Research round-up on geriatric care in Urogynecology

Published: 11^th April 2022

Method: a prospective study of 165 women undergoing prolapse surgery aged >60 within a large academic center. The primary outcome measure was a positive Confusion Assessment Method delirium screen administered in person or by telephone at the time of hospital discharge and postoperative days 1, 3, 5, and 7.

The incidence of positive delirium screening during the first week after surgery was 12.1% (n=20). Most participants screened positive on postoperative day 0, 8.4% (n=14). In univariate analyses, a positive screen was associated with older age and fewer education years, lower 3MS exam score, greater baseline geriatric depression scale score, and more excellent frailty score.

Conclusions: One in 12 women ≥60 years deemed eligible for discharge on the day of prolapse surgery screens positive for delirium. The 7-day POD incidence is comparable to other elective non-cardiac surgery cohorts. Given the increasing trend toward same-day discharge after major prolapse surgery, more research is needed to determine the impact of universal delirium screening as part of discharge assessments.

Postoperative delirium in older patients after undergoing pelvic organ prolapse surgery Mary F. Ackenbom1,2,3 · Halina M. Zyczynski1,2,3 · Meryl A. Butters4 · Samia Lopa1,3 · Steven R. Orris3,5 · Esa M. Davis

https://doi.org/10.1007/s00192-022-05170-0

Cognitive changes in women starting anticholinergic medications for overactive bladder: a prospective study.

Published: 7^th December 2019

Method: This was a prospective cohort study to assess cognitive changes in women 12 months after starting anticholinergic medication for overactive bladder symptoms (OAB).

The study compared women who started anticholinergic OAB medications with women not on anticholinergic OAB medications. The primary outcome was a change over time in the Montreal Cognitive Assessment (MOCA) screening score. At enrolment, women completed a baseline MOCA screening, a Geriatric Depression Screen (GDS), and an assessment of medications to create an anticholinergic burden score (ACB). At 3, 6, 9, and 12 months after enrolment, women were administered the MOCA, GDS, and a review of their medications and medical problems. Statistical analysis was performed using a linear mixed effects model, considering correlated error terms given multiple MOCA assessments at various time points per patient.

Results: The study included 106 patients—60 in the OAB medication group and 46 In the control group. The mean age was 77 years, 93% of women were Caucasian, and 98% completed high school, with no difference between groups. Over time there was no difference in change of MOCA score between the OAB and control groups when controlling for age, GDS score, and ACB score (p = 0.78). This association did not change when women with a neurological diagnosis were excluded (n = 6). On average, MOCA scores for the OAB group increased by 0.76 over 12 months, and the control group increased by 0.39, with no difference between the groups (p = 0.53).

Conclusion: The study found no changes in MOCA scores between OAB medication and control groups after controlling for age, depression, and polypharmacy after 12 months of follow-up.

Shilpa Iyer1 & Svjetlana Lozo2 & Carolyn Botros3 & Chi Wang4 & Alexandra Warren5 & Peter Sand2 & Janet Tomezsko6 & Sylvia Botros7 & Adam Gafni-Kane2 & Karen Sasso2 & Roger P. Goldberg

https://doi.org/10.1007/s00192-019-04140-3

Effect of mirabegron on cognitive function in elderly patients with overactive bladder: MoCA results from a phase 4 randomized, placebo-controlled study (PILLAR)

Published: March 2020

Methods: This was a Randomized-controlled placebo study. This pre-planned analysis aimed to measure differences in cognitive function between mirabegron and placebo, using a rapid screening instrument for mild cognitive impairment: the Montreal Cognitive Assessment (MoCA). Outpatients aged ≥65 years with wet OAB were randomized 1:1 to mirabegron or placebo, stratified by age. There were no exclusion criteria regarding cognitive. Patients randomized to Mirabegron received 25mg/ day with an optional increase to 50 mg/ day after weeks 4-8. The MoCA was completed at the baseline line and the end of treatment (12 weeks).

Results: Of the 887 randomized patients who received ≥1 dose of the study drug, 72.3% were female, 79.5% were white, and 28.1% were aged ≥75. All patients had ≥1 comorbidity, and 94.3% were receiving ≥1 concomitant medication. One-third of patients had a history of psychiatric disorders, the most common being depression (17.2%), insomnia (15.7%), and anxiety (11.4%). Baseline mean (standard error, SE) MoCA total scores were 26.9 (0.1) and 26.8 (0.1) in the mirabegron and placebo groups, respectively. Among patients with MoCA data available at baseline/ EoT, 27.1% (115/425) and 25.8% (106/411) of mirabegron and placebo group patients, respectively, had impaired cognitive function at baseline (MoCA total score

Conclusions: Treatment with mirabegron for 12 weeks did not contribute to drug-related cognitive side effects in patients aged ≥65 years, as measured by the MoCA. Furthermore, the pattern of change in cognition over time in an older OAB trial population does not appear to differ from that of subjects receiving a placebo.

https://doi.org/10.1186/s12877-020-1474-7

Pelvic Organ Prolapse Surgery in the Elderly and Frail: Safety of a Reconstructive Versus Obliterative Approach

Published: September 2021

Method: This was a retrospective cohort study. Characteristics and perioperative complications were compared in patients aged 80 and older who underwent obliterative versus reconstructive surgery. Multivariate logistic regression and propensity score matching were used to control for confounding. A sub-analysis was performed that included patients who were considered frail as defined by the National Surgical Quality Improvement Program Modified Frailty Index 5.

Results: 1654 patients were included in the study. Reconstructive surgery was performed in 56.9% of patients, and Obliterative surgery was performed in 43.1%. The respective composite complication rates were 9.2% and 9.8% (P = 0.69), whereas severe complications were experienced by 1.9% in the reconstructive group versus 0.8% in the obliterative group (P = 0.07). On multivariate logistic regression, reconstructive surgery was not significantly associated with the composite complication rate (adjusted odds ratio, 1.0; 95% confidence interval, 0.7–1.4; P = 0.80). After propensity score matching, composite complications did not differ between groups, but the rate of severe complications was significantly higher in patients who underwent reconstructive surgery compared with obliterative surgery (2.1% vs 0.8%; odds ratio, 2.53; 95% confidence interval, 1.01–6.36; P = 0.05). In frail patients only, complication rates did not differ between groups.

Conclusions: In patients 80 years or older, the overall rate of complications did not differ between those who underwent reconstructive surgery versus obliterative surgery. However, propensity score matching identified an increased risk of the most severe complications in patients who underwent reconstructive surgery.

DOI: 10.1097/SPV.0000000000001029