Constipation in Persons Receiving Hospice Care

Abstract 

Context

Symptom burden at the end of life is incompletely understood.

Objectives

To estimate the natural history of constipation and the relation of clinical and demographic characteristics to moderate or severe constipation among persons who received hospice care in the United States starting in 2005.

Methods

Data were obtained from a national provider of hospice pharmacy services and included information about the hospice organization, patient demographics and clinical characteristics, constipation intensity, and drugs prescribed. Hospice nurses assessed patients’ constipation during the previous 24 hours periodically, using a 0–10 numeric rating scale (NRS; 0=no intensity and 10=worst imaginable; none [NRS 0], mild [NRS 1–3], moderate [NRS 4–6], or severe [NRS 7–10]). Regression models were constructed to identify factors associated with last reported constipation severity scores.

Results

Fifty thousand six hundred forty-one persons received hospice services, had at least two constipation assessments, and had complete clinical and demographic information; 55.3% of these individuals were female, 87.1% were Caucasian, and mean age was 75.9 years. Constipation was assessed a mean of four times per person; 12% of persons had moderate or severe constipation at their first or last assessment, and 19% of persons who reported moderate or severe constipation at the first assessment also had moderate or severe constipation at the last assessment. First constipation and last pain scores, having cancer, and prescription of a laxative were associated with increased likelihood of moderate or severe constipation at the last assessment.

Conclusions

These data provide insight into a common and potentially distressing symptom and also may be useful as process indicators of the quality of hospice care.

Key Words: Constipation, pain, symptom management, hospice, cancer, end of life, opioid