title: Effect of pharmacological treatment for urinary incontinence in the elderly and frail elderly: A systematic review.
abstract: OBJECTIVE
  The prevalence and severity of urinary incontinence (UI) increase with age and comorbidity. The benefits of pharmacotherapy for UI in the elderly are questionable. The aim of the present study was to systematically review the efficacy of pharmacological treatment for UI in the elderly and frail elderly.
  
  
  METHODS
  We searched PubMed, EMBASE, Cochrane library and Cinahl databases through October 2013 to identify prospective controlled trials that evaluated pharmacological treatment for UI in persons aged ≥65 years. Elderly persons living in nursing homes were regarded as frail elderly. Outcomes were urinary leakage, quality of life and adverse events.
  
  
  RESULTS
  We screened 1038 abstracts and assessed 309 full-text articles. We identified 13 trials of high or moderate quality; 11 evaluated anticholinergic drugs and two evaluated duloxetine. Oxybutynin, the only drug studied in the frail elderly population, had no effect on urinary leakage or quality of life in elderly with urgency UI (UUI). Seven trials evaluated the effects of darifenacin, fesoterodine, solifenacin, tolterodine or trospium. Urinary leakage decreased (standard mean difference: -0.24, 95% confidence interval -0.32-0.15), corresponding to a reduction of half a leakage per 24 h. Common side-effects of treatment were dry mouth and constipation. Data were insufficient for evaluation of the effect on quality of life or cognition. The evidence was insufficient to evaluate the effects of duloxetine. No eligible studies on mirabegron and estrogen were found.
  
  
  CONCLUSIONS
  Anticholinergics have a small, but significant, effect on urinary leakage in older adults with UUI. Treatment with drugs for UUI in the frail elderly is not evidence based.
authors: Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
authors: Eva
authors: E
authors: Samuelsson
authors: Jenny
authors: J
authors: Odeberg
authors: Karin
authors: K
authors: Stenzelius
authors: Ulla
authors: U
authors: Molander
authors: Margareta
authors: M
authors: Hammarström
authors: Karin
authors: K
authors: Franzen
authors: Gunnel
authors: G
authors: Andersson
authors: Patrik
authors: P
authors: Midlöv
mesh_terms: D000368:Aged; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D016330:Frail Elderly; D006801:Humans; D014549:Urinary Incontinence / Q000188:drug therapy*
chemical_list: D018680:Cholinergic Antagonists
keywords: elderly; frail elderly; pharmacotherapy; systematic review; urinary incontinence