The status of vitamins B6, B12, folate, and of homocysteine in geriatric home residents receiving laxatives or dietary fiber.

BACKGROUND: Vitamin B12 deficiency as a digestive disorder and constipation as a gastro motility disorder are common in the elderly. Laxative treatment is often chosen without regard for gut health. OBJECTIVE: To investigate whether the addition of oat-bran to the common oral diet for 12 weeks is able to reduce constipation and laxative use and improve gut health. It is assumed that this will lead to improved plasma levels of vitamins B6, B12, folate, and of homocysteine in nursing home residents. METHODS: A controlled, parallel intervention trial. 30 frail patients with multiple chronic diseases, aged 57-98 years, receiving laxative therapy were included. Patients were randomized into a fiber (n=15) and a control group (n=15). The intervention group received 5.2g/d oat-bran for 84 days mixed into the daily common meals. The control group received the ward's habitual diet. Food intake and laxative use were documented and blood samples (on day 01, day 42 and day 84) were collected. Vitamin B12 and folate were analyzed by radioimmunoassay, B6 and homocysteine by RP-HPLC with fluorescence detection, in addition to the routine lab test of albumin and CRP. RESULTS: In the fiber group, the intervention was well tolerated and laxative use decreased significantly (p < 0.001). In the control group, plasma B12 decreased faster (p < 0.05). In both groups, B6 and folate status remained unchanged. Plasma homocysteine decreased in both groups (p < 0.05). General mean energy intake was low (4861.4 kJ/d). CONCLUSION: Oat-bran helps to improve constipation management and B12 bioavailability in elderly, with multiple chronic diseases who live in nursing homes.

Use of fiber instead of laxative treatment in a geriatric hospital to improve the wellbeing of seniors.

INTRODUCTION: Constipation is a common problem in the elderly population, especially in geriatric wards. Laxatives are the most preferred solution but current studies link constipation and laxative use to weight-loss and malnutrition in nursing homes. Dietary fibers also affect stool weight and transit time. So, oat-bran effectiveness in reducing the need for bowel medication and weight-loss for geriatric care patients was examined in a geriatric hospital. AIM: To determine whether the addition of oat-bran to common oral diet can reduce the use of laxatives and improve the wellbeing and bodyweight of the inhabitants of a long-term-care facility. METHODS: The study was designed as a controlled blind intervention trial among 30 frail inhabitants of a geriatric hospital aged 57-100 years with laxative use. Including criteria were: oral food intake and laxatives as therapy and excluding criteria were: parenteral and enteral feeding, surgeries in the gastro- intestinal tract, drugs that shorten or lengthen the passage through the gut, risk of aspiration, swallowing troubles. An intervention and a control group were formed. 15 of them received 7-8 g oat-bran/d for 12 weeks (fiber group) mixed up in the daily common diet of the ward and 15 served as control (control group). DATA COLLECTION: Bodyweight was taken at baseline, after 6 weeks and at the end of the supplementation. Data on laxative use, stool frequency and the eating habits of the elderly were recorded. RESULTS: Laxatives were successfully discontinued by 59% (p < 0.001) in the fiber-group; in the control-group there was an increase of 8% (p=0.218). Bodyweight remained constant in the fiber-group and decreased in the control-group (p=0.002). The oat-fiber supplementation in the introduced form was well tolerated. CONCLUSIONS: Use of oat-fiber allowed discontinuation of laxatives by 59% while improving body-weight and wellbeing of the seniors. Fiber supplementation is a safe and convenient alternative to laxatives in a geriatric hospital.