Open Access Open Badges Research article

Validation of a questionnaire for assessing fecal impaction in the elderly: impact of cognitive impairment, and using a proxy

Marta Barcelo1*, Maria Jose Jimenez-Cebrian2, Manuel Diaz-Rubio1, Alberto Lopez Rocha3 and Enrique Rey1

Author Affiliations

1 Functional GI DiseasesUnit. Division of DigestiveDiseases, Hospital Clínico San Carlos, Departament of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain

2 “Valdeluz” Nursing Homes, Madrid, Spain

3 Spanish Society of Nursing Homes’ Physicians (SEMER), Madrid, Spain

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BMC Geriatrics 2013, 13:24  doi:10.1186/1471-2318-13-24

Published: 7 March 2013



Studies on the epidemiology of fecal impaction are limited by the absence of a valid and reliable instrument to identify the condition in the elderly. Our aim is to validate a questionnaire for identifying fecal impaction in the elderly and to assess the impact of cognitive impairment and the aid of a proxy on its reliability.


We developed a 5 questions’ questionnaire. The questionnaire was presented to twenty doctors to test its face validity. Feasibility was pre-tested with ten non institutionalized subjects who completed the questionnaire twice, once alone or with the help of a proxy, and another along with the researcher.

For the validation of the questionnaire all residents in a single nursing-home were invited to participate, allowing the self-decision of using a proxy. Medical records of all subjects were abstracted without knowledge of subjects’ answers and agreement between fecal impaction according to self-reported and medical records analyzed. Physical impairment was measured with the Barthel’s test and cognitive impairment with the mini-mental test.


In the face validity only minor changes in wording were suggested. In the feasibility pre-test all subjects were able to understand and complete the questionnaire and all questions were considered appropriate and easily understandable.

One-hundred and ninety-nine of the 244 residents participated in the study (mean age 86,1 ± 6,6). One hundred and forty two subjects understood all questions; not understanding them was inversely associated with cognitive impairment score (aOR: 0.86; 95% CI: 0.82-0.91). One hundred and sixty decided to use a proxy; the use of a proxy was inversely associated with educative level (0.13 (0.02-0.72), minimental’s score (0.85; 0.76-0.95) and Barthel’s score (0.96; 0.94-0.99). Agreement between medical records and self-completed questionnaire was 85.9% (kappa 0.72 (0,62- 0,82). Disagreement was unrelated to education and cognitive impairment.


Our simple questionnaire is reliable for identifying fecal impaction in the elderly by self-report. Limitation imposed by cognitive impairment is minimized with the aid of a proxy.