Overactive Bladder Pharmacotherapy and Long‐Term Care Needs, Dementia, and Frailty in Older Women
Kana Ito, Yoko Sato, Nagato Kuriyama, Yoshihiro TanakaABSTRACT
Objectives
To examine the associations of anticholinergic agents and β3‐adrenergic receptor agonists (β3‐agonists) prescribed for overactive bladder (OAB) with worsening long‐term care needs, incident dementia, and frailty among older women.
Subjects/Patients and Methods
This retrospective cohort study used the Shizuoka Kokuho Database, a population‐based administrative claims database in Japan. Women aged 65–84 years who newly initiated anticholinergic agents or β3‐agonists for OAB between 2012 and 2024 and had prescription records consistent with continuous treatment for at least 1 year were included. Follow‐up began 12 months after treatment initiation. Stabilized inverse probability of treatment weighting (sIPTW) was used to balance baseline covariates between groups. Primary outcomes were worsening long‐term care needs and incident dementia; the secondary outcome was changes in the electronic Frailty Index (eFI). Time‐to‐event outcomes were analyzed using sIPTW‐weighted Cox proportional hazards models.
Results
The cohort comprised 1 605 anticholinergic and 2 189 β3‐agonist users. After sIPTW, baseline covariates were well‐balanced. No significant difference was observed in worsening long‐term care needs (hazard ratio [HR], 1.03; 95% confidence interval [CI], 0.87–1.22). Anticholinergic use was associated with a higher risk of claims‐defined incident dementia compared with β3‐agonist use (HR, 1.49; 95% CI, 1.04–2.13). Median eFI did not differ significantly between the groups during 5 years of follow‐up.
Conclusion
Among older women with OAB, anticholinergic use was associated with an increased risk of claims‐defined incident dementia but not with worsening long‐term care needs or frailty compared with β3‐agonists. Residual confounding and differential dementia ascertainment cannot be excluded.