Challenges in the Pharmacological Management of Nursing Home Residents with Overactive Bladder or Urinary Incontinence.
OBJECTIVE
To determine the proportion of nursing home (NH) residents (NHR) with overactive bladder (OAB) or urinary incontinence (UI) with potential pharmacodynamic contraindications to antimuscarinic treatment because of concomitant anticholinergic medications or acetylcholinesterase inhibitors (AChEIs) and nonpharmacological limitations to antimuscarinic treatment.


METHODS
Cross-sectional retrospective analysis.


METHODS
U.S. skilled nursing facilities.


METHODS
Nursing home residents with a diagnosis of OAB or UI.


METHODS
Linked and deidentified pharmacy claims and Minimum Data Set (MDS) 3.0 records (October 1, 2010 to September 30, 2012).


RESULTS
Of NHRs, 71.3% received at least one anticholinergic medication. Medications that can cause or worsen UI were used commonly. AChEIs and antimuscarinic treatment were prescribed concurrently in 24% of NHRs with OAB or UI. NHRs with OAB or UI were more likely to have concurrent moderate to severe cognitive impairment (MSCI) (70.1%) than those without (29.9%) (P < .001). NHRs with or without OAB or UI and with MSCI were more likely to be treated with an anticholinergic medication than those without MSCI (P = .001). When NHRs with MSCI, severe mobility impairment (SMI), and anticholinergic medication and AChEI use were excluded, only a small proportion of NHRs were potential candidates for antimuscarinic treatment (6.6% with OAB or UI, 6.2% with UI).


CONCLUSIONS
This study advances understanding of the challenges in prescribing antimuscarinic treatment safely and appropriately in elderly NHRs with a high prevalence of drug interactions, underlying MSCI, and SMI.
Omnicare, Inc., Cincinnati, Ohio.
Barbara J
BJ
Zarowitz
Omnicare, Inc., Cincinnati, Ohio.
Carrie
C
Allen
Omnicare, Inc., Cincinnati, Ohio.
Terrence
T
O'Shea
Mayo Clinic, Rochester, Minnesota.
Eric G
EG
Tangalos
Astellas Scientific and Medical Affairs, Northbrook, Illinois.
Todd
T
Berner
Department of Integrated Medical Sciences, Charles E. Schmidt College of Biomedical Science, Boca Raton, Florida.
Joseph G
JG
Ouslander
D000368:Aged; D018680:Cholinergic Antagonists / Q000008:administration & dosage*; D002800:Cholinesterase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D018727:Muscarinic Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D009735:Nursing Homes; D012189:Retrospective Studies; D053201:Urinary Bladder, Overactive / Q000453:epidemiology; D014549:Urinary Incontinence / Q000453:epidemiology
D018680:Cholinergic Antagonists; D002800:Cholinesterase Inhibitors; D018727:Muscarinic Antagonists
nursing home; overactive bladder; urinary incontinence