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
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
This is why itís important a
caregiver understand the most common senior-specific
symptoms of a UTI. These include:
- Confusion, or a delirious
- Agitation or restlessness
- Other behavioral changes
- Poor motor skills and/or
- 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
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.