To Örebro University

Aim: The prevalence and severity of urinary incontinence (UI) increase with age and comorbidity. The benefits ofpharmacotherapy for UI in the elderly are questionable. The aim of the present study was to systematically review theefficacy of pharmacological treatment for UI in the elderly and frail elderly.

Methods: We searched PubMed, EMBASE, Cochrane library and Cinahl databases through October 2013 toidentify prospective controlled trials that evaluated pharmacological treatment for UI in persons aged ≥65 years.Elderly persons living in nursing homes were regarded as frail elderly. Outcomes were urinary leakage, quality of lifeand adverse events.

Results: We screened 1038 abstracts and assessed 309 full-text articles. We identified 13 trials of high or moderatequality; 11 evaluated anticholinergic drugs and two evaluated duloxetine. Oxybutynin, the only drug studied in thefrail elderly population, had no effect on urinary leakage or quality of life in elderly with urgency UI (UUI). Seven trialsevaluated the effects of darifenacin, fesoterodine, solifenacin, tolterodine or trospium. Urinary leakage decreased(standard mean difference: −0.24, 95% confidence interval −0.32–0.15), corresponding to a reduction of half a leakageper 24 h. Common side-effects of treatment were dry mouth and constipation. Data were insufficient for evaluationof the effect on quality of life or cognition. The evidence was insufficient to evaluate the effects of duloxetine. Noeligible studies on mirabegron and estrogen were found.

Conclusions: Anticholinergics have a small, but significant, effect on urinary leakage in older adults with UUI.Treatment with drugs for UUI in the frail elderly is not evidence based.