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Indwelling catheter use in home care: Elderly, aged 65+, in 11 different countries in Europe


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To describe possible differences/patterns in the use of indwelling urinary catheters (IUC) in Europe. A prospective, population-based, assessment study. The target population was 4,455 (random sample of 405 from each of 11 countries) aged 65+ receiving home care. The clients were assessed by using the Resident Assessment Instrument MDS-HC; epidemiological and medical characteristics of clients and service utilisation were recorded. The frequency of use of IUC related to the patients' activities of daily living (ADL) and cognitive functioning. The sample consisted of 4,010 informants: 74% female, with mean age 82.3 +/-7.3 years; men 80.9 +/-7.5 years and female 82.8 +/-7.3 years. A total of 216 (5.4%) clients were using IUC. In Italy 23% were using a catheter compared with 0% in The Netherlands. Catheter use was more common in men than in women (11.5% versus 3.3%). Use of IUC was significantly correlated to certain diseases and symptoms and increase in care burden and formal services. Twenty-six per cent of the informants with indwelling catheters scored three or more on a hierarchical ADL scale (0-6). The clients using IUC in the Nordic countries were less dependent on care than in the other European countries. Models built on multivariate analysis explained 37% of the use of IUC. Tradition and attitudes may explain the differences between the sites. Catheter use is associated with formal or family care burden. The need for nursing home placement ought to be considered in some cases. A stricter criterion for using IUC may be considered in the southern European countries.
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Indwelling catheter use in home care in Europe
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doi:10.1093/ageing/afi094 All rights reserved. For Permissions, please email:
Published electronically 18 May 2005
Indwelling catheter use in home care: elderly,
aged 65, in 11 different countries in Europe
Diakonhjemmet University College, Box 184, 0319 Oslo, Norway
STAKES, Lintulahdenkuja 4, PO Box 220, FIN-00531, Helsinki, Finland
Centre for Gerontology and Health Economics, Karolinska Institute, Crafoords v. 12, S-113 24 Stockholm, Sweden
Department of Geriatrics, 1st Medical Faculty, Charles University and Institute of Postgraduate Medical Education, Londýnská
15, 12000 Prague 2, Czech Republic
Via Sabotino 12, 00195 Rome, Italy
Address correspondence to: L. Sørbye. Fax: (+47) 22 451 950. Email:
Objective: to describe possible differences/patterns in the use of indwelling urinary catheters (IUC) in Europe.
Design: a prospective, population-based, assessment study.
Setting: the target population was 4,455 (random sample of 405 from each of 11 countries) aged 65+ receiving home care.
Methods: the clients were assessed by using the Resident Assessment Instrument MDS-HC; epidemiological and medical
characteristics of clients and service utilisation were recorded.
Measurements: the frequency of use of IUC related to the patients’ activities of daily living (ADL) and cognitive
Results: the sample consisted of 4,010 informants: 74% female, with mean age 82.3 ± 7.3 years; men 80.9 ± 7.5 years and
female 82.8 ± 7.3 years. A total of 216 (5.4%) clients were using IUC. In Italy 23% were using a catheter compared with 0%
in The Netherlands. Catheter use was more common in men than in women (11.5% versus 3.3%). Use of IUC was signifi-
cantly correlated to certain diseases and symptoms and increase in care burden and formal services. Twenty-six per cent of
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L. W. Sørbye et al.
the informants with indwelling catheters scored three or more on a hierarchical ADL scale (0–6). The clients using IUC in
the Nordic countries were less dependent on care than in the other European countries. Models built on multivariate analysis
explained 37% of the use of IUC. Tradition and attitudes may explain the differences between the sites.
Conclusions: catheter use is associated with formal or family care burden. The need for nursing home placement ought to
be considered in some cases. A stricter criterion for using IUC may be considered in the southern European countries.
Keywords: elderly, home care, indwelling urinary catheter, quality of care, care burden, RAI-HC, elderly
Urinary incontinence (UI) is a significant cause of disability and
dependency; it is distressing and disproportionately affects older
people [1–3]. The frequency in different samples varies from 15
to 30% depending on the study [4, 5]. About 50% of those who
live at home and receive formal services are incontinent [6, 7].
However, only few studies document the prevalence rates
for indwelling urinary catheters (IUC) in home care. In a popu-
lation study of urinary incontinence in the age group 70–97
years, Molander et al. [8] stated that IUC were not often used.
Smith concluded in a review that the prevalence of IUC was
4% [9], whereas a prevalence rate of 10% was found in Japan
by Gotoh et al. [10]. The complications associated with IUC
cause significant morbidity and mortality [11, 12].
To find out among the clients receiving home care in
11 European sites: (i) the characteristics of the population
that has an indwelling catheter compared with those that have
not; (ii) the differences in practices between the sites; (iii) the
predictors for indwelling catheters for clients in home care.
The study was performed in 11 European countries: Czech
Republic, Denmark, Finland, France, Germany, Iceland,
Italy, The Netherlands, Norway, Sweden and the UK.
Home care agencies providing home care services to older
persons living in a defined geographical urban area were
chosen by the partners to represent as well as possible the
practices of each of the countries. In each of the sites, the
randomly selected study population comprised 405 persons,
aged 65 years or over, and of those all together 4,010 sub-
jects were finally enrolled in the study. The mean age of the
participants was 82 years and 74% were female [13].
Data collection
In the present study, we used the data collection performed
by using Minimum Data Set version 2.0 for home care
(MDS-HC 2,0) at the baseline. The MDS assessment con-
sists of more than 300 internationally validated variables or
scales and has good inter-observer reliability [13–15]. Serv-
ice utilisation, physical capacity, cognitive skills and psycho-
social characteristics of the clients were assessed and
recorded by specially trained nurses. Indwelling catheter
was defined as any catheter inserted to ensure urinary drain-
age, including catheters inserted suprapubicly or via the uri-
nary tract. Use of an indwelling catheter was assessed as
‘yes’ or ‘no’. Missing values were interpreted as no use of
Statistical analyses
Variables previously known to associate with the use of
indwelling catheters were extracted from the database for
the current analyses, which were then performed using SAS
statistical software (Gary Inc., First,
the associates of indwelling catheter use were identified
(chi-square analysis for dichotomised variables and Stu-
dent’s t-test for continuous variables). Then the associates
of catheter use were entered one by one into multivariate
models in clinically meaningful groups. The strongest pre-
dictors for indwelling catheters were entered into the final
model to combine the sites with the clinical factors.
Of the 4,010 persons in the study, IUC was found in
216 persons (5.4%) and the variation between sites was 0–23%.
Table 1 shows that IUC was used more often in males
than in females (11.5% versus 3.3%, P < 0.0001). Use of
catheters followed different patterns in males compared
with females with advancing age (Figure 1).
Table 2 presents comparisons of clients with and with-
out IUC as to the tested clinical features; it also shows the
type of dependency on services as to the clients with IUC
compared with those without it.
Table 1. Use of IUC by gender and by site among the home
care clients in 11 European countries
n =4,010.
Site Number
IUC in
males (%)
IUC in
females (%) Overall %
Czech Republic 428 7.8 0.6 2.1
Denmark 469 5.0 0.3 1.3
Finland 187 2.9 2.0 2.1
France 381 15.0 6.2 8.7
Germany 607 15.7 3.1 6.2
Iceland 405 2.9 1.0 1.5
Italy 412 30.7 18.5 23.1
The Netherlands 198 0 0 0.0
Norway 388 6.4 1.4 2.8
Sweden 246 3.0 0.6 1.2
UK 289 9.5 1.9 3.8
Overall n (%) 4,010 (100) 119 (11.5) 97 (3.3) 216 (5.4)
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Indwelling catheter use in home care in Europe
<75 75-79 80-84 85-89 >90
IUC, Males (%) IUC, Females (%)
Figure 1. Urinary indwelling catheters by gender and age among the home care clients in 11 European countries (n =4,010).
Table 2. Comparison of clinical features and need for help among the home care clients with and without an indwelling
catheter in 11 European countries
n =4,010.
Indwelling catheter
inserted n (%)
No indwelling catheter
inserted n (%) P value
Stroke with hemiplegia n =247 19 (8) 228 (92) 0.0975
Any type of diagnosed dementia n =514 46 (10) 468 (91) 0.0001
Multiple sclerosis n =032 7 (22) 25 (78) 0.0001
Parkinsonism n =200 23 (12) 177 (89) 0.0001
Any cancer n =321 34 (11) 287 (89) 0.0001
Urinary tract infection n =201 38 (19) 163 (81) 0.0001
Renal failure n =129 10 (8) 119 (92) 0.2264
Symptoms and signs
Difficulties in urinating or urinating three or more times during the night n =525 9 (2) 516 (98) 0.0001
Worsening of bladder incontinence within past 90 days n =409 41 (10) 368 (90) 0.0001
Fever n =70 14 (20) 56 (80) 0.0001
Grade 1–4 pressure ulcers n =296 77 (26) 219 (74) 0.0001
Terminal prognosis n =32 6 (19) 26 (81) 0.0008
Decline in mood within past 90 days n =470 37 (9) 433 (92) 0.0111
Functional capacity
ADL > 3 (scale =0–6) n =515 134 (26) 381 (74) 0.0001
CPS > 3 (scale =0–6) n =419 88 (21) 331 (79) 0.0001
Issues related to quality of life and care-giver burden and use of formal services
Client is alone most of the day n =1154 13 (1) 1141 (99) 0.0001
Does not go out of her/his home n =1421 160 (11) 1261 (89) 0.0001
Informal care-giver feels distressed n =259 48 (19) 211 (81) 0.0001
Informal care-giver is dissatisfied with provided support n =112 18 (16) 94 (84) 0.0001
Informal care-giver unable to continue n =184 22 (12) 162 (88) 0.0001
Use of formal services
No review of the medications within past 180 days n =669 16 (2) 653 (98) 0.0002
Hospital admission within past 90 days n =698 83 (12) 615 (88) 0.0001
Visit to emergency room (without hospital admission) n =246 16 (7) 230 (94) 0.4229
Unscheduled emergent care n =324 24 (7) 300 (93) 0.0928
Visits of home carer within past 7 days n =1629 68 (4) 1561 (96) 0.0049
Visits of nurse within past 7 days n =1295 101 (9) 1194 (92) 0.0001
Visits of home-help within past 7 days n =1635 33 (2) 1602 (98) 0.0001
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L. W. Sørbye et al.
The explanatory value for the first model consisting of
only the 11 sites was 17%, when all the other sites were
compared with the samples collected from The Netherlands
and Sweden. The explanatory value for the model consist-
ing of diagnoses was 7%, for cognitive and physical func-
tional capacity 23% and for the symptoms 14%. The
combined results are presented in Table 3.
The AdHOC Study was designed to compare outcomes of
different models of community care using a structured com-
parison of services and a comprehensive standardised
assessment instrument across 11 European countries [13].
The use of IUC varied from 0 to 23% from site to site and
showed a mean prevalence of 5.5%. These devices were
more often found in men than in women in each of the
sites. Occurrence of catheter use was not higher with
advancing age in females; however, an increase of catheters
was seen in ageing males. The diseases with a relationship to
catheter use were those previously shown in the literature
[11–12]. The tendency to insert catheters in males in older
age groups, with advanced dementia, pressure ulcers and poor
functional ability, were our main findings. This occurred
particularly if the client suffered from cancer, multiple scle-
rosis, or if he or she resided in one of the following three
sites: France, Germany or Italy. The explanatory value for
these findings was 37% (r
The frequency of catheter use accords well with the few
previously estimated figures [9]. The presence of cognitive
decline, more serious than moderate dementia, increased the
risk of receiving a catheter almost two-fold; at the same time
the presence of a diagnosis of dementia ceased being signific-
ant in the multivariate model. Thus, not the disease per se, but
the severity of it, is of importance. At the same time the pres-
ence of severe functional decline increased the risk for receiv-
ing IUC a little over four-fold. The presence of pressure ulcers
almost doubled the risk for catheter use. Multiple sclerosis is
not a prevalent disease in this population whereas cancer is
seen slightly more often. When present, the risk for receiving a
catheter increases 6- and 2-fold correspondingly. More fre-
quent use of IUC in males than in females is most certainly
explained by prostate problems that increase with advancing
age. Unfortunately, questions about urinary retention are not a
part of the MDS questionnaire, and this fact makes it some-
what hard to trace the true cause for inserting the catheter.
Variations from country to country in the prevalence of
catheter use may still partially be explained by the case-mix
of the clients. It is of interest that when adjusting the regres-
sion model for dementia and functional capacity in addition
to diseases, the differences vanished between Nordic coun-
tries, The Netherlands and the UK, representing the north-
ern parts of Europe. The Central European or Southern
European region appeared to host different care patterns or
culture of care compared with those living in the north. One
reason for the difference between the sites in the prevalence
of indwelling catheter use could be habit-based instead of
evidence-based practice. Some of the European countries
really had restricted use of IUC, corresponding to the view
of Ouslander [16]. The predictors for the use of indwelling
catheters among the home care clients in Europe (Table 3)
document a complexity in the problem situation [17].
A study from Switzerland documented that the presence
of a urinary catheter was a predictor of unscheduled services
[18]. In our sample the users of IUC had a urinary tract
infection 6.5 times more often than those without a
catheter. Landi et al. [12] conclude that an uncritical use of
IUC should be considered an indicator of poor quality care.
Pilloni et al. [19] documented that intermittent catheterisa-
tion reduces the urinary tract infection. If one has to use an
indwelling catheter, Robinson [20] specifies that fundamen-
tal principles have to be followed. Even if the consequences
of catheter use are beyond the scope of this cross-sectional/
national analysis, the association between catheters and
informal carers’ care-giver burden is alarming.
The use of indwelling catheters among home care clients in
Europe was most frequent in the oldest males with advanced
dementia and poor physical function. The risk for receiving
catheters was additionally increased if the client suffered from
multiple sclerosis, cancer or pressure ulcers and resided in any
of the following sites: France, Germany or Italy.
Moreover, use of urinary catheters was associated with
increased care-giver burden. More research is warranted to
show whether IUC is predicting long-term care placement
among the home care clients in Europe, and if so, will there
be differences between countries.
Key points
Use of indwelling catheters was most frequent in the oldest
males with advanced dementia and poor physical function.
The risk for receiving catheters was additionally increased
if the client resided in France, Germany or Italy.
Table 3. Predictors for IUC among home care clients in 11
European countries
n =4,010. r
Odds ratio 95% CI
Urinary tract infections 6.51 3.91–10.8
Multiple sclerosis 5.89 2.08–16.7
ADL > 3 4.64 3.10–6.92
Male gender 3.53 2.56–4.87
Any type of cancer 2.23 1.39–3.57
CPS > 3 1.87 1.26–2.77
Grade 1–4 pressure ulcers 1.82 1.22–2.72
Czech Republic 2.48 0.64–9.61
Denmark 2.58 0.64–9.67
Finland 2.95 0.63–10.6
France 6.08 1.75–21.1
Germany 5.60 1.65–19.0
Iceland 2.58 0.63–10.6
Italy 14.0 4.12–47.1
The Netherlands 1.00 1.00–1.00
Norway 3.67 0.99–13.7
Sweden 1.00 1.00–1.00
UK 4.90 1.30–18.5
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Indwelling catheter use in home care in Europe
Use of urinary catheters was associated with increased
care-giver burden.
We are grateful to interRAI, a collaborative network of
researchers in over 20 countries committed to improving
health care for people who are elderly, frail, or disabled.
European Commission Vth Framework Programme, con-
tract number QLRT-2000-00002
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... Within Europe, the proportion of NHR with indwelling urinary catheters (IUCs) varies from 0 to 23%, with significantly more male than female NHR. In Germany, it is estimated that over 15% of male NHR are supplied with IUC, which is the second highest rate in Europe [30]. Men are more likely to have suprapubic catheter and women more likely to have transurethral catheter [29][30][31]. ...
... In Germany, it is estimated that over 15% of male NHR are supplied with IUC, which is the second highest rate in Europe [30]. Men are more likely to have suprapubic catheter and women more likely to have transurethral catheter [29][30][31]. In most cases, women's IUCs are changed by the nursing staff on site, while men-regardless of whether suprapubic or transurethral-are not [32]. ...
Full-text available
Background Unplanned emergency department (ED) visits of nursing home residents (NHR) are common, with many transfers not leading to hospitalization. However, there is little research on what diagnostic and therapeutic measures are performed during visits. Aims We analyzed underlying diagnoses, characteristics and performed medical procedures of unplanned outpatient ED visits by NHR. Methods We conducted a multi-center study of 14 nursing homes (NHs) in northwestern Germany in 03/2018–07/2019. Hospital transfers were documented by nursing staff using a standardized questionnaire for 12 months. In addition, discharge letters were used to collect information about the respective transfer, its reasons and the extend of the medical services performed in the ED. Results A total of 161 unplanned ED visits were included (mean age: 84.2 years; 68.3% females). The main transfer reasons were trauma (59.0%), urinary catheter and nutritional probe problems (overall 10.6%; male NHR 25.5%) and altered mental state (9.9%). 32.9% where discharged without imaging or blood test prior. 67.4% of injured NHR ( n = 95) required no or only basic wound care. Catheter-related problems ( n = 17) were mainly treated by changing an existing suprapubic catheter (35.3%) and by flushing the pre-existing catheter (29.4%). Discussion Our data suggest that the diagnostic and therapeutic interventions performed in ED, often do not exceed general practitioner (GP) care and many ED visits seem to be unnecessary. Conclusion Better coordination and consultation with GPs as well as better training of nursing staff in handling catheter problems could help to reduce the number of ED visits.
... The prevalence of long-term catheter use in the community increases with age (0.732% in those older than 70 years, 1.224% in those older than 80 years), especially in men [11]. In a European cross-sectional study, Sørbye et al. reported that among people over 65 years living in home care, 3.8% used long-term catheters, rising to 11.5% when only males were considered [12]. Patients with long-term catheters often experience complications, such as blockage, leakage, and infection. ...
Full-text available
Purpose To report the efficacy and safety of water vapor thermal therapy to achieve catheter removal in frail patients with refractory acute urinary retention. Methods Data from consecutive frail patients with indwelling urinary catheter undergoing the Rezūm™ therapy (Boston Scientific Corporation, Marlborough, MA) at a single center between October 2017 and June 2021 were prospectively collected. The included patients were deemed unfit or at high risk of complications for conventional benign prostatic hyperplasia (BPH) surgery. Prostate volumes up to 120 mL were considered eligible. The primary endpoint was successful cessation of catheter dependency, assessed postoperatively and up to 1 year of follow-up. Results A total of 24 men met our inclusion criteria. The median age, Charlson comorbidity index, and duration of preoperative catheterization were 77 years (IQR 67–86), 6 (IQR 3–7), and 113 days (IQR 87–159), respectively. Two cases (8.3%) of postoperative complications were recorded (Clavien II and Clavien IIIa). After a median postoperative catheterization time of 21 days (IQR 11–32), all patients regained spontaneous voiding. During follow-up, two patients died and a total of 22 patients completed the 1 year follow-up. All patients maintained spontaneous voiding without recurrence of urinary retention. No surgical retreatment was performed. In terms of pharmacological management, 22/24 patients (91.7%) had a BPH medication pre‐Rezūm™; this decreased to 8/22 patients (36.3%) post‐Rezūm™ (p < 0.001). Conclusions In this single-institution, prospective, and observational study, water vapor thermal therapy was found to be effective and safe in restoring successful spontaneous voiding in a cohort of elderly and frail patients.
... The exact prevalence of longterm catheter use is not known (Gould et al 2010). One study of 11 European countries identified that, in the UK, 3.8% of those aged 65 years and over who are receiving home care routinely use a long-term catheter (Sørbye et al 2005). Kohler-Ockmore and Feneley (1996) surveyed three UK community districts and found a long-term catheter prevalence of 0.07% in adults aged over 18 years, rising to 0.5% for those aged 75 years and over. ...
Self-management of long-term urinary catheters can be challenging for patients, and recurrent catheter blockages may cause concern among patients, carers and healthcare professionals. Catheter blockages are a significant challenge for nurses practising in community settings, because frequent and unplanned catheter changes can be costly to healthcare services in terms of time and resources. This article details evidence-based recommendations for the assessment and diagnosis of catheter blockages, as well as the identification of risk factors. It also explains the interventions that can be used to prevent and manage catheter blockages and describes the role of the nurse in supporting patients with a long-term catheter in situ in community settings.
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Background: Catheter-associated urinary tract infection (CAUTI) ranks second among nosocomial infections in elderly patients after lung infections. Improper treatment can lead to death. This study analysed the risk factors, pathogen distribution, clinical characteristics and outcomes of CAUTI in elderly inpatients with a large sample size to provide evidence for clinical prevention and control. Methods: Based on the HIS and LIS, a case‒control study was conducted on all hospitalized patients with indwelling urinary catheters ≥60 years old from January 1, 2019, to December 31, 2022, and the patients were divided into the CAUTI group and the non-CAUTI group. Results: CAUTI occurred in 182 of 7295 patients, and the infection rate was 3.4/per 1000 catheter days. Urine pH ≥6.5, moderate dependence or severe dependence in the classification of self-care ability, age ≥74 years, male sex, hospitalization ≥14 days, indwelling urinary catheter ≥10 days, diabetes and malnutrition were independent risk factors for CAUTI (P<0.05). A total of 276 strains of pathogenic bacteria were detected in urine samples of 182 CAUTI patients at different times during hospitalization. The main pathogens were gram-negative bacteria (n=132, 47.83%), followed by gram-positive bacteria (n=91, 32.97%) and fungi (n=53, 19.20%). Fever, abnormal procalcitonin, positive urinary nitrite and abnormal urination function were the clinical characteristics of elderly CAUTI patients (P<0.001). Once CAUTI occurred in elderly patients, the hospitalization days were increased by 18 days, the total hospitalization cost increased by¥18,000, and discharge all-cause mortality increased by 2.314 times (P<0.001). Conclusion: The situation of CAUTI in the elderly is not optimistic,it is easy to have a one-person multi-bacterial infection, and the proportion of fungal infection is not low. Urine pH ≥ 6.5, moderate or severe dependence on others and malnutrition were rare risk factors for elderly CAUTI in previous studies. Our study analysed the clinical characteristics of CAUTI in the elderly through a large sample size, which provided a reliable basis for its diagnosis and identified the adverse outcome of CAUTI.
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Aim: A knowledge, attitude and practice questionnaire on urine leakage (UL) with an indwelling urethral catheter (IUC) was developed for nurses in China and validated. Design: Observational study. Methods: A systematic literature review, the Delphi method and focus group evaluation were used to develop the questionnaire, which was administered to 304 registered nurses at two hospitals in Guangdong, China. The validity and reliability of the questionnaire were assessed. Results: The 27-item questionnaire had four dimensions: knowledge I (aetiology), knowledge II (prevention and treatment), attitude and practice. The questionnaire showed excellent content validity and reliability. Four factors accounted for 70.526% of the variance. The data were well-fitted to the four-factor construct model. The questionnaire can be used to measure the knowledge of UL with an IUC among nurses in China, along with related attitudes and practices. This can improve nursing care of patients with IUCs. No patient or public contribution.
Blockage and infection are common in hospitals, especially with long-term indwelling catheters, due to bacterial adhesion, colonization, and other reasons. A drug-sustained-release antibacterial coating for urinary catheters was described in this paper. Chlorhexidine (CHX) and triclosan (TCS) were encapsulated in poly(lactic-co-glycolic acid) microspheres and mixed with a modified chitosan hydrogel deposited on the surface of silicone rubber. The results showed that drugs can be released continuously more than 35 days. Catechol-modified chitosan (Chi-C) hydrogel was successful synthesized according to FT-IR and UV spectrophotometry, as well as ¹H NMR. Furthermore, the coating with CHX and TCS presented stable antibacterial ability compared to the other groups. The results of CCK-8 revealed that the coating was cytotoxic-free and had a wide range of applications. The findings could provide a new drug sustained-release system and hydrogel-microsphere assembly for urinary catheters. • Highlights • The microspheres presented a sustained release more than 40 days with a remarkable initial burst release. • The microspheres/catechol-modified chitosan (Chi-C)/silicon rubber system emerged stable binding ability in liquid environment more than 14 days. • The Chi-C/chlorhexidine (CHX)+triclosan (TCS) microspheres system presented better antimicrobial property for entire experiment period. • The coated samples showed no significant difference for relative growth rate (RGR) compared to different groups.
Background : Urinary tract infections (UTIs) are a frequent cause of hospital transfer for home health care (HHC) patients, particularly among patients with urinary catheters. Methods : We conducted a cross-sectional, nationally representative HHC agency-level survey (2018-2019) and combined it with patient-level data from the Outcome and Assessment Information Set (OASIS) and Medicare inpatient data (2016-2018) to evaluate the association between HHC agencies’ urinary catheter policies and hospital transfers due to UTI. Our sample included 28,205 patients with urinary catheters who received HHC from 473 Medicare-certified agencies between 2016-2018. Our survey assessed whether agencies had written policies in place for (1) replacement of indwelling catheters at fixed intervals and (2) emptying the drainage bag. We used adjusted logistic regression to estimate the association of these policies with probability of hospital transfer due to UTI during a 60-day HHC episode. Results : Probability of hospital transfer due to UTI during a HHC episode ranged from 5.62% among agencies with neither urinary catheter policy to 4.43% among agencies with both policies. Relative to agencies with neither policy, having both policies was associated with 21% lower probability of hospital transfer due to UTI (p<0.05). Conclusion : Our findings suggest implementation of policies in HHC to promote best practices for care of patients with urinary catheters may be an effective strategy to prevent hospital transfers due to UTI.
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Objective: To look at best evidence and expert opinion to provide advice in the form of a consensus statement lead by Female, Neurological and Urodynamic Urology (FNUU) section of the British Association of Urological Surgeons (BAUS) in conjunction with the British Association of Urological Nurses (BAUN). Methods: Initially a literature search was performed with incorporation of aspects of the existing guidance and further informed by UK best practice by core members of the group. The document then underwent reviews by the FNUU Executive Committee members, the BAUN executive committee, a separate experienced urologist and presented at the BAUS annual meeting 2020 to ensure wider feedback was incorporated in the document. Results: Complications of long-term indwelling catheters include catheter-associated urinary tract infections (CAUTI), purple urine bag syndrome, catheter blockages, bladder spasms (causing pain and urinary leakage), loss of bladder capacity, urethral erosion ("catheter hypospadias")/dilatation of bladder outlet and chronic inflammation (metaplasia and cancer risk). Conclusions: We have provided a list of recommendations and a troubleshooting table to help with the management of the complications of long term catheters.
The CATHETER II trial is expected to determine if and which policy for prophylactic catheter washout on a weekly basis improves the outcome of care for people living with a long-term catheter. By exploring the views and experiences of both the trial participants and health care professionals in relation to the trial delivery and outcomes, the CATHETER II qualitative study can provide context to the trial findings, clarify the fidelity of the intervention, and inform translation of the intervention into routine policy and practice.
Background Community-acquired acute pyelonephritis (CA-APN) is relatively rare in men. This study aimed to compare the clinical characteristics of CA-APN between male and female patients. Methods We prospectively collected the clinical and microbiological data of hospitalized CA-APN patients aged ≥19 years in South Korea from March 2010 to February 2011 in 11 hospitals and from September 2017 to August 2018 in 8 hospitals. Only the first episodes of APN of each patient during the study period were included. Results From 2010 to 2011, 573 patients from 11 hospitals were recruited, and from 2017 to 2018, 340 patients were recruited from 8 hospitals. Among them, 5.9% (54/913) were male. Male patients were older (66.0 ± 15.2 vs. 55.3 ± 19.0 years, P < 0.001), had a higher Charlson comorbidity index (1.3 ± 1.5 vs. 0.7 ± 1.2, P = 0.027), and had a higher proportion of structural problems in the urinary tract (40.7% vs. 6.1%, P < 0.001) than female patients. Moreover, the total duration of antibiotic treatment was longer (21.8 ± 17.8 d vs. 17.3 ± 9.4 d, P = 0.001) and the proportion of carbapenem usage was higher (24.1% vs. 9.5%, P = 0.001) in men than in women. Male patients were hospitalized for longer durations than female patients (median, 10 d vs. 7 d, P < 0.001). Conclusions Male CA-APN patients were older and had more comorbidities than female CA-APN patients. In addition, male patients received antibiotic treatment for a longer duration than female patients.
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We conducted a 1-day survey to determine the prevalence of urinary incontinence among patients in four home care programs in southern Ontario and the characteristics of incontinent patients. Of the 2801 patients for whom the continence status was known, 22% were assessed as incontinent. The mean age of the incontinent patients was 74 (extremes 18 and 101) years, and 65% were women. A total of 89% had at least one functional disability in cognition, mobility, transferring in and out of bed or chair, or undoing garments. The incontinence was moderate to severe in 41% of the patients, and 95% of the family caregivers living with these patients viewed the incontinence as a problem. Palliative rather than remedial treatment was used most frequently; only 5% of the patients had undergone a urodynamic assessment in the previous year. Future research should emphasize the assessment of remedial interventions.
To investigate whether intermittent catheterisation is a valuable alternative to an indwelling catheter in patients older than 70 years with post-void residuals more than 50% of the bladder capacity. We retrospectively reviewed the medical records of 21 patients (14 women, 7 men) older than 70 years in whom intermittent catheterisation was initiated because of voiding dysfunction with post-void residuals more than 50% of the bladder capacity resistant to other treatment. Twelve patients mastered the technique of intermittent self-catheterisation, seven were catheterised by their partners and two by nurses. The mean age of patients was 76.5 years (range 71-83 years) and the mean observation period with regard to intermittent catheterisation was 27.9 months (range 5-129 months). For those relying on intermittent catheterisation, the urinary tract infection rate was 0.84 per year and patient (range 0-3), and urinary continence was restored in all of the six previously incontinent patients. Eighteen of the 21 patients reported a significantly improved quality of life owing to the restoration of urinary continence, decreasing of daytime frequency, nocturia and urge, and the lowering of the urinary tract infection rate. Intermittent (self-) catheterisation is a safe and valuable technique in older people with significant post-void residuals owing to detrusor underactivity. Urinary continence is restored, urge, daytime frequency and nocturia are decreased, and the urinary tract infection rate is diminished, resulting in improved quality of life. Therefore, intermittent (self-) catheterisation is strongly recommended in older people.
Urinary incontinence (UI) is now recognized as a prevalent, physically and emotionally disruptive, and costly health problem in the geriatric population. Because incontinence may be a manifestation of a subacute or reversible process within or outside of the lower urinary tract, and because effective treatment is available, it is important for primary care physicians to identify and appropriately assess incontinence in their geriatric patients. The initial evaluation of an incontinent geriatric patients. The initial evaluation of an incontinent geriatric patient includes a targeted history and physical examination, urinalysis, and simple tests of lower urinary tract function. Potentially reversible conditions that may be causing or contributing to the incontinence, such as delirium and urinary tract infection (UTI), should be identified and managed. Patients who may benefit from further testing, including urologic or gynecologic examination and/or complex urodynamic tests, should be identified and referred. Several therapeutic modalities can be used to treat geriatric UI. Behavioral therapies are noninvasive and effective, both in functional community-dwelling geriatric patients and in functionally impaired nursing home residents. Behavioral therapies include bladder training, pelvic muscle exercises, biofeedback, scheduled toileting, habit training, and prompted voiding. Pharmacologic therapy is often used in conjunction with behavioral therapy. For stress incontinence, alpha-adrenergic drugs are used and can be combined with topical or oral estrogen therapy in women. For urge incontinence, pharmacologic treatment involves drugs with anticholinergic and direct bladder muscle relaxant properties. Pharmacologic therapy for overflow incontinence is generally not effective on a long-term basis. Surgical treatment is indicated when a pathologic lesion such as a tumor is diagnosed, or when anatomic obstruction is believed to be the cause of the patient's symptoms. Surgical treatment of stress incontinence can be highly effective in properly selected women. Nonspecific, supportive treatments are also important in managing geriatric UI. Education for patients and caregivers is critical for the success of most therapies. Environmental manipulations and the appropriate use of toilet substitutes are especially important in frail, functionally impaired patients. Highly absorbent adult undergarments are helpful for managing many patients, but should not be used as the initial response to incontinence, and are best used in conjunction with more specific treatment whenever possible. Chronic indwelling catheterization should only be used to manage incontinence when it is associated with clinically significant urinary retention, skin conditions that cannot heal because of incontinence, or severe illness that makes the catheter the most comfortable method of management.(ABSTRACT TRUNCATED AT 400 WORDS)
1. Urinary incontinence is a significant cause of disability and dependency among the elderly, and is frequently cited as the major precipitant in long-term institutionalization. 2. Incontinent elderly view their condition as a significant symbol of loss of control as well as self-esteem, and is discussed by them in terms of infantilization. 3. Potential advantages of research and intervention and urinary incontinence include improved well-being of patients, relief of family burden, and cost benefit to society. 4. Evaluating behavioral treatment for incontinence remains an important nursing challenge due to the diversity of the incontinent elderly population in terms of their urinary tract pathophysiology; neurologic, cognitive, and functional status; and their environmental setting.
Most continent geriatric patients can be managed appropriately after a clinical assessment including a history, physical examination, urinalysis and culture, and simple tests of bladder function. A subgroup will benefit from urologic, gynecologic, and formal urodynamic evaluation. Algorithms described in this chapter are being developed and tested; these algorithms will make clinical assessment more practical and cost effective.
Long-term use of an indwelling catheter is seldom free of problems, and the complications associated with indwelling catheters cause significant morbidity and mortality. Often there are alternatives to long-term catheterization; it is assumed in this article that the patient will have been appropriately assessed for other methods of continence control. In this article, leakage around the catheter (bypassing) is discussed. This problem is multifactorial: irritation caused by the catheter balloon, improper sizing of catheter, confusion of the patient, bacteriuria, constipation or fecal impaction, blocked catheters, problems related to materials used in catheter construction, and improper positioning of the catheter are all potential problems contributing to leakage in the patient with an indwelling catheter. Emphasis is placed on etiology because understanding the underlying problem is crucial to implementing effective treatment.
Incontinence is a distressing, complex health problem which disproportionately affects older people. It is commonly endured silently, with many sufferers and carers not receiving appropriate support. In addition, incontinence is generally poorly managed both by families and health-care professionals, and is a major contributing factor in the institutionalization of the elderly. This paper argues that incontinence experienced in later life is often multifactorial in nature, thus health care professionals need to be cognizant of the many causes of incontinence, as well as the impact of lifestyle factors and 'normal' ageing processes. Incontinence in the community-based elderly can be cured or significantly improved in over 60% of cases with conservative management. Unfortunately community and professional attitudes and ignorance remain major barriers to continence.