Evidence Base & Extended References

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This work is informed by evidence across frailty, geriatric syndromes, constipation in older adults, and diagnostic reasoning.

Abe, T., Kunimoto, M., Hachiro, Y., Ohara, K., Inagaki, M., Hishiyama, H. and Murakami, M. (2021) Tolerance and efficacy of polyethylene glycol 4000 in elderly patients with chronic constipation, Journal of the Anus, Rectum and Colon, 5(3). Available from https://pubmed.ncbi.nlm.nih.gov/34395942/ [accessed 11 February 2026].
Al Nou’mani, J., Al Alawi, A.M., Al-Maqbali, J.S., Al Abri, N. and Al Sabbri, M. (2023) Prevalence, recognition, and risk factors of constipation among medically hospitalized patients: a cohort prospective study, Medicina, 59(7), 1347, 1–10. Available from https://doi.org/10.3390/medicina59071347 (accessed 10 February 2026).
Arco, S., Saldaña, E., Serra-Prat, M., Palomera, E., Ribas, Y., Font, S., Clavé, P. and Mundet, L. (2022) Functional constipation in older adults: prevalence, clinical symptoms and subtypes, association with frailty, and impact on quality of life. Gerontology, 68(4), 397–406. Available from https://doi.org/10.1159/000517212 (accessed 11 February 2026).
Beauchamp, T.L. and Childress, J.F. (2019) Principles of biomedical ethics. 8th edn. Oxford: Oxford University Press.
Bharucha, A.E., Pemberton, J.H. and Locke, G.R. (2013) American Gastroenterological Association technical review on constipation, Gastroenterology, 144(1), 218–238. Available from https://doi.org/10.1053/j.gastro.2012.10.028 [accessed 11 February 2026].
Boshuizen, H.P.A. and Schmidt, H.G. (2018) The development of clinical reasoning expertise, in Higgs, J. Jensen, S. Loftus, and N. Christensen (Eds.), Clinical reasoning in the health professions (4th ed., 57-65). Elsevier. Available from https://research.ou.nl/en/publications/the-development-of-clinical-reasoning-expertise/[accessed 11 february 2026].
Boucher, E.L., Gan, J.M., Rothwell, P.M., Shepperd, S. and Pendlebury, S.T. (2023) Prevalence and outcomes of frailty in unplanned hospital admissions: a systematic review and meta-analysis, eClinicalMedicine, 59, 101947. Available from https://doi.org/10.1016/j.eclinm.2023.101947 (accessed 11 February 2026).
British Geriatrics Society (2025) Frailty and social vulnerability. Available from https://www.bgs.org.uk [accessed 11 February 2026].
Burton, L. and Mortimore, G. (2022) Constipation in older people: a clinical review for advanced nurse practitioners, Gastrointestinal Nursing, 20(2), 28–37. Available from https://doi.org/10.12968/gasn.2022.20.2.2(accessed 11 February 2026).
Care Act 2014 (2014) c. 23. London: The Stationery Office. Available from https://www.legislation.gov.uk/ukpga/2014/23/contents [Accessed 9 February 2026].
Cheever, C.R., Shams, R.B., Willingham, K.R., Sim, H., Cook, L.M., Ahmidouch, M.Y., Scholand, K.E. and Wilson, L.A. (2025) (2025) Understanding constipation as a geriatric syndrome, Geriatric Nursing, 61, 440–448. Available from https://doi.org/10.1016/j.gerinurse.2024.12.012 (accessed 11 February 2026).
Clegg, A., Young, J., Iliffe, S., Rikkert, M.O. and Rockwood, K. (2013) Frailty in elderly people, The Lancet, 381(9868), pp. 752–762. Available from https://doi.org/10.1016/S0140-6736(12)62167-9 (accessed 11 February 2026).
Coleman, D.J. and Asiri, N.A.S. (2020) A person‑centred communication approach to working with older people who have dementia, British Journal of Healthcare (BJHA), 14(11), 575‑582. Available from https://www.magonlinelibrary.com/doi/full/10.12968/bjha.2020.14.11.575 [accessed 11 February 2026].
Costa, A.P., Hirdes, J.P., Heckman, G.A., Dey, A.B., Jonsson, P.V., Lakhan, P., Ljunggren, G., Singler, K., Sjostrand, F., Swoboda, W., Wellens, N.I., Gray, L.C. (2014) Geriatric syndromes predict postdischarge outcomes among older emergency department patients: findings from the interRAI Multinational Emergency Department Study. Acad Emerg Med. 21(4):422-33. Available from https://doi.org/10.1111/acem.12353 (accessed 10 February 2026).
Croskerry, P. (2009) A universal model of diagnostic reasoning, Academic Medicine, 84(8), 1022–1028. Available from 10.1097/ACM.0b013e3181ace703 [accessed 11 February 2026].
Davies, K., Maharani, A., Chandola, T., Todd, C. and Pendleton, N. (2021) The longitudinal relationship between loneliness, social isolation, and frailty in older adults in England: a prospective analysis. Lancet Healthy Longevity, 2(2), pp. e70–e77. Available from https://doi.org/10.1016/S2666-7568(20)30038-6[accessed 11 February 2026].
De Giorgio, R., Ruggeri, E., Stanghellini, V., Eusebi, L.H., Bazzoli, F. and Chiarioni, G. (2015) Chronic constipation in the elderly, World Journal of Gastroenterology, 21(13), 3677–3688. Available from https://doi.org/10.1186/s12876-015-0366-3 (accessed 11 February 2026).
Dent, E., Morley, J.E., Cruz-Jentoft, A.J., Woodhouse, L., Rodríguez-Mañas, L., Fried, L.P., Woo, J., Aprahamian, I., Sanford, A., Lundy, J., Landi, F., Beilby, J., Martin, F.C., Bauer, J.M., Ferrucci, L., Merchant, R.A., Dong, B., Arai, H., Hoogendijk, E.O., Won, C.W., Abbatecola, A., Cederholm, T., Strandberg, T., Gutiérrez Robledo, L.M., Flicker, L., Bhasin, S., Aubertin-Leheudre, M., Bischoff-Ferrari, H.A., Guralnik, J.M., Muscedere, J., Pahor, M., Ruiz, J., Negm, A.M., Reginster, J.Y., Waters, D.L. and Vellas, B. (2019) Physical Frailty: ICFSR International Clinical Practice Guidelines for Identification and Management. The Journal of nutrition, health and aging,23(9) 771–787. Available from https://www.sciencedirect.com/science/article/pii/S1279770723011491. [accessed 11 February 2026].
Driver, B.E., Chittineni, C., Kartha, G., Cole, J.B., Klein, L.R. and Rischall, M. (2020) Utility of plain abdominal radiography in adult ED patients with suspected constipation, The American Journal of Emergency Medicine, 38(6), 1092–1096. Available from 10.1016/j.ajem.2019.158377 [accessed 11 February 2026].
Ellis, G., Whitehead, M.A., Robinson, D., O’Neill, D. and Langhorne, P. (2011) Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials, BMJ, 343, d6553, 1–10. Available from https://doi.org/10.1136/bmj.d6553 (accessed 10 February 2026).
Emmanuel, A., Mattace-Raso, F., Neri, M.C., Peterson, K.U., Rey, E. and Rogers, J. (2017) Constipation in older people: a consensus statement. International Journal of Clinical Practice, 71(10), e12920. Available from https://doi.org/10.1111/ijcp.12920 [accessed 11 february 2026].
Epstein, R.M. and Krasner, M.S. (2013) Physician resilience: what it means, why it matters, and how to promote it, Academic Medicine, 88(3), pp. 301–303. Available from https://doi.org/10.1097/ACM.0b013e318280cff0[accessed 11 February 2026].
Gau, J.-T., Patel, P., Pan, J.-J. and Kao, T.-C. (2022) Analyzing fecal loading and retention patterns by abdominal X-rays of hospitalized older adults: A retrospective study. Aging Medicine, 5(1), 38–44. Available from https://doi.org/10.1002/agm2.12199 [accessed 11 February 2026].
Hallyburton, A. (2022) Diagnostic overshadowing: An evolutionary concept analysis on the misattribution of physical symptoms to pre-existing psychological illnesses. Int J Ment Health Nurs.31(6):1360-1372.Available from 10.1111/inm.13034 [accessed 11 February 2026].
Hartweg, D. (1991) Dorothea Orem: Self-Care Deficit Theory, SAGE Publications, Incorporated, Thousand Oaks. Available from ProQuest Ebook Central. [accessed 11 February 2026].
Health Education England (2017) Multi-professional framework for advanced clinical practice in England. London: HEE. Available from https://www.hee.nhs.uk/sites/default/files/documents/multi-professionalframeworkforadvancedclinicalpracticeinengland.pdf [accessed 11 February 2026].
HM Government (2014) The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. SI 2014/2936. London: The Stationery Office. Available from https://www.legislation.gov.uk/uksi/2014/2936/contents [accessed 11 February 2026].
HM Government (2012) The Human Medicines Regulations 2012. SI 2012/1916. London: The Stationery Office. Available from https://www.legislation.gov.uk/uksi/2012/1916/contents [accessed 11 February 2026].
Hsu, R.K. and Hsu, C. (2016) The Role of Acute Kidney Injury in Chronic Kidney Disease. Seminars in nephrology, 36(4) 283–292. Available from https://www.sciencedirect.com/science/article/pii/S0270929516300341.[accessed 11 February 2026].
Inouye, S.K., Studenski, S., Tinetti, M.E. and Kuchel, G.A. (2007) Geriatric syndromes: clinical, research and policy implications of a core geriatric concept. Journal of the American Geriatrics Society, 55(5), pp. 780–791. Available from https://doi.org/10.1111/j.1532-5415.2007.01156.x (accessed 11 February 2026).
Ionising Radiation (Medical Exposure) Regulations (IR(ME)R (2017) SI 2017/1322. London: The Stationery Office. Available from https://www.legislation.gov.uk/uksi/2017/1322/contents [accessed 11 February 2026].
Isaacs, A.W., Macaluso, F., Smith, C., Myburgh, K.H. (2019) C-reactive protein is elevated only in high creatine kinase responders to muscle damaging exercise. Frontiers in Physiology, 10, 86. Available from https://doi.org/10.3389/fphys.2019.00086 [accessed 11 February 2026].
KDIGO (Kidney Disease: Improving Global Outcomes) (2012) Clinical practice guidelines for acute and chronic kidney disease. Available from https://kdigo.org [accessed 9 February 2026].
Kim, D.H. and Rockwood, K. (2024) Frailty in older adults, New England Journal of Medicine, 391(6), pp. 538–548. doi: 10.1056/NEJMra2301292. Available from https://www.nejm.org/doi/10.1056/NEJMra2301292[accessed 11 February 2026].
Knight, T., Atkin, C., Kamwa, V., Cooksley, T., Subbe, C., Holland, M., Sapey, E. and Lasserson, D. (2023) The impact of frailty and geriatric syndromes on metrics of acute care performance: results of a national day of care survey. eClinicalMedicine, 66, 102278.
Available from https://doi.org/10.1016/j.eclinm.2023.102278 (accessed 11 February 2026).
Kojima, G., Taniguchi, Y., Iliffe, S., Walters, K. (2016) Frailty as a Predictor of Alzheimer Disease, Vascular Dementia, and All Dementia Among Community-Dwelling Older People: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc. 1;17(10):881-8.Available from 10.1016/j.jamda.2016.05.013 External Link[accessed 11 February 2026].
Logan Ellis, H., Dunnell, L., Eyres, R., Whitney, J., Jennings, C., Wilson, D., Tippett, J., Stein, D.F., Teo, J., Ibrahim, Z. and Rockwood, K. (2025) What can we learn from 68 000 clinical frailty scale scores? Evaluating the utility of frailty assessment in emergency departments, Age and Ageing, 54, afaf093, 1–11. Available fromhttps://doi.org/10.1093/ageing/afaf093 (accessed 10 February 2026).
Mental Capacity Act 2005 (2005) c. 9. London: The Stationery Office. Available from https://www.legislation.gov.uk/ukpga/2005/9/contents [Accessed 9 February 2026].
Mitchell, G. and Agnelli, J. (2015) Person‑centred care for people with dementia: Kitwood reconsidered, Nursing Standard, 30(7), 46‑50.Available from https://journals.rcni.com/nursing-standard/personcentred-care-for-people-with-dementia-kitwood-reconsidered-ns.30.7.46.s47 [accessed 11 February 2026].
Mounsey, A., Raleigh, M. and Wilson, A. (2015) Management of constipation in older adults, American Family Physician, 92(6), 500–504. Available from https://www.aafp.org/pubs/afp/issues/2015/0915/p500.html[accessed 9 February 2026].
Munir Ehrlington, S., Hörlin, E., Toll John, R., Wretborn, J. and Wilhelms, D. (2024) Frailty is associated with 30-day mortality: a multicentre study of Swedish emergency departments, Emergency Medicine Journal, 41(7), 514–519.Available from https://doi.org/10.1136/emermed-2023-213444 (accessed 10 February 2026).
NHS England (2019) The NHS Long Term Plan. London: NHS England. Available from https://www.longtermplan.nhs.uk (accessed 10 February 2026).
NHS Lincolnshire Integrated Care Board (ICB) (2025) Lincolnshire older people’s five-year strategy 2023–2028. Lincoln: NHS Lincolnshire ICB. Available fromhttps://lincolnshire.icb.nhs.uk/~documents/icb-publications/strategies-and-plans/lincolnshire-older-peoples-five-year-strategy-2023-2028/lincolnshire-older-peoples-five-year-strategy-2023-2028/?layout=file (accessed 11 February 2026).
NICE (2016) Multimorbidity: clinical assessment and management (NG56). London: NICE. Available from https://www.nice.org.uk/guidance/ng56 [accessed 11 February 2026].
NICE (2018) NG108: Decision‑making and mental capacity. London: NICE. Available from https://www.nice.org.uk/guidance/ng108 [accessed 9 February 2026].
NICE (2019) Delirium: prevention, diagnosis and management (NG103). London: NICE. Available from https://www.nice.org.uk/guidance/cg103 [accessed 11 February 2026].
NICE (2021) NG197: Shared decision making. London: NICE. Available from https://www.nice.org.uk/guidance/ng197 [accessed 9 February 2026].
NICE (2025) Constipation. London: National Institute for Health and Care Excellence. Available from https://cks.nice.org.uk/constipation [accessed 11 February 2026].
Nursing and Midwifery Council (2018) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. London: Nursing and Midwifery Council. Available from https://www.nmc.org.uk/standards/code/. [accessed 11 February 2026].
Public Health England (2019) Patient dose information: guidance. London: PHE. Available from https://www.gov.uk/government/publications/medical-radiation-patient-doses/patient-dose-information-guidance [accessed 11 February 2026].
Rao, S.S.C. and Go, J.T. (2010) Update on the management of constipation in the elderly: new treatment options, Clinical Interventions in Aging, 5, 163–171. Available from https://doi.org/10.2147/CIA.S8100[accessed 9 February 2026].
Roque, M.V. and Bouras, E.P. (2015) Epidemiology and management of chronic constipation in elderly patients. Clinical Interventions in Aging, 10: 919–930. Available from https://doi.org/10.2147/CIA.S54304 (accessed 11 February 2026).
Royal College of Radiologists (undated) iRefer: making the best use of clinical radiology. Available from https://www.irefer.org.uk [accessed 11 February 2026].
Salari, N., Ghasemianrad, M., Ammari-Allahyari, M., Rasoulpoor, S., Shohaimi, S. and Mohammadi, M. (2023) Global prevalence of constipation in older adults: a systematic review and meta-analysis, Wiener Klinische Wochenschrift, 135, 389–398. Available from https://doi.org/10.1007/s00508-023-02156-w (accessed 10 February 2026).
Sandhu, K., Lee, J., McGowan, R., et al. (2024) American Urological Association guideline amendment: management of lower urinary tract symptoms attributed to benign prostatic hyperplasia, The Journal of Urology, 209(2), 345‑354. doi: 10.1097/JU.0000000000003220. Available from https://pubmed.ncbi.nlm.nih.gov/37706750/ [accessed 11 February 2026].
Sayuk, G.S. (2022) The Digital Rectal Examination: Appropriate Techniques for the Evaluation of Constipation and Fecal Incontinence. Gastroenterology Clinics of North America, 51(1), 1–16. Available from https://doi.org/10.1016/j.gtc.2021.10.003 [accessed11 February 2026].
Schön, D.A. (1992). The Reflective Practitioner: How Professionals Think in Action. Routledge. Available from https://doi.org/10.4324/9781315237473.[accessed 11 February 2026].
Serrano Falcón, B., Barceló López, M., Mateos Muñoz, B., Álvarez Sánchez, A., Rey, E. (2016) Fecal impaction: a systematic review of its medical complications. BMC Geriatr. 11;16:4. Available from 10.1186/s12877-015-0162-5 [accessed 11 February 2026].
Sørensen, K., Broucke, S.V.D., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z. and Brand, H. (2012) Health literacy and public health: a systematic review and integration of definitions and models, BMC Public Health, 15, 215. Available from https://doi.org/10.1186/1471-2458-12-80 [accessed 11 February 2026].
Woodford, H.J. and George, J. (2011) ‘Diagnosis and management of urinary infections in older people’, Clinical Medicine, 11(1), 80–83. Available from 10.7861/clinmedicine.11-1-80 [accessed 11 February 2026].

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