Overactive bladder: Special considerations in the geriatric population

Overactive bladder (OAB) is a highly prevalent condition among older patien ts, and its presence is associated with the use of substantial healthcare r esources and economic costs. Within the next 30 years, it is expected that the demand for services related to OAB will increase dramatically. Treatmen t of OAB is challenging and depends on several factors, including the age o f the patient, cognitive functioning, and the degree of mobility. Pharmacot herapy, such as the use of tolterodine and oxybutynin, is a viable option f or the treatment of OAB, and muscarinic antagonists are commonly used. The efficacy of an agent may differ in older patients compared with younger one s. In addition, certain side effects can be particularly trouble- some in t he geriatric population. A retrospective analysis of a large managed care d atabase showed an age-related increase in the number of women seeking care for OAB. Caring for incontinent patients in the long-term care setting was shown to result in substantial additional costs, which were higher in those with more frequent incontinent episodes. Prompted voiding may be effective in reducing the number of incontinent epi sodes for those in institutionalized care; however, this practice is labor intensive and generally is only effective in 40% of cases. Moreover, assist ance with prompted voiding must be maintained continuously. Future research should focus on defining the most cost-effective methods of treating OAB i n the longterm care setting.