Drugs & Aging

, Volume 35, Issue 9, pp 773–776 | Cite as

Anticholinergic Drugs for Overactive Bladder in Frail Older Patients: The Case Against

  • Henry J. WoodfordEmail author
Current Opinion


Urinary incontinence (UI) is a common and disabling problem among older people. Anticholinergic drugs (ADs) are a pharmacological option recommended for overactive bladder or mixed UI when non-pharmacological approaches have failed. However, UI is a more prevalent and complex condition in frail older people and to simply assume that AD actions are the same across all age groups would be wrong. This article reviews evidence for the efficacy and safety of these drugs, especially when prescribed for frail older people. Although ADs have a small but statistically significant benefit for UI in non-frail people, the vast majority choose to discontinue treatment because they feel that the beneficial effects do not outweigh the burden of taking the medication. Not only are the most frail older people more likely to experience adverse effects but there is also no evidence that these drugs are effective for UI. In addition, there is a mounting body of evidence that they impair cognitive function. The continued use of ADs in frail older people simply does not hold water.


Compliance with ethical standards


No sources of funding were used to assist in the preparation of this article.

Conflicts of interest

Henry J. Woodford has no conflicts of interest to declare.


  1. 1.
    National Institute for Health and Care Excellence. Urinary incontinence in women: management. Clinical guideline [CG171]. 2013. Accessed 20 July 2018.
  2. 2.
    Shamliyan T, Wyman JF, Ramakrishnan R, et al. Benefits and harms of pharmacologic treatment for urinary incontinence in women: a systematic review. Ann Intern Med. 2012;156:861–74.CrossRefPubMedGoogle Scholar
  3. 3.
    Samuelsson E, Odeberg J, Stenzelius K, et al. Effect of pharmacological treatment for urinary incontinence in the elderly and frail elderly: a systematic review. Geriatr Gerontol Int. 2015;15:521–34.CrossRefPubMedGoogle Scholar
  4. 4.
    Madhuvrata P, Cody JD, Ellis G, et al. Which anticholinergic drug for overactive bladder symptoms in adults. Cochrane Database Syst Rev. 2012;1:CD005429.PubMedGoogle Scholar
  5. 5.
    Chancellor MB, Yehoshua A, Waweru C, et al. Limitations of anticholinergic cycling in patients with overactive bladder (OAB) with urinary incontinence (UI): results from the CONsequences of Treatment Refractory Overactive bLadder (CONTROL) study. Int Urol Nephrol. 2016;48:1029–36.CrossRefPubMedGoogle Scholar
  6. 6.
    Reynolds WS, McPheeters M, Blume J, et al. Comparative effectiveness of anticholinergic therapy for overactive bladder in women: a systematic review and meta-analysis. Obstet Gynecol. 2015;125:1423–32.CrossRefPubMedGoogle Scholar
  7. 7.
    Sexton CC, Notte SM, Maroulis C, et al. Persistence and adherence in the treatment of overactive bladder syndrome with anticholinergic therapy: a systematic review of the literature. Int J Clin Pract. 2011;65:567–85.CrossRefPubMedGoogle Scholar
  8. 8.
    Mauseth SA, Skurtveit S, Spigset O. Adherence, persistence and switch rates for anticholinergic drugs used for overactive bladder in women: data from the Norwegian Prescription Database. Acta Obstet Gynecol Scand. 2013;92:1208–15.PubMedGoogle Scholar
  9. 9.
    Chancellor MB, Migliaccio-Walle K, Bramley TJ, et al. Long-term patterns of use and treatment failure with anticholinergic agents for overactive bladder. Clin Ther. 2013;35:1744–51.CrossRefPubMedGoogle Scholar
  10. 10.
    Krhut J, Gartner M, Petzel M, et al. Persistence with first line anticholinergic medication in treatment-naive overactive bladder patients. Scand J Urol. 2014;48:79–83.CrossRefPubMedGoogle Scholar
  11. 11.
    Veenboer PW, Bosch JLHR. Long-term adherence to antimuscarinic therapy in everyday practice: a systematic review. J Urol. 2014;191:1003–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Tijnagel MJ, Scheepe JR, Blok BFM. Real life persistence rate with antimuscarinic treatment in patients with idiopathic or neurogenic overactive bladder: a prospective cohort study with solifenacin. BMC Urol. 2017;17:30.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Lua LL, Pathak P, Dandolu V. Comparing anticholinergic persistence and adherence profiles in overactive bladder patients based on gender, obesity, and major anticholinergic agents. Neurourol Urodyn. 2017;36:2123–31.CrossRefPubMedGoogle Scholar
  14. 14.
    Yeaw J, Benner JS, Walt JG, et al. Comparing adherence and persistence across 6 chronic medication classes. J Manag Care Pharm. 2009;15:728–40.PubMedGoogle Scholar
  15. 15.
    Cardozo L, Herschorn S, Snijder R, et al. Does BMI, gender or age affect efficacy/tolerability of solifenacin in the management of overactive bladder? Int Urogynaecol J. 2017;28:477–88.CrossRefGoogle Scholar
  16. 16.
    Paquette A, Gou P, Tannenbaum C. Systematic review and meta-analysis: do clinical trials testing antimuscarinic agents for overactive bladder adequately measure central nervous system adverse events? J Am Geriatr Soc. 2011;59:1332–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Oefelein MG. Safety and tolerability profiles of anticholinergic agents used for the treatment of overactive bladder. Drug Saf. 2011;34:733–54.CrossRefPubMedGoogle Scholar
  18. 18.
    Cardwell K, Hughes CM, Ryan C. The association between anticholinergic medication burden and health related outcomes in the ‘oldest old’: a systematic review of the literature. Drugs Aging. 2015;32:835–48.CrossRefPubMedGoogle Scholar
  19. 19.
    Ancelin ML, Artero S, Portet F, et al. Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: longitudinal cohort study. BMJ. 2006;332(7539):455–9.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Han L, Agostini JV, Allore HG. Cumulative anticholinergic exposure is associated with poor memory and executive function in older men. J Am Geriatr Soc. 2008;56:2203–10.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Carriere I, Fourrier-Reglat A, Dartigues J, et al. Drugs with anticholinergic properties, cognitive decline, and dementia in an elderly general population: the 3-City Study. Arch Intern Med. 2009;169:1317–24.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Fox C, Richardson K, Maidment ID, et al. Anticholinergic medication use and cognitive impairment in the older population: the Medical Research Council Cognitive Function and Ageing Study. J Am Geriatr Soc. 2011;59:1477–83.CrossRefPubMedGoogle Scholar
  23. 23.
    Fox C, Smith T, Maidment I, et al. Effect of medications with anti-cholinergic properties on cognitive function, delirium, physical function and mortality: a systematic review. Age Ageing. 2014;43:604–15.CrossRefPubMedGoogle Scholar
  24. 24.
    Gray SL, Anderson ML, Dublin S, et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med. 2015;175:401–7.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Risacher SL, McDonald BC, Tallman EF, et al. Association between anticholinergic medication use and cognition, brain metabolism, and brain atrophy in cognitively normal older adults. JAMA Neurol. 2016;73:721–32.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Chuanga Y, Elangod P, Gonzalez CE, et al. Midlife anticholinergic drug use, risk of Alzheimer’s disease, and brain atrophy in community-dwelling older adults. Alzheimer’s Dementia (N Y). 2017;3:471–9.Google Scholar
  27. 27.
    Papenberg G, Backman L, Fratiglioni L, et al. Anticholinergic drug use is associated with episodic memory decline in older adults without dementia. Neurobiol Aging. 2017;55:27–32.CrossRefPubMedGoogle Scholar
  28. 28.
    Richardson K, Fox C, Maidment I, et al. Anticholinergic drugs and risk of dementia: case–control study. BMJ. 2018;360:k1315.CrossRefGoogle Scholar
  29. 29.
    Wesnes KA, Edgar C, Tretter RN, et al. Exploratory study assessing the risk of cognitive impairment or sedation in the elderly following single doses of solifenacin 10mg. Expert Opin Drug Saf. 2009;8:615–26.CrossRefPubMedGoogle Scholar
  30. 30.
    Staskin D, Kay G, Tannenbaum C, et al. Trospium chloride has no effect on memory testing and is assay undetectable in the central nervous system of older patients with overactive bladder. Int J Clin Pract. 2010;64:1294–300.CrossRefPubMedGoogle Scholar
  31. 31.
    Lipton RB, Kolodner K, Wesnes K. Assessment of cognitive function of the elderly population: effects of darifenacin. J Urol. 2005;173:493–8.CrossRefPubMedGoogle Scholar
  32. 32.
    Kay G, Crook T, Rekeda L, et al. Differential effects of the antimuscarinic agents darifenacin and oxybutynin ER on memory in older subjects. Eur Urol. 2006;50:317–26.CrossRefPubMedGoogle Scholar
  33. 33.
    Geller EJ, Dumond JB, Bowling JM, et al. Effect of trospium chloride on cognitive function in women aged 50 and older: a randomized trial. Female Pelvic Med Reconstr Surg. 2017;23:118–23.CrossRefPubMedGoogle Scholar
  34. 34.
    Geller EJ, Crane AK, Wells EC, et al. Effect of anticholinergic use for the treatment of overactive bladder on cognitive function in postmenopausal women. Clin Drug Investig. 2012;32:697–705.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Szonyi G, Collas DM, Ding YY, et al. Oxybutynin with bladder retraining for detrusor instability in elderly people: a randomized controlled trial. Age Ageing. 1995;24:287–91.CrossRefPubMedGoogle Scholar
  36. 36.
    Ouslander JG, Schnelle JF, Uman G, et al. Does oxybutynin add to the effectiveness of prompted voiding for urinary incontinence among nursing home residents? A placebo-controlled trial. J Am Geriatr Soc. 1995;43:610–7.CrossRefPubMedGoogle Scholar
  37. 37.
    Lackner TE, Wyman JF, McCarthy TC, et al. Efficacy of oral extended-release oxybutynin in cognitively impaired older nursing home residents with urge urinary incontinence: a randomized placebo-controlled trial. J Am Med Direct Assoc. 2011;12:639–47.CrossRefGoogle Scholar
  38. 38.
    DuBeau CE, Kraus SR, Griebling TL, et al. Effect of fesoterodine in vulnerable elderly subjects with urgency incontinence: a double-blind, placebo controlled trial. J Urol. 2014;191:395–404.CrossRefPubMedGoogle Scholar
  39. 39.
    Wagg A, Gibson W, Ostaszkiewicz J, et al. Urinary incontinence in frail elderly persons: report from the 5th International Consultation on Incontinence. Neurourol Urodynam. 2015;34:398–406.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Northumbria HealthcareNorth ShieldsUK

Personalised recommendations