BERKELEY, CA (UroToday Inc.) - The management of urinary incontinence in elderly and frail patients can be a dilemma. How often indwelling catheters are as used as definitive therapy, and whether this leads to increased morbidity and mortality is not known.

Landi and colleagues from Winston-Salem, North Carolina and Rome, Italy performed a retrospective review to determine the prevalence of bladder catheter use in frail and elderly women, and they evaluated the relationship between catheter use and mortality.

Study subjects were part of the larger Italian Silver Network Home Care project where the Minimum Data Set for Home Care (MDS-HC) instrument was used to collect over 350 data elements. From this group they examined 1,004 women who had urinary incontinence, but who had no explicit diagnosis of a terminal disease or cancer.

Their findings were reported in the Nov/Dec 2004 edition of Neurourology and Urodynamics. The prevalence of catheter use was 38.1% (383/1004). The overall average age of the women was 81.3 ± 9.0 years, with no significant difference between the catheterized and catheter free group. The patients with an indwelling catheter had a statistically significant higher level of physical and functional impairment when compared to non-catheterized patients. This difference is expressed by elevated ADL score (6.5 ± 1.3 vs. 5.5 ± 2.2), a higher prevalence of sensory impairment, increased occurrence of pressure ulcers (40% vs. 34%)* and more urinary tract infections (21% vs. 10%). Depression, however, was lower in the catheterized group (17% vs. 27%).

Twelve month follow up after the initial assessment revealed a significantly higher mortality in the catheterized group (24% vs. 15%). After correcting for significantly different variables in the two groups, the relative risk of death was 1.43 in the catheterized group.

The authors concluded that the use of indwelling catheters in elderly and frail female patients may be associated with a higher morbidity and mortality. Therefore it is important for health care providers to determine who is truly in need of a catheter to manage incontinence, and who would be better managed without one.

* These percentages differ from those in the originally published article and were corrected using the raw data that was available in Table 1.

Neurourol Urodyn 2004;23:697-701