Playing Detective

By Jennifer Bradley, Staff Writer


The second-most common type of infection, a urinary tract infection (UTI), is responsible for approximately 8.3 million doctor visits each year, says the National Center for Health Statistics. A healthy number of those visits are from seniors and also repeat patients.

More commonly known as a bladder infection, a UTI can be life threatening to an elderly loved one if left untreated. It may lead to acute or chronic kidney infections, which can cause permanent damage or even kidney failure. A bladder infection is also a leading cause of a potentially life-threatening infection in the bloodstream called sepsis.

UTIs are easy to cure, but harder to diagnose in the senior citizen population. Caregivers must play detective if noticing behavioral changes, especially if the onset of such a shift is sudden. They should also not be surprised when a physician orders a urine analysis for a complaint of increased confusion in a loved one.

Medically speaking, a urinary tract infection happens when bacteria in the bladder or kidney multiplies in the urine. The senior population tends to have more UTIs than other age groups due to a number of factors, the first being weakened bladder muscles. The aging process takes its toll on all muscle groups, and a weakened bladder is the main culprit for incontinence and also more urine being held in the body.

Couple that with extra susceptibility to infections because of age and decreased immune function, as well as a less mobile lifestyle, and UTIs prove to be quite common. A caregiver should know the symptoms of a UTI and some prevention measures in order to save a loved one from more complications as they age.


The diagnosis of UTIs in the elderly is much more difficult than in the general population. The bacteria building in the urine eventually spreads to the blood stream, crossing the blood-brain barrier, causing a barrage of cognitive and mental symptoms. Many times these UTI symptoms in the elderly mimic those of dementia and Alzheimerís, and are diagnosed by caregivers and health care providers as such.

A key fact for caregivers to know is that many senior loved ones will not show the usual symptom of a fever, since the immune system is weakened and canít develop such a response. Experts say that 30 to 40 percent of seniors with an infection do not exhibit signs of a fever.

In addition to fever, many of the other common symptoms may be found, but not reported by elderly people suffering from a UTI, such as strong-smelling urine, pain with urination, pelvic pressure, night sweats, and cloudy or bloody urine. If a loved one does have these symptoms, they may not be able to express them, though a daily caregiver should keep watch.

This is why itís important a caregiver understand the most common senior-specific symptoms of a UTI. These include:

  • Confusion, or a delirious state
  • Agitation or restlessness
  • Hallucinations
  • Other behavioral changes
  • Poor motor skills and/or dizziness
  • Increase in falls
  • Facial grimaces

Sometimes these are the only symptoms that show up. If one day a loved one can change their clothing with no assistance and the next morning is requiring sufficient help, a red flag should be raised in a caregiverís mind.


The diagnosis part of a UTI situation is simple once symptoms are identified and a urinalysis is completed. The treatment most likely will be a course of antibiotics.

Most UTIs clear up in a few days, but age and health, as well as infection severity will determine the treatment course. It can take weeks and involve hospitalization if the need for intravenous antibiotics arises. A physician may also take a culture of the urine to determine exactly what type of bacteria is growing and the most effective medication to prescribe a loved one.

Those living in senior communities or nursing homes often are more resistant to the traditional antibiotics given to UTI patients, such as amoxicillin, and may require something stronger, and/or a longer duration.

A common cause of UTIs is using a catheter. If this is the case, part of the treatment is minimizing use of the device, and removing or replacing it more often. For an in-dwelling catheter, a caregiver should discuss with the physician a changing schedule and ensure it is followed. Some catheters are specially designed to minimize bacterial transmission from the tubing, and may be an option to consider if the UTIs persist over time.

Caregivers may worry if the confusion brought about by a UTI is permanent. Experts say that is dependent on whether, and how quickly, the cause of the confusion is determined. Ruling out a UTI or other infection is an appropriate first step for caregivers when noticing sudden changes in a loved oneís mental status. Early treatment of a UTI can prevent serious symptoms and complications, and will most likely result to a return of a loved oneís normal mental state.


As with many things, the best treatment for a UTI is prevention.

Women who have experienced a UTI at least once see increased odds of a reoccurrence.  Approximately 20 percent of women whoíve had a UTI will experience a second one and 30 percent of those women will get a third.

For a loved one with incontinence, here are some specific tips to apply. First, change the briefs frequently and encourage front-to-back cleaning of the genital area. Keeping that area clean is of utmost importance, as is setting reminders for the memory-impaired to remember to use the bathroom if they are able.

Some other general ways to prevent UTIs include:

  • Drink plenty of fluids (professionals recommend 2 to 4 quarts per day). This makes it harder for bacteria to live and multiply in the urinary tract by flushing it out.
  • Drink cranberry juice or take a cranberry tablet. This is not recommended if a loved one has a personal or family history of kidney stones, however.
  • Avoid caffeine and alcohol, which irritate the bladder
  • Avoid use of feminine hygiene products such as douches
  • If wearing underwear, use cotton and change at least once a day.

Prevention also comes by understanding how UTIS are developed in the senior population to begin with, and what may make a loved one more susceptible to the issue.

First, those with diabetes are at a higher risk. This disease affects many of the systems that protect against any type of infection, and poor circulation reduces the white blood cellsí mobility to the proper places in the body. Women diabetics are more likely to develop a UTI, and some doctors will routinely screen asymptomatic patients in order to prevent more serious complications.

Those with the inability to empty their bladder, or bowel incontinence, as well as those who use a urinary catheter have an increased risk for UTI development. Surgery anywhere around the bladder area can contribute to the rise of the condition, as can kidney stones.

A big risk factor is lack of physical activity, especially for those bound to a wheelchair or bed.

Prevention is important, but caregivers canít be too careful and should keep their eyes and ears open to changes in behavior of a loved one, no matter how subtle. Whether a fall, increased confusion, inability to get to the bathroom on time, these things should be noted and monitored in the event they are smaller symptoms of a larger issue.

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