Predictive factors of adherence to urinary self‐catheterization in older adults

Abstract

Aims The primary aim is to explore the adherence predicting factors in clean intermittent self‐catheterization (CISC) in patients aged over 65 years. The secondary aim is to assess whether in this population, the non‐adherence risk is greater, compared with patients under 65. Methods All patients older than 65 that successfully learned CISC between January 2011 and January 2016 were included. A control population younger than 65 matched with sex, body mass index, and pathology was selected. Results One hundered and thirteen (66.9%) out of the 169 patients older than 65 included were adherent at 1 month, and 80 (47.3%) at 6‐12 months. Obesity (P = 0.027), a low PP test (Pencil and Paper test) score (P = 0.037), significant urinary stress incontinence (SUI) (P = 0.048), and prescription of CISC less than three per day (P = 0.03) were the risk factors predicting stopping CISC at 1 month, but none was associated with non‐adherence at 6‐12 months. Compared with the younger group, age was a risk factor for poor adherence at 1 month. Conclusion Obesity, low PP test score, and important SUI are factors of poor adherence to CISC at 1 month in older adults. Necessity of more than three CISC per day is in favor of treatment continuation, possibly due to absence of spontaneous voiding in these patients. Long‐term adherence to CISC in older adults in this study remains close to adherence to other treatments prescribed in urinary disorders, and thus shows that CISC could be an easily purposed therapeutic option in this population, either on a long‐term or transitory basis.

What criteria affect a patient's choice of catheter for self‐catheterization?

“…Some studies have been conducted to explore factors limiting CISC, whether difficulties in learning or in continued use. These studies found that obesity, being female, or having a motor or cognitive disorders have a negative impact on the ability to learn CISC, and older age, important stress urinary incontinence, and dependency for CISC installation were predictive for a poorer adherence to the method …”

A guide for urogynecologic patient care utilizing telemedicine during the COVID-19 pandemic: review of existing evidence

“…Two recent retrospective cohort studies investigating risk factors for failure to learn and adhere to CISC demonstrated that patients with obesity and a low Pencil and Paper test score (a 4-min test that includes exercises of grip, access to perineum, and cognitive tasks to explore the global capacity for the patient to self-catheterize) are less likely to be good candidates for CISC [105,106]. Age > 65 was not predictive of failure.…”

“…We found 23 articles, of which 10 had data extracted [93][94][95][96][97][98][99][100][101][102]. Thirteen additional articles provided information pertinent to management of voiding dysfunction during this pandemic [103][104][105][106][107][108][109][110][111][112][113][114][115]. Based on review of the literature (23 articles) and expert consensus:…”

“…& Clean intermittent self-catheterization (CISC) may be preferable to an indwelling catheter for urinary retention when possible [104,107,108]. Risk factors that predict poor success with CISC include obesity, poor dexterity, cognitive impairment, and pain with catheterization [105][106][107]. & When patients call with symptoms of possible urinary retention, consider instruction in behavioral modification prior to recommending CISC.…”

Intermittent self-catheterisation: good patient education and support are key

“…It is vital that patients have good dexterity to enable precise positioning and insertion of the catheter to effectively perform CISC (Robinson, 2006). Above all, through dialogue, nurses must evaluate patient satisfaction, attitude and persistence of carrying out CISC, as these factors are known to influence adherence (Barbosa et al, 2012;Hentzen et al, 2019).…”