title: Exploring initial inappropriate use of urinary catheters among hospitalised older patients in Taiwan.
abstract: OBJECTIVE
  To explore the incidence, associated factors and adverse outcomes for initial inappropriate use of urinary catheters in hospitalised older patients.
  
  
  BACKGROUND
  Urinary catheters can lead to substantial complications. The related factors and adverse outcomes associated with initial inappropriate urinary catheter use among hospitalised older patients have not been studied.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  A total of 321 older patients admitted to the hospital in southern Taiwan having urinary catheters placed within 24 hours of admission were recruited. Demographic factors, voiding function history, health conditions and care conditions of catheter placement were collected through a review of medical records, interviewing participants or their primary caregivers. Catheter-associated urinary tract infection during hospitalisation, transfer to a nursing home, length of hospital stay and change in activities of daily living determined as outcomes. Criteria for urinary catheter placement were developed to identify inappropriate use.
  
  
  RESULTS
  The incidence of initial inappropriate use of urinary catheters among hospitalised Taiwanese older patients was 38·3%. The rationale most often reported for initial inappropriate use was 'convenience of care' (49·6%). Factors associated with initial inappropriate use were, chronic constipation, urinary tract infection history, medical treatment diagnosis, cognitive impairment, depressive symptoms and independence in activities of daily living and, insertion of catheter during evening and night shifts and lack of nursing documentation of the rationale for catheterisation. Patients with initial inappropriate use showed greater decline in activities of daily living function between admission and discharge.
  
  
  CONCLUSIONS
  Older patients with greater care needs may become the victims of initial inappropriate use of urinary catheters. Inappropriate use may devastate the activities of daily living in older patients. Nurses' awareness of indications for urinary catheters may prevent inappropriate use.
  
  
  CONCLUSIONS
  A policy to strengthen nurses' awareness of the use of urinary catheters is needed in Taiwan.
authors.affiliation: Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.
authors.forename: Fang-Wen
authors.initials: FW
authors.lastname: Hu
authors.affiliation: Department of Internal Medicine, Division of Geriatrics and Gerontology, National Cheng Kung University, Tainan City, Taiwan.
authors.forename: Chia-Ming
authors.initials: CM
authors.lastname: Chang
authors.affiliation: Department of Nursing, College of Medicine, Tzu Chi University, Hualien City, Taiwan.
authors.forename: Chuan-Hsiu
authors.initials: CH
authors.lastname: Tsai
authors.affiliation: Department of Nursing and Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan.
authors.forename: Ching-Huey
authors.initials: CH
authors.lastname: Chen
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002408:Catheters, Indwelling / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006299:Health Services for the Aged; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D013624:Taiwan / Q000453:epidemiology; D014546:Urinary Catheterization / Q000009:adverse effects* / Q000451:nursing; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000209:etiology / Q000451:nursing / Q000517:prevention & control
keywords: activities of daily living; awareness; documentation; hospitalisation; urinary catheterisation; urinary tract infections