UTIs in the Elderly

• Urinary tract infections (UTIs) are a common issue for older adults that often goes undiagnosed and untreated.
• UTIs are easy to treat as long as you know what to look out for.
• UTIs can cause sudden confusion among seniors, which can be a difficult symptom to connect to a  UTI, and may resemble other more serious conditions like dementia. 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, commonly 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 infections seniors suffer from, it is important to be able to differentiate them from other illnesses so that proper medical treatment can be received. This article will go over some general information about UTIs, why they particularly affect the older adult population, and some common causes and treatments

A UTI is a bacterial infection of any part of the urinary system including the urethra, bladder, ureters, and kidneys. The infection starts at the opening of the urethra. When left untreated, it advances to the bladder, then ureters, and finally the kidneys where permanent damage can be caused. In patients that remain undiagnosed/untreated, a UTI can quickly become a blood infection. Once the infection reaches the blood, the risk to the patient is greatly increased and can quickly lead to sepsis. Early detection and treatment by a professional is essential.1

Why Are Seniors Susceptible to UTIs?

Older individuals are vulnerable to UTIs for several reasons. Advanced age is a primary factor, with women being far more susceptible than men due to anatomy. 10 percent of women over age 65 experience a UTI, along with 30 percent of women over 85.2 Older adults typically need more frequent health care visits, which increases their risk of exposure to a UTI in a facility like the hospital or nursing home. Lastly, an individual’s risk greatly increases with a diagnosis of incontinence, or the presence of a urinary catheter, which is more common in the older adult population.3 General factors that predispose someone to a UTI include access or participation in hygiene, inability to care for oneself mentally or physically,  and having access to a clean living environment.

Urinary retention, or the inability to empty the bladder is common in elderly populations, and can foster the growth of UTI-causing bacteria. There are several reasons this may occur. Older adults with bladder-control issues may lower fluid intake during the day to avoid the inconvenience and unpredictability caused by their diagnosis. This leads to less frequent urination and possibly urinary retention, or urine being held in the bladder much longer. Also, aging men and women may potentially experience a weakening of the muscles of the bladder and pelvic floor, or more severely, a prolapsed bladder, leading them to retain more urine and to experience incontinence.

There are certain health conditions older adults may 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.

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 to ninety percent of all UTI infections are caused by the E. coli bacteria. Several other types of bacteria make up the other ten percent, but E. coli is by far the most prominent. 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 symptoms for UTIs are frequent urination, burning pain, cloudy urine, and lower back pain. Because older adult immune systems are sometimes less effective at identifying and attacking infections, these common symptoms can potentially progress to be much more severe, including but not limited to:

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

Confusion

The reason for confusion in cases of UTIs in our senior population seems to be widely debated and statistically unclear. Any infection will weigh down the immune system and our older folks generally won’t be feeling right when they have one. How this confusion presents, and why, is unknown. In spite of this, the anecdotal evidence is vast, and commonly echo’s an article from British newspaper Express about a typical senior’s experience having a UTI as told below.

An article in the lifestyle section 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.4

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, any type of infection could cause an increase in temperature and brain inflammation, and therefore lead to mental changes, but more broadly there are many theories about the causes of confusion in seniors.

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 treated with antibiotics and hydration makes the environment less hospitable to the bacteria.

How Can UTIs in the Elderly Be Prevented?

Once a UTI infection is treated successfully, 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 perineum, or the skin in the area nearest your urethra 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.

Final Thoughts

As people age they experience more severe reactions to infection, and a wider array of symptoms .  This is where a family member or care professional can step in and really help.  Essentially, better health all boils down to early diagnosis and prompt treatment.

For a more in-depth look at bladder health and UTI prevention, check out the following advice by the US Department of Health & Human Services National Institute on Aging (NIA).