Geriatrics Re: Cognitive Effects of Reducing Anticholinergic Drug Burden in a Frail Elderly Population: A Randomized Controlled Trial H. Kersten, E. Molden, I. K. Tolo, E. Skovlund, K. Engedal and T. B. Wyller Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway J Gerontol A Biol Sci Med Sci 2013; 68: 271e278.

Abstract available at Editorial Comment: Anticholinergic medications are known to have a variety of potentially negative side effects, including dry mouth, constipation and cognitive changes such as increased confusion. These effects can be particularly pronounced in elderly patients, who may already be predisposed to increased adverse events due to underlying physiological changes associated with aging. Numerous medications, including several commonly used in urological care, have anticholinergic properties. This study was designed to compare a pharmacist initiated series of drug reviews to decrease overall anticholinergic burden in a group of nursing home residents compared to control subjects who received usual care. At the conclusion of the trial those older adults randomized to the intervention had a statistically significant reduction in the amount of anticholinergic medications, while the control group had no reduction. However, measured outcomes, including salivary production and cognition, were not significantly different between the groups. Perhaps this finding reflects that many older adults who require nursing home care already have substantial cognitive impairment or other physiological changes that may not be strongly responsive to change by alterations in medications. It would be interesting to see if similar results would be obtained with this type of intervention in a less frail group of community dwelling older adults. Tomas L. Griebling, MD, MPH

Suggested Reading Pontari MA, Mohamed FB, Lebovitch S et al: Central nervous system findings on functional magnetic resonance imaging in patients before and after treatment with anticholinergic medication. J Urol 2010; 183: 1899. Lipton RB, Kolodner K and Wesnes K: Assessment of cognitive function of the elderly population: effects of darifenacin. J Urol 2005; 173: 493.

Re: Sociodemographic and Health Indicators of Older Women with Urinary Incontinence: 2010 National Survey of Residential Care Facilities J. C. De Gagne, A. So, J. Oh, S. Park and M. H. Palmer Byrdine F. Lewis School of Nursing and Health Professions, Georgia State University, Atlanta, Georgia J Am Geriatr Soc 2013; 61: 981e986.

Abstract available at Editorial Comment: The incidence and prevalence of urinary incontinence (UI) increase with age. However, UI should not be considered a normal or inevitable part of the aging process. Many studies have helped define rates of UI in community dwelling older adults, and in nursing home residents. This study was unique in that it examined rates of UI and associated risk factors among 4,930 women living in residential care facilities in the United States. Sometimes called assisted living facilities, these differ substantially from skilled care facilities or nursing homes. Residents in assisted living or residential care facilities are usually more independent and require less in terms of nursing or other direct care interventions. Published research on UI in this population has been relatively limited. Limitations in the activities of daily living (ADLs), such as bathing and dressing, were most strongly correlated with UI in this population. These types of functional changes are often linked to the risk of a variety of geriatric syndromes, including UI. The results lead to considerations about



what initially prompts many older adults to move into assisted living facilities. In some cases this may be directly due to alterations in ADL status. The cross-sectional retrospective design of this particular study prevents identification of causality between ADL impairment and UI but raises important questions regarding this association for future research. Tomas L. Griebling, MD, MPH

Suggested Reading Dooley Y, Kenton K, Cao G et al: Urinary incontinence prevalence: results from the National Health and Nutrition Examination Survey. J Urol 2008; 179: 656. Anger JT, Saigal CS and Litwin MS: The prevalence of urinary incontinence among community dwelling adult women: results from the National Health and Nutrition Examination Survey. J Urol 2006; 175: 601.

Re: The Burden of Urinary Incontinence and Urinary Bother among Elderly Prostate Cancer Survivors R. P. Kopp, L. M. Marshall, P. Y. Wang, D. C. Bauer, E. Barrett-Connor and J. K. Parsons; Osteoporotic Fractures in Men MrOS Research Group Division of Urologic Oncology, UC San Diego Moores Cancer Center, University of California, San Diego, La Jolla, California Eur Urol 2013; 64: 672e679.

Abstract available at Editorial Comment: Urinary incontinence (UI) is one of the most dreaded complications associated with clinical treatment for prostate cancer. The majority of research on the topic has examined associations between either surgical or radiation therapy for prostate cancer and subsequent UI. The relationships between urinary bother and perceived symptom burden of UI as compared to prostate cancer status are less well understood. This study compared these outcomes between men with and without prostate cancer. In addition, outcomes related to various prostate cancer treatments were examined. Men with prostate cancer had a twofold to fivefold increased prevalence of UI compared to controls, and rates increased with longer duration from diagnosis. Increased urinary bother was associated with observation, surgery and androgen deprivation therapy. It is noteworthy that men in the observation group also had increased rates of incontinence compared to men without prostate cancer. This finding raises important questions about potential associated pathophysiology, such as changes to pelvic floor support or other factors, irrespective of cancer treatment. Rates of incontinence and urinary bother increased with longer duration of cancer survivorship. These findings highlight that providers should continue to ask about urinary control issues that may develop in men with a history of prostate cancer. Tomas L. Griebling, MD, MPH

Suggested Reading Malcolm JB, Fabrizio MD, Barone BB et al: Quality of life after open or robotic prostatectomy, cryoablation or brachytherapy for localized prostate cancer. J Urol 2010; 183: 1822. Thompson I, Thrasher JB, Aus G et al: Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol 2007; 177: 2106.

Re: Physical Performance Measures as a Useful Indicator of Multiple Geriatric Syndromes in Women Aged 75 Years and Older S. Seino, N. Yabushita, M. J. Kim, M. Nemoto, S. Jung, Y. Osuka, Y. Okubo, R. Figueroa, T. Matsuo and K. Tanaka Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan Geriatr Gerontol Int 2013; 13: 901e910.

Re: Sociodemographic and health indicators of older women with urinary incontinence: 2010 National Survey of Residential Care Facilities.

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