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