From the Guidelines
The recommended treatment for ileus in bedbound elderly patients involves a conservative management approach, focusing on bowel rest, nasogastric tube decompression, and intravenous fluid therapy to correct electrolyte imbalances, as well as early mobilization and medication management. When considering the treatment of ileus in this population, it's essential to prioritize measures that prevent further complications and promote recovery. The management of constipation in older people with cancer, as outlined in the ESMO clinical practice guidelines 1, provides valuable insights into the care of bedbound elderly patients with ileus. Key aspects of this approach include:
- Ensuring access to toilets and optimizing toileting habits, even for those with decreased mobility 1
- Providing dietetic support and managing decreased food intake, which can negatively impact stool volume and consistency 1
- Using laxatives that are individualized to the patient's medical history, drug interactions, and potential adverse effects, with polyethylene glycol (PEG) offering a safe and efficacious solution for elderly patients 1
- Avoiding certain laxatives, such as liquid paraffin in bed-bound patients and non-absorbable, soluble dietary fibre or bulk agents in non-ambulatory patients with low fluid intake, due to the risk of aspiration lipoid pneumonia and mechanical obstruction, respectively 1
- Considering rectal measures, such as enemas and suppositories, for patients with swallowing difficulties or repeated faecal impaction, with isotonic saline enemas being preferable in older adults 1. Given the complexities of managing ileus in bedbound elderly patients, a stepwise approach that incorporates these considerations can help mitigate morbidity, mortality, and improve quality of life.
From the Research
Treatment Options for Ileus in Bedbound Elderly Patients
- The treatment of ileus in bedbound elderly patients typically involves addressing the underlying cause and providing supportive care 2.
- Pharmacological agents, such as methylnaltrexone, have been studied as potential treatments for postoperative ileus, but their effectiveness is uncertain 3, 4, 5.
- Methylnaltrexone, a peripheral opioid antagonist, may be safely used in patients with postoperative ileus, but it did not significantly reduce time to resolution of ileus, length of stay, duration of gastric decompression, or total parenteral nutrition requirements in one study 3.
- Early enteral nutrition (EEN) has been shown to facilitate return of normal bowel function, achieve enteral nutrition goals, and reduce hospital length of stay in adult surgical patients with ileus 6.
- Promotility agents, such as metoclopramide and erythromycin, have not been found to be effective in expediting the resolution of ileus in adult surgical patients 6.
Considerations for Bedbound Elderly Patients
- Bedbound elderly patients with ileus may require individualized treatment plans that take into account their underlying medical conditions, medications, and overall health status 2.
- The use of opioid analgesics, which can exacerbate ileus, should be carefully managed in bedbound elderly patients 2.
- Standardized enhanced recovery protocols, which include measures such as early mobilization and optimal pain management, may help reduce the incidence of ileus in bedbound elderly patients 2.