Dementia catheterization rate a ‘cause for concern’

Researchers from the UK have found that patients with dementia presenting in primary care with urinary incontinence are significantly more likely to receive pharmacologic treatment or be catheterized than other patients.

The team, reporting in PLoS Medicine, says that this finding is particularly concerning given the known risks associated with indwelling catheters, which include infection, tissue damage, bladder spasm, and bladder calculi formation.

“This finding may indicate that ease of management is prioritised over risk avoidance,” suggest authors Robert Grant (Kingston University and St George’s University of London, UK) and colleagues.

They analyzed data from a primary care database on 54,816 patients with dementia aged 60 to 89 years, as well as a sample of 205,795 people without dementia or incontinence at study entry, with follow-up from 2001 to 2010.

During the study period, men with dementia had a rate of urinary incontinence 3.2 times that of men without dementia, and a rate of fecal incontinence 6.0 times greater. In women, the respective rates were 2.7 and 4.5-fold greater in those with dementia.

The team found that patients with dementia received pharmacotherapy and were catheterized sooner than those without. For example, in women, the median time to pharmacotherapy following incontinence diagnosis was 19 months in those with dementia and 30 months in those without, and time to catheterization was 26 versus 41 months.

After adjusting for confounders, the overall rate of first pharmacologic treatment for urinary incontinence was 2.2 times greater in those with dementia compared with those without, while the rate of prolonged catheterization was 1.6-fold greater in men and 2.3-fold greater in women.

Grant and colleagues say that the findings suggest “that people with dementia were being offered drug treatments for their urinary incontinence earlier and/or in greater numbers than their counterparts without dementia.”

Noting that the increased ratio of pharmacologic treatment in patients with dementia was particularly high for young patients and those with few comorbidities, they suggest that concerns about polypharmacy and drug interactions may inhibit their use in older patients.

However, it is the use of indwelling catheters that they consider the greatest concern arising from their findings.

“Unlike drug treatments, there is a less powerful clinical rationale for catheterising people with dementia sooner,” they comment, adding that the International Continence Society dissuades physicians from the practice.

“Further study is required to understand the clinical reasoning of health care practitioners providing care for this population, particularly in the use of indwelling catheters, given the known risks,” they conclude.

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