Urinary Incontinence and Indwelling Urinary Catheters in Acutely Admitted Elderly Patients: Relationship With Mortality,Institutionalization, and Functional Decline

ObjectivesTo study differences in functional status at admission in acutely hospitalized elderly patients with urinary incontinence, a catheter, or without a catheter or incontinence (controls) and to determine whether incontinence or a catheter are independent risk factors for death, institutionalization, or functional decline.DesignProspective cohort study conducted between 2006 and 2008 with a 12-month follow-up.SettingEleven medical wards of 2 university teaching hospitals and 1 teaching hospital in the Netherlands.ParticipantsParticipants included 639 patients who were 65 years and older, acutely hospitalized for more than 48 hours.MeasurementsBaseline characteristics, functional status, presence of urinary incontinence or catheter, length of hospital stay, mortality, institutionalization, and functional decline during admission and 3 and 12 months after admission were collected. Regression analyses were done to study a possible relationship between incontinence, catheter use, and adverse outcomes at 3 and 12 months.ResultsOf all patients, 20.7% presented with incontinence, 23.3% presented with a catheter, and 56.0% were controls. Patients with a catheter scored worst on all baseline characteristics. A catheter was an independent risk factor for mortality at 3 months (odds ratio OR] = 1.73, 95% confidence interval CI] 1.10–2.70), for institutionalization at 12 months (OR = 4.03, 95% CI 1.67–9.75), and for functional decline at 3 (OR = 2.17, 95% CI 1.32–3.54) and 12 months (OR = 3.37, 95% CI 1.81–6.25). Incontinence was an independent risk factor for functional decline at 3 months (OR = 1.84, 95% CI 1.11–3.04).ConclusionThere is an association between presence of a catheter, urinary incontinence, and development of adverse outcomes in hospitalized older patients.