Alicia Ault

June 08, 2015

NEW ORLEANS — Treating overactive bladder might help reduce the risk for falls in older patients, according to an analysis of Medicare claims presented here at the American Urological Association 2015 Annual Meeting.

We found a signal that treatment might curb the risk for falls, but were unable to draw a firm conclusion, in part because of the limitations of the data, said Ravishankar Jayadevappa, PhD, from the University of Pennsylvania in Philadelphia.

"We don't have that functional status variable. That is very crucial," Dr Jayadevappa told Medscape Medical News. He said he has requested more data from Medicare to help get at the issue.

Levels of mobility, cognition, and the ability to perform activities of daily living are important clues when untangling whether treatment for overactive bladder positively or negatively affects the risk for falls, said Tomas Griebling, MD, from the University of Kansas School of Medicine in Kansas City, who moderated the news conference during which the data were presented.

A recent data brief from the National Center for Health Statistics at the Centers for Disease Control and Prevention reported that in 2012/13, there were 90,640 deaths from unintentional injuries in people 65 years or older, and 55% of these deaths were related to falls.

From 2000 to 2013, the age-adjusted rate of fall injury deaths doubled, from 29.6 to 56.7 per 100,000 people.

More Falls

In their study, Dr Jayadevappa and his colleagues looked at Medicare claims from 2006 to 2009 for beneficiaries 66 years and older with ICD-9 codes for overactive bladder diagnosis, treatment other than behavioral interventions, and falls. These patients represented about 5% of all claims.

Of the 18,157 patients with overactive bladder who were 66 years and older, only 2425 received any treatment; the vast majority — 15,732 — received no help at all.

The researchers compared patients with and without overactive bladder. In the overactive bladder group, there was a balance between the sexes; in the group without overactive bladder, 62% of the patients were women.

The breakdown of Charlson Comorbidity Index scores was similar in the two groups; three-quarters of the patients had a score of 0 and about 20% had a score of 1 or 2.

When the researchers looked at falls in the previous year, the rate was higher in the overactive bladder group than in the group without overactive bladder (3.7% vs 2.4%).

Patients with overactive bladder had a higher unadjusted risk of falls (OR, 1.44). After adjustment, the risk was still 1.3. The two most significant risk factors for a fall were experiencing a previous fall (OR, 1.7) and having an overactive bladder.

When patients with overactive bladder received treatment, it appeared to lower their risk of falls, but not significantly; the odds ratio ranged from 0.96 to 0.98 in several different statistical models.

This suggests that bladder treatment neither increases nor decreases fall risk, but "there is a signal" that it can help reduce falls, said Dr Jayadevappa.

Dr Griebling said he is "impressed with the odds ratio that showed" that having overactive bladder alone increases fall risk. "Really, the only thing that was more predictive was previous falls," he added.

The researchers also found that there was a higher prevalence of falls in patients older than 84 years and a higher rate in patients who had received treatment. Even so, a substantially smaller portion of patients 84 years and older is treated, said Dr Jayadevappa.

"Overactive bladder is an important clinical aspect that should be taken seriously and should be screened for," in older patients in particular, he concluded.

Underevaluated and Undertreated

This study is important "because it broadens what we're looking at," said Dr Griebling. Previous studies linking incontinence to fall risk have focused on nocturnal enuresis, whereas this looks at overactive bladder, which may or may not include incontinence.

Overactive bladder "is certainly underevaluated and undertreated," he said, noting that many older people might not seek treatment because they think it's normal or because there is a lot of stigma associated with the condition.

"It's a common myth among the lay public, and unfortunately among providers as well, that it's a normal part of aging, and that's not true," he added.

Dr Jayadevappa has disclosed no relevant financial relationships. Dr Griebling reports that he is involved in studies with the Donald W. Reynolds Foundation, Medtronic, the National Institute on Aging, and Pfizer.

American Urological Association (AUA) 2015 Annual Meeting: Abstract PD24-09. Presented May 17, 2015.


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