***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE We evaluated the efficacy and safety of flexible dose fesoterodine in medically complex vulnerable elderly subjects with urgency urinary incontinence . MATERIAL S AND METHODS In this 12-week , r and omized , double-blind , flexible dose , placebo controlled trial , subjects were community dwelling men and women 65 years old or older . Subjects had scores of 3 or more on the VES-13 ( Vulnerable Elders Survey ) and 20 or more on the MMSE ( Mini-Mental State Examination ) , and 2 to 15 urgency urinary incontinence episodes and 8 or more micturitions per 24 hours on 3-day baseline diaries . Subjects r and omized to fesoterodine  received 4 mg once daily for 4 weeks and could then increase to 8 mg based on discussion with the investigator . Subjects receiving 8 mg could decrease the dose to 4 mg at any time ( sham escalation and de-escalation for placebo ) . The primary outcome measure was change in daily urgency urinary incontinence episodes . Secondary outcomes included changes in other diary variables and patient reported quality of life measures . Safety evaluations included self-reported symptoms and post-void residual volume . RESULTS A total of 562 patients were r and omized ( mean age 75 years , 50.4 % age 75 years or greater ) . Subjects had high rates of comorbidities , polypharmacy and functional impairment .  At week 12 the fesoterodine group had significantly greater improvements in urgency urinary incontinence episodes per 24 hours ( -2.84 vs -2.20 , p = 0.002 ) and most other diary variables and quality of life , as well as a higher diary dry rate ( 50.8 % vs 36.0 % , p = 0.002 ) . Adverse effects were generally similar to those of younger population s including risk of urinary retention . CONCLUSIONS To our knowledge this is the first antimuscarinic study in a community based , significantly older , medically complex elderly population with urgency urinary incontinence . Flexible dose fesoterodine significantly improved urgency urinary incontinence episodes and other outcomes vs placebo , and was generally well tolerated OBJECTIVE Authors examined the effect of chronic exposure to anticholinergics in a cohort of Alzheimer disease ( AD ) patients . METHODS All patients were examined annually with st and ard neuropsychologic tests and received the cholinesterase inhibitor donepezil hydrochloride at a dose of 10 mg/day . The study population ( N=69 ) was divided into two groups : those receiving one or more concomitant medications with significant anticholinergic properties ( N=16 ) and those receiving no concomitant medications with anticholinergic properties ( N=53 ) . RESULTS At 2 years , MMSE scores were significantly worse for patients receiving anticholinergic medications than for those not on anticholinergics . CONCLUSION Although very preliminary , these data suggest that concomitant therapy with anticholinergics may be associated with significant deleterious effects on acetylcholinesterase therapy , or , more speculatively , that chronic exposure to anticholinergics may have adverse effects on the clinical course of AD OBJECTIVES To examine skin health outcomes of an exercise and incontinence intervention . DESIGN R and omized controlled trial with blinded assessment s of outcomes at three points over 8 months . SETTING Four nursing homes ( NHs ) . PARTICIPANTS One hundred ninety incontinent NH residents . INTERVENTION In the intervention group , research staff provided exercise and incontinence care every 2 hours from 8:00 a.m. to 4:30 p.m. ( total of four daily care episodes ) 5 days a week for 32 weeks . The control group received usual care from NH staff . MEASUREMENTS Perineal skin wetness and skin health outcomes ( primarily blanchable erythema and pressure ulcers ) as measured by direct assessment s by research staff , urinary and fecal incontinence frequency , and percentage of behavioral observations with resident engaged in st and ing or walking . RESULTS Intervention subjects were significantly better in urinary and fecal incontinence , physical activity , and skin wetness outcome measures than the control group . However , despite these improvements , differences in skin health measures were limited to the back distal perineal area , which included the sacral and trochanter regions . There was no difference between groups in the incidence rate of pressure ulcers as measured by research staff , even though those residents who improved the most on fecal incontinence showed improvement in pressure ulcers in one area . CONCLUSION A multifaceted intervention improved four risk factors related to skin health but did not translate into significant improvements in most measures of skin health . Even if they had adequate staffing re sources , NHs might not be able to improve skin health quality indicators significantly if they attempt to implement preventive interventions on all residents who are judged at risk because of their incontinence status OBJECTIVES To study the efficacy of the tension-free vaginal tape ( TVT ) procedure for elderly patients . METHODS Forty-five women , 65 years old or older ( mean 69.1 ; range 65 to 85 ) , were treated for genuine stress incontinence with the tension-free vaginal tape procedure under intravenous anesthesia with heavy sedation . Urodynamic studies and 1-hour pad test were performed before the procedure and at 1 year postoperatively . Vigorous manual pressure against the abdominal wall and ensuring no lifting of urethra by intraoperative introital ultrasonography were used to position and adjust the vaginal taping . RESULTS Forty-one ( 91 % ) were cured , one improved , and three failed . No major surgical complications occurred . Two bladder perforations were noted . The pad test disclosed a reduction in urine leakage from a mean of 28.9 to 1.6 g/hr ( P < 0.001 ) . The average blood loss was 72 mL ( range 30 to 250 ) , operating time was 21 minutes ( range 18 to 35 ) , and postoperative hospital stay was 24.2 hours ( range 12 to 72 ) . Spontaneous voiding with an adequate volume of postvoid residual urine was noted for all patients by the fourth day postoperatively . Urodynamic parameters related to the voiding dysfunction showed no significant difference before and after surgery . De novo detrusor instability was observed in 2 patients . CONCLUSIONS With modifications of the technique and the aid of intraoperative ultrasonography , the TVT procedure can be performed under intravenous anesthesia with heavy sedation . The procedure is safe , effective , and minimally invasive for elderly patients . However , long-term follow-up is needed to determine whether this surgery achieves long-lasting results OBJECTIVES To determine the cognitive and functional consequences of dual use of cholinesterase inhibitors ( ChIs ) and the bladder anticholinergics oxybutynin or tolterodine . DESIGN Prospect i ve cohort study . SETTING Nursing homes ( NHs ) in the state of Indiana . PARTICIPANTS Three thous and five hundred thirty-six Medicaid-eligible NH residents aged 65 and older taking a ChI between January 1 , 2003 , and December 31 , 2004 . Residents were excluded if they were taking an anticholinergic other than oxybutynin or tolterodine .  MEASUREMENTS Indiana Medicaid cl aims data were merged with data from the Minimum Data Set ( MDS ) . Repeated- measures analyses were performed to assess the effects of dual therapy on change in cognitive function measured using the MDS Cognition Scale ( MDS-COGS ; scored 0 - 10 ) and change in activity of daily living ( ADL ) function using the seven ADL items in the MDS ( scored 0 - 28 ) . Potential covariates included age , sex , race , number of medications , and Charlson Comorbidity Index score . RESULTS Three hundred seventy-six ( 10.6 % ) residents were prescribed oxybutynin or tolterodine concomitantly with a ChI. In residents in the top quartile of ADL function , ADL function declined an average of 1.08 points per quarter when not taking bladder anticholinergics ( ChI alone ) , compared with 1.62 points per quarter when taking dual therapy , a 50 % greater rate in quarterly decline in ADL function ( P=.01 ) . There was no excess decline attributable to dual therapy in MDS-COGS scores or in ADL function for residents who started out with lower functioning . CONCLUSION In higher-functioning NH residents , dual use of ChIs and bladder anticholinergics may result in greater rates of functional decline than use of ChIs alone . The MDS-COGS may not be sensitive enough to detect differences in cognition due to dual use BACKGROUND Nocturia ( ie , waking at night to void ) is common and disrupts sleep . Traditionally , one nightly episode has been regarded as clinical ly meaningless , yet the justification for this belief remains weak . OBJECTIVE To evaluate the association among frequency of nocturia and bother and health-related quality of life ( HRQoL ) . DESIGN , SETTING , AND PARTICIPANTS In 2003 - 2004 , a survey was mailed to a r and om sample of 6000 subjects aged 18 - 79 yr who were identified from the Finnish Population Register Centre ( response proportion was 62.4 % ; 53.7 % were females ) . MEASUREMENTS HRQoL and bother from nocturia were examined in relation to self-reported nocturia frequency ( using the American Urological Association Symptom Index and the Danish Prostatic Symptom Score ) . Bother from nocturia was assessed on a four-point scale ( none , small , moderate , major ) . HRQoL was measured with the generic 15D instrument on a 0 - 1 scale with a minimum clinical ly important difference of 0.03 . RESULTS AND LIMITATIONS Degree of bother increased with nocturia frequency ( p<0.01 ) . The most commonly cited degree of bother for those with one , two , and three nightly voids was no bother , small bother , and moderate bother , respectively . The mean age-adjusted 15D score for men ( and women ) without nocturia was 0.953 ( 0.950 ) and 0.925 ( 0.927 ) with one void per night , 0.898 ( 0.890 ) with two voids per night , and 0.833 ( 0.840 ) with three or more voids per night . Statistically significant decreases were found in 15D score and in all 15D dimensions except eating . Although the response rate was high , approximately one third of those contacted did not participate in the study . CONCLUSIONS At least two voids per night is associated with impaired HRQoL. The majority of people report having bother when the number of nocturia episodes is two and moderate or major bother when the number is three or more . One void per night does not identify subjects with interference from nocturia and , thus , is not a suitable criterion for clinical ly relevant nocturia OBJECTIVES To assess the efficacy and safety of flexible-dose fesoterodine in elderly adults with overactive bladder ( OAB ) . DESIGN Twelve-week , r and omized , double-blind , placebo-controlled trial . SETTING Sixty-one outpatient clinics in Europe , Israel , and Turkey . PARTICIPANTS Seven hundred ninety-four individuals aged 65 and older ( 47 % male ) with OAB symptoms for 3 months or longer , mean of eight or more micturitions and three or more urgency episodes per 24 hours , at least some moderate problems on Patient Perception of Bladder Condition ( PPBC ) , and Mini-Mental State Examination ( MMSE ) score of 20 or greater . INTERVENTIONS Participants were r and omized to fesoterodine or placebo for 12 weeks , with stratification according to age ( > 75 vs ≤ 75 ) and dosing time ( morning vs evening ) . Participants receiving fesoterodine started on 4 mg and could increase to 8 mg at week 4 or 8 and de-escalate to 4 mg at week 8 ( sham escalation for placebo ) . MEASUREMENTS Changes from baseline in bladder-diary variables ( primary endpoint , urgency episodes ) and patient-reported outcomes including OAB Question naire , Treatment Benefit Scale ( TBS ) , PPBC , Urgency Perception Scale ( UPS ) , and OAB Satisfaction Question naire ( OAB-S ) ; all observed or reported adverse events . RESULTS By week 8 , 64 % of fesoterodine-treated and 71 % of placebo-treated participants opted for dose escalation . At week 12 , the fesoterodine group had statistically significantly greater improvement than the placebo group in urgency episodes , micturitions , nocturnal micturitions , incontinence pad use , and OAB Question naire scores but not urgency urinary incontinence episodes . Responder rates on TBS , PPBC , UPS , and OAB-S were statistically significantly higher with fesoterodine . Improvements in most diary variables and participant-reported outcomes were greater with fesoterodine than placebo in participants in both age groups and when administered in the morning and evening . Rates of dry mouth and constipation were 34 % and 9 % with fesoterodine and 5 % and 3 % with placebo , respectively . Rates of adverse events and discontinuations were generally similar in participants in both age 
    Output:
    
There have been significant advances in several areas including pharmacological treatment of overactive bladder .