UTIs in the Elderly

• UTIs are a common issue for older adults that often goes untreated.
• Fortunately, UTIs are easy to treat as long as you know what to look out for.
• UTIs can cause sudden confusion among seniors, which leads many people to think they are experiencing symptoms of dementia rather than a UTI. Visit our guide to dementia to learn more about memory loss and the important signs to look out for.

What Are UTIs?

One of the many unseen, hard-to-detect dangers that senior citizens face today is urinary tract infections, more often known as UTIs. Though easily treatable, the symptoms of UTIs in the elderly can often mimic those of other more serious conditions, like dementia. Given that UTIs are one of the most frequent, hidden infections seniors suffer from, it is important to be able to differentiate them from other illnesses, then isolate and eliminate them.  This article will give you the tools needed to combat UTIs – a formidable enemy to senior health.

A UTI is a bacterial infection of any of the four parts of the urinary system. The infection usually starts low in the urethra and moves up the ureters and into the bladder, and then goes to the kidneys.  It eventually can move into the blood system if unchecked. Once the infection is in the circulatory system, it can become very dangerous and leads to sepsis, making early detection and treatment by professionals essential.

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.

Seniors are also more prone to UTIs because they get an assortment of ailments that cause urinary retention.  There are certain health conditions they face that make it harder to pass urine, such as diabetes, kidney infections, and kidney stones.  In addition to slowing the process of urinating, diabetes raises glucose in the urine, which also increases the likelihood of a UTI. An older person’s inability to urinate properly can then necessitate a catheter, which is difficult to keep sanitary, making them even more vulnerable to the same infection.

What Causes UTIs In The Elderly?

Anything that introduces bacteria into the urinary tract or impedes the flow of urine and causes urine to stay in the bladder is very likely to cause a UTI.

Eighty five percent of all UTI infections are caused by Escherichia coli or E. coli bacteria. Several other types of bacteria make up the other fifteen percent, but E.coli is by far the most prominent, and it can make its way into the urinary tract several different ways.

E. coli is found naturally where digestion occurs in the gastrointestinal tract, so it can sneak into the urinary tract. This commonly happens because the end of the gastrointestinal tract is the anus, and the beginning of the urinary tract is the urethra. The anus and the urethra are close to one another, especially on the female body.

Due to the proximity of the entry and exit of the above two pathways, poor hygiene can cause UTIs.  Back-to-front wiping after a bowel movement can transfer bacteria into the urethra. Wearing soiled underwear or disposable undergarments too long can also introduce bacteria into the urinary tract. Bacteria in both cases is an infectious traveler that multiplies.

What Are the Signs and Symptoms of UTIs for Seniors

Detecting UTI symptoms in seniors can be tricky because many of them affect behavior, so they can be missed or attributed to more serious illnesses.

The classic, universal symptoms for UTIs are frequent urination, burning pain, cloudy urine and lower back pain. But because senior citizens’ immune systems are not functioning at optimal levels, the symptoms will take a different turn and produce some unsettling side effects:

•    Confusion
•    Disorientation
•    Agitation
•    Poor motor skills
•    Dizziness
•    Falling
•    Sometimes even depression

Why is this?

Confusion

The reason for confusion in cases of UTIs in our senior population seems to be directly linked to the fact that they are an infection, after all.  Any infection will weigh down the immune system and our older folks generally won’t be feeling right when they have one.

An illuminating 2009 article in the lifestyle section of Express, a British newspaper, tells the story of Susan, a functional, vibrant, 69-year-old mother and grandmother.  One Friday night, she had a headache, and then on Saturday, didn’t know her first name and couldn’t button her own buttons. Since it was too sudden to be dementia, her daughter was worried it was a stroke, so she took her mother to the hospital.  The staff asked Susan simple math problems and what her age was, all of which she got wrong. This was worrying because Susan was normally a sharp woman. Doctors gave her a chest x-ray, an ECG, and a CT scan and did not get any answers. Finally, they gave her a urine test and it came up positive for a UTI!  She was prescribed antibiotics and her symptoms reversed fully.

Susan’s daughter asked the doctors a question many would:  why did a simple UTI cause so much confusion in her elderly mother? The doctors reported that all infections lead to dehydration, and that this affects the medication that seniors are on for other illnesses. Also, that any type of infection could cause an increase in temperature and brain inflammation, and therefore lead to mental changes.

Bottom line: if an older, loved one abruptly starts acting abnormally, the best step is to get them to urgent care so the doctors can administer proper testing to identify whether or not a UTI is the culprit.

How Are UTIs Treated?

Here comes some good news: After submitting to blood and urine tests and being diagnosed with a UTI, the treatment can be relatively easy.  The majority of UTIs are cured by antibiotics and hydration to flush the bacteria out. This is much easier than in the past. UTIs were first documented in 1550 BC and up until the 1930’s, they were treated by herbs and bloodletting!

How Can UTIs in the Elderly Be Prevented?

Once a UTI infection is gone, prevention should consist of maintaining a more set schedule.  Some older people start a urination schedule, setting up alarms to remind themselves to urinate. Implementing better hygiene to keep the midsection area clean and dry is also key.  Seniors should regularly wear and change loose, breathable cotton underwear that can be cleaned easily. A ritual of wiping from front to back when using the bathroom is also critical.

Some urologists claim that there is an ingredient in cranberry juice that prevents bacteria, especially E coli, from adhering to the bladder wall. The ingredient is A-type proanthocyanidins or PACs.  There is debate in the medical and healthcare communities as to whether there are enough PACs in cranberry juice to actually stop bacteria from grabbing onto the bladder wall.  You could say that the theory has caused a healthy, sweet and sour debate! Essentially, all of these preventative measures mentioned boil down to one theme: better care.

Final Thoughts

As people age, they lose certain abilities that we all may take for granted.  This is where a family member or care professional can step in and really help.  Essentially, better health all boils down to better care.

For useful tips on keeping the bladder healthy to better win the battle against UTIs, check out the following advice by the US Department of Health & Human Services National Institute on Aging (NIA).