Karen E. Hall, MD, PhD, Department of Internal Medicine, Division of Geriatric Medicine, University of Michigan Healthcare System; Geriatric Research, Education, and Care Center, Veterans Affairs Medical Center, Ann Arbor, MI, USA.

An understanding of the changes in gastrointestinal function that occur with aging can assist physicians in making patient care decisions. Aging affects many aspects of gastrointestinal function; however, swallowing and colonic function are particularly vulnerable to age-related changes. This explains the high prevalence of swallowing disorders and lower GI tract problems such as constipation and fecal incontinence seen by gastroenterologists and primary care physicians among the older adults they treat. Common comorbid conditions in the geriatric population, such as impairment in cognition and mobility, can affect the treatment of older adults with GI disease. This article highlights important changes in gastrointestinal function that occur with aging.
Key words: dysphagia, constipation, diarrhea, gastrointestinal immunity, gastric function.

Richard Saad, MD, Lecturer, Division of Gastroenterology, Department of Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA.
William D. Chey, MD, AGAF, FACG, FACP, Associate Professor of Internal Medicine; Director, GI Physiology Laboratory, University of Michigan Medical Center, Ann Arbor, MI, USA.

Irritable bowel syndrome (IBS) is traditionally considered a disorder of young adulthood; however, it affects adults of all ages, including older adults. As the older population increases so will the impact of IBS in this age group. Irritable bowel syndrome with constipation (IBS-C) is believed to be particularly significant given the prevalence of constipation among the aged. At present, the evaluation and management of this disorder has been largely driven by data obtained from younger adults. However, there are numerous aspects of the underlying pathophysiology, evaluation, and treatment of IBS-C that remain unique to older adults, of which the clinician should be cognizant.
Key words: irritable bowel syndrome, constipation, older adults, functional bowel disorder.

Marisa Battistella, BScPhm, Pharm D, Education Coordinator & Hemodialysis Pharmacist, Pharmacy Department, University Health Network, Toronto, ON.
Shabbir M.H. Alibhai, MD, MSc, FRCP(C), Staff Physician, University Health Network, Toronto, ON.

Constipation is a common symptom in patients of all ages, but its occurrence is highest among persons 65 years of age or older.^1,2 Constipation has been shown to diminish both quality of life and feeling of well-being.^3-5 Although constipation can have many causes, it is most often functional or idiopathic.^5,6 Furthermore, constipation can lead to serious complications such as malnutrition, fecal impaction, fecal incontinence, colonic dilation and even perforation of the colon.⁷

Definition
Constipation has different meanings to patients and physicians. A patient's perception of constipation may include not only the objective observation of infrequent bowel movements but also subjective complaints of straining with defecation, incomplete evacuation, abdominal bloating or pain, hard or small stools or a need for digital manipulation to enable defecation. Because the definition of constipation can be subjective, an international committee has recommended an operational definition of chronic functional constipation in adults.

Sheldon Singh, BSc

Constipation is a very common complaint. In the United States, it accounts for over 2.5 million physician visits annually. The occurrence is highest among individuals 65 years and older.¹ Constipation has been shown to diminish the quality of life and well-being of individuals. It may also lead to complications such as fecal impaction, fecal incontinence, dilatation and even perforation of the colon.

Defining Constipation
Constipation is not easily defined. Since more than ninety-five percent of the population have between three bowel movements a day and three bowel movements a week, constipation has historically been defined as the passage of fewer than three bowel movements a week. However, most would agree that the effort needed to pass stool and the consistency of the stool are more important; difficulty passing stool, even if one passes stool daily, may constitute constipation. Thus, constipation may be defined as persistent symptoms of difficult, infrequent, or seemingly incomplete evacuation.