Vulnerable elderly patients and overactive bladder syndrome.
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.
Kraus
Stephen R
SR
Department of Urology, University of Texas Health Science Center, San Antonio, Texas 78229-3900, USA. KrausS@uthscsa.edu
Bavendam
Tamara
T
Brake
Tiffany
T
Griebling
Tomas L
TL
D000368:Aged; D000369:Aged, 80 and over; D001521:Behavior Therapy; D005081:Exercise Therapy; D016330:Frail Elderly; D006801:Humans; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D013577:Syndrome; D053201:Urinary Bladder, Overactive / Q000503:physiopathology / Q000628:therapy*; D014549:Urinary Incontinence / Q000503:physiopathology / Q000628:therapy*
D018727:Muscarinic Antagonists
JAMA. 1998 Dec 16;280(23):1995-2000
9863850
J Gerontol. 1983 Jan;38(1):31-5
6129272
J Urol. 2005 Feb;173(2):493-8
15643227
BMJ. 2003 Jan 25;326(7382):196
12543836
Eur Urol. 2005 Sep;48(3):471-7
15990219
J Am Geriatr Soc. 1998 Jan;46(1):8-13
9434659
Urology. 2010 Dec;76(6):1350-7
20974482
Dig Dis Sci. 2007 Feb;52(2):313-6
17219073
Urology. 2005 Oct;66(4):746-50
16230129
Drugs Aging. 2008;25(10):871-7
18808211
Ann Intern Med. 2008 Aug 5;149(3):161-9
18678843
J Am Geriatr Soc. 1992 Dec;40(12):1217-20
1447437
BJU Int. 2008 Jun;101(11):1388-95
18454794
J Am Geriatr Soc. 1995 Jun;43(6):610-7
7775717
J Am Med Dir Assoc. 2001 Sep-Oct;2(5):207-14
12812542
Urology. 2004 Mar;63(3):461-5
15028438
Arch Neurol. 2003 May;60(5):771-3
12756144
Obstet Gynecol. 1997 Apr;89(4):501-6
9083302
Gerontology. 2001 Mar-Apr;47(2):72-6
11287730
J Gerontol A Biol Sci Med Sci. 2003 Aug;58(8):756-62
12902536
JAMA. 1963 Sep 21;185:914-9
14044222
BJU Int. 2011 Jan;107(2):254-61
20590548
Neurourol Urodyn. 2001;20(3):237-47
11385690
BJU Int. 2005 Feb;95(3):346-9
15679791
Int J Clin Pract. 2009 Aug;63(8):1177-91
19575724
J Urol. 2002 Sep;168(3):1027-31
12187215
Curr Med Res Opin. 2007 Oct;23(10):2347-58
17706004
Lancet. 2007 Jul 14;370(9582):173-184
17630041
JAMA. 2002 Nov 13;288(18):2293-9
12425706
J Neurol Sci. 2009 Aug 15;283(1-2):99-106
19264328
J Am Geriatr Soc. 2009 Jul;57(7):1238-44
19467148
BJU Int. 2005 Nov;96(7):1055-62
16225528
J Urol. 2006 Mar;175(3 Pt 1):835-41
16469561
J Clin Epidemiol. 1998 May;51(5):367-75
9619963
Gerontologist. 1969 Autumn;9(3):179-86
5349366
Am J Geriatr Pharmacother. 2006 Mar;4(1):14-24
16730617
World J Urol. 1998;16 Suppl 1:S10-34
9775413
Aging (Milano). 1991 Jun;3(2):161-70
1911905
J Urol. 2005 Oct;174(4 Pt 1):1317-21; discussion 1321-2; author reply 1322
16145411
Age Ageing. 2006 Jan;35(1):16-24
16234314
Neuroimage. 2007 Aug 1;37(1):1-7
17574871
N Engl J Med. 2007 Apr 12;356(15):1575-6
17429089
N Engl J Med. 2003 Dec 4;349(23):2274-5
14657444
J Am Geriatr Soc. 2008 May;56(5):847-53
18384584
Curr Med Res Opin. 2007 Nov;23(11):2697-704
17892634
Arch Intern Med. 2005 Mar 14;165(5):537-42
15767530
Scand J Public Health. 2002;30(1):54-61
11928835
Am J Public Health. 1991 Apr;81(4):443-7
2003621
Pharmacol Rev. 2004 Jun;56(2):163-84
15169926
JAMA. 1998 Feb 25;279(8):585-92
9486752
BJU Int. 2007 Feb;99(2):247-62
17313422
Dis Colon Rectum. 1989 Jan;32(1):1-8
2910654
BJU Int. 2006 Dec;98(6):1238-43
17034500
Clin Drug Investig. 2003;23(6):395-404
17535050
J Urol. 2006 Jul;176(1):177-85
16753396
J Am Geriatr Soc. 2000 Jul;48(7):721-5
10894308
Aging Clin Exp Res. 2002 Oct;14(5):412-9
12602577
Am J Manag Care. 2000 Jul;6(11 Suppl):S574-9
11183900
Ann Intern Med. 2004 Sep 21;141(6):489-92
15381535
Lancet. 1995 Jul 8;346(8967):94-9
7603221
J Urol. 2008 Jul;180(1):217-22
18499184
Curr Urol Rep. 2004 Dec;5(6):423-6
15541209
J Am Geriatr Soc. 2001 Dec;49(12):1691-9
11844005
Br J Pharmacol. 2005 Apr;144(8):1089-99
15723094
J Am Geriatr Soc. 2002 May;50(5):799-807
12028164
J Am Geriatr Soc. 1983 Dec;31(12):721-7
6418786
Gerontologist. 1970 Spring;10(1):20-30
5420677
Am J Psychiatry. 1999 Sep;156(9):1470
10484967
Neurourol Urodyn. 2010;29(1):4-20
19941278
Circulation. 2007 May 15;115(19):2549-69
17502590
Cochrane Database Syst Rev. 2000;(2):CD002113
10796861
Psychiatr Serv. 2004 Nov;55(11):1318-9
15534031
Curr Med Res Opin. 2009 Apr;25(4):911-9
19250059
Age Ageing. 1995 Jul;24(4):287-91
7484484
Rev Urol. 2008 Spring;10(2):92-8
18660862
Arch Gen Psychiatry. 1998 Sep;55(9):809-15
9736007
Ann Pharmacother. 1999 Nov;33(11):1173-6
10573314
Obstet Gynecol. 2006 Apr;107(4):908-16
16582131
J Urol. 2001 May;165(5):1452-6
11342895
Am J Psychiatry. 1992 Oct;149(10):1393-4
1530077
J Am Geriatr Soc. 2000 Apr;48(4):370-4
10798461
Geriatrics. 2007 May;62(5):15-24
17489643
Am J Geriatr Psychiatry. 2003 Jul-Aug;11(4):458-61
12837675
J Urol. 1986 Nov;136(5):1022-5
3490584
Br J Clin Pharmacol. 2004 Jan;57(1):6-14
14678335
J Am Geriatr Soc. 2006 Mar;54(3):507-11
16551321
J Am Geriatr Soc. 2001 Jun;49(6):700-5
11454106
Eur Urol. 2006 Dec;50(6):1306-14; discussion 1314-5
17049716
BJU Int. 2001 Jun;87(9):760-6
11412210
Urology. 2004 Mar;63(3 Suppl 1):17-23
15013648
J Urol. 2008 Dec;180(6):2522-6
18930481
J Urol. 2008 Jul;180(1):47-54
18485378
World J Urol. 2003 May;20(6):327-36
12811491
Int J Clin Pract. 2008 Nov;62(11):1792-800
18699842
Arch Intern Med. 2006 Feb 27;166(4):418-23
16505261
Obstet Gynecol. 2008 Mar;111(3):678-85
18310371
Urology. 2003 Jan;61(1):37-49
12559262
Urology. 2010 Mar;75(3):526-32, 532.e1-18
20035977
Pharmacotherapy. 2005 Apr;25(4):511-9
15977912
Lancet. 2000 Aug 12;356(9229):568
10950240
Am J Manag Care. 2001 Mar;7(2 Suppl):S62-75
11261409
Urology. 2003 Jun;61(6):1123-8
12809878
Eur Urol. 2006 Aug;50(2):317-26
16687205
Arch Gen Psychiatry. 2003 Feb;60(2):198-203
12578438
J Am Geriatr Soc. 2008 May;56(5):862-70
18410326
Arch Intern Med. 2002 Nov 11;162(20):2269-76
12418941
Int J Clin Pract. 2009 Aug;63(8):1198-204
19624787
JAMA. 1991 Feb 6;265(5):609-13
1987410
J Urol. 2009 Apr;181(4):1773-8
19233414
Am J Med. 1992 Dec;93(6):663-9
1466363
J Wound Ostomy Continence Nurs. 2007 Sep-Oct;34(5):535-41
17876216
Value Health. 2004 Jul-Aug;7(4):455-63
15449637
BMJ. 2005 Nov 5;331(7524):1036-7
16269472
BMJ. 2006 Feb 25;332(7539):455-9
16452102
BMJ. 2005 Oct 22;331(7522):935
16093254
Am J Obstet Gynecol. 2007 Aug;197(2):e8
17689620
Can J Urol. 2008 Aug;15 Suppl 1:32-6; discussion 36
18700063
BMC Gastroenterol. 2008 Feb 12;8:5
18269746
Vital Health Stat 10. 1999 Oct;(200):1-203
15782448