The Relationship Between Anticholinergic Exposure and Falls, Fractures, and Mortality in Patients with Overactive Bladder

Suehs, Brandon T.; Caplan, Eleanor O.; Hayden, Jennifer; Ng, Daniel; Gaddy, Rainelle R.

doi:10.1007/s40266-019-00694-5

Cited by 29 publications

(27 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…14 Additionally, anticholinergic medication use for OAB has been associated with an increased risk of falls or fractures in older patients. 15 When an anticholinergic medication is going to be used, extended-release formulations are preferred as they have significantly less dry mouth than their immediate-release counterparts. 3 When cognitive side effects are of specific concern, consideration should be given to use of the lowest effective dosing, and agents with lower central nervous system penetration (active transport out of central nervous system and quaternary amine structure), such as trospium.…”

Section: Medical Managementmentioning

confidence: 99%

Evaluation and Treatment of Overactive Bladder in Women

Raju

Linder

2020

Mayo Clinic Proceedings

View full text Add to dashboard Cite

Overactive bladder (OAB) is a symptom complex that includes urinary urgency, frequency, urgency incontinence, and nocturia. It is highly prevalent, affecting up to 12% of the adult population, and can significantly impact quality of life. The diagnosis of OAB is made by history, physical examination, and a urinalysis to rule out underlying infection or other concerning potential etiologies. The need for additional testing is based on the initial evaluation findings, and is recommended in cases of underlying urinary tract infection, microscopic hematuria, obstructive voiding symptoms, and symptoms refractory to previous treatments. Initial management includes behavioral modification with attention to total daily fluid intake, avoidance of bladder irritants, treatment of constipation, weight loss, timed voiding, urge-suppression techniques, and pelvic floor physical therapy. Options for oral medications include antimuscarinic agents and b adrenergic agents, and can be used following or in conjunction with behavioral treatment. For patients refractory to behavioral therapy and oral medications, consideration should be given to referral to a specialist (eg, a urologist or urogynecologist) for discussion of more advanced therapies such as sacral neuromodulation, percutaneous tibial nerve

show abstract

Section: Medical Managementmentioning

confidence: 99%

Evaluation and Treatment of Overactive Bladder in Women

Raju

Linder

2020

Mayo Clinic Proceedings

View full text Add to dashboard Cite

show abstract

“…An observational retrospective cohort study of 113,311 patients aged over 65 years investigated falls, fractures, and mortality in those taking anticholinergics for OAB compared to those unexposed to anticholinergics 7 . There was a 1.28-fold increased risk of falls and fractures in individuals taking anticholinergics compared to controls.…”

Section: Anticholinergic Loadmentioning

confidence: 99%

Recent advances in managing overactive bladder

et al. 2020

View full text Add to dashboard Cite

Overactive bladder syndrome (OAB) is defined as urinary urgency, usually accompanied by frequency and nocturia, with or without urgency incontinence, in the absence of urinary tract infection or other obvious pathology. In this review, we focus on recent advances in the management of OAB. We examine the evidence on the effect of anticholinergic load on OAB patients. Advances in medical treatment include a new beta-3 agonist, vibegron, which is thought to have fewer drug interactions than mirabegron. Treatment of genitourinary syndrome of the menopause with oestrogens and ospemifene have also shown promise for OAB. Botulinum toxin has been shown to be an effective treatment option. We discuss the new implantable neuromodulators that are on the market as well as selective bladder denervation and laser technology.

show abstract

“…Recent analyses using Medicare claims data estimate that the prevalence of OAB among long-stay nursing home (LSNH) residents is 36%, which is more than double that of some of the estimates for the general population [3,4]. Furthermore, the comorbidity profiles of LSNH residents with OAB indicate that their underlying health status is potentially poor, and they are at an overall higher risk for all-cause mortality [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies that have examined anticholinergic burden among individuals with OAB are limited to the outpatient setting and are therefore representative of a less vulnerable population [5,21,22]; however, these studies have shown that outpatients with OAB had a greater degree of anticholinergic burden than those without OAB [5,21,22]. Although the magnitude of results varies between studies, Szabo et al found that over 80% of individuals with OAB had some degree of anticholinergic burden [21].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Factors Associated with Cumulative Anticholinergic Burden Among Older Long-Stay Nursing Home Residents with Overactive Bladder

et al. 2021

View full text Add to dashboard Cite

Background Overactive bladder (OAB), the primary cause of urinary incontinence in nursing homes, is commonly treated with anticholinergic medications; however, the elderly population is vulnerable to the adverse effects associated with anticholinergic burden. Given the relatively high prevalence of OAB among nursing home residents, it is important to understand the magnitude of anticholinergic burden in this population. Objectives The objectives of this study were to (1) examine the prevalence of cumulative anticholinergic burden among long-stay nursing home (LSNH) residents with OAB; and (2) identify the factors associated with varying levels of cumulative anticholinergic burden. Methods This was a retrospective, cohort study using Minimum Data Set-linked Medicare claims data. Anticholinergic burden was determined based on the Anticholinergic Cognitive Burden scale and patient-specific dosing using defined daily dose. The Andersen Behavioral Model framework was used to identify the predisposing, enabling, and need factors associated with levels of anticholinergic burden. Multivariable logistic regression models were developed to determine the factors associated with levels of anticholinergic burden. Results A total of 123,308 LSNH residents with OAB were identified; 87.2% had some degree of anticholinergic burden and 27.3% had high cumulative burden. Multiple factors were associated with higher levels of burden, including younger age, female sex, and non-Hispanic White ethnicity (predisposing factors); dual eligibility, Southern geographic region, and rural residence (enabling factors); and a number of comorbidities and concomitant medications (need factors). Conclusions This study revealed a high level of anticholinergic burden among LSNH residents. Multiple factors were associated with a high level of burden. There is a need to optimize the use of anticholinergics due to their significant safety concerns in the LSNH setting.

show abstract

The Relationship Between Anticholinergic Exposure and Falls, Fractures, and Mortality in Patients with Overactive Bladder

Cited by 29 publications

References 40 publications

Evaluation and Treatment of Overactive Bladder in Women

Evaluation and Treatment of Overactive Bladder in Women

Recent advances in managing overactive bladder

Prevalence and Factors Associated with Cumulative Anticholinergic Burden Among Older Long-Stay Nursing Home Residents with Overactive Bladder

Contact Info

Product

Resources

About