title: Use of Bladder Antimuscarinics in Older Adults with Impaired Cognition.
abstract: OBJECTIVE
  To examine the use of antimuscarinics for treating urinary incontinence (UI) in older adults with varying levels of cognition.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  National Alzheimer's Coordinating Center from 2005 through 2015.
  
  
  METHODS
  Community-dwelling men and women aged 65 and older (N = 24,106).
  
  
  METHODS
  Clinicians and staff evaluated each participant's dementia status during annual in-person assessments. Participants or their informants reported all medications taken in the 2 weeks before each study visit.
  
  
  RESULTS
  Overall, 5.2% (95% confidence interval (CI) = 4.9-5.5%) of the cohort took a bladder antimuscarinic. Participants with impaired cognition were more likely to be taking an antimuscarinic than those with normal cognition. Rates of bladder antimuscarinic use were 4.0% (95% CI = 3.6-4.4%) for participants with normal cognition, 5.6% (95% CI = 4.9-6.3%) for those with mild cognitive impairment, and 6.0% (95% CI = 5.5-6.4%) for those with dementia (p < .001). Of 624 participants with dementia who took antimuscarinics, 16% (95% CI = 13-19%) were simultaneously taking other medicines with anticholinergic properties.
  
  
  CONCLUSIONS
  Use of bladder antimuscarinics was more common in older adults with impaired cognition than in those with normal cognition. This use is despite guidelines advising clinicians to avoid prescribing antimuscarinics in individuals with dementia because of their vulnerability to anticholinergic-induced adverse cognitive and functional effects. A substantial proportion of cognitively impaired individuals who took antimuscarinics were simultaneously taking other anticholinergic medications. These findings suggest a need to improve the treatment of UI in individuals with impaired cognition.
authors.affiliation: Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Ariel R
authors.initials: AR
authors.lastname: Green
authors.affiliation: Department of Medicine, Johns Hopkins University, Baltimore, Maryland.|Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jodi
authors.initials: J
authors.lastname: Segal
authors.affiliation: Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jing
authors.initials: J
authors.lastname: Tian
authors.affiliation: Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland.|Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland.|Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Esther
authors.initials: E
authors.lastname: Oh
authors.affiliation: Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland.|Center on Aging and Health, Johns Hopkins University, Baltimore, Maryland.
authors.forename: David L
authors.initials: DL
authors.lastname: Roth
authors.affiliation: John A. Burns School of Medicine, University of Hawaii, Honolulu, Haiwaii.
authors.forename: Liam
authors.initials: L
authors.lastname: Hilson
authors.affiliation: Department of Urology, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Dodson
authors.affiliation: Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland.|Department of Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Boyd
mesh_terms: D000368:Aged; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use; D060825:Cognitive Dysfunction / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003704:Dementia / Q000453:epidemiology*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D019338:Polypharmacy; D017410:Practice Guidelines as Topic; D014481:United States / Q000453:epidemiology; D014549:Urinary Incontinence / Q000188:drug therapy*
chemical_list: D002800:Cholinesterase Inhibitors; D018727:Muscarinic Antagonists
keywords: anticholinergic; dementia; urinary incontinence