Treatment of OAB may reduce fall risk in older patients

Philadelphia-Overactive bladder (OAB) and falls often carry a substantial burden for patients and society as a whole, and new research suggests that treatment of OAB may lower fall risk.

In a study of Medicare claims data from 2006-2009, researchers from the University of Pennsylvania, Philadelphia identified 32,587 patients with an OAB diagnosis (average age, 77.7 years). Patients’ medical histories were examined 1 year prior to and 2 years following diagnosis to determine the association between OAB and falls, and the protective effects of treatment of OAB on risk of falls.

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“Often, overactive bladder has been associated with multiple chronic illnesses; falls are in the top five,” lead author Ravishankar Jayadevappa, PhD, associate professor in the department of medicine and division of urology at the University of Pennsylvania, told Urology Times.

“In comprehensive care, especially among elderly people, screening for falls in patients with OAB-and vice versa-is an important and integral part of a collaborative approach incorporating the geriatrician and primary care provider,” said Dr. Jayadevappa, who presented the study findings at the 2015 AUA annual meeting in New Orleans.

Next: 10% higher risk of falls

10% higher risk of falls

Individuals who had an OAB diagnosis had a higher risk (10.2%) of falling compared to those without a diagnosis of OAB (5.3%), Dr. Jayadevappa reported. Incidences of chronic disease or conditions were also higher among those patients with OAB than those without. OAB diagnosis was associated with a 40% increased risk of falling. Importantly, treatment for OAB was associated with a reduced risk of falls compared to no treatment (OR=0.92; 95% CI: 0.87, 0.97).

Only 10% of the individuals diagnosed with OAB received treatment for it, and of those patients, 77% were male.

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Why should urologists be concerned about falls?

“Certainly there are studies that have linked falls with nocturia and getting up at night. I think this study is important because it really broadens what we are looking at. It’s looking at a larger, more generalized population of people who are experiencing overactive bladder systems, which may or may not include incontinence,” said Tomas Griebling, MD, MPH, an AUA spokesperson who is professor and vice chair of urology at the University of Kansas School of Medicine and moderator of presentation.

“Overactive bladder is undertreated and under-diagnosed, and that's a really important takeaway message,” Dr. Jayadevappa said. “The second important message is overactive bladder is associated with increased falls, next to prior history of falls. It has an odds ratio almost 1.4 times higher in overactive bladder patients.

Next: how to minimize fall risk

How to minimize fall risk

Dr. Jayadevappa recommends asking patients if they fell during the last year and using tools that assess fall risk and functional status. He also suggests that urologists provide patients with information that will help them understand how OAB treatment can reduce fall risk.

“When we look at all the data and the guidelines, behavioral therapy is really the mainstay of therapy for this,” said Dr. Griebling. “And then medication has become a second level. But, medications may actually potentially increase the risk of falls. For example, the antimuscarinic medications, if they cause some cognitive impairment, may increase that risk in some more vulnerable patients.”