Optimization of Overactive Bladder Medications in Older Adults Residing in Long-Term Care Facilities

Background Urinary incontinence is a condition prevalent in older adults and has the potential to impact health and quality of life in patients. Commonly prescribed anticholinergic medications have significant side effects that are often heightened in older adults and should be optimized and de-escalated as warranted. Given pharmacists' focus on medication regimens, pharmacists are uniquely equipped to help optimize overactive bladder (OAB) medications in long-term care. Objective To reduce inappropriate use of OAB medications in older adults residing within long-term care facilities. Methods An intervention-based quality improvement project was completed including 27 patients who were residing at multiple care settings within the long-term care facilities studied. A medication review and patient interview were conducted by a clinical pharmacist to assess OAB medication appropriateness. Recommendations for therapy modification were made to the medical team to reduce anticholinergic adverse effects while maintaining treatment effect. Results A total of eight patients (57.1%) in the intervention group reported experiencing lessened or eliminated anticholinergic adverse effects compared with only one patient (10%) reporting the same in the non-intervention group (P = 0.0333; OR [95% CI] = 10.7 [1.007-587.8]). Effects of intervention on OAB symptoms were variable but most patients did not experience worsening of symptoms. A total of 14 OAB medications were deprescribed or dose-reduced. Conclusion Pharmacist optimization of OAB medications for older individuals residing in longterm care facilities is associated with elimination of potentially unnecessary medications, potentially with improvement of adverse effects and without worsening of the OAB symptoms.