Overactive bladder in the vulnerable elderly

Abstract

Overactive bladder (OAB) is a common problem that may occur in individuals of all ages. It has a considerable impact on patient quality of life, and although moderately effective management strategies do exist, this condition often remains undiagnosed and untreated. OAB needs to be viewed as a symptom complex. Its presentation and management are complicated in the vulnerable elderly by the presence of baseline frailty and multiple coexisting chronic conditions. Furthermore, and beyond a simple understanding of symptomatology, providers must address patient goals and motivations as well as the expectations of caretakers. These multiple levels of perception, function, expectations, and treatment efficacy/risks must be tailored to the individual patient. While the vulnerable elderly patient may often have evidence of urinary tract dysfunction, OAB and urge urinary incontinence in this population must be understood as a multifactorial geriatric syndrome and viewed in the context of medical and functional baseline and precipitating risk factors. Expectations and goals must be tailored to the resources of vulnerable elderly patients and their caregivers, and care must be coordinated with other medical care providers. The management of OAB in the vulnerable elderly often poses significant management challenges. Nonetheless, with a thoughtful approach and an aim towards future research specifically for this population, significant reductions in morbidity and mortality long with enhancement in health-related quality of life are possible.

Overactive Bladder Is Strongly Associated With Frailty in Older Individuals

“…13 Our study demonstrates that individuals with OAB are less likely to have fast TUGT times (41.8% versus 60.8%) and are more likely to have slow TUGT times (32.3% versus to 11.0%) when compared to older individuals with other non-oncologic urologic diagnoses. While there are many ways to evaluate frailty in the clinical setting, we advocate for using the timed up and go test as a parsimonious and practical tool.…”

The Aging Overactive Bladder: a Review of Aging-Related Changes from the Brain to the Bladder

“…2 As a symptom complex , overactive bladder is considered to have no singular cause and can be influenced by comorbidities, environmental factors, medications, prior surgeries and age. 3 …”

A current perspective on geriatric lower urinary tract dysfunction

“…A newer drug, mirabegron, which has a selective affinity for β-3 adrenergic receptors, was approved by the U.S. Food and Drug Administration (FDA) as the first agent in this newest category of pharmaceutical treatments for OAB and UI in men and women [ 57 , 58 ]. This drug stimulates the β-3 adrenoceptors (accounts for more than 95% of all β-adrenoceptor mRNA in the human bladder) to relax the detrusor muscle during the storage phase of micturition [ 59 ].…”