None of the 378 catheterized patients had a medical condition indicating a need for a catheter. Among 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.
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.