Vulnerable Elderly Patients and Overactive Bladder Syndrome

Abstract

Overactive bladder (OAB) prevalence increases with age, and the elderly population is rapidly increasing worldwide, particularly those aged >or=75 years. OAB symptoms may be associated with co-morbid conditions, particularly bowel symptoms and falls related to nighttime lavatory trips, as well as with higher rates of mortality in elderly persons. Physical changes associated with age that result in altered bladder function and altered drug solubility, metabolism and clearance, as well as increased polypharmacy, may impact disease management in elderly patients. Clinical trial data indicate that current treatments for OAB are generally effective and well tolerated in elderly patients. However, clinical trial participants have generally been relatively healthy persons aged >or=65 years, which may not reflect the true elderly population. Limited data exist that are specific to the vulnerable elderly, who have been defined as patients aged >or=65 years who are at increased risk of functional decline or death over a 2-year period. Identification and treatment of vulnerable elderly patients with OAB is important, because intervention may limit functional deterioration. Antimuscarinics are associated with improvement in OAB symptoms and health-related quality of life in older patients, although adverse effects such as constipation may be of particular concern in vulnerable elderly patients. Additional research is needed on the potential impact of antimuscarinics on cognition in vulnerable elderly persons. Behavioural interventions, including biofeedback, prompted voiding and pelvic floor muscle exercises, may be effective in some elderly patients without risk of adverse events, and they may enhance the efficacy of antimuscarinic treatment. The International Consultation on Incontinence has recommended behavioural interventions with the cautious addition and trial of antimuscarinic drugs for the treatment of urinary incontinence in frail elderly individuals or those already in a state of decline; these recommendations may also be useful for vulnerable individuals. Greater representation of vulnerable elderly individuals in clinical trials, the development and inclusion of outcomes relevant to this population, and the creation and testing of validated, evidence-based models to guide treatment decisions in vulnerable elderly individuals are needed.

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

“…6 Effective management of OAB in elderly adults is important because of its effects on daily life and potentially serious adverse health consequences, including falls and fractures, institutionalization, and mortality. [7][8][9][10] Despite the availability of effective treatments, many individuals do not discuss their OAB symptoms with a physician and remain untreated. 11,12 Although antimuscarinic drugs are first-line pharmacological treatment for OAB, 13 they may be underused in older individuals.…”

“…11,12 Although antimuscarinic drugs are first-line pharmacological treatment for OAB, 13 they may be underused in older individuals. 10 A large portion of the data on elderly adults has come from post hoc analyses of OAB clinical trial participants aged 65 and older. Few placebo-controlled studies have prospectively evaluated or reported age-stratified data on the efficacy and safety of antimuscarinics in this population.…”

OnabotulinumtoxinA in the treatment of overactive bladder: a cost-effectiveness analysis versus best supportive care in England and Wales

“…These might include damage to the skin from prolonged contact with urine [40,41], possible fractures and injuries from falls [42,43], and increased mortality associated with OAB in elderly patients [44]. If these data become available, they could be incorporated into an updated model.…”

Translational Research and Functional Changes in Voiding Function in Older Adults

“…Several reviews have discussed different aspects of OAB in older adults 5, 7–10 and it has been well established that the syndrome increases with age, and that aging alone can be considered a major risk factor for developing these symptoms.…”