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Executive Summary

Background

Constipation is a problem which has been observed to commonly effect the elderly population, especially those above the age of 60 years, with prevalence rates being about 31%.1 There are currently no national guidelines for the treatment of constipation. Both the NPC and CKS guidelines suggest a stepped approach towards management where first line of treatment is the consideration of dietary/lifestyle modifications.2, 3 Since the use of laxatives is particularly prevalent among the elderly, it is important to tutor elderly on the fact that daily bowel movements and purging are not essential for health; in fact long-term laxative use, besides being associated with high health care costs can also result in adverse effects. 4 Also, long-term constipation can have many health related adverse consequences including haemorrhoids, diverticulae, increased risk for colorectal cancer etc.5, 6

Definition of local needs

Currently, NHS Grampian does not offer any services directly aimed at elderly patients suffering from constipation. NHS Grampian, however does have a "healthy topics programme", one of its topic being nutrition. 7 As part of this, a presentation entitled "healthy eating for older people" is available to raise the awareness regarding the importance of a healthy diet in later life.8 The importance of balanced diet in improving health has become the driver for shaping many policies, 'Eating For Health: A Diet Action Plan for Scotland' (1996)9 and the 2003 document 'Improving Health in Scotland: the Challenge'.10 However a review commissioned by the Food Standards Agency, Scotland in 2006 found that despite these dietary policies there was no significant improvement in intake of high fibre diet over the period, 1996 - 2003/2004. 11 'Delivering for Health' 2005 concluded that there needs to be a shift towards preventive medicine and continuous care in the community by strengthening local services, and providing more support for self-care.

The NHS will incur cost for laxatives given on e- MAS.

It is probable that in the long-term this service will reduce prevalence and incidence of constipation resulting in overall reduction in health care costs.

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