Management of Chronic Diarrhea in Elderly Patients

Immediate Stabilization and Assessment

The American College of Physicians recommends assessing for dehydration signs including orthostatic symptoms, weakness, dry mucous membranes, sunken eyes, and altered mental status—four or more indicators suggest moderate to severe volume depletion requiring aggressive fluid resuscitation 2
Elderly patients are particularly susceptible to dehydration leading to acute kidney injury, electrolyte imbalances, malnutrition, and pressure ulcer formation, according to the American Geriatrics Society 4, 1
Check for tachycardia, orthostatic pulse and blood pressure changes, decreased skin turgor, and absent jugular venous pulsations, as recommended by the Infectious Diseases Society of America 3, 1

The American College of Physicians recommends prescribing ORS containing 65-70 mEq/L sodium and 75-90 mmol/L glucose, with total fluid intake of 2200-4000 mL/day 1
ORS can be prepared by mixing 3.5g NaCl, 2.5g NaHCO₃, 1.5g KCl, and 20g glucose per liter of clean water, according to the Centers for Disease Control and Prevention 3

The American Gastroenterological Association recommends reviewing all medications for recent antibiotics, laxative abuse, cholinesterase inhibitors, antacids, or anti-motility agents 3, 1
Document stool frequency, composition, presence of blood, nocturnal diarrhea, and relationship to meals, as recommended by the American College of Gastroenterology 2

The American College of Gastroenterology recommends implementing a bland/BRAT diet and eliminating all lactose-containing products and high-osmolar dietary supplements 1, 4
Avoid foods high in simple sugars and fats, according to the Centers for Disease Control and Prevention 6

The Infectious Diseases Society of America recommends considering antibiotics when dysentery or high fever is present, when watery diarrhea lasts >5 days, or when stool cultures indicate specific treatable pathogens 6
If underlying malignancy or immunocompromised state exists, initiate broad-spectrum antibiotics covering enteric gram-negatives, gram-positives, and anaerobes, as recommended by the American College of Physicians 2

The American College of Emergency Physicians recommends admitting patients with severe dehydration, persistent vomiting, altered mental status, or signs of peritonitis 1, 2

The American College of Physicians recommends never neglecting rehydration while focusing solely on antimotility agents—fluid replacement is the cornerstone of treatment 2
Do not overuse empiric antibiotics in uncomplicated diarrhea as this promotes antimicrobial resistance, according to the American College of Physicians 2
Do not assume all diarrhea is infectious; fecal impaction with overflow diarrhea is common in elderly patients, as recommended by the American Geriatrics Society 1, 5