title: Are we shortchanging frail older people when it comes to the pharmacological treatment of urgency urinary incontinence?
abstract: Overactive bladder and urgency incontinence are common and distressing conditions in older people, for which the first-line pharmacological treatment is a bladder antimuscarinic agent. Of these, oxybutynin is often recommended in guidelines, but is associated with a higher incidence of adverse drug effects, and in particular has been suggested to have deleterious cognitive effects. Despite this, guidelines often suggest oxybutynin as first-line treatment, and insurance based healthcare systems often require oxybutynin to be used as a first-line therapy and fail before reimbursement for the cost of newer anticholinergics is authorised. We reviewed the literature of bladder antimuscarinics in older adults, using the headings overactive bladder, urinary frequency, urgency, urge, oxybutynin, antimuscarinic, older, older people, and frail. In general, oxybutynin had a similar efficacy to other anticholinergic drugs, but a higher incidence of adverse drug events, in particular significant yet unnoticed cognitive impairment. We conclude that oxybutynin should not be used in frail older people.
authors.forename: W
authors.initials: W
authors.lastname: Gibson
authors.forename: A
authors.initials: A
authors.lastname: Athanasopoulos
authors.forename: H
authors.initials: H
authors.lastname: Goldman
authors.forename: H
authors.initials: H
authors.lastname: Madersbacher
authors.forename: D
authors.initials: D
authors.lastname: Newman
authors.forename: J
authors.initials: J
authors.lastname: Spinks
authors.forename: J J
authors.initials: JJ
authors.lastname: Wyndaele
authors.forename: A
authors.initials: A
authors.lastname: Wagg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001559:Benzhydryl Compounds / Q000009:adverse effects / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003408:Cresols / Q000009:adverse effects / Q000627:therapeutic use; D016330:Frail Elderly; D006801:Humans; D018727:Muscarinic Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D010665:Phenylpropanolamine / Q000009:adverse effects / Q000627:therapeutic use; D053201:Urinary Bladder, Overactive / Q000188:drug therapy*; D014549:Urinary Incontinence / Q000188:drug therapy*
chemical_list: D001559:Benzhydryl Compounds; D018680:Cholinergic Antagonists; D003408:Cresols; D018727:Muscarinic Antagonists; D010665:Phenylpropanolamine