Landi Francesco, Cesari Matteo, Russo Andrea, Onder Graziano, Sgadari Antonio, Bernabei Roberto
Department of Gerontology-Geriatrics and Physiatrics, Catholic University of Sacred Heart, Rome, Italy.
Clin Pharmacol Ther. 2002 Dec;72(6):729-34. doi: 10.1067/mcp.2002.129318.
Urinary incontinence is a common problem among older persons living in different community settings. The multifactorial origin of urinary incontinence has been largely addressed, and many previous studies have identified several reversible factors associated with incontinence. The aim of this study was to estimate the risk of urinary incontinence associated with the use of oxidative or nonoxidative benzodiazepines.
We analyzed data from a large collaborative observational study group, the Italian Silver Network Home Care project, which collected data on patients admitted to home care programs (N = 4583). A total of 22 home health agencies participated in the project, which evaluated the implementation of the Minimum Data Set for Home Care instrument. The main outcomes measure was the prevalence of urinary incontinence and the association with benzodiazepine use.
A total of 1475 individuals (21% of patients aged 60-74 years and 38% aged >or=75 years) reported urinary incontinence. Users of benzodiazepines had an increased risk of urinary incontinence of nearly 45% (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.12-1.83). The risk seemed to be of greater magnitude for exposure to oxidative agents (adjusted OR, 1.47; 95% CI, 1.09-1.99) than to nonoxidative benzodiazepines (adjusted OR, 1.35; 95% CI, 0.93-1.96). Among the oxidative benzodiazepines, the effect mainly resulted from agents with a long elimination half-life (adjusted OR, 1.75; 95% CI, 1.13-2.72).
The metabolic pathway of the benzodiazepines is a good predictor of urinary incontinence. In frail elderly patients, oxidative benzodiazepines are potentially more harmful than nonoxidative agents. Among oxidative benzodiazepines, the best ones seem to be those with a short elimination half-life.
尿失禁是生活在不同社区环境中的老年人的常见问题。尿失禁的多因素起源已得到很大程度的探讨，许多先前的研究已经确定了一些与尿失禁相关的可逆因素。本研究的目的是评估使用氧化型或非氧化型苯二氮䓬类药物与尿失禁相关的风险。
我们分析了来自一个大型协作观察研究组——意大利银色网络家庭护理项目的数据，该项目收集了接受家庭护理计划的患者的数据（N = 4583）。共有22家家庭健康机构参与了该项目，该项目评估了家庭护理工具最小数据集的实施情况。主要结局指标是尿失禁的患病率以及与苯二氮䓬类药物使用的关联。
共有1475人（60 - 74岁患者的21%，≥75岁患者的38%）报告有尿失禁。苯二氮䓬类药物使用者尿失禁风险增加近45%（优势比[OR]，1.44；95%置信区间[CI]，1.12 - 1.83）。暴露于氧化型药物的风险（调整后OR，1.47；95% CI，1.09 - 1.99）似乎比非氧化型苯二氮䓬类药物（调整后OR，1.35；95% CI，0.93 - 1.96）更大。在氧化型苯二氮䓬类药物中，这种影响主要源于消除半衰期长的药物（调整后OR，1.75；95% CI，1.13 - 2.72）。
苯二氮䓬类药物的代谢途径是尿失禁的良好预测指标。在体弱的老年患者中，氧化型苯二氮䓬类药物可能比非氧化型药物更有害。在氧化型苯二氮䓬类药物中，最佳选择似乎是那些消除半衰期短的药物。
