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Prevalent Disease States of Interest in Residents with OAB and/or UI Compared With a Matched Cohort without OAB and/or UI
Source publication
Objective:
To identify clinical characteristics of residents with a diagnosis of overactive bladder (OAB) and/or urinary incontinence (UI) to determine the prevalence of comorbidities, severe mobility impairment (SMI), moderate-to-severe cognitive impairment (MSCI), and a toileting program and the response to that program.
Design:
Cross-sectiona...
Context in source publication
Context 1
... with OAB and/or UI had a higher percentage of hypertension, depression, hyperlipidemia, diabetes, dementia, anemia, anxiety disorder, gastroesophageal reeux disease, heart failure, and urinary tract infection in the last 30 days and cerebrovascular accidents/transient ischemic attacks/stroke (P < 0.001; Figure 2). ey also had a higher percentage of renal failure (11.6%) and benign prostatic hypertrophy (7.2%) than those without OAB and/or UI (9.5% and 6.4%, respectively; P < 0.001) (data not shown). ...
Citations
... Compared with adults without OAB, adults with OAB often have more comorbid medical conditions, such as hypertension, depression, and dementia [8][9][10]. Likewise, older adults with OAB have higher rates of comorbidities, such as hypertension, psychiatric disorders, and urinary tract infections, than older adults without OAB [8]. ...
Background:
Overactive bladder (OAB) is characterized by the presence of bothersome urinary symptoms. Pharmacologic treatment options for OAB include anticholinergics and β3-adrenergic agonists. Use of β3-adrenergic agonists may result in similar treatment efficacy with a decreased side effect profile compared with anticholinergics because high anticholinergic burden is associated with cardiovascular and neurologic side effects. However, the β3-adrenergic agonist mirabegron, one of two approved drugs within this class, is a moderate cytochrome P450 (CYP) 2D6 inhibitor, and coadministration of drugs that are CYP2D6 substrates with mirabegron may lead to adverse drug effects.
Objective:
The aim of this study was to quantify how often CYP2D6 substrates were dispensed in patients receiving mirabegron among adults of any age and among those ≥ 65 years of age.
Methods:
In this retrospective descriptive analysis, a deidentified administrative claims database in the United States, IQVIA PharMetrics® Plus, was used to identify dispensing claims for CYP2D6 substrates and mirabegron from November 2012 to September 2019. Prevalence of CYP2D6 substrate dispensing was assessed in patients dispensed mirabegron among all adults ≥ 18 years old and additionally among a cohort of those ≥ 65 years old. Patient baseline profiles at the time of mirabegron and CYP2D6 substrate codispensing and at the time of mirabegron dispensing were compared. CYP2D6 substrates were categorized as those with the potential for increased risk of QT prolongation, with anticholinergic properties, with narrow therapeutic index (NTI), contraindicated or having a black box warning when used with CYP2D6 inhibitors, or used for depression or other psychiatric disease. Dispensing data and patient profiles were summarized descriptively.
Results:
Overall, 68.5% of adults ≥ 18 years old dispensed mirabegron had overlapping dispensings for one or more CYP2D6 substrate; 60.6% and 53.6% had overlapping dispensings for CYP2D6 substrates with anticholinergic properties or risk of QT prolongation, respectively. CYP2D6 substrates with NTI, contraindicated with CYP2D6 inhibitors, or for psychiatric use were codispensed in 17.7%, 16.6%, and 38.0% of adult mirabegron users, respectively. Mirabegron users receiving one or more concurrent CYP2D6 substrate were more likely to be older, have more comorbidities and baseline polypharmacy, and have increased healthcare resource utilization compared with those without concurrent CYP2D6 substrates. Commonly codispensed CYP2D6 substrates included hydrocodone, oxycodone, tramadol, metoprolol, and tamsulosin. Findings were similar for patients in the older cohort (≥ 65 years old), with 72.1% receiving overlapping CYP2D6 substrates.
Conclusions:
Codispensing of CYP2D6 substrates, especially those with anticholinergic properties or risk of QT prolongation, was common among adults and older adults receiving mirabegron. Results highlight the need for improved awareness of CYP2D6 substrate prescribing among patients receiving pharmacologic treatment for OAB that inhibits the CYP2D6 pathway.
... An estimated 23% of Americans ≥ 40 years old have bothersome symptoms of overactive bladder (OAB) [1], and the proportion of adults who report urgency or urgency urinary incontinence increases with age in both men and women [1,2]. Among residents of long-term care (LTC) facilities who are ≥ 65 years old, approximately 65-70% report urinary incontinence [3,4], which is the second-leading cause for the placement of older adults into care facilities [5]. Compared to individuals without OAB, adults with OAB have a significantly higher prevalence of comorbid medical conditions, particularly cardiovascular and central nervous system (CNS) comorbidities [6,7]. ...
... In LTC facilities, the prevalence of OAB and/or urinary incontinence is high, with reports of 65-70% [3,4]. Approximately 89% of nursing home residents need assistance with toileting, and 92% need assistance with walking or locomotion [25]. ...
... Approximately 89% of nursing home residents need assistance with toileting, and 92% need assistance with walking or locomotion [25]. Consistent with the general population, residents of LTC facilities with urinary incontinence and/or OAB have a significantly higher prevalence of comorbidities such as hypertension, hyperlipidemia, dementia, depression, and anxiety disorders than residents without OAB [4]. Additionally, rates of frailty in LTC facilities are high, with one report suggesting that approximately 85% of LTC residents are frail [26], which may be related to comorbidities. ...
Overactive bladder (OAB) is a common disorder in the general population, and the prevalence increases with age. Adults with OAB typically have a greater number of comorbid conditions, such as hypertension, depression, and dementia, compared with adults without OAB. Subsequent to an increased number of comorbidities, adults with OAB take a greater number of concomitant medications, which may increase the risk of potentially harmful drug‒drug interactions. There are two important considerations for many of the medications approved for the treatment of OAB in the USA: anticholinergic burden and potential for drug‒drug interactions, notably related to cytochrome P450 (CYP) 2D6, which is responsible for the metabolism of approximately 25% of all drugs. A substantial number of drugs used for the treatment of OAB and comorbid conditions (e.g., cardiovascular and neurologic disorders) are CYP2D6 substrates or inhibitors. Furthermore, a substantial number of drugs with CYP2D6 properties also have strong anticholinergic properties. Here, we review polypharmacy associated with OAB and its common comorbidities, identify drugs with reported anticholinergic properties, and provide an overview of clinically relevant drug‒drug interactions in the treatment of OAB as they relate to CYP2D6 metabolism. This review aims to provide clinicians with essential information necessary for making treatment decisions when managing OAB.
... 9 OAB is estimated to affect as many as 47% of women and 40% of men !65 years of age living in the community, 10 whereas in a nursing home setting, up to 65% of residents may have OAB and/or urinary incontinence. 11 Though more recent evidence is lacking, a study conducted in the year 2000 estimated that 25% of OAB costs were accrued in nursing homes. 12 The national costs of OAB have been estimated at US$65.9 billion in 2007, with $51.4 billion due to direct medical expenditure, and $14.6 billion due to indirect costs. ...
... As the US population ages, a growing number of individuals are estimated to transition to nursing home facilities, and up to 65% of these individuals may have OAB. 11,29 In anticipation of the growing number of individuals anticipated to make this transition, the present study provides health care decision makers with recent estimates of the burden of OAB among nursing home residents. The study findings can assist health care resource planning decisions and allow nursing homes to plan resources appropriately for the management of OAB. ...
Objectives
To determine the all-cause health care resource utilization and costs among long-term nursing home (LTNH) residents with and without overactive bladder (OAB).
Design
Retrospective cohort study.
Setting and Participants
Minimum Data Set (MDS)–linked Medicare Part A, B, and D claims data from 2013 to 2015 were analyzed. LTNH residents aged 65 years or older with a diagnosis of OAB (n = 216,731) were propensity score matched with LTNH residents without OAB (n = 300,327) (non-OAB cohort).
Methods
We measured health care resource utilization and costs associated with OAB by setting (inpatient, outpatient, emergency department, or prescription) during the 6 months following nursing home admission. Descriptive and multivariate (negative binomial for health care resource utilization and 2-part model for costs) analyses were performed to examine the health care resource utilization and costs among LTNH residents with and without OAB. The annual cost attributed to OAB was calculated as the difference between total annual OAB costs and total annual non-OAB costs.
Results
A total of 214,505 patients were included in each matched cohort. Across all health care resource categories, LTNH residents with OAB had higher health care resource utilization and costs compared to the non-OAB cohort (all P < .001). The mean annual direct total cost was $57,984 in the OAB cohort compared with $54,285 in the non-OAB cohort. The annual cost of OAB in nursing homes was estimated at $793 million. Adjusted analyses revealed that the OAB cohort was 9% more likely to have hospitalization and emergency department visits, 15% more likely to have outpatient visits, 27% more likely to have physician visits, and 12% more likely to have prescription counts compared with the non-OAB cohort.
Conclusions and Implications
The study findings suggest that LTNH residents with OAB have significantly more health care resource utilization compared with patients without OAB. These results provide health care decision makers with recent estimates of the burden of OAB in LTNH to assist them with resource planning.
... These stakeholders develop targeted fall-prevention management, and assess residents based on factors associated with a fall [5]. Prior studies identified a number of risk factors for falls; including age, sex, visual deficits, psychotropic medications, cognitive dysfunction [6][7][8], range of motion, urinary incontinence [9][10][11], hours per resident day (HPRD) of registered nurses (RNs), and skill mix [12]. ...
... Psychiatric medication was a very strong predictor of falls, consistent with previous research [6,7,9,10], but inconsistent with a couple of studies [34,35]. The proportion of residents with urinary incontinence was an important factor in falls, supported in previous research [9][10][11][12], but not supported in other studies [7,32]. Results confirmed that the frequency of resident falls relates to increased psychiatric medication and urinary incontinence [9,12,36,37]. ...
... The proportion of residents with urinary incontinence was an important factor in falls, supported in previous research [9][10][11][12], but not supported in other studies [7,32]. Results confirmed that the frequency of resident falls relates to increased psychiatric medication and urinary incontinence [9,12,36,37]. No practical guide exists for NH staff based on scientific evidence [38]. ...
Background: A machine learning (ML) system is able to construct algorithms to continue improving predictions and generate automated knowledge through data-driven predictors or decisions. Objective: The purpose of this study was to compare six ML methods (random forest (RF), logistics regression, linear support vector machine (SVM), polynomial SVM, radial SVM, and sigmoid SVM) of predicting falls in nursing homes (NHs). Methods: We applied three representative six-ML algorithms to the preprocessed dataset to develop a prediction model (N = 60). We used an accuracy measure to evaluate prediction models. Results: RF was the most accurate model (0.883), followed by the logistic regression model, SVM linear, and polynomial SVM (0.867). Conclusions: RF was a powerful algorithm to discern predictors of falls in NHs. For effective fall management, researchers should consider organizational characteristics as well as personal factors. Recommendations for Future Research: To confirm the superiority of ML in NH research, future studies are required to discern additional potential factors using newly introduced ML methods.
Oral pharmacotherapy for overactive bladder, a condition that increases with age, includes anticholinergics and β3‐adrenergic receptor agonists. Older adults, including those with dysphagia, may have difficulty swallowing tablets. In this phase 1 study in healthy adults, we assessed the pharmacokinetic profile of the β3‐adrenergic receptor agonist vibegron administered as a single 75‐mg dose as an intact tablet versus crushed and mixed with applesauce. Additional end points included safety (assessed by adverse events), perception of taste (assessed via questionnaire), and stability over 4 hours after crushing and mixing in applesauce (assessed by chromatography). Overall, 30 participants were randomized, and 29 were included in the pharmacokinetic analysis. Crushing a vibegron tablet and mixing with applesauce decreased vibegron maximum observed plasma concentration and area under the plasma concentration–time curve from time 0 to infinity by ≈30% and ≈10%, respectively; however, these decreases were not considered clinically significant. Treatment‐emergent adverse events were reported in 16 (53.3%) participants. Approximately half of participants reported the vibegron and applesauce mixture tasted as expected; of those reporting the taste was different than expected, 50% reported the taste as bitter. The mixture was stable for 4 hours in applesauce. The results of this study showed that crushing and administering vibegron with applesauce may be an appropriate option for patients with overactive bladder and swallowing difficulties.
Purpose:
To determine factors associated with improvement in urinary incontinence (UI) for long-stay postacute, complex continuing care (CCC) patients.
Design:
A retrospective cohort investigation of patients in a CCC setting using data obtained from the Canadian Institute for Health Information's Continuing Care Reporting System collected with interRAI Minimum Data Set 2.0.
Setting and participants:
Individuals aged 18 years and older, were admitted to CCC hospitals in Ontario, Canada, between 2010 and 2018.
Methods:
Multivariable logistic regression was used to determine the independent effects of predictors on UI improvement, for patients who were somewhat or completely incontinent on admission and therefore had the potential for improvement.
Results:
The study cohort consisted of 18 584 patients, 74% (13 779) of which were somewhat or completely incontinent upon admission. Among those patients with potential for improvement, receiving bladder training, starting a new medication 90 days prior (odds ratio, OR: 1.54 [95% confidence interval, CI: 1.36-1.75]), and triggering the interRAI Urinary Incontinence Clinical Assessment Protocol to facilitate improvement (OR: 1.36 [95% CI: 1.08-1.71]) or to prevent decline (OR: 1.32 [95% CI: 1.13-1.53]) were the strongest predictors of improvement. Conversely, being totally dependent on others for transfer (OR: 0.62 [95% CI: 0.42-0.92]), is rarely or never understood (OR: 0.65 [95% CI: 0.50-0.85]), having a major comorbidity count of ≥3 (OR: 0.72 [95% CI: 0.59-0.88]), Parkinson's disease, OR: 0.77 (95% CI: 0.62-0.95), Alzheimer/other dementia, OR: 0.83 (95% CI: 0.74-0.93), and respiratory infections, OR: 0.57 (95% CI: 0.39-0.85) independently predicted less likelihood of improvement in UI.
Conclusions and implications:
Findings of this study suggest that improving physical function, including bed mobility, and providing bladder retraining have strong positive impacts on improvement in UI for postacute care patients. Evidence generated from this study provides useful care planning information for care providers in identifying patients and targeting the care that may lead to better success with the management of UI.
The current study assessed the impact of urinary incontinence (UI) on residents, staff, care processes, and quality measures in long-term care (LTC) settings. A 70-question quantitative online survey was sent to directors of nursing (DONs) who had worked for ≥1 year in a ≥100-bed facility (≥80% LTC beds). Of the 62% of residents with UI, 40% were always incontinent, and 81% used incontinence products for UI. Overall, 59% of DONs reported that UI management contributes to certified nursing assistant turnover. Approximately 36% of resident falls occurred while trying to get to the bathroom. LTC quality measures reported as significantly impacted by UI included urinary tract infection and falls with major injury. Only 14% of residents with UI were treated with medication. Most (75%) DONs were unaware of any link between anticholinergic medications and risk of cognitive side effects. These results highlight the need for improved UI treatment, awareness, and management in this population. [Journal of Gerontological Nursing, 48(7), 38-46.].
Background
Overactive bladder (OAB) is a prevalent condition commonly treated with anticholinergic medications. The extent to which anticholinergic burden is associated with costs and healthcare resource use (HCRU) in the long-stay nursing home (LSNH) setting is currently unknown.Objectives
This research evaluated the impact of anticholinergic burden on HCRU and related costs among LSNH residents with OAB.Methods
This was a cohort study based on 2013–2015 Minimum Data Set-linked Medicare claims data involving LSNH residents aged ≥ 65 years with OAB and having Parts A, B and D coverage 6 months pre- and ≥ 12 months post-nursing home admission date (index date). Cumulative anticholinergic burden was determined using the Anticholinergic Cognitive Burden scale and defined daily dose. Direct medical costs related to HCRU were examined. HCRU included inpatient, outpatient, emergency room (ER), and physician office visits. Costs and HCRU associated with levels of anticholinergic burden were evaluated using generalized linear models.ResultsA total of 123,308 LSNH residents with OAB were included in this study. Most residents (87.2%) had some level (12.8%, none; 18.0%, low; 41.9%, moderate; and 27.3%, high) of cumulative anticholinergic burden. Results indicate that all types of resource utilization were higher among those with any level of anticholinergic burden than those with no burden. The outpatient, ER, and physician costs tended to be higher with increasing anticholinergic burden.Conclusions
Costs and HCRU patterns reflected increasing trends with anticholinergic burden. Targeted efforts towards reducing anticholinergic burden among LSNH residents with OAB may result in decreases in costs and HCRU.
Résumé
Introduction
Le syndrome clinique d’hyperactivité vésicale (SCHV) est une pathologie fréquente ayant un retentissement fonctionnel important chez les patients qui en souffrent.
Objectif
Effectuer une synthèse des connaissances actuelles sur la définition, l’épidémiologie et le retentissement du SCHV.
Méthode
Une revue systématique de la littérature à partir de Pubmed, Embase, Google Scholar a été menée en juin 2020.
Résultats
Le SCHV est défini par la survenue d’urgenturies avec ou sans incontinence urinaire, habituellement associées à une pollakiurie ou une nycturie en l’absence d’infection urinaire ou de pathologie locale organique évidente (tumeur, infection, calcul). En France, le SCHV affecte 14 % de la population générale et cette prévalence augmente avec l’âge. Cette pathologie est une source d’altération majeure de la qualité de vie avec un retentissement physique (chutes, fractures, troubles du sommeil, fatigue), psychique (anxiété, dépression) social (limitation des loisirs, isolement) et économique.
Conclusion
Le SCHV est défini de manière standardisée. Il s’agit d’une pathologie fréquente ayant des conséquences fonctionnelles importantes avec une altération notable de la qualité de vie.
Background
Evidence‐based guidelines for the management of frail older persons with urinary incontinence are rare. Those produced by the International Consultation on Incontinence represent an authoritative set of recommendations spanning all aspects of management.
Aims
To summarize the available evidence relating to the management of urinary incontinence in frail older people published since the 5th International Consultation on Incontinence.
Materials and Methods
A series of systematic reviews and evidence updates were performed by members of the working group to update the 2012 recommendations.
Results
Along with the revision of the treatment algorithm and accompanying text, there have been significant advances in several areas of the management of lower urinary tract symptoms in frail older people.
Discussion
The committee continues to note the relative paucity of data concerning frail older persons and draw attention to knowledge gaps and research opportunities. Clinicians treating older people with lower urinary tract symptoms should use the available evidence from studies of older people combined with careful extrapolation of those data from younger subjects. Due consideration to an individual's frailty and wishes is crucial.
