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.
Ongoing Management Of Uti
Dr N: So, shes going to come in next week and give a urine sample. Well see if the E coli has been cleared and then try to figure out what the next step will be.
Urine testing should be in response to symptoms as outlined in the Figure. Repeated urine testing as a test of cure is not warranted among older patients. Among patients with recurrent symptomatic UTI , use of chronic suppressive antibiotics for 6 to 12 months are effective at reducing UTI episodes and should be considered.68 Nitrofurantoin given at 50 mg daily is used in older patients with minimal adverse effects and no growth of nitrofurantoin-resistant fecal flora after 1 year of treatment.69 Six months of trimethoprim-sulfamethoxazole , trimethoprim , and nitrofurantoin are also effective,70 but trimethoprim-sulfamethoxazole resistant E coli fecal isolates were more common in patients treated with trimethoprim-based regimens.71
Risk Factors In Older Adults In Long
Older adults residing in long-term care facilities are more likely to suffer from significant functional and cognitive impairments, both of which have been shown to increase the risk of developing UTI in this population. Disorders such as dementia, Parkinsons disease, and stroke often lead to voiding abnormalities, impede adequate self-hygiene, and increase the need for urinary catheterization. In a study by Eriksson and colleagues,13 having a history of UTI within the previous year was significantly associated with vertebral fractures, multi-infarct dementia, and stroke. Many of these impairments have also been shown to increase the risk of persistent bacteriuria in older adults. In a cohort of long-term care residents without indwelling catheters, having persistent bacteriuria was significantly associated with requiring total nursing care, in comparison with adults with transient or no bacteriuria . This study also concluded that persistent bacteriuria in women was significantly associated with the diagnosis of dementia .29
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How Do Utis Affect Pregnancy
Changes in hormone levels during pregnancy raise your risk for UTIs. UTIs during pregnancy are more likely to spread to the kidneys.
If youâre pregnant and have symptoms of a UTI, see your doctor or nurse right away. Your doctor will give you an antibiotic that is safe to take during pregnancy.
If left untreated, UTIs could lead to kidney infections and problems during pregnancy, including:
- Premature birth
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Urinary Tract Infections In Women
UTIs are common, particularly with increasing age. Women are more likely to get a UTI than men. Nearly 1 in 3 women will have a UTI needing treatment before the age of 24.
In women, the urethra is short and straight, making it easier for germs to travel into the bladder. For some women, UTIs relate to changes in their hormonal levels. Some are more likely to get an infection during certain times in their menstrual cycle, such as just before a period or during pregnancy.
In older women, the tissues of the urethra and bladder become thinner and drier with age as well as after menopause or a hysterectomy. This can be linked to increased UTIs.
During pregnancy, the drainage system from the kidney to the bladder widens so urine does not drain as quickly. This makes it easier to get a UTI. Sometimes germs can move from the bladder to the kidney causing a kidney infection. UTIs during pregnancy can result in increased blood pressure, so it is very important to have them treated as soon as possible.
Women are more at risk of repeated UTIs if they:
- use spermicide jelly or diaphragm for contraception
- have had a new sexual partner in the last year
- had their first UTI at or before 15 years of age
- have a family history of repeated UTIs, particularly their mother
- suffer from constipation
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The Risk Of Utis As You Age
When you think of urinary tract infections , you may think they occur mostly in young adults, especially women. But UTIs are the most common type of bacterial infection in older adults over age 65particularly for those living in nursing homes.
While UTIs can cause mild problems for young adults, they can have more severe consequences in seniors. If left untreated, it can lead to kidney failure or sepsis, a potentially life-threatening infection in the blood.
UTIs are a common problem seen in most medical practices, especially in older patients, said Gerald Oldham, MD, a geriatric medicine physician with Banner Health Center in Peoria, AZ. They seldom occur between ages 15-50, are more common in women and can be a severe issue in dementia patients.
If youre caring for an older adult whos at risk for a UTI, heres what you should know to make sure they are protected.
Summary Of The Evidence
Following this review, it is evident that all of the studies which have explored the association between suspected UTI and confusion are methodologically flawed, due to poor case definition for UTI or confusion, or inadequate control of confounding factors introducing significant bias. Subsequently, no accurate conclusions about the association between UTI and confusion can be drawn. One study of acceptable quality shows an association between confusion and bacteriuria. However, this sample of patients in whom they tested bacteriuria and pyuria were patients already suspected of having a UTI, introducing a bias into their calculation . In summary, none of the 22 publications had sufficient methodological quality to enable valid conclusions.
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How Centric Healthcare Can Help
It has been well-established by medical researchers that older adults have a greater risk of getting UTI than the rest of the population. At the same time, demographers are projecting that the population of our state and our country continues to age dramatically. Therefore, the impact of UTI on our health will continue to grow.
Listed below are some of the services offered by Centric Healthcare that can help you and your loved one prevent and manage UTI.
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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Check If It’s A Urinary Tract Infection
Symptoms of a urinary tract infection may include:
- pain or a burning sensation when peeing
- needing to pee more often than usual during the night
- pee that looks cloudy, dark or has a strong smell
- 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
The Evidence: Diagnosis Management And Prevention
We searched Ovid for English-language human studies conducted among adults aged 65 years and older and published in peer-reviewed journals from 1946 to November 20, 2013. We focused on community-dwelling older adults. Search terms included UTI, asymptomatic bacteriuria, risk factors and UTI, community-onset UTI, functional decline and UTI, delirium and UTI, dehydration and UTI, diagnosis and UTI, diet and drug therapy and UTI, prevention and UTI, and urine tests and UTI. We also searched for recently published Cochrane reviews regarding treatment and prevention of UTI in community-dwelling older adults. The recommendations that follow are based on evaluation of the existing evidence.
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Treating Utis In The Elderly
If you think your loved one might have a urinary tract infection, see a doctor right away to avoid further complications. An urgent care clinic is a viable alternative if you cannot get an appointment with their primary care physician soon enough. Urinalysis and/or a urine culture are typically required to diagnose a UTI, determine what kind of bacteria are present in the urine and select the most appropriate antibiotic for treatment. If caught early on, a course of antibiotics typically clears the infection in no time.
Keep in mind that older individuals are also prone to a related condition called asymptomatic bacteriuria, which is characterized by the presence of bacteria in the urine but the absence of any signs or symptoms of a urinary tract infection. The estimated incidence of asymptomatic bacteriuria is 15 percent or greater in women and men between 65 and 80 years of age and continues to climb after age 80 to as high as 40 to 50 percent of long-term care residents.
Research shows that most patients with asymptomatic bacteriuria do not develop symptomatic UTIs, therefore antibiotic treatment is not beneficial. In fact, antibiotic use can result in adverse side effects, such as Clostridium difficileinfection, and contribute to the development of resistant bacteria. A seniors physician will consider their symptoms and test results to differentiate between a UTI and asymptomatic bacteriuria and determine whether treatment is necessary.
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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Role Of Urinary Testing In Diagnosing Symptomatic Utis In Older Adults
The utility of urinary dipstick testing, urinalysis, and urine culture is challenging in the older adult because of the high prevalence of bacteriuria and pyuria that may not be clinically important. As in the case of Mrs M, all urinary studies to evaluate for leukocyte esterase, nitrites, pyuria, and bacteriuria over a 2-year period were positive.
The urinary dipstick, although easy and convenient, has variable test characteristics.38 Sensitivity and specificity for urinary dipstick testing to evaluate for leukocyte esterase, nitrites, or both vary in older adults by the age of study participants, clinical suspicion of UTI, and laboratory definition for UTI used . The sensitivity and specificity for a positive dipstick test in older patients with was 82% and 71% , respectively.27 Other studies of elderly patients showed the negative predictive value for dipstick testing ranges from 92% to 100%.4,28 Urinary dipstick analysis should be performed in the out-patient setting primarily to rule out and not to establish a diagnosis of UTI. In a patient with a low pretest probability of UTI, if the dipstick is negative for leukocyte esterase and nitrites, it excludes the presence of infection and mitigates the need to obtain urinalysis and urine culture . High false-positive rates limit dipstick testing effectiveness.27 Further urinary studies are warranted for patients with a high pretest probability of UTI.
Bacteriuria In Young Vs Elderly Women
Foxman et al conducted a case-control study investigating the role of health behavior and sexual and medical history in UTI risk among otherwise healthy women aged 40 to 65 years . They showed that sexual activity was not associated with acquiring UTI in this age group, whereas a history of UTI during the past year, urine loss, antibiotic use during the previous 2 weeks, and exposure to cold during the previous 2 weeks were positively associated with UTI. In addition, drinking cranberry juice and taking vitamin C were moderately protective .
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Antimicrobial Treatment For Symptomatic Utis
Antimicrobial treatment is appropriate for symptomatic UTIs but not for asymptomatic bacteriuria.13,25 A meta-analysis of six randomized controlled trials involving 328 elderly patients with asymptomatic bacteriuria showed no significant benefit for antimicrobial treatment over placebo in the resolution of bacteriuria .3
The 2018 EAU guidelines on urological infections3 recommend fosfomycin, pivmecillinam, or nitrofurantoin as first-line treatment for uncomplicated cystitis in adult women. Combination antimicrobial therapy with amoxicillin plus an aminoglycoside, or a second-generation cephalosporin plus an aminoglycoside, is recommended for treatment of complicated UTIs. For complicated UTI with systemic symptoms, empirical intravenous treatment with a third-generation cephalosporin is recommended. Although EAU guidelines state that fluoroquinolones may be considered for use in certain circumstances,3 the European Medical Agency has suspended or restricted their use due to disabling and potentially permanent side effects involving muscles, tendons or joints, and the nervous system. The EMA advises special caution if using quinolones or fluoroquinolones in the elderly due to their higher risk of tendon injury.26
The increasing antimicrobial resistance of uropathogens is challenging the paradigm of empirical antibiotic therapy for symptomatic UTIs, underscoring the need for alternative treatment strategies.
Ways To Prevent A Uti
Antibiotics and natural medicines are available to help clear up UTIs, but there are preventative measures you can take to help ensure your body is able to stave off infections that tend to occur through the normal course of life. Read on to see three ways weve discovered through careful research to help prevent urinary tract infections in older women.
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Uti Tests And Diagnosis
If you suspect that you have a urinary tract infection, go to the doctor. Youll give a urine sample to test for UTI-causing bacteria.
If you get frequent UTIs and your doctor suspects a problem in your urinary tract, they might take a closer look with an ultrasound, a CT scan, or an MRI scan. They might also use a long, flexible tube called a cystoscope to look inside your urethra and bladder.
Are Utis The Same In Older Women As Younger Women
Although women can get UTIs at any age, they can affect older women differently. UTI symptoms can be different or more severe in older women. Sometimes older women can have a UTI and be asymptomatic.
In addition to the general symptoms listed above, older women should be aware of these additional symptoms:
- Delirium or hallucination
- Agitation and restlessness
- Social withdrawal
Older women are also more likely to have an underlying medical condition thats triggering their recurrent UTIs or causing UTI-like symptoms. For example, pelvic organ prolapse can cause symptoms that are very similar to UTIs, such as a frequent urge to urinate or pain and pressure in the lower abdomen.
Since these conditions cant be treated with the antibiotics often prescribed for UTIs, its important to have a comprehensive medical exam. At Alpenglow Gynecology, we rule out underlying causes or conditions that may be causing your UTI symptoms.
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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.
Senior Uti Do You Know The Symptoms
Urinary tract infections, or UTIs, are the most common bacterial infection in older adults,affecting women more often than men.
UTIs can typically be treated effectively with antibiotics once diagnosed.Unfortunately, not all UTIs are treated quickly, and some aren’t even identified, particularly in seniors.
What is a UTI?
A UTI is an infection in the urinary tract. The urinary tract includes the kidneys, bladder, ureters and the urethra which carries urine out of the body. They are most commonly caused by bacteria but can also be a fungal infection.
A lower UTI is a common infection, affecting the lower part of the urinary tract, the urethra and urinary bladder. Infection of the urethra is urethritis while a bladder infection is cystitis. An upper UTI affects the kidneys.
What causes a UTI?
A typical bacterial UTI is caused by bacteria, often fecal bacteria, entering the urethra through the urethral opening where urine is released from the body. Usually, the body can fight off these bacteria and prevent infection. However, if the immune system is too weak, the bacteria multiply, causing infection.
Fungal UTIs usually stem from fungus in the bloodstream. Fungal UTIs are relatively uncommon, impacting mainly those with illnesses that compromised their immune system.
What are the symptoms of a UTI?
When typical, healthy adults get a UTI, the symptoms are usually easy to identify, and the infection is simple to diagnose:
If left untreated, a person may experience:
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