Re: Prevalence of commonly prescribed medications potentially contributing to urinary symptoms in a cohort of older patients seeking care for incontinence: Editorial comment

摘要

Urinary incontinence (UI) can be caused by a wide variety of factors, including anatomical and physiological alterations. Among the most common potential etiological factors, particularly in older adults, are medications that can induce or worsen UI. This cross-sectional study examined 390 new patients 60 years or older presenting to specialty clinics for evaluation and treatment of UI. Identification of drugs potentially associated with UI was done through detailed review of medication records for each patient. The overall prevalence of medications potentially linked to UI was 60.5%. A wide variety of medications were identified among a number of different drug classes. Interestingly only polypharmacy was identified as a statistically significant contributor to UI in this particular cohort, and the effect was substantial (OR 4.9, 95% CI 3.1-7.9). Anecdotal evidence suggests that discontinuing medications that could promote UI might lead to a reduction in symptoms. This study was not designed to examine this effect, but it begs the question of whether de-prescribing of medications or substituting drugs with less likelihood of causing UI might lead to improved urinary symptoms in older adults. The findings highlight the importance of considering possible polypharmacy in elderly patients, and identifying medications that could be contributing to symptoms. They also indicate the importance of identifying UI as a potential side effect of medications, which can help to reduce the "prescribing cascade," a syndrome where a new drug is added to treat what is essentially a side effect of other medications, leading to increased polypharmacy.