The impact of frailty on treatment for overactive bladder in older adults

Abstract

Aims: To examine the impact of frailty on treatment outcomes for overactive bladder (OAB) in older adults starting pharmacotherapy, onabotulinumtoximA, and sacral neuromodulation. Methods: This is a prospective study of men and women age ≥60 years starting pharmacotherapy, onabotulinumtoxinA, or sacral neuromodulation. Subjects were administered questionnaires at baseline and again at 1- and 3-months. Frailty was assessed at baseline using the timed up and go test (TUGT), whereby a TUGT time of ≥12 seconds was considered to be slow, or frail. Response to treatment was assessed using the overactive bladder symptom score (OABSS) and the OAB-q SF (both Bother and HRQOL subscales). Information on side effects/adverse events was also collected. Mixed effects linear modeling was used to model changes in outcomes over time both within and between groups. Results: A total of 45 subjects enrolled in the study, 40% (N=18) of whom had a TUGT ≥12 seconds. Both TUGT groups demonstrated improvement in OAB symptoms over time and there were no statistically significant differences in these responses per group (all p-values >0.05). Similar trends were found for both OAB-q SF Bother and OAB-q SF HRQOL questionnaire responses. Side effects and adverse events were not significantly different between groups (all p’s >0.05). Conclusions: Adults ≥60 years of age starting second- and third-line treatments for OAB, regardless of TUGT time, demonstrated improvement in OAB symptoms at 3 months. These findings suggest that frail older adults may receive comparable benefit and similar rates of side effects compared to less frail older individuals.

Is sacral neuromodulation effective in patients with Parkinson's disease? A retrospective review

“…We also found no differences in implantation based on time to PD diagnosis or PD disease severity based on NHY staging which is similar to the findings in the study by Greenberg et al 17 This is in keeping with literature suggesting that frailty does not preclude treatment success with third‐line therapies 28 …”

Evaluation and treatment of urinary incontinence in the aging male

“…Post void residual greater than 150 mL after treatment was significantly higher in the frail (defined as meeting 3 or more of the following criteria: unintentional weight loss, selfreported exhaustion, weakness, slow walking speed, and/or low physical activity) elderly (defined as older than 65 years) group compared to the elderly without frailty or younger than 65 groups and success rate was significantly lower compared to the other two groups [75]. Conversely, a prospective study assessing impact of frailty (defined as baseline time up and go test ≥ 12 seconds) on treatment of OAB in men and women 60 years of age or older noted that frail subjects starting pharmacotherapy or undergoing on botulinum toxin A or sacral neuromodulation demonstrated improved OAB symptoms without statistically significant differences between groups when assessing OAB questionnaire responses, side effects, or adverse events [76].…”

Third‐line therapy for overactive bladder in the elderly: Nuances and considerations

“…The mean age was 70.3 years. There was a significant improvement in patient‐reported outcomes with no difference based on frailty across therapies 28 . The study did not evaluate adverse side effect rates specific to BTX‐A.…”