Incidence & Prevalence Of Uti & Asb
UTI is one of the most commonly diagnosed infections in older adults. It is the most frequently diagnosed infection in long-term care residents, accounting for over a third of all nursing home-associated infections . It is second only to respiratory infections in hospitalized patients and community-dwelling adults over the age of 65 years . As our population ages, the burden of UTI in older adults is expected to grow, making the need for improvement in diagnostic, management and prevention strategies critical to improving the health of older adults.
How Dangerous Is A Urinary Tract Infection
Urinary tract infection often occur in older adults, it happens when a bacterial infection affect the bladder which is supposed to be a sterile environment, the seriousness of urinary tract infections and how dangerous it could be can vary from a minor medical issue easy to solve with antibiotics to a life threatening condition,
it also depends on the overall state of health for the affected person and whether or not the infection spread to other parts and organs of the body or not.
In most cases with UTIs symptoms are mainly related to bladder irritation such as a burning sensation while urinating, blood in the urine, pain and urge to urine frequently, oral antibiotics treatment usually result in quick improvement.
In older adults specially ones with dementia, a UTI can cause delirium which is a worsening situation for their mental state and that can be dangerous because it put them at risk of failing and hurting themselves.
A urinary tract infection can become even more serious when it affects the other parts of the body like the kidney or it spreads to the bloodstream, in this situation a life threatening low blood pressure may occur, intravenous antibiotics may be used to treat this spreading UTI.
Note: There is a condition that is often confused with urinary tract infections but it isnât, Asymptomatic bacteriuria which happens when a urine culture grows bacteria, even though the person may not show any symptoms,
Characteristics Of Included Studies
There were four large retrospective cross-sectional studies, and among the remaining studies the number of patients in each study varied considerably from small community samples of 9 to larger hospital samples of 710 . The majority of the studies identified were cross-sectional in design. Approximately half of the studies had an entirely elderly population65years , with the other half of studies having populations deemed to be representative of an elderly population by median or mean age65years . In the two remaining studies, one conducted in a nursing home and the other in a psychogeriatric unit, the demographics of the patient sample were not provided. They were believed to be representative of an elderly population by their care setting. The proportion of participants with urinary catheters was unclear in the majority of included studies . In the remaining studies, urinary catheter rates were high, 3751% , low 1.85.5% and none . The majority of the studies were conducted in a hospital setting , followed by nursing homes and community settings . Interestingly, only two of the included studies had the explicit aim of exploring the association between confusion and UTI however, ten studies did partially explore this association.
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Bacteria In The Urine Isnt Necessarily A Problem
Elevated urinary bacteria doesnt cause any symptoms and can often be corrected by increasing fluid intake.
The condition occurs in about 6 to 16 percent of women over age 65, 20 percent of women over age 80, and 25 to 50 percent of women living in nursing facilities.
Doctors should not treat urinary bacteria with antibiotics unless there are multiple other signs or symptoms of a UTI. This can encourage antibiotic resistance and make future UTIs harder to treat, says Dr. Lathia.
The presence of antibiotic-resistant bacteria in the urine also increases the risk of serious complications, including C. difficile infection and death.
Are Frequent Utis A Sign Of Diabetes Or Is A Uti A Symptom Of Diabetes
A review from 2005 found that an astounding 50% of people with diabetes have some type of dysfunction of their bladder- thats half of every man and woman with diabetes. There are quite a few theories which we have already discussed, but again, most of the newer theories and research have only been conducted on rats.
Another fact this review highlights is that women who have Type 1 diabetes have a higher risk for kidney infections , which can potentially damage the kidneys function long term. This may lead to the need for a kidney transplant as the damage becomes severe.
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How Is A Uti Treated
The treatment for your uti will depend on what type of infection it is. If it is a bacterial infection, it will be treated with an antibiotic. If it is determined that it is a fungal infection, it will be treated with a different medication which targets fungal infections.
The first step your doctor will take will be to obtain a urine sample this urine sample will determine if you have an infection. If so, the urine is then also cultured to determine which antibiotic it is sensitive to, in other words, which antibiotic will effectively treat and kill the bacteria. This will take a few days because the bacteria has to grow in a petri dish. See, there really are reasons some of these tests take time!
In the meantime, your physician will immediately start you on a broad spectrum antibiotic this is an antibiotic that effectively treats many types of bacteria. If when the tests come back it is determined that you need a different antibiotic, your doctor will notify you and prescribe a different antibiotic which will treat your specific infection.
Sometimes the pain of a urinary tract infection is so great you may require a medication to alleviate the pain. Your doctor can prescribe a special medication which targets the pain associated with UTIs.
Follow-up is essential to determine if the infection has cleared, so if your physician asks you to come back, please do so!
Tips For Preventing Utis In The Elderly
The following lifestyle and personal hygiene changes can significantly reduce a seniors risk of developing a urinary tract infection.
- Drink plenty of fluids.
- Drink cranberry juice or use cranberry tablets, but NOT if the elder has a personal or family history of kidney stones.
- Avoid or limit caffeine and alcohol, which irritate the bladder.
- Do not douche or use other feminine hygiene products.
- After toileting, always wipe from front to back .
- If incontinence is not an issue, wear breathable cotton underwear and change them at least once a day.
- Change soiled incontinence briefs promptly and frequently.
- Keep the genital area clean and dry.
- Set reminders/timers for seniors who are memory impaired to try to use the bathroom instead of an adult brief.
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Treatment From A Gp For Utis That Keep Coming Back
If your UTI comes back after treatment, you may have a urine test and be prescribed different antibiotics.
Your doctor or nurse will also offer advice on how to prevent UTIs.
If you keep getting UTIs and regularly need treatment, a GP may give you a repeat prescription for antibiotics.
If you have been through the menopause, you may be offered a vaginal cream containing oestrogen.
What Causes A Urinary Tract Infection
The main cause of UTIs, at any age, is usually bacteria. Escherichia coli is the primary cause, but other organisms can also cause a UTI.
In older adults who use catheters or live in a nursing home or other full-time care facility, bacteria such as Enterococci and Staphylococci are more common causes.
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Antibiotics For Urinary Tract Infections In Older People
Antibiotics are medicines that can kill bacteria. Health care providers often use antibiotics to treat urinary tract infections .
The main symptom of a UTI is a burning feeling when you urinate.
However, many older people get UTI treatment even though they do not have these symptoms. This can do more harm than good. Heres why:
Antibiotics usually dont help when there are no UTI symptoms.
Older people often have some bacteria in their urine. This does not mean they have a UTI. But health care providers may find the bacteria in a routine test and give antibiotics anyway.
The antibiotic does not help these patients.
- It does not prevent UTIs.
- It does not help bladder control.
- It does not help memory problems or balance.
Most older people should not be tested or treated for a UTI unless they have UTI symptoms. And if you do have a UTI and get treated, you usually dont need another test to find out if you are cured. You should also not be tested just in case there is a UTI.
You should only get tested or treated if UTI symptoms come back.
Antibiotics have side effects.
Antibiotics can have side effects, such as fever, rash, diarrhea, nausea, vomiting, headache, tendon ruptures, and nerve damage.
Antibiotics can cause future problems.
Antibiotics can kill friendly germs in the body. This can lead to vaginal yeast infections. It can also lead to other infections, severe diarrhea, hospitalization, and even death.
When should older people take antibiotics for a UTI?
Factors Associated With The Treatment Outcomes Of Utis Among The Elderly Population
The different associated factors involved in the treatment outcomes of UTIs among the elderly population have been predicted by using binary logistic regression analysis. Gender, marital status, age, race, smoking status, alcohol consumption, home, polypharmacy, and presence of co-morbidities are the factors that are analyzed to predict their association with the treatment outcomes of UTIs among the study population. Out of these nine independent variables, only four of them show statistically significant association with the treatment outcomes in binary logistic regression. These associated variables are then tested in multiple logistic regression, all of them show significant association except the age factor . Table 5 shows the detailed presentation of binary and multiple logistic regression analysis.
Table 5. Predictors affecting the treatment outcomes of UTIs among the study population.
Bladder Infections In Females Vs Males
Because bacteria can more easily reach the bladder in women, women are more prone to get bladder infections. For men it is more difficult to contract a UTI, than for women for basic anatomy reasons. However that doesnt mean it cant happen. Everyone should keep good hygiene and stay hydrated to help lower the risk of UTIs.
Tests And Treatments For Utis In Older People
UTIs are infections of the urinary tract. The main symptoms of UTIs are:
- A burning feeling when you urinate
- A strong urge to urinate often
Bacteria cause most UTIs. Doctors usually treat UTIs with antibiotics, which are strong medicines that kill bacteria.
Older adults are often tested for UTIs, especially in nursing homes. But if you dont have symptoms, urine tests are not very useful. The tests can lead to unnecessary treatments that can even be harmful. This is especially true in older adults. Heres why:
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Who Is Affected By Utis And How Are They Treated
Women are more commonly affected by them than men. Around half of women will need treatment for at least one UTI during their lifetime.
If treated with the right antibiotics, UTIs normally cause no further problems and the infection soon passes. Though complications are uncommon, they can be serious and include kidney damage and blood poisoning, which can be fatal.
When To See A Health Care Providerand What To Expect
If you have any of the signs of a bladder problem or urinary tract infection, talk to your healthcare provider. Read advice on talking to your doctor about sensitive subjects, like bladder problems.
When you see your healthcare provider, he or she may perform the following tests to try to figure out what might be causing your bladder problem:
- Give you a physical exam to look for any health issues that may cause a bladder problem. For women, the physical exam may include a pelvic exam. For men, the physical exam may include a prostate exam, which is usually done with a rectal exam.
- Take a urine sample to check for a bladder infection.
- Examine the inside of your bladder using a cystoscope, a long, thin tube that slides up into the bladder through the urethra. This is usually done by a urinary specialist.
- Fill the bladder with warm fluid to check how much fluid your bladder can hold before leaking.
- Check a bladder scan using ultrasound to see if you are fully emptying your bladder with each void.
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What Is A Uti
A UTI is an infection of the urinary tract, most commonly the bladder. For most people, key symptoms of a UTI include the need to urinate frequently and/or urgently, a burning sensation while urinating, and urine with an unusual color or odor. Sometimes a small amount of blood in the urine is even visible. However, these symptoms are often missing in older adults or they are unable to articulate them. Instead, seniors may suffer from unexplained incontinence, fatigue, or sudden changes their behavior and mental status.
Older people can get markedly confused, agitated or sleepy, explains Dr. Smith. Sometimes they can hallucinate or see things that arent there, like bugs crawling on the ceiling. They can also experience delusions and become paranoid.
According to Dr. Smith, a UTI is the most common cause of a sudden increase in confusion in dementia patients. The medical community isnt sure why UTIs cause confusion in older people. Although, in dementia patients, the lower baseline for clear thinking and effective communication is likely a contributing factor.
How Is A Uti Diagnosed
In older adults who have symptoms of a UTI, a simple urine test called a urinalysis can confirm infection. In some cases, the doctor requests a urine culture to identify the type of bacteria causing the infection and help determine the best antibiotic to treat it.
However, its important to know that older adults often have bacteria in the urine that dont cause any symptoms. This condition is called asymptomatic bacteriuria, and it often resolves on its own without treatment.
Doctors now recommend against doing a urine test to check for a UTI, unless patients have typical, bothersome UTI symptoms. This is to avoid the excessive use of antibiotics to treat infection, which can lead to antibiotic resistance.
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What Is The Best Antibiotic For Uti In Elderly
Antibiotics are the treatment of choice for UTIs in older adults and younger people. Your doctor may prescribe amoxicillin and nitrofurantoin . More severe infections may require a broad-spectrum antibiotic such as ciprofloxacin and levofloxacin .
What Is The Outlook
Most people improve within a few days of starting treatment. See a doctor if you do not quickly improve. If your symptoms do not improve despite taking an antibiotic medicine then you may need an alternative antibiotic. This is because some bacteria are resistant to some types of antibiotics. This can be identified from tests done on your urine sample.
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Older Adults Dont Need Powerful Antibiotics For Utis
Treatment for UTIs should begin with narrow-spectrum antibiotics, say Dr. Lathia and Dr. Goldman.
These drugs are less likely to lead to antibiotic resistance and problematic side effects than broad-spectrum antibiotics.
Today, amoxicillin is commonly prescribed as first-line treatment for UTIs in older adults.
Other common narrow-spectrum must be used with caution when patients have chronic kidney disease or take blood pressure medication, as many older adults do or because their side effects can be serious in older adults.
Quality Assessment / Risk Of Bias
Two review authors assessed the risk of bias of included studies independently, with any discrepancies being resolved by consensus, or through discussion with a third reviewer , if necessary. The risk of bias was assessed using a modified version of the assessment checklist developed by Downs and Black . Quality items that pertained to interventions and trial studies were removed as they were not deemed to be appropriate for the studies included in this review. An additional five quality items were added to the quality assessment to determine if studies described the criteria used for confusion, UTI and bacteriuria, and if their criteria for UTI and confusion were valid and reliable. Criteria for confusion were deemed valid and reliable if accepted criteria were utilised, including: the Confusion Assessment Method, the Organic Brain Syndrome Scale or the Diagnosis and Statistical Manual criteria . Similarly, criteria for UTI were deemed valid and reliable if established criteria for UTI were utilised, including: the McGeer Criteria, the revised McGeer Criteria, the Loeb Criteria, or the Revised Loeb Criteria . The modified checklist finally consisted of 14 quality items, grouped into: reporting, internal validity, external validity and criteria . The risk of bias for each quality item was reported as low risk of bias, high risk of bias, unclear risk of bias or not applicable.
Table 2 Quality Assessment Criteria
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How To Tell The Difference Between Asymptomatic Bacteriuria And A Uti
By definition, in asymptomatic bacteriuria, there should be no UTI symptoms present.
The following signs and symptoms can be caused by UTI:
- Burning or pain with urination
- Increased frequency or urgency of urination
- Bloody urine
- Pain in the low abdomen, flank, or even back
30103-7/fulltext?rss=yes” rel=”nofollow”> Cloudy, Foul-Smelling Urine Not a Criteria for Diagnosis of Urinary Tract Infection in Older Adults.)
Whether or not an older person has a clinical UTI, the urine dipstick may be abnormal, in part because certain abnormal results suggestive of UTI may in fact only reflect bacterial colonization of the bladder. So one should not rely on urine dipsticks or related urine analysis tests as the sole justification for diagnosing a UTI. Symptoms are necessary!
The thing is, some older adults may only show vague or non-specific symptoms when they get a UTI, such as confusion or weakness. This is especially true of seniors who are frail, or are quite old, or have Alzheimers or another dementia.
For this reason, it can be difficult to determine whether a frail or cognitively impaired older person is having UTI symptoms that warrant treatment.
Experts are currently debating whether its justified to treat for possible UTI, for those cases in which an older person with asymptomatic bacteriuria shows signs of delirium, but no other UTI symptoms.