R E V I E W Choice of antimuscarinic agents for overactive bladder in the older patient: focus on darifenacin Bilal Chughtai1 Robert Levin2 Elise De1 1Albany Medical College, Division of Urology; 2Albany College of Pharmacy and Stratton VAMC, Albany, NY, USA Correspondence: Robert M Levin Albany College of Pharmacy, 106 New Scotland Ave, Albany, NY 12208, USA Tel +1 518 694 7306 Email levinr@acp.edu Abstract: Overactive bladder (OAB) is a difﬁcult condition to live with and is very costly to the community. OAB affects 16% of the adult population and rises with increasing age. We describe the necessary steps in evaluation and behavioral therapy prior to initiating medical therapy. There are several medications that have been used for the treatment of patients who suffer from OAB. This manuscript discusses the popular agents used for OAB, with a focus on the recent clinical trials on darifenacin. Keywords: darifenacin, overactive bladder, urge incontinence, older patients, aging Introduction Overactive bladder (OAB) is a problem characterized by urgency; a sudden desire to urinate that cannot be postponed. According to the International Continence Soci- ety (ICS) “urgency, with or without urge incontinence, usually with frequency and nocturia, can be described as the overactive bladder syndrome, urge syndrome, or urgency-frequency syndrome. These terms can be used if there is no proven infection or obvious pathology.”(Wein and Rovner 2002). It can be associated with frequency and nocturia, and it may occur with urinary incontinence. OAB affects approximately 16% of the adult population in the US and the prevalence increases with age (Wein and Rovner 2002; Beneton and De Parisot 2003). OAB costs an estimated US$12 billion annually in the US, with US$9 billion incurred in the community (Basra and Kelleber 2007). The estimate includes both the direct costs of care, protective undergarments, and treatment as well as consequential costs, such as those resulting from urinary tract infections and falls due to urgency to get to the bathroom. There are intangible costs such as pain, suffering, and poor quality of life. The negative impacts on health, the ability to function, and quality of life have been well-documented. The elderly with OAB and subsequent incontinence are more likely to be admitted to nursing homes. Thom et al (1997) found at least a 2-fold increase in risk of admission to a nursing facility for patients with incontinence. Urinary incontinence can lead to anxiety, negative self-image, and isolation (Basra and Kelleber 2007). OAB places individuals at risk for other forms of morbidity. Problems associated with OAB include skin ulceration and urinary tract infections. Nocturia, waking up more than one time per night to void, is common with OAB and is among the most bothersome of lower urinary tract symptoms (Ohelke 2005). In addition to sleep interruption and resulting fatigue, patients with nocturia may be more likely to suffer from falls and fractures, which are associated with high morbidity in elderly patients (33% of patients do not survive beyond 1 year after a hip fracture) (Reeves et al 2006). The immediate consequences and co-morbidities of OAB can have a negative inﬂu- ence on quality of life, particularly among the elderly. The effect of OAB becomes Clinical Interventions in Aging 2008:3(3) 503–509 © 2008 Dove Medical Press Limited. All rights reserved 503