Understanding UTIs in the elderly

 A senior woman's hands grab the front of her trousers in an effort to prevent a leak due to incontinence.

Understanding UTIs in the elderly

Anyone with an aging parent, grandparent or is aging themselves, needs to be aware of the facts on urinary tract infections (UTIs).  When we are young and healthy, developing a UTI is usually not a big deal as our immune system will take over fighting it off.  But the effects of aging can make UTIs in the elderly not only harder to detect but harder to cure. 

UTIs are common - they are responsible for around 8.1 million doctor visits each year.  Women are four times more likely to get UTIs than men because their urethras are shorter than men’s urethras.  Around 6% to 16% of women over the age of 65, 20 % of women over age 80, and 25% to 50% of women living in long-term nursing facilities, experience UTIs in any given year.   Elderly men are also susceptible to UTIs and need to be monitored for them as well.

What are urinary tract infections?

A UTI happens when bacteria in the urethra, bladder, or kidneys multiply in the urine.  If left untreated, a UTI can lead to acute or chronic kidney infections, which could permanently damage these vital organs possibly leading to kidney failure.  These common infections are also a leading cause of sepsis, a potentially life-threatening infection of the bloodstream.

Urinary tract infections can develop in anyone, but especially for older adults, a UTI can be a nuisance.  For the elderly, they are more likely to have the potential to cause serious health problems, including hospitalization and even death.  That is why it is important to know the facts of UTIs in the elderly and why they need to be carefully monitored and treated.

Why are UTIs in the elderly more common?

It is the elderly who are most vulnerable and likely to experience a UTI for many reasons, one of which is a weakened immune system making their overall susceptibility to infection probable.  Elderly men and women also experience a weakening of the muscles of the bladder and pelvic floor, which can lead to increased urine retention (incomplete emptying of the bladder) and incontinence, both contributing to infection.

Other reasons why the elderly are more susceptible to UTIs are as follows:

·      Diabetes

·      Use of a urinary catheter

·      Bowel incontinence

·      Urinary incontinence

·      Enlarged prostate

·      Immobility  - anyone who has to lie in bed for extended periods of time

·      Surgery of any area around the bladder

·      Kidney stones

Usual symptoms of UTIs

The typical symptoms of a UTI are the following:

·      Bloody urine

·      Strong or foul-smelling urine

·      Frequent or urgent need to urinate

·      Pain or burning during urination

·      Feelings of pressure in the lower pelvis

·      Low-grade fever

·      Night sweats, shaking or chills

Symptoms of UTIs in the elderly

Older adults may not exhibit the same symptoms of a UTI as does a younger person.  Since the elderly’s immune system is not able to respond as well to the infection, signs or symptoms of a UTI may not necessarily occur.  Another factor is that for some seniors, their ability or lack thereof to express their discomfort associated with a UTI, could result in their caregiver not realizing they are suffering from one with the UTI going unnoticed until it progresses and becomes worse.

Because of the above reasons and because the elderly simply respond differently to infection, it is important to know and look for various signs and symptoms seen in this age group.  Sometimes when an elderly person has a UTI, it can be mistaken for the early stages of dementia.  The reason is sometimes they may have the following symptoms occurring that mimic dementia or Alzheimer’s disease:

·      Confusion or delirium

·      Agitation

·      Hallucinations

·      Other unusual behavioral changes

·      Poor motor skills or loss of coordination

·      Dizziness

·      Falling

Knowing that the above symptoms could actually be signaling a UTI instead of dementia, it is crucial to be alert to any sudden changes in the behavior and mental state of the elderly.

Steps to reduce UTIs in the elderly

There are several recommendations on how to reduce the risk of an elderly person developing a UTI.  They include the following:

·      If they wear adult incontinence briefs, change them promptly and frequently

·      Encourage front –to-back wiping and cleansing

·      Keep the genital area clean

·      Set reminders/timers for seniors who are memory-impaired to try to use the bathroom instead of an adult brief if they can

·      Drink plenty of fluids (2 to 4 quarts of water each day unless this conflicts with a physician’s orders)

·      Drink cranberry juice or use cranberry tablets but not if they have a history of kidney stones

·      Avoid or at least limit caffeine and alcohol intake, which irritates the bladder

·      Wear breathable cotton underwear and change them at least once a day

To avoid serious complications, at the first sign of a UTI in an elderly person, they should see a doctor right away.  If UTIs are caught early, a simple course of antibiotics typically clears up the infection in no time.