Popular treatments for lower urinary symptoms may be doing more harm than good

A new study published in Age & Ageing, the scientific journal of the British Geriatrics Society, has revealed that many of the drugs commonly prescribed for older people with lower urinary tract symptoms may be doing more harm than good, and should either be used with caution or avoided altogether.

Researchers from the University of Heidelberg and an international rater team analysed data from 25 different clinical trials and other available evidence. Of the 16 drugs included in the study, only three were classified as beneficial for older people.

The majority were rated as questionable, meaning they should be avoided where possible, especially when patients are receiving other drugs at the same time. Five drugs were rated as “avoid”, with the authors recommending that they should not be used for older patients at all.

Drugs for the treatment of lower urinary tract symptoms rank amongst the most frequently prescribed medications for older people, and yet this new research is the first systematic comparative study looking at their appropriateness for older patients.

Speaking on behalf of the British Geriatrics Society, Professor Adam Gordon said:

“Lower urinary tract symptoms are common in older patients and can be a source of considerable distress. There is increasing recognition that many of the drugs prescribed for lower urinary tract symptoms may have harmful side-effects, particularly related to memory and thinking. 

Against that background, this study is a timely reminder that there is limited evidence of benefit in older patients for many drugs used. This has a number of implications. 

Firstly, drugs should only be used where non-drug treatments have been shown not to work. Secondly, they should be used with careful attention as to what side-effects they may be causing. Thirdly, more research is required to understand what combination of medications will achieve the best outcomes in older patients with lower urinary tract symptoms.”

Martin Wehling, corresponding author of the study said:

“The FORTA (Fit fOR The Aged) system – a simple approach to label drugs to be used in older people from A (indispensable), B (beneficial), C (questionable) to D (avoid) – was applied here to separate beneficial from less favourable drugs.

It is meant to provide guidance at a glance to improve often complex medication schemes which are all too common and carry considerable risk in this important age group. The respective FORTA list classifies drugs to treat major indications, with a new chapter on those used for lower urinary tract symptoms now added.”

Inappropriate drug use among older persons: is it time for action?

Andreas Schoenenberger works with the Division of Geriatrics, Department of General Internal Medicine at Bern University Hospital, and with the University of Bern, Switzerland. Here he describes his recent editorial in Age and Ageing journal, written with Andreas Stuck.

Despite recent efforts to improve drug management for older people, we have not yet arrived at an optimal strategy for reducing inappropriate drug use. Drugs are considered inappropriate, if the risk outweighs the potential benefit of the drug. Along with pathophysiological changes during the ageing process, and the increasing number of co-morbidities/-medications, the potential risks of drugs increase with age and adverse drug reactions (ADRs) are encountered more frequently in older persons.

Microneedles: the next step in transdermal drug delivery?

Helen Quinn is a pharmacist and PhD student at Queen’s University Belfast.

Pharmaceutical research in a laboratory and clinical practice may sometimes feel like worlds apart but it is my belief that the best informants of research are those who are actually involved in caring for the patient.  This should be the principal motivation behind any research. My PhD project is based on the use of microneedles, an innovative form of transdermal drug delivery, which is rapidly gathering pace towards commercialisation. In an industry traditionally focussed on the discovery of new drugs, a new method for delivery of medication is long awaited to challenge the accepted routes of oral and parenteral delivery, which although suitable for the majority, are not without their drawbacks, particularly in the geriatric patient.

Medicines management of polypharmacy – Making it Safe and Sound

Stephen Jackson is Professor of Clinical Gerontology at King’s Health Partners

This is a recent King’s Fund Report which takes another look at polypharmacy. It is unclear why as there has been a rather better report published by NHS Scotland. One would assume the King’s fund would check who is doing what before commissioning such a report. Interestingly there is no mention of the G (geriatrician) word anywhere in the report although the terms “older care clinician”, “clinicians who specialise in care of older people” and orthogeriatrician do appear. I thought there was insufficient recognition of the fact that multiple pathology and hence polypharmacy is essentially a problem associated with ageing.  The authors rightly differentiate between appropriate polypharmacy and what they call problematic polypharmacy known to many as inappropriate polypharmacy. Polypharmacy merely means “many medicines” as opposed to “too many medicines”.  The report could be criticised for giving the impression that appropriate prescribing is only necessary when polypharmacy is present.

Which drugs to stop in which older patients?

Tischa van der Cammen is a Consultant Geriatrician and Carolyn Sterkeis a public health researcher. Both are based at the Erasmus University Medical Center in Rotterdam, Netherlands and have recently published a paper in Age and Ageing journal.

Drug treatment has brought many benefits for older patients. For example, the treatment of hypertension in patients aged over 80 led to a major reduction in stroke and mortality, as was shown in the HYVET study.

As people age, diseases may accumulate, and hence older patients usually are prescribed several drugs at the same time. It is ‘rule rather than exception’ that patients above age 75 use 4 or more drugs, this is called polypharmacy. There are a variety of definitions for polypharmacy – in the UK it is generally 4 or more prescribed medicines – as specified by Department of health and Rollason.

Inappropriate poly-pharmacy in older patients may lead to negative health impacts

Improving compliance through dosing aids

Dr Henk-Frans Kwint is A Care Community Pharmacist at Stevenshof Pharmacy affiliated with the SIR Institute for Pharmacy Practice and Policy.

A recent Dutch study on older patients receiving their drugs via a sophisticated dosing aid, called multidose drug dispensing, has shown a higher self-reported medication adherence compared to patients receiving manually-dispensed drugs, despite a lower knowledge and lower cognitive function among patients receiving these dosing aids. The research is published in Age and Ageing.

Vitamin D and bone health: A practical clinical guideline for patient management – National Osteoporosis Society Guideline

Dr Terence Ong is a Research Fellow at Nottingham University Hospitals NHS Trust.

Professor Opinder Sahota is Professor of Orthogeriatric Medicine and Consultant Physician at Nottingham University Hospitals NHS Trust

image by epSos.de

Vitamin D is not, in the truest sense, a vitamin because it is not exclusively obtained through diet alone. It is a secosteroid, mostly obtained intrinsically by the effect of ultraviolet radiation on previtamin D compounds and subsequent hydroxylation in the liver and kidneys.

Vitamin D plays an important role in calcium and phosphate homeostasis through its effect on gut and bone metabolism. Besides that, it also plays a key role in muscle function. In recent years, our understanding of vitamin D has expanded and we are starting to appreciate its much broader role in areas such as the immune system, cancer and cardiovascular disease.