During Medication Counseling for Elderly Patients, Review for Drug-Induced Causes of Urinary Incontinence
Elderly patients with urinary incontinence may experience not only embarrassment but also even more severe health consequences. This condition can lead to bladder damage or infection, and it hinders social interaction and physical activity—two of the most fundamental components for ensuring a higher quality of life. Then there’s this shocker: urinary incontinence raises the risk for entering a long-term care facility.
Pharmacist intervention is truly critical for these patients. There’s a good chance elderly patients are taking multiple medications that are known causes of urinary incontinence, so they depend on your expertise to give them a heads up. And at least half of them don’t consult a doctor for their incontinence, which means you may be the only health professional who can help.
Overview of Patients Pharmacists Will Encounter
It’s hard to estimate exactly how many patients with the condition pharmacists may encounter because urinary incontinence is underreported. One thing is certain—the number of people visiting your pharmacy for help with this condition is larger than you might anticipate. The estimated prevalence is already high and it’s on an upward trend that will continue as baby boomers get older:
- Prevalence is 2.9 percent of adults aged 55 to 64 years.1
- Age-adjusted prevalence in 2008 was 51 percent of women and nearly 14 percent of men, based on data from adults aged 20 years and older who participated in the National Health and Nutrition Examination Survey.2
- In women, prevalence is only 7 percent in those aged 20 to 39 years, but increasing to 23 percent in 60 to 79-year-olds and 32 percent in women older than 80 years.
Here’s additional information to give you a better picture of the patients you’re likely to counsel:
- Age is the largest risk factor.
- Women have double the risk compared to men.
- 50 to 70 percent of women do not seek medical evaluation and treatment.
- Patients live with the condition for 6 to 9 years before seeking medical attention.
You may not think of urinary incontinence as potentially life-altering, but it is—it’s one of the biggest risk factors for placement in a long-term care facility. This is primarily due to the added burden it places on caregivers. Their ability to manage activities of daily living accurately predicts institutionalization, according to a study in the Journal of Aging Research in August 2015.3
Screen for Medications that Can Cause Urinary Incontinence
The urinary tract is normally susceptible to adverse effects from drugs excreted in the urine, but the extra load caused by polypharmacy in elderly adults makes them especially vulnerable to drug-related urinary problems. As a result, it’s essential for pharmacists to counsel patients when they fill prescriptions for medications that can cause urinary incontinence. A variety of medications disrupt normal urinary function through different mechanisms, with some affecting nerves and receptors, while others interfere with muscles:
- Alpha-adrenergic antagonists – Alpha-adrenoceptors affect muscles in the lower urinary tract and mediate nerve transmission to the bladder and urethral sphincter. Blocking these receptors reduces bladder outlet resistance and leads to incontinence.4
- Alpha-adrenergic agonists – Cause urine retention in the bladder, resulting in involuntary leakage.
- Antidepressants – It’s estimated that 13 percent of elderly patients take antidepressants.5 While different classes may affect the urinary tract, tricyclic antidepressants can interfere with bladder contraction and cause overflow incontinence.
- Antipsychotics – May cause a sudden urge to urinate and uncontrollable loss of urine. Incontinence may appear shortly after initiating therapy or take weeks to develop. The diverse actions of antipsychotics may impact the urinary tract through cholinergic action or alpha-adrenergic and dopamine blockage.
- Sedatives, muscle relaxants, and narcotics – Relax bladder muscles, leading to urine retention and overflow incontinence. They can also cause urinary accidents through drowsiness or limited mobility.
- Calcium channel blockers – Like sedatives, calcium channel blockers decrease muscle contractility in the bladder, causing retention and overflow incontinence.
- ACE inhibitors and angiotensin receptor blockers – Through their effect on the renin-angiotensin system, these medications cause stress urinary incontinence. They sometimes cause a dry cough that also increases the risk of stress incontinence.
- Estrogen – A study published Journal of the American Geriatrics Society in September 2010 reported that using oral and transdermal estrogen increased the risk of urinary incontinence by 45 to 60 percent in community-dwelling elderly women.6
- Diuretics – It makes sense that diuretics may cause urgency and subsequent incontinence, but the prescribing physician should educate the patient about steps to avoid incontinence, such as Kegel exercises to strengthen pelvic floor muscles and regular voiding. Loop diuretics may double the risk when they’re taken together with an alpha-blocker.
- Antihistamines – Interfere with nerve signals to the bladder, which inhibits muscle contraction and leads to overflow incontinence.
- Hydroxychloroquine – In 2013, the Journal of Clinical Pharmacy and Therapeutics reported the first case of hydroxychloroquine-caused incontinence in an elderly woman.7 However, this effect is considered rare and the condition resolved when the medication was discontinued.
Pharmacist Outreach Improves Quality of Life for Elderly
When you motivate an elderly patient to get a diagnosis and proper treatment for urinary incontinence, you improve their overall health along with their quality of life. Untreated incontinence puts them at risk for developing urinary tract infections, bladder damage, and kidney damage. Patients may also have an underlying problem that needs treatment, such as an under- or over-active bladder. And don’t forget about the extreme value of treating a condition that may lead to institutionalization.
Urinary incontinence is difficult for many seniors to talk about, but pharmacists have the advantage of using medication reviews to open the topic. You could also print out a flyer that gives an overview of the condition and offers a free consultation, then ask the clerk at the checkout to discreetly hand it to elderly customers who buy incontinence products. No matter how you approach it, remember that you may be the only reason they decide to see a doctor rather than wait six or more years.
Pharmaceutica North America supports your patients by providing prescription drug products, unit-dose and bulk active pharmaceutical ingredients and OTC supplements. Contact us today to talk about how we can help with your pharmaceutical needs.
- “Urinary Incontinence,” October 2015, http://emedicine.medscape.com/article/452289-overview ↩
- “Prevalence and Trends of Urinary Incontinence in Adults in the United States, 2001 to 2008,” August 2011, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197263/ ↩
- “Which Part of a Short, Global Risk Assessment, the Risk Instrument for Screening in the Community, Predicts Adverse Healthcare Outcomes?” August 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4540996/ ↩
- “Drug-Induced Urinary Incontinence,” August 2014, https://www.uspharmacist.com/article/druginduced-urinary-incontinence ↩
- “Medication Use in the Older Population,” accessed October 2016, http://www.nhtsa.gov/people/injury/olddrive/DrugUse_OlderDriver/pages/med_use.htm ↩
- “The Impact of Medication Use on Urinary Incontinence in Community Dwelling Elderly Women,” September 2010, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2945433/ ↩
- “A Case of Urinary Incontinence by Hydroxychloroquine in a Geriatric Patient,” April 2013, https://www.ncbi.nlm.nih.gov/pubmed/23194101 ↩