American Journal of Epidemiology Vol. 135, No. 3: 291-301
Copyright © 1992 by The Johns Hopkins University School of Hygiene and Public Health
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The Association between the Use of Urinary Catheters and Morbidity and Mortality among Elderly Patients in Nursing Homes
1Department of Internal Medicine, The Ohio State University Columbus, OH
2Department of Preventive MeoWne, The Ohio State University Columbus, OH
Reprint requests to Dr. Calvin M. Kunin, Department of Internal Mecfldne, The Ohio State University, M110 Starling Loving Hall, 320 West 10th Avenue, Columbus, OH 43210
To determine whether the use of urinary catheters in elderly patients in nursing homes has an independent effect on morbidity and mortality, the authors conducted a 1 -year prospective study among 1,540 patients in a stratified random sample of nursing homes. Patient mortality was assessed at 1 year in relation to the presence or absence of a catheter at entry to the study, acquisition of a catheter, and the proportion of nursing home days spent catheterized during the study year. The independent association of catheter use with mortality was assessed by logistic regression analysis adjusted for age, activities of daily living, mental status, skin condition (decubitus ulcers), and 20 medical diagnoses. The effect of catneterization on hospitalization, use of systemic antimicrobial drugs, and mortality was also examined by matched pairs analysis. At entry, 10.5% of patients had catheters, and they tended to remain catheterized during most of the study year. An additional 10% were catheterized during the year. The following factors were found to have a significant independent association with mortality: urinary catheters, age, mental status or activities of daily living, cancer, cardiac disease, diabetes, and skin condition. There was a stepwise increase in mortality with duration of catneterization. Patients who were catheterized for 76% or more of their days in the nursing home were three times more likely to die within a year. The number of hospttalizations, duration of hospitalization, and use of antimicrobial drugs were all three times greater among catheterized patients. Am J Epidemiol 1992;135:291–301.
activities of daily living; aged; antibiotics; catheters; indwelling; costs and cost analysis; mental health; nursing homes
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