UTIs in Seniors: What You Might Not Know

November is bladder health month! We thought we would take this opportunity to talk about UTIs. We have handled many panicked phone calls from family members or individuals in dire need of care. As we have listened and learned, this is not always the case. One thing to consider is that the individual may be suffering from a Urinary Tract Infection. They may have commonly known symptoms such as painful or frequent urination but they also may have lesser-known symptoms such as confusion, hallucinations, and memory loss. You might not need ongoing care, after all! Read on to learn more!

A urinary tract infection (UTI) is a bacterial or fungal infection in part of the urinary system, which includes the kidneys, ureters, bladder, and urethra. UTIs are one of the most common infections in seniors, who can experience more severe symptoms than younger people.

Symptoms of a UTI may include:

• more urgent need to urinate
• increased urination
• burning, pain, or discomfort when urinating
• feeling pressure in the lower abdomen or pelvis
• cloudy, thick, or odorous urine
• the bladder not feeling empty after urination
• fever
• pain in the lower abdomen, flank, or back
• blood in the urine
• fatigue
• nausea
• vomiting

Seniors can exhibit behavior that can be similar to dementia or other illnesses and cause loved ones to panic or misdiagnose. These symptoms can include changes in behavior such as restlessness, hallucinations, social withdrawal, agitation, and confusion.  

UTI’s in Seniors

According to the Cleveland Clinic, there are a few lesser-known pieces of information when it comes to UTIs in Seniors:

When an older adult becomes confused, many people — both medical and non-medical — assume that a UTI is responsible.  But aging increases the incidence of confusion and delirium, especially among those who are cognitively impaired, depressed, malnourished or completely dependent.  “Delirium can be caused by various factors, the most common one being dehydration,” notes Dr. Lathia of the Cleveland Clinic.

Elevated urinary bacteria (asymptomatic bacteriuria) doesn’t cause any symptoms and can often be corrected by increasing fluid intake.  The condition occurs in about 6 to 16 percent of women over age 65, 20 percent of women over age 80, and 25 to 50 percent of women living in nursing facilities.

Be sure to mention whether these symptoms are also present:

• Fever over 100.5 °F
• Worsening urinary frequency or urgency
• Sudden pain with urination
• Tenderness in the lower abdomen, above the pubic bone
• Having at least two of the symptoms above, along with a positive urine culture, will confirm a UTI.

Older adults may have other conditions that increase their risk for a UTI or that produce similar symptoms.  “For example, bladder obstruction is what usually causes UTIs in older men,” explains Dr. Goldman of the Cleveland Clinic. “Focusing only on the UTI can mask this serious underlying problem.”

Risk Factors for Seniors

Factors that increase the risk of older adults developing a UTI include:

• changes in the immune system
• exposure to different bacteria in the hospital or care facility
• other health conditions, such as incontinence
• having had a prior UTI
• changes in the way the urinary system works, including prostatic hypertrophy in males
• presence of a urinary catheter, which is a tube that connects the bladder to a bag outside of the body to allow urine to drain

It is important for caregivers to be aware of these risk factors and observe any cognitive changes that could indicate a UTI.

Treatment

The standard treatment for a UTI is antibiotics, which kill the bacteria causing the infection. Older adults generally don’t need powerful antibiotics for UTIs.  Treatment for UTIs should begin with narrow-spectrum antibiotics, says Dr. Lathia and Dr. Goldman.  These drugs are less likely to lead to antibiotic resistance and problematic side effects than broad-spectrum antibiotics.

Today, amoxicillin is commonly prescribed as a first-line treatment for UTIs in older adults.

Other common narrow-spectrum must be used with caution when patients have chronic kidney disease or take blood pressure medication, as many older adults do; or because their side effects can be serious in older adults.

Prevention

Taking steps to prevent a UTI is vital for people who have a higher risk of getting one, including older adults.

Methods to prevent a UTI include:

• drinking plenty of fluids
• avoiding caffeine and alcohol
• wiping from front to back after going to the bathroom
• promptly changing incontinence pads or underwear when soiled
• Promote genital and urinary hygiene
• Ask the doctor about low-dose vaginal estrogen cream for postmenopausal women (to rejuvenate the vaginal skin and support the presence of good bacteria)

Dr. Goldman says researchers are also studying D-Mannose for UTI prevention. The supplement, which has few side effects, sticks to bladder receptors that normally attract the E. coli bacteria usually responsible for UTIs.  Researchers also believe D-Mannose may keep bad bacteria from colonizing the digestive tract, which can harbor the bacteria responsible for UTIs in women.

Acknowledgments:

The Cleveland Clinic

Web MD

Medical News Today