Research article

Mobility and other predictors of hospitalization for urinary tract infection: a retrospective cohort study

Mary AM Rogers^1,2 , Brant E Fries^3,4,5 , Samuel R Kaufman^1,2 , Lona Mody^5,6 , Laurence F McMahon Jr^1,2 and Sanjay Saint^1,2,7

¹  Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA

²  Patient Safety Enhancement Program, Veterans Affairs Medical Center and University of Michigan Health System, Ann Arbor, Michigan, USA

³  Institute of Gerontology, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA

⁴  School of Public Health, University of Michigan, Ann Arbor, Michigan, USA

⁵  Geriatric Research, Education, and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA

⁶  Division of Geriatric Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA

⁷  Center for Practice Management and Outcomes Research, Ann Arbor Veterans Affairs Health Services Research & Development Center of Excellence, Ann Arbor, Michigan, USA

author email corresponding author email

BMC Geriatrics 2008, 8:31doi:10.1186/1471-2318-8-31

Published:	25 November 2008

Abstract

Background

Many hospitalizations for residents of skilled nursing facilities are potentially avoidable. Factors that could prevent hospitalization for urinary tract infection (UTI) were investigated, with focus on patient mobility.

Methods

A retrospective cohort study was conducted using 2003–2004 data from the Centers for Medicare and Medicaid Services. The study included 408,192 residents of 4267 skilled nursing facilities in California, Florida, Michigan, New York, and Texas. The patients were followed over time, from admission to the skilled nursing facility to discharge or, for those who were not discharged, for 1 year. Cox proportional hazards regression was conducted with hospitalization for UTI as the outcome.

Results

The ability to walk was associated with a 69% lower rate of hospitalization for UTI. Maintaining or improving walking ability over time reduced the risk of hospitalization for UTI by 39% to 76% for patients with various conditions. For residents with severe mobility problems, such as being in a wheelchair or having a missing limb, maintaining or improving mobility (in bed or when transferring) reduced the risk of hospitalization for UTI by 38% to 80%. Other potentially modifiable predictors included a physician visit at the time of admission to the skilled nursing facility (Hazard Ratio (HR), 0.68), use of an indwelling urinary catheter (HR, 2.78), infection with Clostridium difficile or an antibiotic-resistant microorganism (HR, 1.20), and use of 10 or more medications (HR, 1.31). Patient characteristics associated with hospitalization for UTI were advancing age, being Hispanic or African-American, and having diabetes mellitus, renal failure, Parkinson's disease, dementia, or stroke.

Conclusion

Maintaining or improving mobility (walking, transferring between positions, or moving in bed) was associated with a lower risk of hospitalization for UTI. A physician visit at the time of admission to the skilled nursing facility also reduced the risk of hospitalization for UTI.