Are we prescribing medications responsibly to nonagenarians seeking urologic care?
Emily Chedrawe1, Anjali Maria Lobo2, Tarek Lawen2, Ashley R. Cox2.
1Faculty of Medicine, Dalhousie University, Halifax, NS, Canada; 2Department of Urology, Dalhousie University, Halifax, NS, Canada
Introduction: As life expectancy continues to increase, urologists will be expected to be more comfortable managing the oldest members of our population. In 2020 there were an estimated 323,069 nonagenarians in Canada. Our previous research in nonagenarians showed hematuria and lower urinary tract symptoms (LUTS), including urinary retention, was the reason for referral in 65.6% of patients. The purpose of this study is to evaluate the frequency of anticoagulation use and assess anticholinergic burden in this nonagenarian population.
Methods: We performed a retrospective chart review for nonagenarians referred to urology at Dalhousie University affiliated hospitals from 2009-2014. We specifically recorded their medication lists as well as medications prescribed at their visit. The anticholinergic burden for each patient was calculated using the Anticholinergic Cognitive Burden Scale (ACB).
Results: Data was collected for 154 nonagenarians referred to urology. Hematuria was the most common reason for referral (n=43, 27.9%). Of those referred for hematuria, 78.1% were on anticoagulation therapy. Urinary retention and LUTS was seen in 22 and 36 patients, respectively. Mild, moderate and severe ACB scores were seen in 76.6%, 9.33% and 14.0%, respectively, for the study population. Of those with urinary retention 21 out of 22 had low ACB scores. Those referred for LUTS had statistically significant higher ACB scores than the general population (1.44 ± 1.34 versus 0.96 ± 1.17, p=0.04). In total 4 patients were started on anticholinergic medications for management of LUTS.
Conclusions: Our study shows many nonagenarians referred with hematuria are on anticoagulation therapy. ACB does not appear to contribute to patients with urinary retention but is significantly higher in nonagenarians with LUTS. Review of medications in nonagenarian patients is essential to provide both urologic and overall health benefits.
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