Over the years, I have written a number of newsletters that discuss the benefits of probiotics for children and adults. This month will focus on the older generation, an important topic since there are currently 11.4 million people living in nursing homes in the United States ⁽¹⁾. This figure includes 14% of the population older than 84.

For anyone who has loved ones in nursing homes and is concerned for their well-being, there are numerous reasons I recommend all nursing home patients take probiotics.

Scenario One: Hospitalization

A recurring story is that of a functioning senior citizen living at home who fractures a hip due to a fall or experiences a stroke. The following series of events is likely to happen:

1. Upon injury, 9-1-1 is called.
2. The individual becomes a hospitalized patient.
3. The patient is required to take medications, including antibiotics.
4. The antibiotics adversely affect the gastrointestinal tract.
5. The individual is now at risk of developing hospital-acquired infections like Clostridia difficile and methicillin-resistant staph infections.
6. Eventually, the patient improves and is transferred to a rehab unit or nursing home.

The seniors may have had normal intestinal function prior to hospitalization, but with all the medications and change in activity level, constipation and diarrhea become real problems. These disorders can severely affect quality life and health of the people within the nursing homes.

For instance, other healthy nursing home residents are now at risk of being exposed to surface areas that have become contaminated by the arrival of the recently hospitalized patients.

This scenario is one reason to consider giving probiotics to healthy nursing home residents. Should a resident be exposed, the probiotics can prevent harmful bacteria from colonizing the intestines and causing damage.

Scenario Two: General Aging Process

Another main reason to give probiotics has to do with the changes that occur in the normal intestines as they age. Due to reduction in acid production, enzyme secretions, reduced intestinal immunity and slowed motility, the healthy intestinal bacteria population is reduced. This change in the intestinal microflora contributes to the risk of diarrhea and constipation.

According to the Administration of Aging ⁽²⁾, among healthy adults 65 years of age and older, 26% of men and 34% of women experience constipation. These numbers increase drastically for elderly people living in nursing homes – more than 80% suffer from constipation.  Medications, immobility, and dementia are all contributing factors for this increase.

Residents of nursing homes have a much higher risk of developing infectious diarrhea. In the United States, nursing home residents are four times more likely to die from gastroenteritis than those living outside nursing homes. Additionally, of all deaths occuring from diarrheal disease, nursing home residents account for 17.5% ^(3,4).

The physicians and nursing staff are very aware of the health risks associated with severe constipation and diarrhea. Unfortunately, nursing home patients often require medications that can slow intestinal motility, damage the lining cells, and disrupt the healthy balance of the intestinal bacteria. As a result, severe intestinal disorders can occur despite good medical care.

Probiotics Improve Constipation and Diarrhea

During the last three years, there have been several reports published that found that probiotics improved constipation and diarrhea in nursing home residents ^(5,6,7).  The research protocols were similar; One group of residents received probiotics containing Lactobacillus and/or Bifidobacteria, and the other group received a placebo. The research findings revealed that the frequency and consistency of the stools improved in the groups treated with probiotics, as compared to the control groups ^(5,6,7).

After considerable review of the literature, I have come to the conclusion that giving nursing home residents daily probiotics can help to improve intestinal function, quality of life, and lessen the risk of serious health issues.

The real concern in medicine is that we “do no harm.” Probiotics, fortunately, have an excellent safety profile. It is worth noting, though, that there have been rare reports of infections due to probiotics in seriously immune-compromised patients ⁽⁹⁾.

Take Home Message

If you have a loved one in a nursing home, ask the health care provider to consider giving them a probiotic. The daily dosage should be at least 10 billion and contain multiple strains of Lactobacillus and Bifidobacteria, like EndoMune Advanced.

Eat healthy, exercise and live well!
Dr. Hoberman

References:

(1) National Center for Health Statistics. Health, United States, 2009: with special feature on
medical technology. Hyattsville, MD, 2010.

(2) Sources: Data releases from the web sites of the National Center for Health Statistics; and from the Bureau of Labor Statistics web site

(3) Mortality due to gastroenteritis of unknown etiology in the United States. Frenzen PD.J Infect Dis. 2003 Feb 1;187⁽³⁾:441-52. Epub 2003 Jan 24

(4) Clin Infect Dis. 2010 Oct 15;51⁽⁸⁾:907-14.Surveillance for outbreaks of gastroenteritis in long-term care facilities, Australia, 2002-2008. Kirk MD, Fullerton KE, Hall GV, Gregory J, Stafford R, Veitch MG, Becker N

(5) Efficacy of Lactic Acid Bacteria (LAB) supplement in management of constipation among nursing home residents. 1)Sources: Data releases from the web sites of the National Center for Health Statistics; and from the Bureau of Labor Statistics web site

(6) Fermented cereal with specific bifidobacteria normalizes bowel movements in elderly nursing home residents. A randomized, controlled trial.Pitkala KH, Strandberg TE, Finne Soveri UH, Ouwehand AC, Poussa T, Salminen S.J Nutr Health Aging. 2007 Jul-Aug;11(4):305-11

(7) Clostridium difficile in the long-term care setting. Makris AT, Gelone S.J Am Med Dir Assoc. 2007 Jun;8⁽⁵⁾:290-9. Review

(8) Probiotics and the nursing home: should we give bacteria for breakfast?Morley JE.J Am Med Dir Assoc. 2009 Jul;10⁽⁶⁾:365-7.

(9) Safety assessment of probiotics for human use.Sanders ME, Akkermans LM, Haller D, Hammerman C, Heimbach J, Hörmannsperger G, Huys G, Levy DD, Lutgendorff F, Mack D, Phothirath P, Solano-Aguilar G, Vaughan E.Gut Microbes. 2010 May;1⁽³⁾:164-185. Epub 2010 Mar 4.