Choosing oral drug therapy for overactive bladder in older people

Overactive bladder (OAB) and urgency incontinence are common in older people. Nevertheless, there remains a paucity of prospectively collected data on the efficacy of commonly used drug treatments for the condition. Many trials have included older people, but have seldom reported results stratified by age or reported adverse events of particular relevance to older people in clinical practice. This has partially been rectified with the introduction of more recently introduced antimuscarinic agents, particularly fesoterodine, and the beta-3-agonist, mirabegron. Areas covered: This article discusses evidence from recent trials relevant to robust and medically complex older people including synthesis of evidence on the association of anticholinergic medications and impaired cognition with relevance to OAB medications Expert opinion: There are increasing data concerning pharmacological therapy in both robust and medically complex older adults. There is a need to explore the efficacy and tolerability of pharmacological treatment of OAB and UUI (urgency urinary incontinence) in specific subgroups and to produce confirmatory real-world data on efficacy and tolerability. Guidelines which address treatment of older people is currently sparse but, as time progresses and data improve, more specific guidance should become available.