O’Shea, Terrence

Objectives To determine the proportion of nursing home ( NH ) residents ( NHR ) with overactive bladder ( OAB ) or urinary incontinence ( UI ) with potential pharmacodynamic contraindications to antimuscarinic treatment because of concomitant anticholinergic medications or acetylcholinesterase inhibitors ( AC h EI s) and nonpharmacological limitations to antimuscarinic treatment. Design Cross‐sectional retrospective analysis. Setting U.S. skilled nursing facilities. Participants Nursing home residents with a diagnosis of OAB or UI . Measurements Linked and deidentified pharmacy claims and Minimum Data Set ( MDS ) 3.0 records (October 1, 2010 to September 30, 2012). Results Of NHR s, 71.3% received at least one anticholinergic medication. Medications that can cause or worsen UI were used commonly. AC h EI s and antimuscarinic treatment were prescribed concurrently in 24% of NHR s with OAB or UI . NHR s with OAB or UI were more likely to have concurrent moderate to severe cognitive impairment ( MSCI ) (70.1%) than those without (29.9%) ( P < .001). NHR s with or without OAB or UI and with MSCI were more likely to be treated with an anticholinergic medication than those without MSCI ( P = .001). When NHR s with MSCI , severe mobility impairment ( SMI ), and anticholinergic medication and AC h EI use were excluded, only a small proportion of NHR s were potential candidates for antimuscarinic treatment (6.6% with OAB or UI , 6.2% with UI ). Conclusions This study advances understanding of the challenges in prescribing antimuscarinic treatment safely and appropriately in elderly NHR s with a high prevalence of drug interactions, underlying MSCI , and SMI .