Diarrhea in the Elderly

Definition: Significant increase in frequency (usually >3 times a day) of loose or liquid stools/day and stool weight >200 g/day

Preventative measures
 Avoid foods and medications that trigger diarrhea
 May consider yogurt or other source of probiotic.

Assess: vital signs, presence of bowel sounds, dehydration, duration of symptoms, and inflammation
Evaluate for potential causes such as1-8:
 Fecal impaction  Infection: bacterial, viral, parasitic
 Medications, including but not limited to antibiotics, laxatives, NSAIDS  Inflammatory Bowel Diseases (e.g. ulcerative colitis or Crohn’s
magnesium-containing antacids, antihypertensives, antiarrhythmics, Disease)
 Food: Caffeine, insoluble fiber, lactose intolerance  Malabsorption syndromes
 Irritable bowel syndrome (IBS)  Carcinoid tumors

Fecal impaction Medication or Infectious diarrhea Suspected

IBD, IBS, and Assess patient history and send laboratory and microbiologic testing (as appropriate)
 Manual diet related other
disimpaction malabsorption
 Enemas or  Stop or syndromes
suppositories decrease any  Stress Bacterial (NOT Clostridium Clostrium difficile infection (Depending on testing
as needed agents that
Management Difficile), Viral, and Parasitic methodology and presentation, may need to start antibiotics
 Polyethylene may be
glycol solutions and Patient empirically if high suspicion of C. difficile infection)
associated
 Increase with diarrhea. Education VIRAL Assess for severity and recurrence
mobility  Decrease any  Lactose-Free - infections are  Mild/mod infection: without severe symptoms
 Avoidance of foods that and Caffeine- usually self-limiting  Severe without complications: WBC >15, or Scr >1.5
anti-diarrheals may upset Free Diet. and should resolve from baseline
and digestive  Also avoid themselves with  Severe with complications: hypotension/shock,
constipating system such other foods time (usually 48 ileus/obstruction, toxic megacolon
medications as spicy that can cause hours). Until then,  Recurrent disease: Repeat infection within 2-8 weeks of
 Increased foods, fried or make fluids and last infection
electrolytes should General measures
dietary fiber foods, citrus diarrhea worse
be replaced. If  Stop anti-peristalsis agents (e.g. loperamide)
fruit, and like
traveler’s diarrhea  Stop any unnecessary antibiotics
dairy. artificialsweetn is suspected,  Place patient on isolation precautions
ers bacteria is the
 cause a majority of
 the time and
Mild to mod Severe infection Severe infection
empiric antibiotic
infection without with
therapy is
recommended. Initial or 1st complications complications
recurrence  Likely requires  Admit patient
 Ciprofloxacin 500mg PO  Metronidazole hospitalization to hospital for
daily for 3 days. 500 mg PO  Vancomycin further
three times a 125 mg PO evaluation and
day, 10-14 days four times a higher level of
 Azithromycin 500mg PO
daily for 3 days ≥2nd recurrence day, 10-14 care
(Thailand).  Vancomycin days
125 mg PO four
If unresolved, may be times a day, 10-
PARASITIC 14 days

Metronidazole 500mg PO Recurrent disease

three times daily for 10-14  Follow guidance on based on severity (metronidazole use
days beyond 1st recurrence not recommended)
 Vancomycin taper/pulse therapy
 ID consult encouraged

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