Factors Associated With Inappropriately Use of Urinary Catheters in Elderly Patients Hospitalized in Internal Medicine Departments

Abstract Purpose To identify factors resulting in excess rates of urinary catheterization in elderly hospitalized patients to internal medicine departments. Methods We retrospectively selected randomly a sample of about 30% (n = 350) of the hospital charts of 1176/4571 (25.7%) discharged patients aged 65 or older who were newly catheterized and admitted during six months in 2019 and during 3 months in 2021 to one of three internal medicine departments in the Laniado Hospital, a 400-bed regional hospital. The independent variables included patient age, sex, disorientation (demented and or confused), urine volume on catheterization, and serum creatinine. The outcome variables were proportion of patients with inappropriately inserted catheters on admission and not adhering to consensus indications for keeping the catheter in after admission. Results There were 25.7% (1176/4571) of patients aged ≥ 65 years with newly placed urinary catheter. From a random sample reviewed, only 11.1% (39 /350) had consensus criteria for an indwelling catheter. There were 144 (41.1%) patients catheterized to obtain a urine sample for culture, not removed after admission in 57 (39.6%). Factors associated with failure to remove the catheter (odds ratios, 95% confidence intervals) included an incidentally detected increase in urine volumes (1.69,1.155–2.47), elevated serum creatinine values (2.71,1.66–4.42), and being disoriented (1.75,1.06–2.87). Conclusions Adherence to consensus criteria would have reduced urinary indwelling catheterization rates by nearly 90%, and efforts to ensure removal on admission might focus on those catheterized to obtain a urine sample, those with an incidentally detected increase in urine volumes, and those disoriented.