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Effect of pharmacological treatment for urinary incontinence in the elderly and frail elderly: A systematic review

Samuelsson, Eva; Odeberg, Jenny; Stenzelius, Karin; Molander, Ulla; Hammarstrom, Margareta; Franzen, Karin; Andersson, Gunnel and Midlöv, Patrik LU (2015) In Geriatrics & Gerontology International 15(5). p.521-534
Abstract
Aim: 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... (More)
Aim: 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. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
elderly, frail elderly, pharmacotherapy, systematic review, urinary, incontinence
in
Geriatrics & Gerontology International
volume
15
issue
5
pages
521 - 534
publisher
Wiley-Blackwell
external identifiers
  • wos:000355732800001
  • scopus:84928209691
ISSN
1444-1586
DOI
10.1111/ggi.12451
language
English
LU publication?
yes
id
6add59e9-a109-41e1-9ea8-8affd474df35 (old id 7605143)
date added to LUP
2015-08-03 10:10:50
date last changed
2017-07-30 03:00:17
@article{6add59e9-a109-41e1-9ea8-8affd474df35,
  abstract     = {Aim: 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.},
  author       = {Samuelsson, Eva and Odeberg, Jenny and Stenzelius, Karin and Molander, Ulla and Hammarstrom, Margareta and Franzen, Karin and Andersson, Gunnel and Midlöv, Patrik},
  issn         = {1444-1586},
  keyword      = {elderly,frail elderly,pharmacotherapy,systematic review,urinary,incontinence},
  language     = {eng},
  number       = {5},
  pages        = {521--534},
  publisher    = {Wiley-Blackwell},
  series       = {Geriatrics & Gerontology International},
  title        = {Effect of pharmacological treatment for urinary incontinence in the elderly and frail elderly: A systematic review},
  url          = {http://dx.doi.org/10.1111/ggi.12451},
  volume       = {15},
  year         = {2015},
}