SYSTEMATIC REVIEW article
Front. Med.
Sec. Geriatric Medicine
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1644609
Nonpharmacologic Treatment for Elderly with Constipation: A Systematic Review and Meta-analysis
Provisionally accepted
- 1Changchun University of Chinese Medicine, Changchun, China
- 2Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
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Objective:This study evaluated the efficacy and safety of non-pharmacological interventions such as acupuncture, abdominal massage, ear acupoints, probiotics, and dietary fiber in the treatment of constipation in the elderly. Methods: Randomized controlled trials (RCTs) published up to March 2025 were retrieved from Cochrane Library, PubMed, Web of Science, Embase, and Chinese databases. The research quality was evaluated using the Cochrane risk of bias assessment tool. Data analysis was performed using RevMan5.4.1 and Stata software. Grade evidence quality was assessed on the analysis's outcome indicators. Results: Forty-one studies involving 3005 patients aged ≥60 years were included. The non-pharmacologic treatment group demonstrated significantly higher efficacy compared to the control group (RR=1.15, 95% CI=1.09 to 1.21, p<0.00001), with high heterogeneity ( I2 = 58 %, p < 0.0001 ). Subgroup analysis revealed superior therapeutic efficacy of acupuncture (n=15), abdominal massage (n=11), and ear acupoint therapy (n=3) compared to the control group. The incidence of adverse events in the non-drug-treated group was lower than that in the control group (RR=0.35, 95% CI=0.16 to 0.74, p=0.006); its heterogeneity was ( I2 = 46 %, p = 0.04 ). Meta-analysis of the Constipation-Related Quality of Life Scale (CQLS) revealed that the non-pharmacological treatment group had a more significant therapeutic effect on anxiety or distress. In addition, in the Bristol stool scale, the non-pharmacologic treatment group had better results (standardized mean difference (SMD)=0.87, 95% CI=0.14- 1.60, p=0.02), and better improvement was achieved after the treatment cycle >4 weeks. In the CSBM scale, the non-pharmacological treatment group showed better efficacy (SMD=0.44, 95% CI=-0.52- 0.12, p=0.03). Symptom score analysis showed that in addition to abdominal distension, eight indicators, including abdominal pain, number of bowel movements, and stool consistency, in the non-pharmacologic treatment group were significantly improved (p＜0.05). Some RCTs included in this study had publication bias, and the sensitivity analysis results were robust.
Keywords: Non-pharmacologic treatment, Elderly, Constipation, Meta-analysis, efficacy, adverse events
Received: 10 Jun 2025; Accepted: 21 Aug 2025.
Copyright: © 2025 Xu, Leng, Dai, Gao, Chu, Chen, Yang, Li and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Tiezheng Yang, Affiliated Hospital to Changchun University of Chinese Medicine, Changchun, China
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