Signs Of Urinary Tract Infection In Elderly

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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What Can Happen If A Uti Is Not Treated

If treated right away, a UTI is not likely to damage your urinary tract. But if your UTI is not treated, the infection can spread to the kidneys and other parts of your body. The most common symptoms of kidney infection are fever and pain in the back where the kidneys are located. Antibiotics can also treat kidney infections.

Sometimes the infection can get in the bloodstream. This is rare but life-threatening.

Why Do Elderly Get Uti

Elderlies have a weak immune system compared to younger adults. Hence, they are less capable of fighting off foreign invaders in their bodies.

Older adults also have less capacity to care for themselves and maintain proper hygiene.

Most of them also have chronic illnesses that lead to urinary incontinence. At the same time, some health conditions can cause urine blockage.

Elderlies using catheters are also prone to UTIs, given that bacteria can penetrate the body through the tube.

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Presentation And Diagnosis Of Asymptomatic Bacteriuria And Symptomatic Uti In Older Adults

Dr N: Do you feel ill from the bladder infection that you can tell?

Mrs M: Just in my head. I dont have any of the accompanying symptoms. Theres no odor, theres no burning or anything like that. But for the past at least half-dozen years, it just has been there, thats all. Every time they took a test, there was a very small amount of E coli. Whatever that means.

Dr N: For me, its just so challenging. Were taught in medical school that you dont treat asymptomatic bacteriuria in people. It doesnt help them. The problem when people have chronic urinary symptoms is that we are trying to determine if this is now a symptomatic bacterial infection and how do I figure out what is a UTI sign or symptom in somebody who has these chronic voiding problems to begin with. So, thats always been the tricky part. She has been hospitalized a couple of times for UTIs. She basically presented with dizziness, had trouble walking, confusion, and low blood pressure. She was admitted and found to have a UTI based on urine cultures. She was treated with antibiotics intravenous fluids and got better.

Common Bladder Problems And When To Seek Help

Bladder problems can disrupt day-to-day life. When people have bladder problems, they may avoid social settings and have a harder time getting tasks done at home or at work. Common bladder problems include urinary tract infections, urinary incontinence, and urinary retention.

Some signs of a bladder problem may include:

• Inability to hold urine or leaking urine
• Needing to urinate more frequently or urgently
• Pain or burning before, during, or after urinating
• Trouble starting or having a weak stream while urinating
• Trouble emptying the bladder

If you experience any of these symptoms, talk to your health care provider.

Treatment for bladder problems may include behavioral and lifestyle changes, exercises, medications, surgery, or a combination of these treatments and others. For more information on treatment and management of urinary incontinence, visit Urinary Incontinence in Older Adults.

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Strengths And Limitations Of This Study

A major strength of this study is the use of individual patient level data for adults older than 65 years extracted from a large nationwide general practice records database and linked to hospital and mortality records. This provided the opportunity to track the care pathways of a vulnerable population with a diagnosis of UTI in the community with a 60 day follow-up. The linkage with mortality data from the Office for National Statistics minimised possible bias in the risk estimates of all cause mortality among older adults treated in a routine care setting.

The large sample size of about 160000 patients with more than 300000 distinct UTI episodes substantially increased the power of the analyses, especially for rare severe adverse events in older adults . As the base population is representative of the English general population, our results are generalisable to the entire English population of elderly patients.

The main limitations of our study are common to observational studies using routinely collected electronic health record data, and include unmeasured and residual confounders, missing data and potential biases, such as confounding by indication, misclassification biases, or inconsistencies in coding within and between practices and over time.

Check If Its A Urinary Tract Infection

Symptoms of a UTI may include:

• pain or a burning sensation when peeing
• needing to pee more often than usual during the night
• pee that looks cloudy
• needing to pee suddenly or more urgently than usual
• needing to pee more often than usual
• lower tummy pain or pain in your back, just under the ribs
• a high temperature, or feeling hot and shivery
• a very low temperature below 36C

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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,

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When You Need Themand When You Dont

Antibiotics are medicines that can kill bacteria. Doctors often use antibiotics to treat urinary tract infections . The main symptoms of UTIs are:

• A burning feeling when you urinate.
• A strong urge to urinate often.

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 doctors 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 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, and severe diarrhea, hospitalization, and even death.

Antibiotics can be a waste of money.

When should older people take antibiotics for a UTI?

10/2013

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Uti Diagnosis In The Geriatric Population

Symptoms in the elderly may differ from those in the general population. General criteria for diagnosing a UTI are presented in TABLES 2 and3.34-37 Also important for diagnosis is a history of recent or multiple sexual contacts or ethanol or drug abuse resulting in syncope and poor hygiene.7,14

Physical Characteristics: A patient with clinically significant UTI appears ill and in distress. Physical findings, while variable, generally include fever . Abdominal examination usually demonstrates tenderness over the suprapubic area, usually without rebound tenderness. Further evaluation may reveal CVA tenderness, which may be considered a hallmark of pyelonephritis or stones. Both males and females may present with urethral discharge. Females may demonstrate evidence of organ prolapse upon gynecologic examination, while in males examination may reveal an enlarged, tender prostate with discharge upon massage and manipulation.37

Laboratory Findings: Laboratory findings in clinically significant UTI will vary depending on the area of the system that is involved. Typically, urinalysis shows proteinuria and red blood cells , and tests are nitrite positive . White blood cells are present, but indicate clinical infection only in excess of 10 per high-power field.31 CBC may show leukocytosis, often with a larger-than-normal number of immature WBCs present .38

What Is The Treatment For A Urine Infection In Older People

• A course of anantibiotic medicine will usually clear the infection quickly. You should see a doctor if your symptoms are not gone, or nearly gone, after a few days.
• Paracetamol or ibuprofen will usually ease any pain, discomfort, or high temperature .
• An underlying cause such as an enlarged prostate gland or constipation may be found and need treatment.

Note: if you have an infection of your bladder then having plenty to drink is traditional advice to flush out the bladder. However, there is no proof that this is helpful when you have cystitis. Some doctors feel that it does not help and that drinking lots may just cause more toilet trips, giving you more unnecessary pain. Therefore, it is difficult to give confident advice on whether to drink lots or just to drink normally when you have mild symptoms of cystitis. However, if you have a high temperature and/or feel unwell, having plenty to drink helps to prevent having a lack of fluid in your body .

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Why Recurrent Urinary Tract Infections Are Most Common In Older Women

Urinary tract infections are an aggravation at any age, but theyre most common in older women. For senior women, UTIs can cause serious health problems and may not come with the usual symptoms.

At Alpenglow Gynecology, we help patients of all ages in Littleton, Colorado, treat the uncomfortable symptoms associated with UTIs. Rickie Guida, WHNP-BC and our entire care team are committed to helping older women understand and treat UTIs before they cause lasting damage. We offer a comprehensive line of womens health services to help you feel your best at every age.

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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Patient And Public Involvement

This project was developed within a context of strong patient and public involvement already established within our research team, university, and trust. Two former patients aged 65 and older reviewed the protocol. Their input helped to refine the research question and to improve the protocol considerably. The dissemination plan targets a wide audience, including members of the public, patients, health professionals, and experts in the specialty through various channels available: written communication, events and conferences, networks and social media.

Private Duty Nursing Services

Sometimes, seniors need help with more than daily living tasks and require a licensed medical professional. Centric Healthcare offers the services of private duty nurses who attend to your or your loved ones medical needs in your home. Examples of our services that can assist in the treatment and prevention of UTI include assistance with catheter care, medication administration, and a trained eye that can help identify self-care needs and watch for classic and non-classic UTI symptoms.

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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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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 The Urinary Tract Works

Urine is made by your two kidneys, one on each side of the tummy . Urine drains down tubes called ureters into the bladder. There it is stored and passed out through a tube called the urethra, when you go to the toilet.

In the average adult patient there should be a urine output of: 0.5-1 ml/kg/hr. This means that an average 70 kg man should produce 35-70 mls an hour. However urine output decreases in older patients and the target urine output should be 0.25-0.5 ml/kg/hr. This means that a 70 kg man who is aged over 65 years should produce 17.5-35 mls per hour.

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That stress can result in confusion and abrupt changes in behavior in older adults with a UTI. And for seniors with Alzheimers disease or other types of dementia, any kind of stress, physical or emotional, will often make dementia temporarily worse, Forciea says.

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Uti Signs And Symptoms In Childrenare Different

UTIs are the second most common type of infection in children, behind ear infections. Unfortunately, early symptoms of UTI in young children are not always apparent. And sometimes there are no UTI symptoms at all, or your child is simply unable to articulate the UTI symptoms he or she is experiencing. When it comes to babies under 2 years old, parents need to tune in to these signs of a urinary tract infection:

• Fever A fever of 104°F or higher may be the sole symptom in babies. Its also the most common symptom of UTI during babys first two years.
• Jaundice Up to 18 percent of babies with prolonged or worsening jaundice also have UTIs. When jaundice occurs one full year after birth, its a strong indicator of UTI.
• Vomiting or diarrhea
• Crying while urinating

Meanwhile, older children generally have similar symptoms to adults, including urgency, cloudy urine, and pain during urination. For children whove already been toilet trained, bed-wetting is also a sign of a UTI.

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