{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T06:01:54Z","timestamp":1780034514886,"version":"3.53.1"},"reference-count":59,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T00:00:00Z","timestamp":1773532800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T00:00:00Z","timestamp":1773532800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Prescribing cascades occur when cholinesterase inhibitor (ChEI)\u2010induced urinary incontinence is misinterpreted as a new condition, leading to overactive bladder (OAB) antimuscarinic initiation. We evaluated whether the ChEI\u2010OAB antimuscarinic prescribing cascade was associated with delirium or falls compared with mirabegron in older adults living with dementia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using the Anlitiks All\u2010Payor Claims database (2015\u20132020). Participants were adults aged \u2265\u200965\u2009years with dementia newly prescribed a ChEI with no prior ChEI or OAB therapy (180\u2009days). A 60\u2010day window identified OAB treatment initiation after ChEI therapy. Exposures were OAB antimuscarinics or mirabegron. Outcomes were incident delirium and falls identified using diagnosis codes. Propensity score\u2010based weighting balanced baseline characteristics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 2693 patients (mean age 80\u2009years; 66.3% female), 201 (7.5%) initiated antimuscarinics and 2492 (92.5%) started mirabegron. Over 1\u2009year, 8 (4.0%) antimuscarinic users developed delirium versus 95 (3.8%) mirabegron users (adjusted HR 1.35; 95% CI, 0.64\u20132.86). Falls occurred in 3 (1.5%) antimuscarinic users and 63 (2.5%) mirabegron users (adjusted HR 0.66; 95% CI, 0.20\u20132.15).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In older adults living with dementia, the estimated association between initiation of OAB antimuscarinics following ChEIs and the risks of delirium or falls, compared with mirabegron, was statistically compatible with benefit, harm, or no clinically meaningful difference. These findings highlight the need to evaluate whether OAB antimuscarinics are prescribed in response to true clinical need or as part of a prescribing cascade. Given the limited number of outcome events and resulting wide 95% CIs, future studies are needed to more precisely estimate the risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70386","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T03:08:12Z","timestamp":1773630492000},"page":"1314-1325","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Cholinesterase Inhibitor\u2010Overactive Bladder Antimuscarinic Prescribing Cascade and Risk of Delirium and Falls Among Individuals Living With Dementia"],"prefix":"10.1111","volume":"74","author":[{"given":"Sarah Beth","family":"Tucker","sequence":"first","affiliation":[{"name":"Department of Clinical Pharmacy and Outcomes Sciences University of South Carolina  Columbia South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan L.","family":"Love","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy and Outcomes Sciences University of South Carolina  Columbia South Carolina USA"},{"name":"Center for Outcomes Research and Evaluation, University of South Carolina College of Pharmacy  Columbia South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0789-0942","authenticated-orcid":false,"given":"Chijioke M.","family":"Okeke","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Health Outcomes and Policy College of Pharmacy, University of Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7174-198X","authenticated-orcid":false,"given":"Erin D.","family":"Zwick","sequence":"additional","affiliation":[{"name":"Anlitiks Inc.  Windermere Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengwen","family":"Teng","sequence":"additional","affiliation":[{"name":"Department of Clinical Pharmacy and Outcomes Sciences University of South Carolina  Columbia South Carolina USA"},{"name":"Center for Outcomes Research and Evaluation, University of South Carolina College of Pharmacy  Columbia South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingkai","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine University of Texas Health Science Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibraheem M.","family":"Karaye","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology Montefiore Medical Canter\/Albert Einstein College of Medicine  Bronx New York USA"},{"name":"Department of Population Health Hofstra University  Hempstead New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saud","family":"Alsahali","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Practice College of Pharmacy, Qassim University  Buraidah Qassim Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krithika","family":"Rajagopalan","sequence":"additional","affiliation":[{"name":"Anlitiks Inc.  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