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.
Urinary Tract Infections And Dementia
Urinary tract infections are a type of infection common among older people. If a person with a memory impairment or dementia has a UTI, this can cause sudden and severe confusion known as delirium.
Urinary tract infections and dementia
Institutionalized Older Adults & Catheterized Patients
Similar to other populations, the diagnosis of symptomatic UTI in nursing home residents requires the presence of genitourinary symptoms in the setting of a positive urine culture. In older adults who are cognitively intact, the diagnosis of symptomatic UTI is relatively straightforward. However, nursing home residents often suffer from significant cognitive deficits, impairing their ability to communicate, and chronic genitourinary symptoms , which make the diagnosis of symptomatic UTI in this group particularly challenging. Furthermore, when infected, nursing home residents are more likely to present with nonspecific symptoms, such as anorexia, confusion and a decline in functional status fever may be absent or diminished . In the setting of atypical symptoms, providers are often faced with the challenge of differentiating a symptomatic UTI from other infections or medical conditions. The high prevalence of bacteriuria plus pyuria in this population often leads to the diagnosis of UTI. Although bacteriuria plus pyuria is necessary for diagnosis of a laboratory-confirmed UTI, alone it is not sufficient for making the diagnosis of symptomatic UTI. To date, universally accepted criteria for diagnosing UTI in this population do not exist, making it difficult for providers to distinguish a symptomatic UTI from other conditions in the presence of new nonspecific symptoms.
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And It Won’t Hurt To Try These
Like many women, you may have memorized the following age-old advice for preventing UTIs:
Wipe from front to back.
Urinate before and after sex.
Drink lots of water.
Avoid tight underpants and jeans.
These suggestions are directed at flushing the bladder and keeping E. coli from spreading into the urinary tract. Although studies have failed to show that they prevent either primary or recurrent UTIs, there’s no harm in trying them, Dr. Gupta says. “They can’t hurt, and if they help, you’re ahead of the game.”
Why Do Seniors Get Utis
Older adults are more vulnerable to UTIs, because as we age, we tend to have weaker muscles in our bladder and pelvic floor that can cause urine retention or incontinence. Whenever the urine stays in the urinary tract, theres a potential for bacteria, such as Escherichia coli, or E. coli, to multiply and cause an infection to spread.
Other factors that increase the risk of UTIs in seniors are a weakened immune system, the use of catheters to empty the bladder, diabetes and kidney problems.
Older women have UTIs more often than older men because of the female anatomy and lower estrogen. Women produce lower amounts of estrogen after menopause. This can create an imbalance of good and bad bacteria in the vagina, which can lead to infection.
Other causes are due to aging inflammation in the vagina, such as atrophic vaginitis, fallen bladders producing impaired urine flow or from irritation during intercourse, Dr. Oldham said. Prophylactic antibiotics after sex may help if this is a recurring issue.
UTIs are less prevalent in men mainly because of the male anatomy, but they are susceptible to UTIs if they are uncircumcised or have an enlarged prostate, known as benign prostate hyperplasia . UTIs associated with BPH occur as a result of patients not completely emptying their bladder, Dr. Oldham said. The stagnant urine acts as a conduit for bacteria.
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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.
Symptoms Can Be Different
In younger adults, symptoms of a UTI can be pretty dramatic: pain and burning during urination, as well as a frequent, often urgent need to pee. But Fishburne notes that symptoms are often less obvious in older adults.
Its not always easy to separate the signs of an infection like incontinence and the need to go the bathroom more frequently from other underlying conditions such as overactive bladder, which are more common in the older population. Among older adults, UTIs may cause symptoms not seen in younger people, such as confusion or agitation. That doesnt mean your loved one definitely has a UTI if they are just showing signs of delirium, stresses Fishburne. But if they have the symptoms above, lower back pain, blood in their urine or tenderness in their abdomen, they should see a physician immediately.
Some older adults may also present with a fever over 100 degrees, but this does not occur in every situation and would more suggest involvement of the upper urinary tract or the kidneys. Any of these symptoms should prompt a call to your doctor. At-home test kits arent always accurate and may often be unnecessary.
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Uti And Confusion In The Elderly: Can A Urinary Tract Infection Cause Dementia
When it comes to the elderly, its important to respect them, their privacy, and their autonomy, even when it comes to life and death situations involving their health. However, there are several instances that could be concerning and must be addressed quickly in order to avoid complications, and in many cases, the senior may not be aware of the underlying issue or may not notice the symptoms.
This can be the case with a urinary tract infection, or UTI. For most younger people, UTIs are a minor irritation. In the elderly, urinary tract infections are a potential killer. Even more concerning, the symptoms of a UTI in senior citizens may not be readily apparent to caretakers without proper education.
Why Some Women Get Recurrent Utis
The infections are usually caused by Escherichia coli, a bacterium that lives in the intestinal system. If E. coli are carried from the rectum to the vagina, they can enter the urethra and infect the bladder.
Risk factors for UTI vary with age. Before menopause, the most common risk factors are sexual intercourse and use of spermicides. It’s thought that sex increases the number of bacteria in the bladder, and many experts advise women to urinate after sex to flush them out. Spermicides may kill off Lactobacilli, beneficial bacteria in the vagina, making it easier for E. coli to move in.
After menopause, certain physical changes help set the stage for UTIs. The numbers of Lactobacilli in the vagina naturally decline. The bladder also contracts less strongly than it once did, making it more difficult to empty it completely.
In both premenopausal and postmenopausal women, genes play a role as well. Having a mother or sister who has frequent UTIs is also a risk factor.
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.
Uti Symptoms In Seniors: What To Watch Out For
For seniors, many of the symptoms of a urinary tract infection are linked to changes in behavior, and they may include:
- Social withdrawal
Many of these atypical UTI symptoms mimic the signs of dementia, and the initial reaction to a senior acting in this way may be fear of developing or worsening dementia or Alzheimers. The first thing to do is to find out if the elderly individual has a UTI, since a UTI can exacerbate symptoms of dementia or cause these symptoms in an elderly individual who has not developed dementia.
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Can I Prevent Recurrent Utis
There are steps you can take to help reduce UTIs. The most basic is to drink plenty of fluids. This encourages frequent urination and helps flush out bacteria.
For women, following good hygiene practices is especially important:
- After a bowel movement, wipe from front to back to reduce the chance of moving E. coli bacteria from the rectal area to the urethra.
- Pee immediately before and after sex.
- Dont douche or use feminine deodorants on your genitals.
- Wear cotton underwear.
For older adults, take care to deal with retention problems, which are especially an issue as you age.
I tell them to double-void urinate and then go back and urinate again, Dr. Vasavada says.
What about drinking cranberry juice to fight UTIs?
Thats one of the most commonly asked questions, Dr. Vasavada says. Theres conflicting data. Its not going to cure an infection, but it could help prevent one, so we dont discourage it.
Why Does My Dog Keep Getting Urinary Tract Infections
Your dog is urinating in the house and youre sure that its a urinary tract infection. You go to the vet, gets some antibiotics, and everything gets better for a while. Then a few weeks or few months later youre back in the same vet office with the same problem. Whats going on?
Why Does Your Dog Keep Getting Urinary Tract Infections? The most common reasons why treatment fails for a UTI are because the owner didnt finish the medication as directed, the course of therapy was too short, the antibiotics werent the right ones, or theres an underlying issue thats causing the infection to return.
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You Dont Drink Enough Water
Guzzling H2O will make you go pretty often. And thats a good thing. When you do this, the bacteria gets flushed out before they have a chance to grab hold, Minkin says.
Consider that your cue to make a giant water bottle your BFF. Hooton TM, et al. . Effect of increased daily water intake in premenopausal women with recurrent urinary tract infections: A randomized clinical trial. DOI: 10.1001/jamainternmed.2018.4204
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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Did A Loved One Suffer A Urinary Tract Infection In A Missouri Nursing Home Call Us For Help
Anytime a resident suffers a urinary tract infection in a Missouri nursing home the resident or the residents family should call our St. Louis nursing home abuse and neglect lawyer to learn how we can help. While a UTI could occur due to normal complications and risks, most times it is an indicator that something is wrong at a nursing home. You are paying nursing homes a lot of money to care for your loved one, and a urinary tract infection is simply a sign that they are not getting the care they require or deserve. Call to schedule a FREE appointment with the Terry Law Firm to learn what your rights are by dialing 334-1441.
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.
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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.
Risk Factors For Urinary Tract Infections
And now a brief note about reproductive parts: Although people with penises do get UTIs, people with vaginas are more at risk. It all boils down to the anatomy, Minkin says.
Bacteria that cause UTIs often make their way from the back door to the front and then up the urethra to wreak havoc on the urinary system.
Because the male reproductive system has a longer urethra than the female reproductive system, the bacteria have farther to travel, which makes it more difficult for a UTI to develop.
But regardless of anatomy, once youve had one UTI, youre more likely to get another, especially if you have a vagina. Hickling DR, et al. . Management of recurrent urinary tract infections in healthy adult women.
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Tips To Keep Your Bladder Healthy
People rarely talk about bladder health, but everyone is affected by it. Located in the lower abdomen, the bladder is a hollow organ, much like a balloon, that stores urine. Urine contains waste and extra fluid left over after the body takes what it needs from what we eat and drink. Each day, adults pass about a quart and a half of urine through the bladder and out of the body.
As people get older, the bladder changes. The elastic bladder tissue may toughen and become less stretchy. A less flexible bladder cannot hold as much urine as before and might make you go to the bathroom more often. The bladder wall and pelvic floor muscles may weaken, making it harder to empty the bladder fully and causing urine to leak.
While you cant control everything that affects your bladder, here are 15 steps you can take to keep it as healthy as possible:
How To Help Your Loved One Avoid Utis
We dont have enough research to support their effectiveness in UTI prevention, although their medical benefits cant be ruled out completely, says Dr. Goldman.
Instead, he recommends these tried-and-true prevention strategies:
- Encourage sufficient fluid intake
- Promote genital and urinary hygiene
- Ask the doctor about low-dose vaginal cream for postmenopausal women
Dr. Goldman says researchers are also studying D-Mannose for UTI prevention. The supplement, which has few side effects, sticks to bladder receptors that normally attract the E. coli bacteria usually responsible for UTIs.
Researchers also believe D-Mannose may keep bad bacteria from colonizing the digestive tract, which can harbor the bacteria responsible for UTIs in women.
Following these tips should help your aging relative stay healthy, productive and out of the hospital.