Why Not Just Insert an Indwelling Urinary Catheter?
Almost one quarter of hospitalized medical patients 70 years of age or older without a clear medical indication for catheterization receive an indwelling urinary catheter.3 The independent risk factors for catheterization without clear medical indication include female gender, multiple comorbid diseases, cognitive impairment, functional dependency, bed rest orders, and urinary incontinence. The more risk factors an older patient has, the more likely he or she is to be catheterized, indicating that the frail elderly patient is at highest risk for catheterization without a clear medical indication. Placing a urinary catheter in these patients more than doubles their risk of death and also increases their length of hospital stay.4 Indwelling urinary catheters cause 80% of all nosocomial urinary tract infections.5,6 One quarter of patients catheterized for 2–10 days develop bacteruria. Among those who develop bacteruria, 25% develop a symptomatic urinary tract infection and 4% become bacte
