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Urinary Tract Infections in the Elderly: Causes, Symptoms, Prevention and Treatment

Urinary Tract Infections

Discover how urinary tract infections can display differently in older adults.

Chances are, your elderly parent or grandparent has experienced a urinary tract infection, or “UTI,” at some point during his or her life. In a healthy adult, a UTI can be an annoyance, but is generally pretty straightforward in symptoms and in treatment. The hallmark signs of a UTI are burning pain with urination, frequency of urination, back pain, fever, and cloudy, foul-smelling urine. When UTIs are diagnosed early, antibiotics and fluids are prescribed and recovery lasts just a few days. Yet, the presence of a UTI in an elderly, frail person can be deceptive, and left undetected, can potentially lead to hospitalization and even death.

A UTI generally refers to a bacterial infection in any of the four parts of the urinary tract system: urethra, bladder, ureters or kidneys. An un-checked UTI can eventually migrate into the circulatory system, resulting in sepsis. This is why early detection is so critical.

In the elderly population, UTI’s are the most common, yet often most hidden infection they can suffer from.  Because elders often lack the normal symptoms of a UTI, the infection may become septic before an infection is even suspected or diagnosed.  This is why a UTI in an elder requires immediate attention and treatment.  So, if you are caring for an elder loved one, it will be important to differentiate a UTI from other illness and get your loved one immediate medical attention in order to eliminate the infection.

Causes and Risk Factors

Most often, about 85% of the time, a UTI is caused by Escherichia coli, or E. coli bacteria. This bacteria is naturally found in the GI tract, but especially for women, E. coli can easily sneak into the urinary tract. Although women have a higher risk for developing UTIs and generally acquire them much more frequently, men are much more likely to develop severe UTIs, requiring hospitalization. It is important to note the common causes and risks associated for developing a UTI:

  • Poor hygiene habits
    • Wiping back-to-front after a bowel movement
    • Wearing soiled underwear
    • Wearing incontinent briefs
  • Incontinence
  • Not urinating frequently enough
  • Not relaxing and emptying the bladder with urination
  • Post-menopausal thinning and weakening of the urinary tract (in women)
  • Enlarged prostate, leading to retention of urine in the bladder (in men)
  • Catheterization
  • Immobility
  • Dehydration
  • Diabetes
  • Kidney stones
  • Bladder prolapse
  • Diabetes
  • Certain medications

Seniors in general are more susceptible to UTIs due to the above mentioned factors; however, the biggest culprit to developing UTIs is a weakened immune system. Your loved one may also have a diminished ability to take care of herself/himself for physical and cognitive reasons. These factors lead to decreased attention to hygiene overall. Seniors also tend to limit their fluid intake in an effort to avoid the embarrassment and inconvenience caused by bladder control issues. As urine pools in the bladder longer, it leads to urinary retention and a greater incidence of infection.

If your loved one wears incontinent briefs, there’s a very high probability of developing a UTI. No matter how often briefs are changed, fecal matter can enter the urinary tract very easily, even with minimal contact.

Signs and Symptoms

Detecting the symptoms of a UTI in an elder can be tricky. Your loved one may show all of the classic signs, yet often, because the immune system is not functioning optimally, the normal symptoms we have all come to know are not exhibited. Along with the more typical signs, be alert for these signs and symptoms:

  • Confusion
  • Dizziness
  • Disorientation
  • Agitation
  • Poor motor skills
  • Falling
  • Shortness of breath
  • Cough
  • Blood in urine
  • Malaise
  • Fever and chills
  • Nausea and vomiting

Confusion and UTIs

The symptom of confusion deserves special mention, as this is a frequent sign in an elder suffering from a UTI. Confusion will usually come on abruptly with a UTI, or for those already experiencing memory challenges, will increase dramatically. An infection will weigh down the immune system and lead to an increase in temperature and brain inflammation, which then leads to dehydration. The combination of these factors leads to mental changes in an elder with a UTI. The most important take-away from this: if your elder loved one show signs of a sudden increase in confusion, seek urgent medical attention to rule out a possible UTI or another cause.

UTIs and Dementia

As noted, with the onset of a UTI, confusion can increase rapidly in your loved one living with dementia. It can also worsen other behaviors such as agitation, hallucinations, insomnia and aggression. You may also notice sundowning symptoms becoming worse. It may be even more difficult to narrow down the cause when your loved one has difficulty communicating other symptoms. If you notice your loved one’s symptoms suddenly accelerating, it is better to be safe than sorry, and seek immediate medical attention.

Treatment and Prevention 

The good news is, once diagnosed by a simple urine test, treatment of a UTI in an elder is relatively straightforward. The majority of UTIs are treated with fluids and antibiotics. Once the infection is cured, prevention should be the primary focus. Here are some simple tips to encourage urinary tract health:

  • Stay hydrated: water is best, but any fluids your loved one enjoys should be offered
  • Bladder training: encourage toileting to empty the bladder every two hours
  • Offer a bedside commode or bedpan, if the person is worried about incontinence
  • Practice good perineal hygiene: wipe from front to back, clean the perineal area with soap and water and pat dry
  • If incontinence briefs are used, change frequently and clean the perineum between each change
  • If a catheter is necessary, clean around the insertion site twice daily, and after each bowel movement, with soap and water and pat dry
  • Wear and change loose, breathable cotton underwear daily and when soiled
  • Provide clean linens and towels; even a drop of urine or stool on linens should be changed
  • Avoid perfumed soaps, deodorants, toilet papers and douches
  • Provide wet wipes to make clean-up easier after toileting

The Scottsdale senior home care professionals at Nightingale Homecare are always on hand to provide education, helpful resources, and hands-on assistance in the comfort of home to help older adults remain healthy, comfortable, safe, and thriving. Call us any time at (602) 504-1555 to learn more!

The Role of Your Home Health Care Team

senior care Phoenix

Discover the roles of each home health care team member.

You may have questions about the home health care professionals sent to your senior loved one’s home and the role that each one plays in his or her recovery. While not every senior will receive every type of service, allhome care professional services are ordered by the doctor who is overseeing care at home, and all professional home visitors will be in close communication with each other and with the doctor. Nightingale Homecare, providers of the top rated senior care Phoenix AZ families need, breaks down the details on each of the types of home health care professionals who may visit your senior loved one:

What is the role of the nurse?

If a registered nurse is involved in your loved one’s care, you can expect him/her to do a thorough review of any medications the senior is on, and provide instruction regarding those medications. If necessary, the nurse might organize medications in a medication cassette or “pill box” to make it easier to keep things straight. Nurses will also monitor and treat any wounds, change wound dressings if necessary, administer intravenous (IV) medications or certain injections, change catheters, help manage pain, and evaluate vital signs and disease symptoms. The RN will also teach the senior and family members how to provide self-care. Nurses play a big role in helping provide understanding of specific illnesses and how to best manage these illnesses to prevent hospitalizations.

What is the role of the physical therapist?

If a physical therapist is part of your senior loved one’s home health care team, she/he will evaluate how the senior is moving and functioning in the home and develop an exercise program designed specifically to help the senior regain mobility and function. Physical therapists can work on strength, mobility, balance and coordination. They also play a big role in looking at the home environment and making recommendations to prevent falls and injuries. They make sure the senior is using the correct mobility equipment, such as walkers or canes, and that the way the senior is moving around is safe. They teach both the senior and his or her caregivers how to safely transfer if help is needed in going between the bed and a chair. Therapists are also required to check vital signs to make sure the senior is well enough to receive therapy.

What is the role of the occupational therapist?

The occupational therapist will evaluate how the senior is doing with activities of daily living, such as bathing, getting dressed, getting meals and tending to the home. They take a close look at how any problems with movement, muscle weakness, sensation, vision, hearing, breathing and thinking might be affecting activities of daily living. They have a lot of knowledge about special devices that can make activities of daily living easier for those experiencing challenges. They also make recommendations for how minor changes at home, such as moving things around, can make activities of daily living manageable.

What is the role of the speech therapist?

A speech therapist will focus on problems the senior may be having with memory, problem solving, swallowing, speaking, and/or understanding speech. She/he will develop a personalized plan to address specific problems in these areas.
What is the role of the social worker? The social worker will evaluate whether there are any community programs or services that could assist the senior with any physical, financial or emotional challenges. Social workers are skilled at helping people cope with stress and improve difficult family situations. They are also very knowledgeable about different types of housing and how much support is available in different housing environments. They are available to help in figuring out how to plan for the future needs of someone whose health is declining.

What is the role of the dietician?

A dietician will look closely at the senior’s medical diagnosis, eating patterns and nutritional status. She/he will develop an eating plan that works for the senior and that follows any medical instructions. She/he will also help with planning meals and provide tips for shopping and cooking. Sometimes dieticians are called in to work with patients who have severe issues with weight gain or weight loss, diseases that affect their nutritional status or dietary needs, and patients that have to be fed through a tube.

What is the role of the home health aide?

Home health aides work under the strict direction of the nurse or therapist, following a care plan that is developed by the professionals involved in the senior’s care. She/he will help with personal care, such as bathing/showering and getting dressed and ready for the day. The home health aide can also tidy up after providing personal care and help with any exercises that the therapist has ordered. Home health aide visits are limited to the amount of time it takes to provide personal care services. Home health aide visits usually are provided one to three times a week, depending on each individual’s circumstances.  The number of visits your senior loved one receives is determined by Medicare criteria and will be explained by the nurse or therapist. If the senior needs more help than what the home health aide can provide under Medicare guidelines, Nightingale will be happy to talk with you about options to consider. We are experts with in-home supportive care services and have helped many people that are having difficulty managing at home.

We’d love to talk with you to share more details on how our full team of home health care professionals can work together to keep your senior loved one safe, healthy and thriving at home. As the top providers of senior care Phoenix AZ families rely on, Nightingale Homecare is here for you! Call us at (602) 504-1555 to learn more.

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Psychotropic Medications: Are They Helping or Harming Seniors?

Scottsdale home care agencyMedications that are capable of affecting the mind, emotions and behaviors are called psychotropic medications. These include commonly used pain medications called opioids as well as medications used to treat depression, anxiety, mood disorders, sleep problems, dementia and other mental illnesses. When given to older adults, psychotropic medications are typically intended to improve quality of life and ability to function. The doctor must assure, however, that the patient is accurately diagnosed, that the dose is correct, that harmful side effects don’t occur and that the psychotropic medication doesn’t interact badly with other medications that the patient is taking.

At Nightingale Homecare, the top provider of home care in Paradise Valley, we want to help seniors and their caregivers better understand the types of psychotropic medications they may be prescribed, how they can help, and the effects they may experience.

Some examples of psychotropic medications include:

  • Depression medications (e.g. Zoloft, Paxil, Elavil, Effexor, Wellbutrin)
  • Anxiety medications (e.g. Valium, Xanax, BuSpar, Ativan, Halcion)
  • Mood stabilizer medications (Depacote, Lithium)
  • Antipsychotics (e.g. Risperdal, Haldol, Zyprexa, Seroquel)
  • Stimulants (e.g. Adderal, Ritalin)
  • Anti-dementia medications (i.e. Aricept, Namenda, Exelon, Cognex)
  • Sleep medications (e.g. Ambien, Sonata, Lunesta, Remeron, Desyrel, Pamelor,)
  • Opioid pain medications (e.g. Percocet, Vicodin, OxyContin, Morphine, Meperidine, Hydromorphone, and Fentanyl)

The use of psychotropic medications and opioids has increased steadily in older adults over the last ten years. In the United States, people over the age of 65 represent just 13 percent of the population, yet this age group takes over one-third of the drugs prescribed in this county. What is even more disturbing is that a recent study found that the number of older Americans who take three or more brain-affecting medications has doubled in the last ten years. For adults age 65-80, nine out of ten have prescriptions for psychotropic medications written by a doctor that is not a psychiatrist.

Although they can be beneficial at times, psychotropic and opioid medications can also be dangerous when taken by older adults, especially when taken long-term. The elderly are more sensitive to the effects of these medications because most drugs are eliminated from the body through the kidneys and liver, both of which may work less efficiently in later years. Another age-related change is an increase in the amount of body fat. Seniors are at high risk for “drug toxicity,” or the result of drugs accumulating in the body because the drugs are often stored in fat. Drug toxicity is very serious and can be fatal.

Even though there is a well-known connection between the use of psychotropic medications in older adults and the potential toxicity from them, health care professionals often do not recognize what is happening. More than likely, they attribute the symptoms of medication toxicity to some sort of new health condition or worsening of an existing health condition.

Side effects from psychotropic drugs are more frequent and severe in older adults, especially feelings of sleepiness or being “out of it.” Memory and movement problems are also very common and can lead to falls, fractures and other accidents.

Most older adults who take psychotropic medications also take other prescribed and over-the-counter medications. Because of this, careful evaluation is needed to make sure that unwanted, uncomfortable or dangerous side effects and interactions are not occurring. Bad medication reactions commonly include: hallucinations, confusion, dizziness, constipation, drowsiness, weakness, slurred speech, lack of balance or coordination, slow and shallow breathing, poor judgement, falls with broken bones, addiction and even death. In addition, a recent study found that use of benzodiazepine (or anti-anxiety medication) results in a higher risk of developing Alzheimer’s disease.

Hospitalization due to bad drug reactions occurs about four times more frequently in older patients than in younger ones – and, these bad reactions could have been prevented in almost 90% of cases!

Due to the risks involved, psychotropic medications should only be prescribed by a senior’s doctor after very careful consideration, and only after trying medications or treatments that pose a lower health risk.

When considering treatment foranxiety, depression, psychological distress, sleep disorders and chronic pain,non-pharmaceutical strategies are often considered preferable to drug options in the elderly. These include:

  • Exercise
  • Meditation
  • Physical therapy
  • Acupuncture
  • Thai chi
  • Cognitive behavioral therapy
  • Yoga
  • Biofeedback
  • Chiropractic therapy
  • Guided imagery
  • Progressive muscle relaxation
  • Hot and cold treatments
  • Deep breathing
  • Relaxation training

When it comes to pain management, there is a perception that opiate pain medications are the best treatment, but studies have determined that there is no advantage to using opioid pain medications for the treatment of chronic pain in older adults when the pain is not caused by cancer. For non-cancer pain, opioids are recommended for a maximumof 3-7 days, and some over-the counter pain medications may actually be more effective.
Nightingale Homecare is committed to keeping seniors safe and well through trusted in-home care services, skilled nursing care, and more. Contact us today at (602) 504-1555 for further information on psychotropic medications or for set up a consultation for home care in Paradise Valley and the surrounding area.

The Top Benefits of Skilled Nursing Care at Home

skilled nursing care at home

With the vast majority of older adults preferring to remain at home throughout aging, in-home senior care, such as companion care, help with personal care needs, meal preparation, transportation, and other non-medical services are invaluable. But what happens when a senior has medical needs that require skilled nursing care, such as a chronic condition like COPD, CHF, or diabetes? Or what about those who are recovering from a fall or surgical procedure? Is a nursing home or transitional care facility a necessity in those cases, or is it possible to receive skilled nursing care at home?

The Sun City home health care team at Nightingale Homecare is pleased to share that not only is this a possibility, but it’s been shown to reduce the risk of rehospitalizations and enhance healing and overall health and wellbeing. Here are just a few of the additional benefits seniors can receive through the services of skilled nursing care at home:

  • One-on-One Care: Quality of care is greatly enhanced when a senior is cared for by his or her own personal nurse and/or home health aide, as opposed to the average ratio of 10 seniors per one caregiver in a nursing home. Changes in condition or any other concerns can be picked up on and addressed immediately without the need to wait until care staff are available.
  • Comfort: There’s no place like home, as the saying goes, and that’s especially true when recovering from an illness, injury or surgical procedure. Seniors can sleep better, eat healthier, and experience reduced stress and anxiety when in their own familiar surroundings and the assistance of skilled nursing care at home.
  • Independence and Freedom: The intangible benefits of being able to choose what and when to eat, where to sleep or relax, when to invite family and friends to visit, and even something as simple as whether to allow the family cat to curl up beside you are priceless in boosting a senior’s feelings of remaining in control of his or her life choices.

If you’d like to explore skilled nursing care at home for your senior loved one, Nightingale Homecare is on hand to help, with a full range of both skilled and non-medical in-home care services for seniors. Just a few of the many ways we can help, right in the comfort of home, include:

  • Medication management
  • Infusion services
  • Ventilator/respiratory services
  • Wound care
  • Blood draws
  • Chronic care management education
  • Tube feedings
  • Stoma care
  • Nursing evaluations
  • Specialized care for Alzheimer’s disease and dementia
  • And much more

Contact us any time to learn more about our Sun City home health care solutions at (602) 504-1555.

 

Don’t Let the Stages of COPD Leave You Breathless

Stages of COPDIt impacts tens of millions of Americans, for a variety of reasons, but smoking and long-term chemical exposure are the top causes. And many simply struggle with the symptoms without even realizing there’s an official diagnosis for the breathing problems they’re facing. COPD, while currently without a cure, can be treated to ease symptoms, reduce the risk of developing further complications, and enhancing quality of life.

COPD can be broken down into four typical stages, although each person encounters the disease uniquely. Understanding these four stages and reviewing the particular symptoms and concerns your loved one is experiencing with the physician is a good starting point. Nightingale Homecare’s Arizona home health care professionals share helpful information on what to expect in each stage of the disease:

  • Mild (Stage 1): A chronic cough and an increase in mucous produced are often the first symptoms noted – and for some people in this stage, they aren’t bothersome enough to be very noticeable or to warrant a visit with the doctor.
  • Moderate (Stage 2): During this stage, COPD patients begin to struggle with shortness of breath, in addition to the continuing cough and mucous production. Symptoms are more troubling, and the doctor may prescribe a long-acting bronchodilator to help.
  • Severe (Stage 3): Frequency of symptoms is increased in this stage, as well as severity. Normal day-to-day functioning may become compromised at this point, and additional treatment methods may be employed by the doctor, such as oxygen therapy, corticosteroids, or other medications.
  • Very Severe (Stage 4): Symptoms continue to increase in both frequency and severity, and surgery may be considered. There is also an increased risk for serious health complications during this stage, such as heart and blood pressure problems, pneumonia, and lung cancer.

Depression is also a common risk factor in those with COPD, so it’s important to share any and all concerns – physical and emotional – with the senior’s medical team.

You can also call on the skilled medical care professionals at Nightingale Homecare for assistance. Our registered nurses and caregiving staff are available to help with all necessary care needs for those with COPD, from oxygen therapy, inhalation treatments, ventilator management and care, and other skilled care services, to compassionate companionship to engage in conversations, share in enjoyable activities together, and help with meals, housework – and everything in between. And, our Pathlink chronic disease management program helps those with conditions such as COPD learn a variety of innovative techniques to better manage their disease and improve their overall quality of life.

You can reach us at (602) 504-1555 any time with questions, to request additional COPD resources, and to learn more about our Arizona home health care for seniors.