Advertisement

Drugs & Aging

, Volume 35, Issue 9, pp 777–780 | Cite as

Anticholinergics for Overactive Bladder in Frail and Medically Complex Older People: The Case For

  • Adrian Wagg
Current Opinion
  • 104 Downloads

Abstract

Overactive bladder (OAB) is a common, troublesome condition affecting the lives of many older people. When pharmacotherapy is considered, antimuscarinics remain the mainstay for treatment. Bladder antimuscarinics are effective in the relief of symptoms for OAB and treatment leads to significant improvements in quality of life for those with the condition. However, many older people (> 65 years) with OAB are in later life (> 75 years) and a proportion of these will either be medically complex, with multiple comorbid conditions, or frail. This article discusses the evidence for OAB treatment in the frail or medically complex elderly, outlines where caution should be exercised, giving examples from the recent literature, and advocates for an active approach for this group, who are often left without any treatment.

Notes

Compliance with Ethical Standards

Conflicts of interest and funding

Adrian Wagg has received, either personally or for his institution, financial support for research, speaker honoraria or consultancy fees, from Astellas Pharma, Pfizer Corporation and Essity Health and Hygiene AB. No support was connected to this article.

References

  1. 1.
    Abrams PH, Fall M, Cardozo L, et al. The standardization of terminology of lower urinary tract function: report from the standardization sub-committee of the International Continence Society. Neurourol Urodyn. 2002;21:167–78.CrossRefPubMedGoogle Scholar
  2. 2.
    Irwin DE, Milsom I, Hunskaar S, et al. Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol. 2006;50:1306–14 (discussion 14–5).CrossRefPubMedGoogle Scholar
  3. 3.
    Coyne KS, Sexton CC, Irwin DE, Kopp ZS, Kelleher CJ, Milsom I. The impact of overactive bladder, incontinence and other lower urinary tract symptoms on quality of life, work productivity, sexuality and emotional well-being in men and women: results from the EPIC study. BJU Int. 2008;101:1388–95.CrossRefPubMedGoogle Scholar
  4. 4.
    Ganz ML, Liu J, Zou KH, Bhagnani T, Luo X. Real-world characteristics of elderly patients with overactive bladder in the United States. Curr Med Res Opin. 2016;32:1997–2005.CrossRefPubMedGoogle Scholar
  5. 5.
    Zarowitz BJ, Allen C, O’Shea T, Tangalos E, Berner T, Ouslander JG. Clinical burden and nonpharmacologic management of nursing facility residents with overactive bladder and/or urinary incontinence. Consul Pharm. 2015;30:533–42.CrossRefGoogle Scholar
  6. 6.
    Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173:489–95.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Wang CJ, Hung CH, Tang TC, et al. Urinary incontinence and its association with frailty among men aged 80 years and older in taiwan: a cross-sectional study. Rejuvenation Res. 2017;20(2):111–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Wagg A, Gibson W, Ostaszkiewicz J, et al. Urinary incontinence in frail elderly persons: report from the 5th International Consultation on Incontinence. Neurourol Urodyn. 2015;34:398–406.CrossRefPubMedGoogle Scholar
  9. 9.
    Burgio KL, Burgio LD. Behavior therapies for urinary incontinence in the elderly. Clin Geriatr Med. 1986;2:809–27.CrossRefPubMedGoogle Scholar
  10. 10.
    Nambiar AK, Bosch R, Cruz F, et al. EAU guidelines on assessment and nonsurgical management of urinary incontinence. Eur Urol. 2018;73:596–609.CrossRefPubMedGoogle Scholar
  11. 11.
    Gormley EA, Lightner DJ, Faraday M, Vasavada SP, American Urological A. Society of Urodynamics FPM. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. J Urol. 2015;193:1572–80.CrossRefPubMedGoogle Scholar
  12. 12.
    Corcos J, Przydacz M, Campeau L, et al. CUA guideline on adult overactive bladder. Can Urol Assoc J. 2017;11:E142–73.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    National Collaborating Centre for Women’s and Children’s Health (UK). Urinary Incontinence in Women: The Management of Urinary Incontinence in Women. London. Royal College of Obstetricians and Gynaecologists; 2013.Google Scholar
  14. 14.
    Wagg A, Duckett J, McClurg D, Harari D, Lowe D. To what extent are national guidelines for the management of urinary incontinence in women adhered? Data from a national audit. BJOG. 2011;118:1592–600.CrossRefPubMedGoogle Scholar
  15. 15.
    Gibson W, Harari D, Husk J, Lowe D, Wagg A. A national benchmark for the initial assessment of men with LUTS: data from the 2010 Royal College of Physicians National Audit of Continence Care. World J Urol. 2016;34:969–77.CrossRefPubMedGoogle Scholar
  16. 16.
    Kistler KD, Xu Y, Zou KH, Ntanios F, Chapman DS, Luo X. Systematic literature review of clinical trials evaluating pharmacotherapy for overactive bladder in elderly patients: an assessment of trial quality. Neurourol Urodyn. 2018;37:54–66.CrossRefPubMedGoogle Scholar
  17. 17.
    Wagg A, Wyndaele JJ, Sieber P. Efficacy and tolerability of solifenacin in elderly subjects with overactive bladder syndrome: a pooled analysis. Am J Geriatr Pharmacother. 2006;4:14–24.CrossRefPubMedGoogle Scholar
  18. 18.
    Kraus SR, Ruiz-Cerda JL, Martire D, Wang JT, Wagg AS. Efficacy and tolerability of fesoterodine in older and younger subjects with overactive bladder. Urology. 2010;76:1350–7.CrossRefPubMedGoogle Scholar
  19. 19.
    Choo MS, Song C, Kim JH, et al. Changes in overactive bladder symptoms after discontinuation of successful 3-month treatment with an antimuscarinic agent: a prospective trial. J Urol. 2005;174:201–4.CrossRefPubMedGoogle Scholar
  20. 20.
    Wagg A, Khullar V, Marschall-Kehrel D, et al. Flexible-dose fesoterodine in elderly adults with overactive bladder: results of the randomized, double-blind, placebo-controlled study of fesoterodine in an aging population trial. J Am Geriatr Soc. 2013;61:185–93.CrossRefPubMedGoogle Scholar
  21. 21.
    Wagg A, Khullar V, Michel MC, Oelke M, Darekar A, Bitoun CE. Long-term safety, tolerability and efficacy of flexible-dose fesoterodine in elderly patients with overactive bladder: open-label extension of the SOFIA trial. Neurourol Urodyn. 2014;33:106–14.CrossRefPubMedGoogle Scholar
  22. 22.
    Dubeau CE, Kraus SR, Griebling TL, et al. Effect of fesoterodine in vulnerable elderly subjects with urgency incontinence: a double-blind, placebo controlled trial. J Urol. 2014;191(2):395–404.CrossRefPubMedGoogle Scholar
  23. 23.
    Min L, Yoon W, Mariano J, et al. The vulnerable elders-13 survey predicts 5-year functional decline and mortality outcomes in older ambulatory care patients. J Am Geriatr Soc. 2009;57:2070–6.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Wagg A, Diles, D. Four year persistence and drug treatment patterns in overactive bladder: data from Canadian datasets. 68th Annual Meeting of the Canadian Urological Association; 22–25 Jun 2013: Niagra Falls, ON.Google Scholar
  25. 25.
    Chapple CR, Nazir J, Hakimi Z, et al. Persistence and Adherence with Mirabegron versus Antimuscarinic Agents in Patients with Overactive Bladder: a Retrospective Observational Study in UK Clinical Practice. Eur Urol. 2017;72:389–99.CrossRefPubMedGoogle Scholar
  26. 26.
    Wagg A, Franks B, Ramos B, Berner T. Persistence and adherence with the new beta-3 receptor agonist, mirabegron, versus antimuscarinics in overactive bladder: early experience in Canada. Can Urol Assoc J. 2015;9:343–50.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Cheng LI, Durden E, Limone B, et al. Persistance and compliance with osteroporosis therapies among women in a commercially insured population in the United States. J Manag Care Spec Pharm. 2015;21(824–33):33a.Google Scholar
  28. 28.
    Benner JS, Nichol MB, Rovner ES, et al. Patient-reported reasons for discontinuing overactive bladder medication. BJU Int. 2010;105:1276–82.CrossRefPubMedGoogle Scholar
  29. 29.
    Richardson K, Fox C, Maidment I, et al. Anticholinergic drugs and risk of dementia: case–control study. BMJ. 2018;361:k1315.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Wagg A, Arumi D, Herschorn S, et al. A pooled analysis of the efficacy of fesoterodine for the treatment of overactive bladder, and the relationship between safety, co-morbidity and polypharmacy in patients aged 65 years or older. Age Ageing. 2017;46:620–6.PubMedGoogle Scholar
  31. 31.
    Oelke M, Murgas S, Schneider T, Heßdörfer E. Influence of propiverine ER 30 mg once daily on cognitive function in elderly female and male patients with overactive bladder: a noninterventional study to assess real life data. Proceedings of the International Continence Society Annual Scientific Meeting, 2013:201.Google Scholar
  32. 32.
    Tsao JW, Heilman KM. Transient memory impairment and hallucinations associated with tolterodine use. N Engl J Med. 2003;349:2274–5.CrossRefPubMedGoogle Scholar
  33. 33.
    Donnellan CA, Fook L, McDonald P, Playfer JR. Oxybutynin and cognitive dysfunction. BMJ. 1997;315:1363–4.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Stuhec M. Solifenacin-induced delirium and hallucinations. Gen Hosp Psychiatry. 2013;35(682):e3–4.Google Scholar
  35. 35.
    Lipton RB, Kolodner K, Wesnes K. Assessment of cognitive function of the elderly population: effects of darifenacin. J Urol. 2005;173:493–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Kay GG, Maruff P, Scholfield D, et al. Evaluation of cognitive function in healthy older subjects treated with fesoterodine. Postgrad Med. 2012;124:7–15.CrossRefPubMedGoogle Scholar
  37. 37.
    Kay GG, Staskin DR, Macdiarmid S, McIlwain M, Dahl NV. Cognitive effects of oxybutynin chloride topical gel in older healthy subjects: a 1-week, randomized, double-blind, placebo- and active-controlled study. Clin Drug Investig. 2012;32:707–14.CrossRefPubMedGoogle Scholar
  38. 38.
    Kay G, Kardiasmenos, K., Crook, T. Differential effects of the antimuscarinic agents tolterodine tartrate ER and oxybutynin chloride ER on recent memory in older subjects. Proceedings of the 36th meeting of the International Continence Society, 2006;25:P087.Google Scholar
  39. 39.
    Wagg A, Dale M, Tretter R, Stow B, Compion G. Randomised, multicentre, placebo-controlled, double-blind crossover study investigating the effect of solifenacin and oxybutynin in elderly people with mild cognitive impairment: the SENIOR study. Eur Urol. 2013;64:74–81.CrossRefPubMedGoogle Scholar
  40. 40.
    Lackner TE, Wyman JF, McCarthy TC, Monigold M, Davey C. Randomized, placebo-controlled trial of the cognitive effect, safety, and tolerability of oral extended-release oxybutynin in cognitively impaired nursing home residents with urge urinary incontinence. J Am Geriatr Soc. 2008;56:862–70.CrossRefPubMedGoogle Scholar
  41. 41.
    Britt DM, Day GS. Over-prescribed medications, under-appreciated risks: a review of the cognitive effects of anticholinergic medications in older adults. Mo Med. 2016;113:207–14.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Wagner TH, Hu TW, Bentkover J, et al. Health-related consequences of overactive bladder. Am J Manag Care. 2002;8:S598–607.PubMedGoogle Scholar
  43. 43.
    Thom DH, Haan MN, Van Den Eeden SK. Medically recognized urinary incontinence and risks of hospitalization, nursing home admission and mortality. Age Ageing. 1997;26:367–74.CrossRefPubMedGoogle Scholar
  44. 44.
    LaBossiere J, Fernet M, Herschorn S, Carlsson M, Oelke M, Wagg A. Symptom relief from OAB. What an “average” patient might expect: data from a pooled analysis of fesoterodine treated patients. Proceedings of the International Continence Society Annual Scientific Meeting; 28–31 Aug 2018: Philadelphia (PA).Google Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of MedicineUniversity of AlbertaEdmontonCanada

Personalised recommendations