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

aaA 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.”