Synopsis

We aimed to determine risk factors for new onset constipation in a large population based cohort of older Australian women over a 9 year period. Our participants were 12,762 women (aged 70-75 years) who participated in the first survey of the Australian Longitudinal Study on Women's Health in 1996. Of these women, n =3716, aged 79-84 years also completed a follow-up survey in 2005. Both the first and follow-up survey asked women “Have you had constipation in the past 12 months?” The following baseline variables were asked in the first survey. Demographic factors included nationality, educational, marital and socioeconomic status. Lifestyle factors assessed included smoking, alcohol intake, body mass index, number of live births and a history of a prolapse repair. The number of stressful life events in the past year was assessed as was depression using the Centre for Epidemiological Studies-Depression scale (CES-D). Domains of quality of life were assessed using the valid SF-36. Of the 3716 women who responded to the first and follow-up survey, we found 1501 (40.3%) developed constipation over the 9 year period. Univariately, we found an increased number of live births, increased number of stressful life events, lower socioeconomic status and reduced functioning in the following SF 36 domains: general health, bodily pain, mental health, physical and social functioning, role emotional and physical and vitality to be significantly associated with new onset constipation. However in a multiple regression model that included these significant variables we found the rate of constipation in those women who have given birth versus those who had not (43% vs 34%; OR= 1.1; 95%CI 1.0-1.1, P=0.003) and reduced functioning on the SF- 36 subscales for vitality (M=6.4 vs M=6.8; OR=0.9; 95%CI 0.9-1.0, P=0.000) and bodily pain (M=6.8 vs M=7.4; OR=0.9; 95%CI0.9-1.0, P=0.001) were independent risk factors for developing constipation among women who did not report constipation on the first survey. Therefore we showed that constipation is an extremely common problem among older community dwelling women and causes decrement in health related quality of life. Our prospective data suggests factors related to childbirth and generally being unwell as reflected by poor quality of life are risk factors for developing new onset constipation among older women. This work was published as an abstract in Gastroenterology and presented at Digestive Disease Week in 2011 in the poster session. We have since also looked at risk factors associated with a shorter time to constipation among older women and are preparing to submit this work as an abstract to Digestvie Diseases Week in 2013 (with permission from ALSWH). We are also working on a manuscript focussing more on the risk factors associated with a shorted time to constipation as we feel this takes advantage of the several time points of data available. A draft of this manuscript is almost complete and will be sent around to authors during November 2012.