Inappropriate use of urinary catheters among hospitalized elderly patients: Clinician awareness is key.

Abstract

To investigate incidence, reasons, risk factors and outcomes for inappropriate use of urinary catheters in hospitalized elderly patients. The prospective study enrolled 321 patients aged 65 years and older with a urinary catheter placed within 24 h of hospitalization. Collected data included characteristics of patients and catheter use, reasons for urinary catheter use, mortality, length of hospital stay, time to first removal of catheter, catheter remaining in place at discharge, catheter-associated urinary tract infections and complications, change of activities of daily living, and new admission to nursing home after discharge. The use of 418 urinary catheters was observed. Among these patients with a total of 1958 urinary catheter-days, 1035 (52.8%) urinary catheter-days were inappropriate in hospitalized elderly patients. Inappropriate catheter use occurred mostly in women and surgical patients, and was associated with initially inappropriate catheter use and lack of medical documentation. "Convenience of care" was the most common reason for inappropriate catheter use. Inappropriate use was a significant predictor for longer hospital stay, delayed timing of first removal of catheter, increased rate of catheterization in place at discharge, increased incidence of catheter-associated urinary tract infections and catheter-related complications, and decline in activities of daily living. The study highlights a considerable percentage of inappropriate use of urinary catheters and its association with adverse outcomes in hospitalized elderly patients. Efforts to improve quality of documentation by clinicians and to emphasize catheterization education for patients and caregivers are necessary to reduce the incidence of inappropriate urinary catheter use. Geriatr Gerontol Int 2015; 15: 1235-1241.