USE OF LAXATIVE MEDICATION IN OLDER PERSONS AND ASSOCIATIONS WITH LOW SERUM-ALBUMIN

Objective: To study laxative use among older persons and the association of laxative intake with hypoalbuminemia. Design: Cross-sectional study in a population-based cohort. Setting: Community and institutions in the Iowa and Washington counties, Iowa site of the Established Populations for Epidemiologic Studies of the Elderly. Participants: Persons aged 71 years or older, who were interviewed at the 6th year of follow-up and for whom drug intake information was obtained (n = 2,529). Main Outcome Measures: Laxative medication use and prevalence of hypoalbuminemia. Results: The prevalence rate of laxative use was 8.8% in the community and 74.6% in nursing homes. Increasing age was independently associated with laxative use (odds ratio [OR] = 1.66, 95% confidence interval [CI] = 1.33 to 2.07 for a 10-year increase), after adjusting for gender, institutionalization, disability in activities of daily living, body mass index, and use of the following drugs: furosemide, benzodiazepines, antidepressants, codeine, and calcium antagonists. Laxative use was independently associated with hypoalbuminemia (OR = 3.17, 95% CI = 1.42 to 7.08) after adjusting for age, gender, anemia, number of comorbid conditions, disability in activities of daily living, body mass index, use of furosemide, and institutionalization status. Compared with those who never used laxatives, those who took laxatives only at the 6th year of follow-up were at increased risk of hypoalbuminemia (OR = 2.65, 95% CI = 1.04 to 6.77), and those who used laxatives at both the 3rd and 6th years of follow-up were at greatest risk (OR = 4.02, 95% CI = 1.53 to 10.06). Conclusion: Laxatives are used by large numbers of older persons, and the investigation on unknown adverse effects is important. Prospective studies are needed to confirm the association of laxative use with hypoalbuminemia found in this study and to assess the mechanisms of this association.