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

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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.

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References

  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.

    Article  PubMed  Google Scholar 

  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).

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  9. Burgio KL, Burgio LD. Behavior therapies for urinary incontinence in the elderly. Clin Geriatr Med. 1986;2:809–27.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  12. Corcos J, Przydacz M, Campeau L, et al. CUA guideline on adult overactive bladder. Can Urol Assoc J. 2017;11:E142–73.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  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. Benner JS, Nichol MB, Rovner ES, et al. Patient-reported reasons for discontinuing overactive bladder medication. BJU Int. 2010;105:1276–82.

    Article  PubMed  Google Scholar 

  29. Richardson K, Fox C, Maidment I, et al. Anticholinergic drugs and risk of dementia: case–control study. BMJ. 2018;361:k1315.

    Article  PubMed  PubMed Central  Google Scholar 

  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.

    PubMed  Google Scholar 

  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.

  32. Tsao JW, Heilman KM. Transient memory impairment and hallucinations associated with tolterodine use. N Engl J Med. 2003;349:2274–5.

    Article  PubMed  CAS  Google Scholar 

  33. Donnellan CA, Fook L, McDonald P, Playfer JR. Oxybutynin and cognitive dysfunction. BMJ. 1997;315:1363–4.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Stuhec M. Solifenacin-induced delirium and hallucinations. Gen Hosp Psychiatry. 2013;35(682):e3–4.

    Google Scholar 

  35. 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 

  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.

    Article  PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

  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.

    Article  PubMed  CAS  Google Scholar 

  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.

    Article  PubMed  Google Scholar 

  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.

    PubMed  PubMed Central  Google Scholar 

  42. Wagner TH, Hu TW, Bentkover J, et al. Health-related consequences of overactive bladder. Am J Manag Care. 2002;8:S598–607.

    PubMed  Google Scholar 

  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.

    Article  PubMed  CAS  Google Scholar 

  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).

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Correspondence to Adrian Wagg.

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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.

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Wagg, A. Anticholinergics for Overactive Bladder in Frail and Medically Complex Older People: The Case For. Drugs Aging 35, 777–780 (2018). https://doi.org/10.1007/s40266-018-0577-8

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  • DOI: https://doi.org/10.1007/s40266-018-0577-8

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