Implementing probiotics in elderly care

Antibiotic-associated diarrhoea (AAD) is a common side effect of antibiotics (Allen 2013). In the case of vulnerable elderly people in care institutions, this can entail health risks such as malnutrition or dehydration (Hood 2014), as well as a higher risk of reinfection and a poorer quality of life. Diarrhoea in the elderly also increases the workload for care staff, which brings additional costs.

Antibiotic-associated diarrhoea is caused by dysbiosis of the intestinal microbiota and the (opportunistic) growth of specific pathogens.

Probiotics are living microorganisms that contribute to the maintenance and restoration of the intestinal microbiota. Various studies have shown that specific probiotics, such as Ecologic® AAD, can prevent the occurence of AAD (Floch 2018, Hell 2013, Koning 2007).

Proud Project

The reason behind this initiative was to understand why evidence based probiotics, such as Ecologic® AAD, are not more widely used in care institutes. Especially since the impact of AAD on quality of life and the resulting additional costs (extra nursing attention) are especially high and the beneficial effects of certain probiotics on AAD are well documented.

Study design

At three different elderly care institutes of the Rivas Zorggroep (Gorinchem, the Netherlands) Ecologic® AAD was used as standard, when broad-spectrum antibiotic (amoxicillin/clavulanic acid and ciprofloxacin) were prescribed. Ecologic® AAD was taken twice daily, from the first day of antibiotic use, till one week after cessation of the antibiotic course.

During a period of 9 months probiotics were implemented in practice, and the results on development of AAD and chances and challenges on implementation were compared with a period where no probiotics were used in conjugation with antibiotics (control period), in a mixed method way.

Results

Probiotics reduced incidence of antibiotic associated diarrhea from 36% to 20% in the total population. In clients of which data was present from both the control period as well as the period in which probiotics were used, half of them (14/27) originally developed diarrhea, of which 11 did not develop diarrhea in the period with probiotic use (78%).

Conclusions

The implementation of evidence based probiotics, such as Ecologic® AAD, can verifiably reduce the incidence of antibiotic associated diarrhoea (AAD) in elderly care institutions. It is feasible to implement probiotics in daily practice in elderly care, with the right preparation. In addition, the costs of the pobiotics were not seen as a hurdle in context of the effect.