Indwelling urethral catheter and mortality in frail elderly women living in community.
OBJECTIVE
Urinary incontinence is one of the most common, disruptive and often disabling conditions affecting frail older people living in community. The aims of present study were to describe the prevalence of bladder catheter in a population of older women living in community and to examine the relationship between urinary catheter and mortality.


METHODS
This was an observational cohort study. We analyzed data from the Italian Silver Network Home Care project that collected data on patients admitted to Home Care programs. A total of twelve Home Health Agencies participated in such project evaluating the implementation of the Minimum Data Set for Home Care (MDS-HC) instrument. A total of 1,004 women were enrolled in the present study. The main outcome measures were prevalence of bladder catheter and 1-year survival according to catheterization.


RESULTS
The prevalence of incontinent patients with bladder catheter was 38.1%. Incontinent patients with indwelling bladder catheter did not show significant difference for age and comorbidity while they showed a significant higher level of physical and functional impairment, as expressed by higher score in activities of daily living (ADL) scale (6.5 +/- 1.3 vs. 5.5 +/- 2.2, P < 0.001) and higher prevalence of sensory impairment, pressure ulcers (44% vs. 12%, P < 0.001), and urinary tract infections (21% vs. 10%, P < 0.001). After adjusting for age and for all the variables significantly different between catheterized and not-catheterized subjects at baseline, subjects with indwelling bladder catheter were more likely to die compared to those without catheter (RR, 1.44; 95% CI 1.01-2.07).


CONCLUSIONS
Catheterization has an important prognostic implication for frail old women living in the community, independent of age and other clinical and functional variables. A failure in decreasing the unnecessary bladder catheter use and the duration of catheterization among frail incontinent women should be considered an indicator of poor quality of care.
Landi
Francesco
F
Department of Gerontology-Geriatric and Physiatric, Catholic University of Sacred Heart, Rome, Italy. francesco_landi@rm.unicatt.it
Cesari
Matteo
M
Onder
Graziano
G
Zamboni
Valentina
V
Barillaro
Christian
C
Lattanzio
Fabrizia
F
Bernabei
Roberto
R
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition / Q000502:physiology; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006699:Home Care Services; D006801:Humans; D007558:Italy / Q000453:epidemiology; D018570:Risk Assessment; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014546:Urinary Catheterization / Q000401:mortality* / Q000706:statistics & numerical data; D014549:Urinary Incontinence / Q000453:epidemiology