Why do we have different urinary catheter use in European home care?

Abstract

About 50% of the elderly patients receiving home care are incontinent. The prevalence of catheter use in these patients is 5.4%, varying in different European countries from 0 to 23% according to Sorbye et al., in this issue [1]. At first sight, there are alarming differences among the countries investigated, but one should keep in mind that the AdHOC Study was designed to compare outcomes of different models of community care and not nations. Nevertheless, these results should make the southern European countries think about catheter policy, especially given that the use of urinary catheters is associated with increased caregiver burden. Often, one reason given for using urinary catheters—at least in Germany—is to reduce the burden of care! However, catheter use might as well be an expression of caregiver burden; supporting the caregiver might then prevent the use of indwelling catheters. The use of urinary catheters was most frequent in very old men with advanced dementia and poor physical functioning. Why primarily in men? Because they have enlarged prostates resulting in urinary retention, perhaps? But is prostatic enlargement pathophysiologically correlated with dementia or poor physical functioning? Not to our knowledge! The reason for a higher rate of catheter use in such persons is unclear.