Catheters May Pose Risks to the Elderly : Medicine: The devices save time and money, but they may contribute to the early deaths of some nursing home patients, researchers say.

Growing old is no fun. But it gets worse when you lose control over your bladder.

For about 15% of America’s 1.5 million nursing home residents, the solution is a urinary catheter, a plastic tube inserted into the urinary tract to channel urine into a storage bag.

It’s an old technology, and not very elegant. But catheters keep patients dry, and that helps protect them from slow-healing skin sores. They also reduce odors, preserve dignity and save the costs of repeated washing, linen changes or diapers.

But catheterized patients are vulnerable to urinary infections, which can be fatal if they spread to the blood or kidneys.

Ohio State University researchers say they have shown for the first time that long-term catheterization can triple the risk of death among nursing home patients.

The study found that the longer patients in the study were catheterized, the greater was their risk of fatal complications.

Dr. Calvin M. Kunin and four colleagues at Ohio State studied 1,540 patients in 13 Ohio nursing homes. Their report was published recently in the American Journal of Epidemiology.

After controlling statistically for other risk factors in the patients they studied, the researchers found that long-term catheterization was as much a threat to their lives as cancer, cardiac disease, high blood pressure, diabetes and age.

Also, “catheterized patients were hospitalized about three times more often, stayed in the hospital three times as many days and received antibiotics . . . about three times longer” than comparable patients who weren’t catheterized, the study said.

And that costs Medicare alone more than $344 million a year, the researchers estimated.

Not everyone is convinced.

Dr. John W. Warren, head of infectious diseases at the University of Maryland Health System, said that catheterized patients are usually sicker than other patients and that those in Kunin’s study may have died for reasons researchers did not consider.

Kunin advocates increased Medicare reimbursement to allow patient-care homes to buy more adult diapers. The reimbursement system channels most of its resources to hospitals to cure complications, rather than to nursing homes to help prevent them, he said.

The solution, he believes, may lie in research that would lead to better catheters.

“The bladder mechanism is an exquisite sort of thing,” he said. The insertion of a catheter changes that.

Besides the drainage tube, the catheter includes a tiny balloon that is inflated inside the bladder to hold the tube in place. But the tube and the balloon also prevent the system from emptying completely.

“So you have urine left behind . . . and bacteria can grow,” Kunin said.

What’s really needed, he said, is a new catheter design.

But manufacturers want to keep their products inexpensive, so research has been sparse.

Patients and family members should ask nurses how they can help avoid catheterization or at least shorten its duration.

“I would try every other thing, including frequent attention to clothes and bedclothes,” Warren said. “Behavior modification and medications are sometimes useful.”

“They should realize, however, that there may be times when there is no recourse” to catheterization, Kunin said.

Once a catheter is in place, Warren said, patients and family members “should keep asking the physician whether it has to stay in place. Patients have got to be persistent questioners, and the family has to be an advocate for the patient.”