Why Are Seniors At Risk For Utis
Men and women older than 65 are at greater risk for UTIs. This is because both men and women tend to have more problems emptying their bladder completely as they age, causing bacteria to develop in the urinary system.
In older men, this often happens because of a common condition called benign prostatic hyperplasia , or an enlarged prostate gland. The enlarged prostate blocks the flow of urine and prevents the bladder from fully emptying.
As women age, the bladder muscles weaken and prevent the bladder from emptying completely, increasing the risk of infection. Women also produce lower amounts of estrogen after menopause. This creates an imbalance of good and bad bacteria in the vagina, which can lead to infection.
Other risk factors for UTIs in older adults include:
- Using a catheter to empty the bladder
- Having kidney stones, which can block the flow of urine
- Having a suppressed immune system, which lowers the bodys defense against infection
A Doctor Explains Why A Urinary Tract Infection Mimics Alzheimers Dementia In Elderly People
As odd as it is, its true: A urinary tract infection , also known as a bladder infection, will often produce cognitive dysfunction in an elderly personsymptoms that resemble dementia or Alzheimers disease. Usually, the elderly patient does not experience burning or painful urination.
A savvy physician will order a UTI test in an elderly patient whos been exhibiting new-onset cognitive impairment.
But what is it about a bladder infection that could cause symptoms that mimic dementia?
We know that any patient who is medically compromised , can get worsening symptoms with an infection anywhere in the body, including a bladder infection, says Kenneth Peters, MD, chief of urology for Beaumont Hospital, Royal Oak, MI. This includes patients with underlying dementia and other neurologic disorders such as multiple sclerosis.
The exact mechanism of action is unknown, but if the infection causes fever, this is a systemic reaction that may have a transient effect on the patients underlying symptoms.
What if a seemingly cognitively intact elderly person exhibits sudden-onset signs of cognitive impairment, and its found that this person has a urinary tract infectionand after the infection clears up, the confusion and memory problems also go away?
An elderly person may seem normal and still be well-functioning in the activities of daily living, yet actually score in the mild cognitive range on the SLUMS test. SLUMS stands for Saint Louis University Mental Status.
What Is A Urine Infection And What Causes It
Most urine infections are caused by germs that come from your own bowel. They cause no harm in your bowel but can cause infection if they get into other parts of your body. Some bacteria lie around your back passage after you pass a stool. These bacteria sometimes travel up the tube called the urethra and into your bladder. Some bacteria thrive in urine and multiply quickly to cause infection.
A urine infection is often called a urinary tract infection by healthcare professionals. When the infection is just in the bladder and urethra, this is called a lower UTI. If it travels up to affect one or both kidneys as well then it is called an upper UTI. This can be more serious than lower UTIs, as the kidneys can be damaged by the infection.
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Epidemiology Of Asymptomatic Bacteriuria
Asymptomatic bacteriuria is rare in younger people, but over the age of 75 years, it is found in 7â10% of men and 17â20% of women. A study among nursing home residents reported up to 25%-50% had ASB at any given time. Prevalence of ASB is 100% in patients with long-term indwelling catheters and about 3%â5% with short-term use.
How Is It Diagnosed
If doctors suspect that a UTI is present, they will test a urine sample in the office or send it to a laboratory for a urinalysis.
A urine culture can confirm which bacteria are causing the infection. Knowing the specific type of bacteria allows the doctor to determine a suitable treatment plan.
A condition called asymptomatic bacteriuria is also common in older adults. ASB occurs when there are bacteria in the urine, but they do not cause any signs or symptoms of infection.
Although ASB is common in older adults, it does not typically require treatment, unless it causes other clinical symptoms.
The standard treatment for a UTI is antibiotics, which kill the bacteria causing the infection. Doctors will prescribe an antifungal medication instead if a fungus is causing the UTI.
It is essential that people take the antibiotic or antifungal medication precisely according to the prescription, even if they begin to feel better. Completing the entire prescription will help to destroy all of the infectious bacteria.
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Risk Factors For Urinary Tract Infection In Older Adults
Certain factors may increase the risk of UTIs in older people.
Conditions common in older adults may lead to urinary retention or neurogenic bladder. This increases the risk of UTIs. These conditions include Alzheimers disease, Parkinsons disease, and diabetes.
They often require people to wear incontinence briefs. If the briefs arent changed regularly, an infection may occur.
Several other things put older adults at risk for developing a UTI:
- a history of UTIs
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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Infection In The Elderly: Signs And Symptoms
Because seniors bodies respond differently to infections, they dont always show symptoms that younger patients typically do. For this reason, infections can sometimes be tricky to diagnose in seniors. Even blood samples can miss some signs of infection, since senior patients might not show a spike in their white blood cell count a common indicator of infection even if theyre sick.
Most importantly, different types of infections cause different symptoms, and some common symptoms will present in some seniors but not others based on factors like overall health and fitness. However, there are some typical, familiar signs to watch for to spot a number of common infections in older adults:
- Sudden headaches
- Loss of appetite
Why Are Seniors Susceptible To Utis
Older individuals are vulnerable to UTIs for several reasons. The biggest culprit is an immune system weakened by time that increases susceptibility to any infection. Also, the elderly may have a diminished ability to take care of themselves. Reduced cognitive abilities and lower energy levels are issues that cause decreased hygiene and increased bacteria in seniors too. Becoming less communicative, often due to the same diminished cognitive capabilities, can be a contributing factor as well.
Urine overstaying its welcome in the bladder is common in elderly populations, and can foster bacteria that spreads and turns into a UTI. There are several reasons this may occur. One is that seniors may lower fluid intake during the day to avoid the embarrassment and inconvenience caused by bladder control issues. This leads to less frequent urination and a pool of urine being held in the bladder much longer. Also, aging men and women undergo a gradual weakening of the muscles of the bladder and pelvic floor, or a prolapsed bladder, leading them to retain more urine and to experience incontinence.
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Uti In The Elderly: Signs Symptoms And Treatments
Urinary tract infections arent just a nuisance in the senior populationthey can cause serious health problems. A UTI occurs when bacteria in the urethra, bladder or kidneys multiplies in the urine. Left untreated, a UTI can lead to acute or chronic kidney infections, which could permanently damage these vital organs and even lead to kidney failure. UTIs are also a leading cause of , an extreme and potentially life-threatening response to an infection.
Other Symptoms Of Utis
If the person has a sudden and unexplained change in their behaviour, such as increased confusion, agitation, or withdrawal, this may be because of a UTI.
These pages explain what a UTI is, the different types of UTIs, their symptoms and treatments, and gives tips on how they may be prevented.
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Symptoms Of A Uti In Dementia Patients
Aside form the common symptoms experienced during a UTI, such as a burning feeling while urinating, an increased need to urinate, pain in the lower abdomen, blood in urine, cloudy urine, urine with a foul odor, fever, delirium, nausea, and vomiting, there are certain UTI symptoms specific to dementia.
UTI symptoms in dementia include increased frequency of falls, changes in behavior such as aggression, changes in appetite, sleeping more or less than usual, an increase in confusion or disorientation, and an overall decline in function due to another condition that developed suddenly.
Causes Of Urinary Tract Infections
Urinary tract infections are usually caused by bacteria from poo entering the urinary tract.
The bacteria enter through the tube that carries pee out of the body .
Women have a shorter urethra than men. This means bacteria are more likely to reach the bladder or kidneys and cause an infection.
Things that increase the risk of bacteria getting into the bladder include:
- having sex
do not use scented soap
do not hold your pee in if you feel the urge to go
do not rush when going for a pee try to fully empty your bladder
do not wear tight, synthetic underwear, such as nylon
do not drink lots of alcoholic drinks, as they may irritate your bladder
do not have lots of sugary food or drinks, as they may encourage bacteria to grow
do not use condoms or a diaphragm or cap with spermicidal lube on them try non-spermicidal lube or a different type of contraception
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What Can I Do To Prevent Recurrent Utis
The majority of UTIs, about 90%, are caused by E. coli, a bacteria that naturally occurs in your intestines where its helpful. When this bacteria comes in contact with your urinary tract system, however, it can be harmful and lead to a UTI.
For most people, simple hygiene and lifestyle changes can help prevent recurrent UTIs. To help stop a UTI before it starts, try implementing these tips:
- Avoid spreading E. coli by washing your genitals with warm water and mild soap before and after sex.
- Drink plenty of fluids to flush out any wandering bacteria from the urinary system.
- Be sure to urinate after having sex to keep bacteria from lingering in the urethra.
- When you feel the urge to urinate, go postponing urination increases your risk of developing a UTI.
- Be sure to wipe from front to back to avoid spreading E. coli to the vagina.
Ready to learn more about UTIs and how they affect older women? Experiencing symptoms of a UTI? Contact our Littleton office or book an appointment online now and the help you need!
Other Ways To Prevent Some Utis Coming Back
If you keep getting a bladder infection , there is some evidence it may be helpful to take:
- D-mannose a sugar you can buy as a powder or tablets to take every day
- cranberry products available as juice, tablets or capsules to take every day
Speak to your doctor before taking any of these during pregnancy.
Be aware that D-mannose and cranberry products can contain a lot of sugar.
If you’re taking warfarin, you should avoid cranberry products.
Page last reviewed: 22 March 2022 Next review due: 22 March 2025
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Common Uti Symptoms And Signs
The urine of most healthy, properly hydrated people appears light yellow or clear and is nearly free of odor. It also causes zero pain or discomfort to pass.
But for the majority of people who experience a urinary tract infection, thats not the case. Instead, they will likely encounter at least one of the following indicators:
When the kidneys are infected, other noticeable symptoms may include:
- Fever, shaking, and chills
- Nausea and vomiting
- Upper back, side, or groin pain
While its been long noted that confusion in the elderly is a sign of UTI, a 2019 report in BMC Geriatrics concludes that theres insufficient evidence connecting the symptom to that diagnosis.
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Role Of Urine Dipstick Testing
Dipstick testing of urine is often used as a fast method for ruling out UTI as the cause of symptoms. This test detects the presence of leucocyte esterase and nitrites . However, Gram-positive bacteria and other organisms such as Enterococci and Pseudomonas species account for larger proportion of UTI in older adults and these microorganisms do not reduce urinary nitrates to nitrites. This may mean that urine dipstick nitrite test will not test positive for these organisms.
Results from a study conducted by Juthani-Mehta et al. in nursing home residents suggests that a dipstick test result that is negative for both leukocyte esterase and nitrite can effectively exclude the diagnosis of UTI. This study, however, observed a positive predictive value of only 45% suggesting that dipstick test is not useful for identifying patients who meet laboratory criteria for UTI. Another study conducted amongst nursing home residents with asymptomatic bacteriuria also observed a very high negative predictive value of urine dipstick testing.
Cortes-Penfield et al. provide a great analogy of urine dipstick testing interpretation. They note that the clinical utility of the urinalysis for diagnosing UTI is similar to that of the D-dimer for the diagnosis of a pulmonary embolism a negative result is of great value for ruling out embolism in patients with all but the highest pre-test probabilities of disease, while a positive result is not sufficient to establish the diagnosis.
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What Are The Common Symptoms
Common symptoms of a UTI infection include the following:
- Dark or cloudy urine
- Pain or burning sensation during urination
- Pressure or tenderness in the lower abdomen
- Low-grade fever
- Night sweats, shaking, or chills
However, older adults may not experience any of these symptoms when they have a UTI, which can make identifying the infection difficult. This is due to the fact that seniors have weakened immune systems that arent able to respond to bacterial infections as effectively. The symptoms mentioned above are actually signs that the immune system is working to fight the infection off.
Seniors have a unique set of symptoms as a result of a UTI, including the following:
- Poor coordination, which can lead to falling
Usually, these symptoms will appear suddenly if the cause is an infection. But many of these symptoms could be symptoms of other health conditions, like dehydration, dementia, and others. They could also be normal signs of aging, which makes it difficult to identify a UTI in a senior loved one.
Another factor that seniors face with experiencing a UTI is a lack of communication with their loved ones or caregivers. Many seniors may choose not to tell others about their discomfort or simply cannot express it.
The symptoms of a UTI can also change when the infection worsens and spreads to the kidneys. These symptoms include:
- Nausea and vomiting
- Back pain
Treatment From A Gp For Utis That Keep Coming Back
If your UTI comes back after treatment, or you have 2 UTIs in 6 months, a GP may:
- prescribe a different antibiotic or prescribe a low-dose antibiotic to take for up to 6 months
- prescribe a vaginal cream containing oestrogen, if you have gone through the menopause
- refer you to a specialist for further tests and treatments
In some people, antibiotics do not work or urine tests do not pick up an infection, even though you have UTI symptoms.
This may mean you have a long-term UTI that is not picked up by current urine tests. Ask the GP for a referral to a specialist for further tests and treatments.
Long-term UTIs are linked to an increased risk of bladder cancer in people aged 60 and over.
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How To Prevent Utis In Seniors
Older adults can help prevent UTIs by drinking plenty of fluids to flush the bacteria from their systems, Forciea says. She recommends older adults drink four to six 8-ounce glasses of water a day. Forciea further notes that drinking cranberry juice or taking cranberry tablets also can make urine less inviting for bacteria.
Use these strategies to help prevent UTIs in elderly women:
- Urinating promptly after the urge arises
- Wiping front to back
- Emptying the bladder shortly after sex
- Taking showers instead of baths
If your loved one has frequent UTIs or other challenges that require help with daily tasks, consider talking to one of our Senior Living Advisors about home care or senior living options that can improve their quality of life.