Frailty is an important predictor of poor medical and surgical outcomes among older individuals, however, the impact of frailty on second- and third-line treatments for overactive bladder (OAB) in frail older adults remains unknown.  The purpose of this study is to examine the effect of frailty on treatment outcomes in older adults starting pharmacotherapy, onabotulinumtoximA and sacral neuromodulation.

This is a prospective study of men and women ages 60 years or older starting pharmacotherapy, onabotulinumtoxinA or sacral neuromodulation for OAB.  Subjects were administered a questionnaire at baseline and again at 1- and 3-months.  Frailty was assessed at baseline using the timed up and go (TUG) test (whereby a TUG time of >/=12 seconds was considered to be slow, or frail).  Response to treatment was assessed using the overactive bladder symptom score (OABSS) and the OAB-q SF (both bother and HRQOL subscales).  Information on side effects/adverse events was also collected.  Mixed effects linear modeling was used to model changes in outcomes over time both within and between groups.

A total of 45 subjects (22 pharmacotherapy; 12 onabotulinumtoxinA; 11 sacral neuromodulation) enrolled in the study, 40% (N=18) of whom had a TUG >/=12 seconds.  There were no differences in responses to baseline OAB questionnaires between TUG groups (all p-values >0.05).  Both TUG groups demonstrated improvement in OAB symptoms over time and there were no statistically significant differences in these responses per group (all p-values >0.05) (Figure).  Similar trends were found for both OAB-q Bother and OAB-q HRQOL questionnaire responses.  Side effects and adverse events were comparable between groups (p’s>0.05).

Adults >/=60 years of age starting second- and third-line treatments for OAB, regardless of TUG time, demonstrated improvement in OAB symptoms at 3 months.

These findings suggest that frail older adults receive comparable benefit and similar rates of side effects compared to less frail individuals, supporting the use of second- and third-line OAB treatments in properly selected older adults.