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

Chances are, your elderly parent or grandparent has experienced urinary tract infections, or “UTIs,” 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, UTIs 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 care at home 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. If you need home care in Scottsdale, AZ and the nearby areas, call us any time at (602) 504-1555 to learn more!