ABSTRACT
A multidisciplinary German expert group met in 2012 to discuss the current status and prospects of health care of geriatric patients with urinary incontinence in Germany. The purpose of this position paper is to raise awareness among health care providers for the challenges associated with adequate management of urinary incontinence in frail elderly. The experts agree that a multidisciplinary collaboration is essential for the successful treatment of urinary incontinence symptoms which are often associated with loss of autonomy and social isolation. For most geriatric patients, usually the general practitioner is the first contact when seeking help. Hence, the general practitioner plays a crucial role in the coordination of diagnosis and treatment. The involved health care providers should have adequate education and training in their respective disciplines and should be networked allowing quick turnaround times. Non-pharmacological treatments (e.g. behavioural interventions) should have been tried before any pharmacotherapy is initiated. If pharmacological treatment of urinary incontinence involves the use of anticholinergic agents, cognitive performance should be monitored regularly. If indicated, anticholinergic agents with a documented efficacy and safety profile, explicitly assessed in the elderly population, should be preferred.
Subject(s)
Behavior Therapy/methods , Cholinergic Antagonists/therapeutic use , Practice Guidelines as Topic , Quality Improvement/standards , Urinary Incontinence/diagnosis , Urinary Incontinence/therapy , Urology/standards , Aged, 80 and over , Female , Frail Elderly , Geriatric Assessment/methods , Germany , Humans , MaleABSTRACT
Anticholinergic agents are used for treatment of overactive bladder syndrome (OAB) by competitive blockade of acetylcholine at the muscarinic receptor. At present five different subtypes of M-receptors can be differentiated. Primary detrusor effects are mediated by M3-receptors as are side effects like dry mouth and constipation. Cardiac and central nervous system side effects appear to be M2 or M1 related. OAB symptom relief by the unselective drugs tolterodine, oxybutynin or trospium chloride and by M3-selective agents like darifenacin or solifenacin seems to be rather similar. Central side effects are different depending on gastrointestinal reabsorption, serum metabolism and penetration of the blood-brain barrier. Slow release formulations may be better tolerated. Anticholinergics that penetrate the blood-brain barrier may cause cognitive imbalance in older patients, as recent studies have shown for oxybutynin. Here M3-selective agents may offer an advantage.
Subject(s)
Anticholesteremic Agents/adverse effects , Anticholesteremic Agents/therapeutic use , Cognition Disorders/chemically induced , Muscarinic Antagonists/adverse effects , Muscarinic Antagonists/therapeutic use , Urinary Bladder, Overactive/drug therapy , Urinary Incontinence/drug therapy , Aged , Aged, 80 and over , Cognition Disorders/diagnosis , Female , Germany , Humans , Male , Middle Aged , Practice Guidelines as Topic , Practice Patterns, Physicians' , Risk Assessment , Risk Factors , Urinary Bladder, Overactive/prevention & control , Urinary Incontinence/prevention & controlABSTRACT
There has been accumulating evidence that PLG influence behavior in humans after peripheral administration. In a randomized double blind study with 10 healthy male subjects in each group, the effect of 25 mg PLG i.v. on writing regulation was investigated and computer evaluated. The writing pressure test was selected as a sensitive parameter to ascertain an effect of PLG on motor behavior. As compared to the placebo group, PLG effects an increase of writing time and a reduction of writing pressure. The results suggested an peptide effect on writing performance in healthy subjects.
