Naushia Pandya

Urinary catheters shouldn’t be used routinely to manage urinary incontinence, according to new guidelines released by The Society for Post-Acute and Long-Term Care Medicine (AMDA).

The Choosing Wisely guidelines are designed to identify and reduce the use of medical tests and procedures that could be unnecessary or harmful.

“A urinary catheter leads to future immobilization and contributes to further decline,” says AMDA President Naushira Pandya, M.D., past chair of the AMDA Clinical Practice Committee. “It’s like a tether.”

Pandya says nursing home patients who arrive with a catheter might never have it taken out. She adds that a cultural change is beginning to happen, especially in hospitals leery of catheter-related UTIs and possible readmissions.

Other new recommendations from ADMA suggest questioning or limiting:

• Screening for breast, colorectal or prostate cancer if life expectancy is estimated at less than 10 years

• Obtaining a C. difficile toxin test to confirm a cure if symptoms have resolved

• Starting aggressive care for a frail elder without a clear understanding of the individual’s goals and possible benefits and burdens

• Initiating antihypertensive treatment in individuals 60 or older for systolic blood pressure  less than 150 mm Hg or diastolic blood pressure less than 90 mm Hg.