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Vulnerable Elderly Patients and Overactive Bladder Syndrome

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Abstract

Overactive bladder (OAB) prevalence increases with age, and the elderly population is rapidly increasing worldwide, particularly those aged ≥75 years. OAB symptoms may be associated with co-morbid conditions, particularly bowel symptoms and falls related to nighttime lavatory trips, as well as with higher rates of mortality in elderly persons. Physical changes associated with age that result in altered bladder function and altered drug solubility, metabolism and clearance, as well as increased polypharmacy, may impact disease management in elderly patients. Clinical trial data indicate that current treatments for OAB are generally effective and well tolerated in elderly patients. However, clinical trial participants have generally been relatively healthy persons aged ≥65 years, which may not reflect the true elderly population. Limited data exist that are specific to the vulnerable elderly, who have been defined as patients aged ≥65 years who are at increased risk of functional decline or death over a 2-year period. Identification and treatment of vulnerable elderly patients with OAB is important, because intervention may limit functional deterioration. Antimuscarinics are associated with improvement in OAB symptoms and health-related quality of life in older patients, although adverse effects such as constipation may be of particular concern in vulnerable elderly patients. Additional research is needed on the potential impact of antimuscarinics on cognition in vulnerable elderly persons. Behavioural interventions, including biofeedback, prompted voiding and pelvic floor muscle exercises, may be effective in some elderly patients without risk of adverse events, and they may enhance the efficacy of antimuscarinic treatment. The International Consultation on Incontinence has recommended behavioural interventions with the cautious addition and trial of antimuscarinic drugs for the treatment of urinary incontinence in frail elderly individuals or those already in a state of decline; these recommendations may also be useful for vulnerable individuals. Greater representation of vulnerable elderly individuals in clinical trials, the development and inclusion of outcomes relevant to this population, and the creation and testing of validated, evidence-based models to guide treatment decisions in vulnerable elderly individuals are needed.

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Acknowledgements

Dr Kraus has received research support from Pfizer Inc and the National Institutes of Health, is a consultant for Pfizer Inc and Eli Lilly, and has received speaker’s honoraria from Pfizer Inc and Novartis. Dr Griebling has served as a consultant for Medtronic and Pfizer Inc and has received research support from The National Institutes of Health, the John A. Hartford Foundation, the American Geriatrics Society, Medtronic and Pfizer Inc. Dr Bavendam is an employee of Pfizer Inc. Tiffany Brake is an employee of Complete Healthcare Communications Inc., which received funding from Pfizer Inc for the development of this manuscript.

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Authors and Affiliations

  1. Department of Urology, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, MC 7845, San Antonio, Texas, 78229-3900, USA

    Stephen R. Kraus

  2. Pfizer Inc, New York, New York, USA

    Tamara Bavendam

  3. Complete Healthcare Communications Inc., Chadds Ford, Pennsylvania, USA

    Tiffany Brake

  4. Department of Urology and The Landon Center on Aging, Mailstop 3016, University of Kansas, 3901 Rainbow Boulevard, Kansas City, Kansas, 66160, USA

    Tomas L. Griebling

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  1. Stephen R. Kraus
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  2. Tamara Bavendam
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  3. Tiffany Brake
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  4. Tomas L. Griebling
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Correspondence to Stephen R. Kraus or Tomas L. Griebling.

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Kraus, S.R., Bavendam, T., Brake, T. et al. Vulnerable Elderly Patients and Overactive Bladder Syndrome. Drugs Aging 27, 697–713 (2010). https://doi.org/10.2165/11539020-000000000-00000

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