Skip to main content

Advertisement

SpringerLink
Log in

Anticholinergic Drugs for Overactive Bladder in Frail Older Patients: The Case Against

  • Current Opinion
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Urinary incontinence (UI) is a common and disabling problem among older people. Anticholinergic drugs (ADs) are a pharmacological option recommended for overactive bladder or mixed UI when non-pharmacological approaches have failed. However, UI is a more prevalent and complex condition in frail older people and to simply assume that AD actions are the same across all age groups would be wrong. This article reviews evidence for the efficacy and safety of these drugs, especially when prescribed for frail older people. Although ADs have a small but statistically significant benefit for UI in non-frail people, the vast majority choose to discontinue treatment because they feel that the beneficial effects do not outweigh the burden of taking the medication. Not only are the most frail older people more likely to experience adverse effects but there is also no evidence that these drugs are effective for UI. In addition, there is a mounting body of evidence that they impair cognitive function. The continued use of ADs in frail older people simply does not hold water.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. National Institute for Health and Care Excellence. Urinary incontinence in women: management. Clinical guideline [CG171]. 2013. www.nice.org.uk/guidance/cg171. Accessed 20 July 2018.

  2. Shamliyan T, Wyman JF, Ramakrishnan R, et al. Benefits and harms of pharmacologic treatment for urinary incontinence in women: a systematic review. Ann Intern Med. 2012;156:861–74.

    Article  PubMed  Google Scholar 

  3. Samuelsson E, Odeberg J, Stenzelius K, et al. Effect of pharmacological treatment for urinary incontinence in the elderly and frail elderly: a systematic review. Geriatr Gerontol Int. 2015;15:521–34.

    Article  PubMed  Google Scholar 

  4. Madhuvrata P, Cody JD, Ellis G, et al. Which anticholinergic drug for overactive bladder symptoms in adults. Cochrane Database Syst Rev. 2012;1:CD005429.

    PubMed  Google Scholar 

  5. Chancellor MB, Yehoshua A, Waweru C, et al. Limitations of anticholinergic cycling in patients with overactive bladder (OAB) with urinary incontinence (UI): results from the CONsequences of Treatment Refractory Overactive bLadder (CONTROL) study. Int Urol Nephrol. 2016;48:1029–36.

    Article  PubMed  CAS  Google Scholar 

  6. Reynolds WS, McPheeters M, Blume J, et al. Comparative effectiveness of anticholinergic therapy for overactive bladder in women: a systematic review and meta-analysis. Obstet Gynecol. 2015;125:1423–32.

    Article  PubMed  CAS  Google Scholar 

  7. Sexton CC, Notte SM, Maroulis C, et al. Persistence and adherence in the treatment of overactive bladder syndrome with anticholinergic therapy: a systematic review of the literature. Int J Clin Pract. 2011;65:567–85.

    Article  PubMed  CAS  Google Scholar 

  8. Mauseth SA, Skurtveit S, Spigset O. Adherence, persistence and switch rates for anticholinergic drugs used for overactive bladder in women: data from the Norwegian Prescription Database. Acta Obstet Gynecol Scand. 2013;92:1208–15.

    PubMed  Google Scholar 

  9. Chancellor MB, Migliaccio-Walle K, Bramley TJ, et al. Long-term patterns of use and treatment failure with anticholinergic agents for overactive bladder. Clin Ther. 2013;35:1744–51.

    Article  PubMed  CAS  Google Scholar 

  10. Krhut J, Gartner M, Petzel M, et al. Persistence with first line anticholinergic medication in treatment-naive overactive bladder patients. Scand J Urol. 2014;48:79–83.

    Article  PubMed  CAS  Google Scholar 

  11. Veenboer PW, Bosch JLHR. Long-term adherence to antimuscarinic therapy in everyday practice: a systematic review. J Urol. 2014;191:1003–8.

    Article  PubMed  CAS  Google Scholar 

  12. Tijnagel MJ, Scheepe JR, Blok BFM. Real life persistence rate with antimuscarinic treatment in patients with idiopathic or neurogenic overactive bladder: a prospective cohort study with solifenacin. BMC Urol. 2017;17:30.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Lua LL, Pathak P, Dandolu V. Comparing anticholinergic persistence and adherence profiles in overactive bladder patients based on gender, obesity, and major anticholinergic agents. Neurourol Urodyn. 2017;36:2123–31.

    Article  PubMed  CAS  Google Scholar 

  14. Yeaw J, Benner JS, Walt JG, et al. Comparing adherence and persistence across 6 chronic medication classes. J Manag Care Pharm. 2009;15:728–40.

    PubMed  Google Scholar 

  15. Cardozo L, Herschorn S, Snijder R, et al. Does BMI, gender or age affect efficacy/tolerability of solifenacin in the management of overactive bladder? Int Urogynaecol J. 2017;28:477–88.

    Article  Google Scholar 

  16. Paquette A, Gou P, Tannenbaum C. Systematic review and meta-analysis: do clinical trials testing antimuscarinic agents for overactive bladder adequately measure central nervous system adverse events? J Am Geriatr Soc. 2011;59:1332–9.

    Article  PubMed  Google Scholar 

  17. Oefelein MG. Safety and tolerability profiles of anticholinergic agents used for the treatment of overactive bladder. Drug Saf. 2011;34:733–54.

    Article  PubMed  CAS  Google Scholar 

  18. Cardwell K, Hughes CM, Ryan C. The association between anticholinergic medication burden and health related outcomes in the ‘oldest old’: a systematic review of the literature. Drugs Aging. 2015;32:835–48.

    Article  PubMed  CAS  Google Scholar 

  19. Ancelin ML, Artero S, Portet F, et al. Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: longitudinal cohort study. BMJ. 2006;332(7539):455–9.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Han L, Agostini JV, Allore HG. Cumulative anticholinergic exposure is associated with poor memory and executive function in older men. J Am Geriatr Soc. 2008;56:2203–10.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Carriere I, Fourrier-Reglat A, Dartigues J, et al. Drugs with anticholinergic properties, cognitive decline, and dementia in an elderly general population: the 3-City Study. Arch Intern Med. 2009;169:1317–24.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Fox C, Richardson K, Maidment ID, et al. Anticholinergic medication use and cognitive impairment in the older population: the Medical Research Council Cognitive Function and Ageing Study. J Am Geriatr Soc. 2011;59:1477–83.

    Article  PubMed  Google Scholar 

  23. Fox C, Smith T, Maidment I, et al. Effect of medications with anti-cholinergic properties on cognitive function, delirium, physical function and mortality: a systematic review. Age Ageing. 2014;43:604–15.

    Article  PubMed  Google Scholar 

  24. Gray SL, Anderson ML, Dublin S, et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med. 2015;175:401–7.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Risacher SL, McDonald BC, Tallman EF, et al. Association between anticholinergic medication use and cognition, brain metabolism, and brain atrophy in cognitively normal older adults. JAMA Neurol. 2016;73:721–32.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Chuanga Y, Elangod P, Gonzalez CE, et al. Midlife anticholinergic drug use, risk of Alzheimer’s disease, and brain atrophy in community-dwelling older adults. Alzheimer’s Dementia (N Y). 2017;3:471–9.

    Google Scholar 

  27. Papenberg G, Backman L, Fratiglioni L, et al. Anticholinergic drug use is associated with episodic memory decline in older adults without dementia. Neurobiol Aging. 2017;55:27–32.

    Article  PubMed  CAS  Google Scholar 

  28. Richardson K, Fox C, Maidment I, et al. Anticholinergic drugs and risk of dementia: case–control study. BMJ. 2018;360:k1315.

    Article  Google Scholar 

  29. Wesnes KA, Edgar C, Tretter RN, et al. Exploratory study assessing the risk of cognitive impairment or sedation in the elderly following single doses of solifenacin 10mg. Expert Opin Drug Saf. 2009;8:615–26.

    Article  PubMed  CAS  Google Scholar 

  30. Staskin D, Kay G, Tannenbaum C, et al. Trospium chloride has no effect on memory testing and is assay undetectable in the central nervous system of older patients with overactive bladder. Int J Clin Pract. 2010;64:1294–300.

    Article  PubMed  CAS  Google Scholar 

  31. Lipton RB, Kolodner K, Wesnes K. Assessment of cognitive function of the elderly population: effects of darifenacin. J Urol. 2005;173:493–8.

    Article  PubMed  Google Scholar 

  32. Kay G, Crook T, Rekeda L, et al. Differential effects of the antimuscarinic agents darifenacin and oxybutynin ER on memory in older subjects. Eur Urol. 2006;50:317–26.

    Article  PubMed  CAS  Google Scholar 

  33. Geller EJ, Dumond JB, Bowling JM, et al. Effect of trospium chloride on cognitive function in women aged 50 and older: a randomized trial. Female Pelvic Med Reconstr Surg. 2017;23:118–23.

    Article  PubMed  Google Scholar 

  34. Geller EJ, Crane AK, Wells EC, et al. Effect of anticholinergic use for the treatment of overactive bladder on cognitive function in postmenopausal women. Clin Drug Investig. 2012;32:697–705.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  35. Szonyi G, Collas DM, Ding YY, et al. Oxybutynin with bladder retraining for detrusor instability in elderly people: a randomized controlled trial. Age Ageing. 1995;24:287–91.

    Article  PubMed  CAS  Google Scholar 

  36. Ouslander JG, Schnelle JF, Uman G, et al. Does oxybutynin add to the effectiveness of prompted voiding for urinary incontinence among nursing home residents? A placebo-controlled trial. J Am Geriatr Soc. 1995;43:610–7.

    Article  PubMed  CAS  Google Scholar 

  37. Lackner TE, Wyman JF, McCarthy TC, et al. Efficacy of oral extended-release oxybutynin in cognitively impaired older nursing home residents with urge urinary incontinence: a randomized placebo-controlled trial. J Am Med Direct Assoc. 2011;12:639–47.

    Article  Google Scholar 

  38. 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;191:395–404.

    Article  PubMed  CAS  Google Scholar 

  39. Wagg A, Gibson W, Ostaszkiewicz J, et al. Urinary incontinence in frail elderly persons: report from the 5th International Consultation on Incontinence. Neurourol Urodynam. 2015;34:398–406.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Northumbria Healthcare, North Shields, Tyne and Wear, UK

    Henry J. Woodford

Authors
  1. Henry J. Woodford
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Henry J. Woodford.

Ethics declarations

Funding

No sources of funding were used to assist in the preparation of this article.

Conflicts of interest

Henry J. Woodford has no conflicts of interest to declare.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Woodford, H.J. Anticholinergic Drugs for Overactive Bladder in Frail Older Patients: The Case Against. Drugs Aging 35, 773–776 (2018). https://doi.org/10.1007/s40266-018-0575-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-018-0575-x

Search

Navigation