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Dual use of bladder anticholinergics and cholinesterase inhibitors: long-term functional and cognitive outcomes.
J Am Geriatr Soc. 2008 May; 56(5):847-53.JA

Abstract

OBJECTIVES

To determine the cognitive and functional consequences of dual use of cholinesterase inhibitors (ChIs) and the bladder anticholinergics oxybutynin or tolterodine.

DESIGN

Prospective cohort study.

SETTING

Nursing homes (NHs) in the state of Indiana.

PARTICIPANTS

Three thousand five hundred thirty-six Medicaid-eligible NH residents aged 65 and older taking a ChI between January 1, 2003, and December 31, 2004. Residents were excluded if they were taking an anticholinergic other than oxybutynin or tolterodine.

MEASUREMENTS

Indiana Medicaid claims data were merged with data from the Minimum Data Set (MDS). Repeated-measures analyses were performed to assess the effects of dual therapy on change in cognitive function measured using the MDS Cognition Scale (MDS-COGS; scored 0-10) and change in activity of daily living (ADL) function using the seven ADL items in the MDS (scored 0-28). Potential covariates included age, sex, race, number of medications, and Charlson Comorbidity Index score.

RESULTS

Three hundred seventy-six (10.6%) residents were prescribed oxybutynin or tolterodine concomitantly with a ChI. In residents in the top quartile of ADL function, ADL function declined an average of 1.08 points per quarter when not taking bladder anticholinergics (ChI alone), compared with 1.62 points per quarter when taking dual therapy, a 50% greater rate in quarterly decline in ADL function (P=.01). There was no excess decline attributable to dual therapy in MDS-COGS scores or in ADL function for residents who started out with lower functioning.

CONCLUSION

In higher-functioning NH residents, dual use of ChIs and bladder anticholinergics may result in greater rates of functional decline than use of ChIs alone. The MDS-COGS may not be sensitive enough to detect differences in cognition due to dual use.

Authors+Show Affiliations

Section on Gerontology and Geriatric Medicine, Department of Medicine, School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27157, USA. kmsink@wfubmc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18384584

Citation

Sink, Kaycee M., et al. "Dual Use of Bladder Anticholinergics and Cholinesterase Inhibitors: Long-term Functional and Cognitive Outcomes." Journal of the American Geriatrics Society, vol. 56, no. 5, 2008, pp. 847-53.
Sink KM, Thomas J, Xu H, et al. Dual use of bladder anticholinergics and cholinesterase inhibitors: long-term functional and cognitive outcomes. J Am Geriatr Soc. 2008;56(5):847-53.
Sink, K. M., Thomas, J., Xu, H., Craig, B., Kritchevsky, S., & Sands, L. P. (2008). Dual use of bladder anticholinergics and cholinesterase inhibitors: long-term functional and cognitive outcomes. Journal of the American Geriatrics Society, 56(5), 847-53. https://doi.org/10.1111/j.1532-5415.2008.01681.x
Sink KM, et al. Dual Use of Bladder Anticholinergics and Cholinesterase Inhibitors: Long-term Functional and Cognitive Outcomes. J Am Geriatr Soc. 2008;56(5):847-53. PubMed PMID: 18384584.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dual use of bladder anticholinergics and cholinesterase inhibitors: long-term functional and cognitive outcomes. AU - Sink,Kaycee M, AU - Thomas,Joseph,3rd AU - Xu,Huiping, AU - Craig,Bruce, AU - Kritchevsky,Steven, AU - Sands,Laura P, Y1 - 2008/04/01/ PY - 2008/4/4/pubmed PY - 2008/5/22/medline PY - 2008/4/4/entrez SP - 847 EP - 53 JF - Journal of the American Geriatrics Society JO - J Am Geriatr Soc VL - 56 IS - 5 N2 - OBJECTIVES: To determine the cognitive and functional consequences of dual use of cholinesterase inhibitors (ChIs) and the bladder anticholinergics oxybutynin or tolterodine. DESIGN: Prospective cohort study. SETTING: Nursing homes (NHs) in the state of Indiana. PARTICIPANTS: Three thousand five hundred thirty-six Medicaid-eligible NH residents aged 65 and older taking a ChI between January 1, 2003, and December 31, 2004. Residents were excluded if they were taking an anticholinergic other than oxybutynin or tolterodine. MEASUREMENTS: Indiana Medicaid claims data were merged with data from the Minimum Data Set (MDS). Repeated-measures analyses were performed to assess the effects of dual therapy on change in cognitive function measured using the MDS Cognition Scale (MDS-COGS; scored 0-10) and change in activity of daily living (ADL) function using the seven ADL items in the MDS (scored 0-28). Potential covariates included age, sex, race, number of medications, and Charlson Comorbidity Index score. RESULTS: Three hundred seventy-six (10.6%) residents were prescribed oxybutynin or tolterodine concomitantly with a ChI. In residents in the top quartile of ADL function, ADL function declined an average of 1.08 points per quarter when not taking bladder anticholinergics (ChI alone), compared with 1.62 points per quarter when taking dual therapy, a 50% greater rate in quarterly decline in ADL function (P=.01). There was no excess decline attributable to dual therapy in MDS-COGS scores or in ADL function for residents who started out with lower functioning. CONCLUSION: In higher-functioning NH residents, dual use of ChIs and bladder anticholinergics may result in greater rates of functional decline than use of ChIs alone. The MDS-COGS may not be sensitive enough to detect differences in cognition due to dual use. SN - 1532-5415 UR - https://www.unboundmedicine.com/medline/citation/18384584/Dual_use_of_bladder_anticholinergics_and_cholinesterase_inhibitors:_long_term_functional_and_cognitive_outcomes_ L2 - https://doi.org/10.1111/j.1532-5415.2008.01681.x DB - PRIME DP - Unbound Medicine ER -