Characteristics of inappropriate multiple medication use in older urological outpatients

Cho, Sung Tae; Kim, Jun Seok; Noh, Ji Heon; Moon, Hong Sang; Min, Seung Ki; Bae, Su Mi; Bae, Jae Hyun; Seo, Young Jin; Chang, Young Seop; Jeong, Chang Wook; Han, Jun Hyun; Kim, Hyung Jee

doi:10.1016/j.archger.2019.03.024

Cited by 9 publications

(21 citation statements)

References 23 publications

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“…Elderly people often consume multiple medications (polypharmacy), so it is necessary to accurately evaluate all medications prior to treatment. 31 Among the medications for chronic diseases, the components of anticholinergic drugs are often contained, so it is important to carefully determine and plan the total amount and duration of treatment with anticholinergic drugs. In the elderly, the cumulative use of anticholinergic medications is associated with increased risk of cognitive impairment.…”

Section: Treatmentmentioning

confidence: 99%

Relationship between Lower Urinary Tract Dysfunction and Dementia

Cho

2020

Dement Neurocogn Disord

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Lower urinary tract dysfunction (LUTD) is a common health challenge in dementia patients with significant morbidity and socioeconomic burden. It often causes lower urinary tract (LUT) symptoms, restricts activities of daily life, and impairs quality of life. Among several LUT symptoms, urinary incontinence (UI) is the most prominent storage symptom in the later stages of dementia. UI in patients with dementia results not only from cognitive impairment, but also from urological defects such as detrusor overactivity. Management of LUTD in patients with dementia is based on multiple factors, including cognitive state, functional impairment, concurrent comorbidities, polypharmacy and urologic condition. Behavioral therapy under caregiver support represents appropriate treatment strategy for UI in these patients. Pharmacological treatment can be considered in patients refractory to behavioral therapy, but it is more effective when combined with behavioral therapy. Antimuscarinics and mirabegron, a beta-3 receptor agonist, are effective for managing storage symptoms involving the LUT. However, anticholinergic side effects in elderly subjects are a concern, particularly when there is a risk of exacerbating cognitive impairment with prolonged use of antimuscarinics. Proper recognition and treatment of LUTD in dementia can improve quality of life in these patients.

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Section: Treatmentmentioning

confidence: 99%

Relationship between Lower Urinary Tract Dysfunction and Dementia

Cho

2020

Dement Neurocogn Disord

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“…In particular, older adults who visit the urology department often have several underlying chronic diseases and take several drugs associated with urologic diseases, including benign prostate hyperplasia and urinary incontinence; thus, the possibility of polypharmacy is high. Therefore, a clinical study on polypharmacy in older urologic patients in South Korea was conducted with KSGUC research support [ 2 ]. In that study, a significant number of older patients who visited the urology department took potentially inappropriate medications.…”

Section: Geriatric Urology In Koreamentioning

confidence: 99%

“…In that study, a significant number of older patients who visited the urology department took potentially inappropriate medications. Therefore, drug use in older patients, especially in the urology department, should be carefully monitored [ 2 ].…”

Section: Geriatric Urology In Koreamentioning

confidence: 99%

“…According to this global demographic trend, health problems in older adults are emerging as important personal and social issues. In addition, many older people experience illness, disability, and dependency, which are associated with high costs of medical and social care [ 2 , 3 ]. Furthermore, South Korea is becoming one of the most rapidly aging countries worldwide [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Urology and Geriatrics in Korea: Present Status and Future Directions

Cho

2022

Int Neurourol J

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Globally, the population aged 65 years and over is growing faster than all other age groups. South Korea, in particular, is one of the most rapidly aging societies worldwide. With the increase in the older population, the incidence of urologic diseases has increased significantly along with that of chronic diseases. Urologic diseases are an important component of the health problems faced by an aging society. Among those, urinary incontinence and voiding dysfunction cause significant health and quality of life problems in older adults. To properly manage these diseases, especially in the field of urology, it is necessary to propose appropriate policies for the health care of older people. Accordingly, the significance of geriatrics, particularly geriatric urology, has increased. Although geriatric urology in South Korea began relatively recently, the founding of the Korean Society of Geriatric Urological Care represents a significant step in the development of geriatric urology as a subspecialty. The goal of this review is to elaborate on the concept of geriatrics and to provide an overview of geriatric urology with a focus on its current status in South Korea. Furthermore, future challenges in the face of rapid demographic changes are reviewed.

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“…Clinical practice guidelines for the management of LUTS as a result of presumed benign prostatic hyperplasia list α 1a -blockers, such as tamsulosin, as the first-line therapy [ 4 ]. Widespread adoption of α 1a -blocker therapy for prolonged durations may expose patients, particularly those who are nonresponders, to unnecessary potential harms such as orthostatic hypotension and dizziness, which can result in falls [ 5 ] and polypharmacy [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Tracking Lower Urinary Tract Symptoms and Tamsulosin Side Effects Among Older Men Using a Mobile App (PERSONAL): Feasibility and Usability Study

Lee¹,

Kenfield²,

Wang³

et al. 2021

JMIR Form Res

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Background Continuous α1a-blockade is the first-line treatment for lower urinary tract symptoms (LUTS) among older men with suspected benign prostatic hyperplasia. Variable efficacy and safety for individual men necessitate a more personalized, data-driven approach to prescribing and deprescribing tamsulosin for LUTS in older men. Objective We aim to evaluate the feasibility and usability of the PERSONAL (Placebo–Controlled, Randomized, Patient-Selected Outcomes, N-of-1 Trials) mobile app for tracking daily LUTS severity and medication side effects among older men receiving chronic tamsulosin therapy. Methods We recruited patients from the University of California, San Francisco health care system to participate in a 2-week pilot study. The primary objectives were to assess recruitment feasibility, study completion rates, frequency of symptom tracking, duration of tracking sessions, and app usability rankings measured using a follow-up survey. As secondary outcomes, we evaluated whether daily symptom tracking led to changes in LUTS severity, perceptions of tamsulosin, overall quality of life, medication adherence between baseline and follow-up surveys, and perceived app utility. Results We enrolled 19 men within 23 days, and 100% (19/19) of the participants completed the study. Each participant selected a unique combination of symptoms to track and recorded data in the PERSONAL app, with a median daily completion rate of 79% (11/14 days). The median duration of the app session was 44 (IQR 33) seconds. On a scale of 1 (strongly disagree) to 5 (strongly agree), the participants reported that the PERSONAL app was easy to use (mean 4.3, SD 1.0), that others could learn to use it quickly (mean 4.2, SD 0.9), and that they felt confident using the app (mean 4.4, SD 0.8). LUTS severity, quality of life, and medication adherence remained unchanged after the 2-week study period. Fewer men were satisfied with tamsulosin after using the app (14/19, 74% vs 17/19, 89% at baseline), although the perceived benefit from tamsulosin remained unchanged (18/19, 95% at baseline and at follow-up). In total, 58% (11/19) of the participants agreed that the PERSONAL app could help people like them manage their urinary symptoms. Conclusions This pilot study demonstrated the high feasibility and usability of the PERSONAL mobile app to track patient-selected urinary symptoms and medication side effects among older men taking tamsulosin to manage LUTS. We observed that daily symptom monitoring had no adverse effects on the secondary outcomes. This proof-of-concept study establishes a framework for future mobile app studies, such as digital n-of-1 trials, to collect comprehensive individual-level data for personalized LUTS management in older men.

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Characteristics of inappropriate multiple medication use in older urological outpatients

Cited by 9 publications

References 23 publications

Relationship between Lower Urinary Tract Dysfunction and Dementia

Relationship between Lower Urinary Tract Dysfunction and Dementia

Urology and Geriatrics in Korea: Present Status and Future Directions

Tracking Lower Urinary Tract Symptoms and Tamsulosin Side Effects Among Older Men Using a Mobile App (PERSONAL): Feasibility and Usability Study

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