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Senior Citizen Medical Alert
Older Patients Being Given Urinary Catheters for No
Reason
Women, all over 85,
chronically ill, and frail are especially at risk
 May 22, 2006 - A study of 1,586 hospitalized senior
citizens - age 70 and older - at two Ohio hospitals
indicates that 24 percent of these elderly patients were given medically
unnecessary urinary catheters, according to investigators led by a
researcher at the San Francisco VA Medical Center.
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None of the 378 catheterized senior patients had a
medical condition indicating a need for a catheter. Among elderly
patients 85 or older, the rate of unnecessary catheterization was 32
percent.
The risk of medically inappropriate catheterization
was also higher among women, patients with disability or dementia, and
patients admitted with a geriatric condition such as confusion or
frequent falls.
The study appears in the December, 2005 issue of
the Journal of Patient Safety, which has just been published.
The study authors note that, in previous research,
catheterization has been shown to cause urinary infection in one fourth
of patients catheterized.
"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
catheterizations," observes principal investigator Seth Landefeld, MD,
associate chief of staff of geriatrics and extended care at SFVAMC and
Senior Scholar in the VA National Quality Scholar Program.
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About Urinary Catheters |
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From
Medline Plus
A urinary catheter is any tube system
placed in the body to drain and collect urine from the bladder.
Information
A Foley catheter is a soft plastic or
rubber tube that is inserted into the bladder to drain the urine.
Urinary catheters are sometimes recommended as way to manage
urinary incontinence and urinary retention in both men and women.
There are several different types of catheters, which may be used for a
variety of different reasons.
Urinary Catheters
Urinary catheters may be used to drain
the bladder. This is often a last resort because of the possible
complications associated with continuous catheter usage. Complications
of catheter use may include: urinary tract or kidney infections, blood
infections (septicemia),
urethral injury, skin breakdown,
bladder stones, and
blood in the urine (hematuria). After many years of catheter use,
bladder cancer may also develop.
Your health care provider may recommend
use of a catheter for short term use or long term use (indwelling). The
catheter may be left in place during this time, or you may be instructed
on a procedure for placing a catheter just long enough to empty the
bladder and then remove it (clean
intermittent self-catheterization).
Catheters come in a large variety of
sizes, materials (latex, silicone, Teflon) and types (Foley catheter,
straight catheter, coude tip catheter). It is recommended that you use
the smallest size of catheter, if possible.
Some people may require
larger catheters to control leakage of urine around the catheter or if
the urine is thick and bloody or contains large amounts of sediment. Be
aware that larger catheters are more likely to cause damage to the
urethra.
Some people have developed
allergies or sensitivity to latex after long-term latex catheter
use. These people should use the silicone or Teflon catheters.
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The study identified nine specific risk factors for
unnecessary catheterization: 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 catheterized
unnecessarily.
"None of these factors are in themselves an
indication for having a catheterization," says Landefeld, who is also a
professor of medicine at the University of California, San Francisco.
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."
When the reasons are eventually determined, he
says, the next step would be think about ways to decrease unnecessary
catheter use. "It's like hand washing in hospitals, which has become
much more common recently thanks to interventions that encourage
hospital staff to modify their behavior," he says. "We need very obvious
approaches that will get people to think three times before placing the
catheter and once it's in, to think how quickly they can get it out."
Landefeld says that he and his fellow researchers
have completed a follow up study on what happens to patients who have
been catheterized unnecessarily: "Are they more likely to decline and be
unable to care for themselves? Are they more likely to die, or go to a
nursing home?" That study is currently under peer review.
More about study:
Co-authors of the study were Jayna M. Holyroyd-Leduc,
MD, currently of the University of Toronto and of SFVAMC at the time of
the study; Laura P. Sands, PhD, of Purdue University, Indiana; Steven R.
Counsell, MD, of the Indiana University School of Medicine; Robert M.
Palmer, MD, MPH, of the Cleveland Clinic, Ohio; and Denise M. Kresevic,
RN, PhD, of Louis Stokes Cleveland VAMC and University Hospitals of
Cleveland.
The study was funded by grants from the National
Institute on Aging and the Summa Health Foundation, and by support from
the Department of Veterans Affairs.
SFVAMC has the largest medical research program in
the national VA system, with over 200 research scientists, all of whom
are faculty members at UCSF.
UCSF is a leading university that consistently
defines health care worldwide by conducting advanced biomedical
research, educating graduate students in the life sciences, and
providing complex patient care.
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