Geriatric nurse supporting a weak patient

Certain surgically implanted, or suprapubic, catheters do not improve outcomes that are important for older adults’ well-being, such as functional ability and cognitive status, a study in nursing homes has found. The use of these devices should be primarily limited to palliative care, the researchers say.

The study examined outcomes in more than 9,600 long-term nursing home residents who had suprapubic tube placement (SPT) from 2014 to 2016 in the United States. The researchers looked at mortality, activities of daily living scores and mental status scores at one year after implantation, and 30-day postoperative complications.

An SPT drains urine from the bladder after being surgically implanted through a small incision in the belly. By one year after the procedure, about 38% of study participants with SPT had died. Among the survivors, 34% had worsened functional status and 36% had worsened mental status, Wesley H. Chou, BA, of Harvard Medical School in Boston reported.

Although the study could not attribute these outcomes directly to the catheter placement, it was evident that there was no improvement in either function or cognitive status in the year after the surgery. Residents’ functional status, for example, was compared to relatively stable status before the operation and never recovered to baseline, Chou and colleagues said.

These outcomes are important to the well-being of older adults, and this invasive procedure may be best used on a limited basis, the authors said.

“These findings emphasize that this ‘minor’ procedure should be considered with caution in this population and primarily for palliation,” they concluded.

Indwelling urinary catheters (which include urethral and suprapubic) are used by up to 13% of men and 12% of women on admission to nursing homes in the United States, according to the authors of a 2017 study.

Suprapubic catheters may be used to lower the risk of catheter-associated urinary tract infections and urethral erosion, as well as increased ease of care when compared to other catheter types, the authors noted.

The study was published in the Journal of the American Geriatric Society.

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