Constipation in Older Adults: Pathophysiology, Clinical Impact, and Management Strategies

Background/Objectives: Constipation is a common gastrointestinal problem in older adults and is associated with impaired quality of life, decline in activities of daily living, frailty, and increased risk of delirium and cognitive decline. Its pathogenesis involves age-related changes in gastrointestinal motility, neural regulation, comorbidities, and polypharmacy. This narrative review aims to summarize recent literature on the pathophysiology, contributing factors, and management of constipation in older adults, emphasizing its characterization as a systemic geriatric syndrome. Methods: A narrative literature search was conducted using PubMed for articles published between January 1, 2023, and December 31, 2025. MeSH terms included “Constipation” [Major Topic] and “Aged” [MeSH Terms]. English-language original studies, systematic reviews, and clinical or epidemiological studies involving adults aged ≥65 years were included. Results: Diagnosis in older adults is often complicated by secondary causes such as medications and neurological disorders, as well as atypical presentations in those with cognitive impairment. Constipation prevalence increases markedly with age. Pathophysiological mechanisms include reduced interstitial cells of Cajal, impaired smooth muscle contractility, enteric and autonomic nervous system dysfunction, and gut microbiota dysbiosis, which may promote low-grade inflammation. Major contributing factors include physical inactivity, sarcopenia, dehydration, inappropriate defecation posture, and polypharmacy, particularly opioids and anticholinergic agents. Management should be stepwise, prioritizing non-pharmacological interventions, followed by pharmacological and microbiota-targeted therapies when necessary. Conclusions: Constipation in older adults should be recognized as a systemic geriatric syndrome rather than a localized gastrointestinal disorder. Comprehensive, individualized management beyond simple laxative use is essential to reduce complications and preserve functional health in aging populations.