Aging Clinical and Experimental Research
The association of indwelling urinary catheter with delirium
in hospitalized patients and nursing home residents: an explorative
analysis from the “Delirium Day 2015”
· Paola Porrino
· Simona G. Di Santo
· Andrea Mazzone
· Antonio Cherubini
· Enrico Mossello
· Massimo Musicco
· Alberto Ferrari
· Nicola Ferrara
· Claudia Filippini
· Alessandro Morandi
· Giuseppe Bellelli
· on behalf of the Italian Study Group on
Received: 8 March 2018 / Accepted: 22 May 2018
© Springer International Publishing AG, part of Springer Nature 2018
Backround Use of indwelling urinary catheter (IUC) in older adults has negative consequences, including delirium.
Aim This analysis, from the “Delirium Day 2015”, a nationwide multicenter prevalence study, aim to evaluate the associa-
tion of IUC with delirium in hospitalized and Nursing Homes (NHs) patients.
Methods Patients underwent a comprehensive geriatric assessment, including the presence of IUC; inclusion criteria were
age > 65 years, being Italian speaker and providing informed consent; exclusion criteria were coma, aphasia, end-of-life
status. Delirium was assessed using the 4AT test (score ≥ 4: possible delirium; scores 1–3: possible cognitive impairment).
Results Among 1867 hospitalized patients (mean age 82.0 ± 7.5 years, 58% female), 539 (28.9%) had IUC, 429 (22.9%)
delirium and 675 (36.1%) cognitive impairment. IUC was signiﬁcantly associated with cognitive impairment (OR 1.60,
95% CI 1.19–2.16) and delirium (2.45, 95% CI 1.73–3.47), this latter being signiﬁcant also in the subset of patients without
dementia (OR 2.28, 95% CI 1.52–3.43). Inattention and impaired alertness were also independently associated with IUC.
Among 1454 NHs residents (mean age 84.4 ± 7.4 years, 70.% female), 63 (4.3%) had IUC, 535 (36.8%) a 4AT score ≥ 4, and
653 (44.9%) a 4AT score 1–3. The multivariate logistic regression analysis did not show a signiﬁcant association between
4AT test or its speciﬁc items with IUC, neither in the subset of patients without dementia.
Discussion We conﬁrmed a signiﬁcant association between IUC and delirium in hospitalized patients but not in NHs
Conclusion Environmental and clinical factors of acute setting might contribute to IUC-associated delirium occurrence.
Keywords 4AT test · Geriatric assessment · Cognition · Delirium
The indwelling urinary catheter (IUC) has a wide, and some-
times inappropriate, use among older patients, especially in
the acute setting [1–5]. In European hospitals, prevalence
of IUC is reported to be 17.5%, with even higher prevalence
(24.6%) in geriatric setting [1–3] while prevalence in United
States (US) hospital is 23.6% . A wide cross-sectional
study among US acute wards shows that approximately
30–40% of IUC are placed without an appropriate indica-
The indwelling urinary catheter has several well-known
negative eﬀects: up to 67% of urinary tract infection in all
hospital patients are catheter associated and IUC use can
result in increased risk of sepsis, mortality, longer hospital
stay and higher care cost [6, 7].
Delirium itself can lead to negative outcomes, such as
poor quality of life, longer length of hospital stay, increased
mortality, long-term cognitive and functional impairment,
institutional placement, distress for family members and
national health expenditure [8–11].
The members of the Italian Study Group on Delirium (ISGoD) are
provided in the Acknowledgements section.
* Paola Porrino
Extended author information available on the last page of the article