OBJECTIVES: The 2015 American Geriatrics Society Beers’ criteria recommends avoiding strong anticholinergics including antimuscarinics in patients with dementia because anticholinergics can worsen the cognition. However, little is known about the management of Overactive Bladder (OAB) in elderly dementia patients. This study examined the incidence and predictors of antimuscarinic medication use in elderly dementia patients with OAB.

METHODS: The study used a new-user cohort design involving elderly patients with dementia and OAB based on the 2013-2015 Medicare Claims Data involving parts A, B, and D. The study involved patients aged 65 years with a diagnosis of dementia and OAB. Antimuscarinic medications included oxybutynin, tolterodine, trospium, fesoterodine, darifenacin, and solifenacin. Descriptive statistics and logistic regression model were used to determine the incidence and predictors of new antimuscarinic medication use respectively, following 12 months of baseline period.

RESULTS: Of the 3,383,603 Medicare beneficiaries with dementia in the study period, over one million (1,049,897) had OAB for overall prevalence of 31.03%. Among OAB patients, 287,612 (27.01%) were prevalent antimuscarinics users during the study period. After applying continuous eligibility criteria, 21,848 (10.34%) incident antimuscarinic users after dementia diagnosis and 189,257 (89.66%) non-users were reported. Multivariable analysis revealed that patients 75 years or older, blacks, and those with schizophrenia, epilepsy, delirium, and Elixhauser’s score had decreased likelihood of initiating antimuscarinics. Females, those with abnormal involuntary moments, bipolar disorder, gastroesophageal reflux disease, insomnia, irritable bowel syndrome, muscle spasm/low back pain, neuropathic pain, benign prostatic hyperplasia, falls/fractures, myasthenia gravis, glaucoma, Parkinson's disease, syncope, urinary tract infection and vulvovaginitis had increased likelihood of initiating antimuscarinic medication.

CONCLUSIONS: The study found that nearly one-third of dementia patients had OAB. Approximately 27% elderly dementia patients with OAB used antimuscarinic medications. Given the high prevalence of OAB among dementia patients, it is critical to monitor the cognitive status and optimize antimuscarinic use in this at-risk population.