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Overactive Bladder in Frail Older Adults

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Abstract

Overactive bladder (OAB) and frailty are multidimensional syndromes, and the prevalence of both increases with age. Little evidence exists for a direct association between OAB and frailty, but urinary urgency may well be a precursor of frailty in older people. Frail older adults are no less deserving of treatment than fit older adults, and lifestyle, behavioral, and pharmacological interventions remain the primary options for treatment, with some evidence for efficacy. Data on onabotulinumtoxinA therapy or percutaneous tibial nerve stimulation in frail older adults are sparse. Frail older adults are often excluded from drug trials, but evidence is accumulating that antimuscarinics and, to a lesser extent, beta-adrenergic agonists are safe, well-tolerated, and effective in older adults. Cognitive impairment associated with frailty should not be used as justification for avoiding the use of antimuscarinics. More studies are required to better understand the association between OAB and frailty, as both are associated with poor outcomes and may be amenable to intervention. Drug trials for OAB treatments should be encouraged to include frail older adults, as this population is highly affected yet often excluded.

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  1. Division of Geriatric Medicine, Department of Medicine, University of Alberta, 1-198 Clinical Sciences Bldg, 11350 83 Ave, Edmonton, AB, T6G 2P4, Canada

    Christina Shaw & Adrian Wagg

  2. Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada

    Christina Shaw

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Dr. Shaw has no conflicts of interest that are directly relevant to the content of this article. Dr. Wagg has received funding for consultancy, speaker fees, and research from Astellas Pharma, Pfizer Inc, and Essity Health and Hygiene AB.

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Shaw, C., Wagg, A. Overactive Bladder in Frail Older Adults. Drugs Aging 37, 559–565 (2020). https://doi.org/10.1007/s40266-020-00777-8

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