Use of Bladder Antimuscarinics Questioned at VA Nursing Homes

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LEXINGTON, KY — Should bladder antimuscarinics (BAMs) be used in elderly residents at VA Community Living Centers?

That is the question presented by a recent study evaluating the risks and benefits of the drugs. The University of Kentucky-led authors concluded that the medications should be used cautiously in that setting, especially immediate-release oxybutynin chloride.1

The retrospective cohort study of adults 65 and older admitted for long-term care between Oct. 1, 2002, and Sept. 30, 2009, to a VA long-term care facility used multiple data sources — VA’s Minimum Data Set (MDS), inpatient, outpatient and pharmacy prescriptions administrative files.

Outcomes evaluated included:

  • fractures (hip fracture and “any” fracture) identified from inpatient and/or outpatient data (ICD-9-CM codes) and from MDS;
  • cognitive performance measured using the validated MDS Cognitive Performance Scale;
  • improvement in urinary incontinence measured from MDS; and
  • quality of life measured from MDS using two validated instruments: Index of Social Engagement and Health Status Index.

Variables including demographic characteristics; baseline bladder and bowel continence status and management; preexisting urinary tract infections; body mass index; comorbidities; other medication use; cognitive status, and mobility at baseline were used to calculate the propensity score of BAM initiation.

Researchers found that BAMs were used by 9.8% of the residents 65 years and older admitted for long-term care, with 44% (1,195) being new users. Of those, all but 53 received nonselective immediate-release preparations, predominantly oxybutynin chloride (75%).

BAM initiation resulted in improved urinary continence status (odds ratio = 1.27, 95% confidence interval [CI] 1.07-1.5) and better social engagement (difference in mean index of social engagement score = 0.2074, 95% CI 0.055-0.3598).

On the other hand, the risk of fractures was significantly increased in new users compared with nonusers (hip fracture: hazard ratio [HR] = 3.67, 95% CI 1.46-9.34; “any” fracture: HR = 2.64, 95% CI 1.37-5.10).

Overall, the number needed to treat (NNT) to obtain improvement in urinary incontinence after 90 days of treatment (NNT = 32, 95% CI 17-125) was similar to the number needed to harm (NNH) at 90 days in the hip fracture analysis (NNH = 36, 95% CI 12-209).

No differences in cognitive performance or overall quality-of-life scores associated with BAM use, according to the study.

“These results question the continued use of BAMs, particularly immediate-release oxybutynin chloride in elderly nursing home residents,” the authors wrote.

  1. Moga DC, Carnahan RM, Lund BC, Pendergast JF, Wallace RB, Torner JC, Li Y, Chrischilles EA. Risks and Benefits of Bladder Antimuscarinics Among Elderly Residents of Veterans Affairs Community Living Centers. J Am Med Dir Assoc. 2013 Apr 29. doi:pii: S1525-8610(13)00139-4. 10.1016/j.jamda.2013.03.008. [Epub ahead of print] PubMed PMID: 23639715.

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