The study included 1,586 patients from age 70 hospitalised at two Ohio hospitals. None of 378 catheterised patients had a medical condition indicating a need for a catheter. Among patients 85 or older, the rate of unnecessary catheterisation was 32 percent.
The risk of medically inappropriate catheterisation was also higher among women, patients with disability or dementia, and patients admitted with a geriatric condition such as confusion or frequent falls. "This highlights the fact that the people who are most likely to suffer the adverse effects of a urinary tract infection are exactly the people who seem to be getting unnecessary catheterisations," observes principal investigator Seth Landefeld, MD, associate chief of staff of geriatrics and extended care at SFVAMC.
The study identified nine specific risk factors for unnecessary catheterisation: female gender, chronic illness, cognitive impairment, incontinence, inability to carry out common activities of daily living, a physician's order for bed rest, and three geriatric conditions – confusion, falls, and failure to thrive at home. Patients with five or more risk factors had a 50% risk of being catheterised unnecessarily.
"None of these factors are in themselves an indication for having a catheterisation," says Landefeld. The study did not examine the question of why unnecessary catheters are being placed. "Other studies have found that most doctors don't know whether their patient has a catheter in place or not," Landefeld notes. "It's something that happens frequently for reasons that have not been fully teased out."
MEDICA.de; Source: University of California - San Francisco