Urinary Incontinence in Elderly

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Urinary Incontinence in Elderly

Introduction

Urinary incontinence is very common in the elderly; so common that it is socially viewed as a ‘normal’ aspect of ageing and is thus underreported (Coppola et al, 2002).  Although urinary incontinence does increase with age, it’s absence in over half of women suggests that it not a part of normal ageing (Conner & Lind, 2001).

According to Resnick (1988) and Miller (2003), detrusor instability (also known as overactive bladder) is the most common form of urinary incontinence in the elderly.  It presents with symptoms of increased frequency of micturition (>8 micturitions/24hrs) and urgency to pass urine while only passing small amounts at a time (Lee et al, 2002).  Studies using urodynamics have demonstrated such sufferers usually have no sensation of the bladder filling-up or any activity of the detrusor muscle until, at a certain bladder volume, an involuntary detrusor contraction occurs and subsequent urine leakage may prevail (Griffiths, 1998).

Treatment aims at improving control of the bladder by reducing the frequency and detrusor contractions during filling.  Although behavioural therapy and physiotherapy are available, patient compliance amongst the elderly is highest in pharmacotherapy (Thüroff et al, 1998).

Detrusor contractions are mediated by neurally-released acetylcholine stimulating bladder receptors; urinary incontinence occurs when this stimulation produces an increase in sensitivity.  Anticholinergics inhibit the binding of acetylcholine to the cholinergic-receptor, hence suppressing involuntary bladder contractions.  The two main drugs that are used in the pharmacological treatment of detrusor instability are Oxybutynin and Tolterodine.  Oxybutynin is an anticholinergic agent with minor antispasmodic, analgesic and local anaesthetic properties (Sathyan et al, 2001).  Tolterodine was actually the first drug developed specifically for urinary incontinence and demonstrates functional selectivity for the bladder as opposed to the widespread systemic effects of other anticholinergics (Freeman et al, 2003).  This is a significant property since most anticholinergics decrease salivation producing a dry mouth leading to non-adherence to treatment.  Patient compliance is important, since it has been noted that the effectiveness of the anticholinergic drugs are more effective in the first dosing schedule as opposed to stopping and then resuming treatment.

This report aims to identify the efficacy of treatment of detrusor instability with Oxybutynin and Tolterodine in clinical trials previously conducted.  In addition to this, a case study will be conducted in order to explore the adverse effects of the drug Tolterodine from a patient’s perspective.

Question/Aim

To Compare the Efficacy of Oxybutynin and Tolterodine in Detrusor Instability With Insight Into a Patient’s Experience of Tolterodine

Method

Literature Search

A literature search was conducted with two objectives:

  1. To gain studies describing detrusor instability, Oxybutynin and Tolterodine for background information
  2. To recruit papers to this literature review

The following search engines were used:

  • EBSCO
  • Cochrane Library
  • British Medical Library (with ‘search across multiple journals’ option applied)
  • New England Journal of Medicine
  • The Lancet
  • PubMed Central
  • Science Direct
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The search terms run through these databases included ‘urinary incontinence’, ‘urinary incontinence elderly’, ‘treatment for urinary incontinence’, ‘Oxybutynin’ and ‘Tolterodine’.

The searches were conducted to include all relevant scientific information between the dates of 1942 to 2004.

Recruiting Papers

The use of a criteria helps to recruit studies that are matched in important categories such as relevance of sample, reliability and validity of methods and clarity of report so that accurate inferences can be drawn.  A good criterion will reject studies with unreliable data and accept studies that can be reproduced.  

Types of studies

All randomised-controlled trials ...

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