Overactive Bladder Pharmacotherapy and Long-Term Care Needs, Dementia, and Frailty in Older Women

To examine the associations of anticholinergic agents and β3-adrenergic receptor agonists (β3-agonists) prescribed for overactive bladder (OAB) with worsening long-term care needs, incident dementia, and frailty among older women.

This retrospective cohort study used the Shizuoka Kokuho Database, a population-based administrative claims database in Japan. Women aged 65-84 years who newly initiated anticholinergic agents or β3-agonists for OAB between 2012 and 2024 and had prescription records consistent with continuous treatment for at least 1 year were included. Follow-up began 12 months after treatment initiation. Stabilized inverse probability of treatment weighting (sIPTW) was used to balance baseline covariates between groups. Primary outcomes were worsening long-term care needs and incident dementia; the secondary outcome was changes in the electronic Frailty Index (eFI). Time-to-event outcomes were analyzed using sIPTW-weighted Cox proportional hazards models.

The cohort comprised 1 605 anticholinergic and 2 189 β3-agonist users. After sIPTW, baseline covariates were well-balanced. No significant difference was observed in worsening long-term care needs (hazard ratio [HR], 1.03; 95% confidence interval [CI], 0.87-1.22). Anticholinergic use was associated with a higher risk of claims-defined incident dementia compared with β3-agonist use (HR, 1.49; 95% CI, 1.04-2.13). Median eFI did not differ significantly between the groups during 5 years of follow-up.

Among older women with OAB, anticholinergic use was associated with an increased risk of claims-defined incident dementia but not with worsening long-term care needs or frailty compared with β3-agonists. Residual confounding and differential dementia ascertainment cannot be excluded.