Good and safe care for elderly persons treated with a catheter in the urinary bladder

Indwelling urethral catheters are a common treatment among elderly persons in the emergency care as well as in elderly care. Approximately eight percent of the elderly living in nursing homes have an indwelling urethral catheter. Common complications associated with the treatment are urinary tract infections (UTI) which can result in increased mortality risk and prolonged hospital stays (Fang-Wen Hu et al 2015, SALAR Caring related infections 2011). The Swedish Association of Local Authorities and Regions (SALAR) have created a document with an aim of reducing indwelling catheter associated UTIs. Some of the suggested precautions are to identify persons with a special risk for UTIs and to only prescribe indwelling ureteral catheters for strict indications (SALAR Caring related infections 2011). Indwelling ureteral catheters are considered to be an appropriate treatment if the patient has urinary retention,  bladder outlet obstruction associated with incomplete emptying of the bladder, for measuring urine volume in a 24 hour period, sacral wound due to urinary incontinence, and administration of medication in the urinary bladder. Unfortunately, it has been shown in studies among hospitalized persons, that the majority of the patients had inappropriate indications, in which half of the persons were given an indwelling catheter for reasons such as “convenience of care”.  Other reasons were for preventing urinary retention, UTIs, and urinary incontinence in the absence of wounds.  Additionally, several patients had no documented indications at all (Fang-Wen Hu et al 2015). Elderly persons living in nursing homes have an increased risk for having antibiotic-resistant bacteria (Sundvall P-D et al 2014), and there is specially a high prevalence among persons treated with indwelling urethral catheters in the bladder (Albu S et al 2018).

To enable good and safe care for persons treated with indwelling ureteral catheters in the bladder, it is important to investigate the extent of the treatment and how it may effect the person’s health and wellbeing. This investigation may facilitate interventions with the aim of improving the  quality of care for this group of people.