Bladder antimuscarinics use in veterans affairs community living centers

Abstract

Background: No recent study evaluated initiation and the magnitude of bladder antimuscarinics (BAM) use in the Veterans Affairs (VA) nursing homes, known as Community Living Centers (CLC). Objectives: To evaluate utilization and predictors of BAM initiation for urinary incontinence management in the VA CLC. Methods: The study employed multiple VA data sources (Minimum Data Set [MDS], inpatient, outpatient, and pharmacy administrative files). We assembled a retrospective cohort that included individuals 65 years and older admitted for long-term care (> 90 days) in any of the VA CLC between October 1, 2002 and September 30, 2009. BAM use included immediate- or extended- release products (oxybutynin chloride, tolterodine, darifenacin, solifenacin, trospium, hyoscyamine, dicyclomine, or flavoxate). Exposure to a BAM was identified from pharmacy data. Based on the BAM use prior to CLC admission and the first dispensing date after CLC admission, users were classified as incident, prevalent, or former users. We constructed a logistic regression model to identify patient characteristics predicting BAM initiation compared to non-use. Results: BAMs were used by 9.8% of the residents 65 years and older admitted for long-term care; 44% (1,195) were new users. All but 53 received nonselective immediate release preparations, predominantly oxybutynin chloride (75%). For new users, mean BAM use was161.48 days (median = 49 days). Predictors of BAM initiation included demographic characteristics, bladder and bowel continence status, comorbidities, other medication use, cognitive performance and functional status. Women (odds ratio [OR] = 2.11; 95% CI: 1.54-2.88) and those with an indwelling catheter (OR = 3; 95% CI: 2.55-3.54) were more likely to start BAM treatment. Cognitive impairment (OR = 0.71; 95% CI: 0.53-0.95) and limited mobility (OR = 0.98; 95% CI: 0.97-0.99) decreased the odds of BAM initiation. New-users had less comorbidity burden, but used more medications and had a higher anticholinergic load. Conclusions: Our results suggest treatment selection based on overall health status or patient tolerability (fewer adverse effects with previous medication could increase the chance of getting a new drug).