The nonuse of urethral catheterization in the management of urinary incontinence in the teaching nursing home.

A survey of all patients in a 527-bed skilled nursing facility was carried out to determine the prevalence of bladder catheterization. The institution surveyed is a teaching nursing home and rehabilitation center comprising three intermediate-stay and rehabilitation units of 126 beds and nine long-term care units. The institutional prevalence of recurrent urinary incontinence was 46 per cent, or 243 patients. The prevalence of chronic indwelling urethral catheters was 2.5 per cent, or 13 patients. The prevalence of urethral catheterization was further reduced to 1.5 per cent on the long-term care units, where the rate of recurrent urinary incontinence exceeded 60 per cent. The results of our survey were then compared with similar surveys at the institution during the years 1975 through 1980. Despite a fluctuating but increasing prevalence of incontinence over the years studied, a favorable trend was shown toward a reduction in the number of patients with indwelling urethral catheters. This study indicates that unless specific complicating factors are present, urinary incontinence in all but a very few of the elderly can be successfully managed without chronic indwelling catheterization. The authors believe that the introduction and growth of an education and research program in the nursing home environment has led to improvement in the standards of medical and nursing care.