Annals of Long Term Care

Randomized, Placebo-Controlled Trial of the Cognitive Effect, Safety, and Tolerability of Oral Extended-Release Oxybutynin in Cognitively Impaired Nursing Home Residents with Urge Urinary Incontinence

Thomas E. Lackner, PharmD, Jean F. Wyman, PhD, Teresa C. McCarthy, MD, Melinda Monigold, MS, and Cynthia Davey, MS

OBJECTIVES: Determine the cognitive effect, safety, and tolerability of oral extended-release oxybutynin in cognitively impaired older nursing home residents with urge urinary incontinence.

DESIGN: Randomized, double-blinded, placebo-controlled trial.

SETTING: Twelve skilled nursing homes.

PARTICIPANTS: Fifty women aged 65 and older with urge incontinence and cognitive impairment.

INTERVENTION: Four-week treatment with once-daily oral extended-release oxybutynin 5 mg or placebo.

MEASUREMENTS: Withdrawal rates and delirium or change in cognition from baseline at 1, 3, 7, 14, 21, and 28 days after starting treatment using the Confusion Assessment Method (CAM), Mini-Mental State Examination (MMSE), and Severe Impairment Battery (SIB). The Brief Agitation Rating Scale, adverse events, falls incidence, and serum anticholinergic activity change with treatment were also assessed.

RESULTS: Participants’ mean age ±standard deviation was 88.6±6.2, and MMSE baseline score was 14.5±4.3. Ninety-six percent of subjects receiving oxybutynin (n=26) and 92% receiving placebo (n=24) completed treatment (P=.50). The differences in mean change in CAM score from baseline to all time points were equivalent between the oxybutynin and placebo groups. Delirium did not occur in either group. One participant receiving oxybutynin was withdrawn because of urinary retention, which resolved without treatment. Mild adverse events occurred in 38.5% of participants receiving oxybutynin and 37.5% receiving placebo (P=.94).

CONCLUSION: Short-term treatment using oral extended-release oxybutynin 5 mg once daily was safe and well tolerated, with no delirium, in older female nursing home participants with mild to severe dementia. Future research should investigate different dosages and long-term treatment. J Am Geriatr Soc 2008;56(5):862-870.

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Residual Urine as a Risk Factor for Lower Urinary Tract Infection: A 1-Year Follow-Up Study in Nursing Homes

Ragnhild Omli, RN, Liv H. Skotnes, RN, Arnstein Mykletun, PhD, August M. Bakke, MD, PhD, and Esther Kuhry, MD, PhD

OBJECTIVES: To determine whether postvoid urine is a risk factor for the development of lower urinary tract infections (UTIs) in nursing home residents.

DESIGN: Prospective surveillance with a follow-up period of 1 year.

SETTING: Six Norwegian nursing homes.

PARTICIPANTS: One hundred fifty nursing home residents.

METHODS: Postvoid residual (PVR) urine volumes were measured using a portable ultrasound. UTIs were registered prospectively for 1 year.

RESULTS: Ninety-eight residents (65.3%) had a PVR less than 100 mL, and 52 (34.7%) had a PVR of 100 mL or greater. During the follow-up period, 51 residents (34.0%) developed one or more UTIs. The prevalence of UTI in women was higher than in men (40.4% vs 19.6%; P=.02). There was no significant difference in mean PVR between residents who did and did not develop a UTI (79 vs 97 mL, P=.26). PVR of 100 mL or greater was not associated with greater risk of developing a UTI (P=.59).

CONCLUSION: High PVR is common in nursing home residents. No association between PVR and UTI was found. J Am Geriatr Soc 2008;56(5):871-874.

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PROGRESS IN GERIATRICS

Magnetic Resonance Imaging Characterization of Brain Structure and Function in Mild Cognitive Impairment: A Review

Michele L. Ries, PhD, Cynthia M. Carlsson, MD, Howard A. Rowley, MD, Mark A. Sager, MD, Carey E. Gleason, PhD, Sanjay Asthana, MD, and Sterling C.