation. Constipation is painful, worrisome, affects mood and more and more we're finding it also affects appetite. Traditional solutions (suppositories, enemas and manual dissipation) are uncomfortable for residents and may be labour intensive. Laxatives are no longer covered by B.C. Government, so residents needing or wanting to maintain bowel regularity with medications must now pay for them. Other residents might want to use this as an opportunity to improve dietary habits that promote bowel regularity.

Dietary fibre, in combination with a good fluid intake, has proven beneficial effects on bowel movements, fecal bulk and stool consistency. However, increasing fibre and fluid intake in seniors is not as easy as it sounds. Poor dentition and swallowing difficulties make many high-fibre foods hard for seniors to eat. For example, we found many of our residents have trouble chewing the raisins in Raisin Bran cereal, but were able to chew the raisins when they were cooked into rice pudding. Our residents report that the skins of vegetables and fruits are difficult to cut, chew and digest.

Inglewood's menu is reviewed for fibre and fluid content by a Registered Dietitian Nutritionist. The Cooks and Dietary Manager work closely with the Dietitian to design a menu with easy to chew and swallow high-fibre foods. Bran is cooked into our hot breakfast cereal so the end product is more palatable. In our Extended Care Unit where reduced mobility further impacts constipation, "fruit lax" (a prune, applesauce, bran and jam mixture) as well as bran, is cooked into the hot cereal. Our Special Care Unit residents are tending to prefer a lower-fibre puree diet, related to a loss of memory on how to chew; however, due to their increased mobility, constipation does not seem to be a big problem. Some of our intermediate care residents use fruit lax as a spread on toast, but many tire of it. Fruit lax is a good product, and a simplistic solution might be a widespread use of fruit lax.

We offer bran muffins, bran cookies, All Bran and Bran Flakes cereals. Whole-wheat bread is used for toast and sandwiches. At least five servings of fruits and vegetables (canned or frozen are easier to chew) are offered daily. Beans and lentils make high-fibre additions to our soups (e.g. tomato lentil, split pea, navy bean). Other high-fibre foods offered include: peanut butter sandwiches, rhubarb crisps, canned pears, carrots and fresh baked squash. Crab-apples or cranberries are used as high-fibre garnishes. Some residents experience gas with menu items such as baked beans, brussel-sprouts, corn, green and wax beans and broccoli. They often say "I love it, but it doesn't love me". A product called "BEANO" is available as a caplet to be taken before eating gassy foods, or as a liquid to put on gassy food.

Fibre provides stool bulk but fluids are essential for a soft consistency.  Our menu and between meal fluids we offer the recommended 6 to 8 cups of fluids daily. Good fluid replacement include: water, milk, unsweetened fruit juices, low fat milk and decaffeinated pop. Coffee and strong tea have a diuretic effect on the body and are poor fluid replacement. Offering fluids does not guarantee fluid intake. Factors lowering fluid intake may include: an inability to hold a cup, reduced access to fluids related to mobility, fear of needing to  use the toilet after drinking and a reduced sense of thirst as we age. Some residents say they "forget to drink" even when water is placed on the table and even if they have water coolers in their room. Others say they "grew up in a generation that was not used to drinking water". We try to increase fluid intake, by offering high fluid content foods, such as Jell-O and watermelon garnishes.

Suggestions for how you can help your family member with constipation:

		Bring treats such as date squares, peanut butter cookies, blueberries, blackberries, kiwi fruit or figs.
		Cut up an orange from our fruit basket for your family member.
		For those residents who enjoy vegetables but find them gassy, see if they want "Beano".
		When visiting, encourage water or juice rather than tea and coffee.
		Bring a thermos of ice tea or lemonade and a special glass and enjoy a visit on the patio.
		When you take your resident out to a restaurant, order a glass of water for them.
		Encourage your family member to try hot water with breakfast instead of tea and coffee, Some of our residents swear by this, that it "does the trick".
		Bring good fluid treats, such as decaffeinated soft drinks (ginger ale, 7-Up, orange) or flavoured mineral waters.
		Ask for a referral to our Inglewood  Occupational Therapist if you think there may be a feeding device that your family member could use to encourage independence of accessing water.
		Encourage mobility by taking a walk on the path behind Inglewood, or in the halls.

By Jocelyn Macdonald, Registered Dietitian Nutritionist.

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Revised: December 30, 2007 .