Development of care programs based on assessment of functional bowel disorders for geriatric residents in health service facilities

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In order to investigate an appropriate care method for defecation problems, an actual condition survey on defecation problems as well as the causes and care methods of these problems were conducted for elderly residents in nursing homes. Nursing care for elderly individuals suffering from diarrhea and incontinence due to laxative use involved scheduled toileting and use of diapers, and did not include assessment of desire to defecate or the ability to maintain a sitting position.Moreover, we provided nursing care based on the assessment of the state of fecal incontinence among nursing home residents and evaluated the effects of the nursing care. The subjects were aged nursing home residents who habitually took laxatives to ease constipation.For the first 4 weeks, we observed to assess the states of subjects' defecation troubles and formulated treatment plans based on the individual assessment. For the next 4 weeks, we guided the subjects to a toilet to provide opportunity of defecation within 30 minutes after meals, monitored and confirmed the desire to defecate, helped increase abdominal pressure and stabilize sitting position by handrails and other aid equipment. We also encouraged to take more dietary fiber, gave hot-pad, and conducted abdomen massage to facilitate transit of stools whenever appropriate.We provided the nursing care to 5 subjects with severe dementia (1man, 4 women). They had ability to maintain sitting position with wheelchair, and they needed aides in daily life. Three subjects had never passed stools on a toilet seat. During the nursing care, most increased the number of defecation on a toilet seat, and one could do most cases successfully, avoiding incontinence of feces. All increased the number of defecation desire. They also showed some improvement over the ability of maintaining their posture and easier transfer in arising from and returning to wheelchair.