Use of indwelling urinary catheters in nursing home residents: results from a cross-sectional study in 21 German nursing homes

Abstract

Background: Indwelling urinary catheters often lead to complications such as symptomatic urinary tract infections. In nursing home residents, catheter prevalence is high, but prevalence differences by sociodemographic characteristics, comorbidities, and health services use have rarely been investigated. The purpose of this work was to describe the use of indwelling urinary catheters in nursing home residents and to examine whether catheter use is associated with individual characteristics. Methods: Cross-sectional data of the “Inappropriate Medication in patients with REnal insufficiency in Nursing homes” (IMREN) study conducted in 21 German nursing homes between October 2014 and April 2015 were analyzed. For all residents of the involved care units, nurses of the participating institutions completed an anonymous questionnaire including the Modified Rankin Scale to assess physical impairments. The proportion of nursing home residents with indwelling urinary catheter was determined. Associations between catheter use and individual characteristics were investigated via cluster-adjusted multivariable logistic regression. Results: Of 852 residents (76.5% female; mean age 83.5 years), 13.4% had an indwelling urinary catheter. The adjusted odds ratios for catheter use for men vs. women was 2.86 (95% confidence interval 1.82–4.50). For residents with “moderate” disability vs. those with “no to slight” disability it was 3.27 (1.36–7.85), for individuals with “moderately severe” disability vs. the reference group it was 9.03 (3.40–23.97), and for those with “severe” disability vs. the reference group it was 26.73 (8.60–83.14). For residents who had been hospitalized within the last 12 months vs. those without a hospitalization it was 1.97 (1.01–3.87). For age, dementia, overweight/obesity, other indwelling devices, and long-term medications no significant associations were found. Conclusions: Male nursing home residents, residents with a higher degree of physical impairment, and those who had been hospitalized within the last 12 months were more likely to use an indwelling urinary catheter than their counterparts. Data on circumstances of and indications for catheters, catheter types, and duration of catheterization are needed to evaluate the appropriateness of catheter use in nursing home residents and the need for interventions.