OAB Medication in Elderly — RACP Adult Medicine MCQ

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EasyGeriatric MedicineOAB Medication in ElderlyRACP Adult Medicine

A 78-year-old man is admitted with a hip fracture. He takes 8 regular medications. A pharmacist conducts a medication review and identifies that oxybutynin (anticholinergic for OAB) is contributing to his confusion and falls. What is the recommended alternative for overactive bladder in elderly patients?

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Correct answer: C — Mirabegron (beta-3 agonist)

Mirabegron is a beta-3 adrenergic receptor agonist that relaxes the detrusor muscle WITHOUT anticholinergic activity. It is the preferred pharmacological agent for OAB in elderly patients because it avoids the anticholinergic side effects (cognitive impairment, falls, constipation, dry mouth, urinary retention, delirium) that make traditional OAB medications (oxybutynin, tolterodine, solifenacin, darifenacin) potentially harmful in older adults. All anticholinergic OAB medications are on the Beers Criteria list. Non-pharmacological approaches (bladder training, pelvic floor exercises) should always be tried first.

Reference: Beers Criteria – 2023 – AGS; AMH – 2025 – Urological Medications