A urinary tract infection (UTI) is a bacterial or fungal infection in part of the urinary system, which includes the kidneys, ureters, bladder, and urethra. UTIs are one of the most common infections in seniors, who can experience more severe symptoms than younger people.
Symptoms of a UTI may include:
- a more urgent need to urinate
- increased urination
- burning, pain, or discomfort when urinating
- feeling pressure in the lower abdomen or pelvis
- cloudy, thick, or odorous urine
- the bladder not feeling empty after urination
- pain in the lower abdomen, flank, or back
- blood in the urine
Older adults are more likely to experience confusion, delirium, or behavior changes in addition to the typical UTI symptoms above.
Doctors should check for a UTI in any older adults who have a sudden change in behavior or become increasingly confused.
Changes in behavior that may indicate a UTI include:
- social withdrawal
Why are symptoms different in seniors?
Doctors are not sure why additional symptoms such as confusion or delirium occur in older adults.
One theory is that the blood vessels that supply the brain are weaker and may be more likely to allow the infection to pass to the nervous system.
Bacteria or fungi that have entered the urinary tract are responsible for causing UTIs.
Many UTIs occur due to E. coli, a type of bacteria that is commonly present in stool and can enter the urinary system through the urethra.
Other organisms that are capable of causing a UTI may be present in older adults who have a catheter or reside in a hospital or care facility.
In fact, UTIs are most common in residents of long-term care facilities such as nursing homes.
Factors that increase the risk of older adults developing a UTI include:
- changes in the immune system
- exposure to different bacteria in the hospital or care facility
- other health conditions, such as incontinence
- having had a prior UTI
- changes in the way the urinary system works, including prostatic hypertrophy in males
- presence of a urinary catheter, which is a tube that connects the bladder to a bag outside of the body to allow urine to drain
It is important for caregivers to be aware of these risk factors and observe any cognitive changes that could indicate a UTI.
UTIs are common, but they can potentially lead to severe complications without treatment.
An untreated UTI can spread to the kidneys and cause kidney damage or disease.
Kidney infections are serious and require intravenous antibiotics and hospitalization.
Another complication of UTIs is sepsis.
Sepsis is a life-threatening condition in which the infection spreads to the bloodstream and then throughout the body. Untreated sepsis can lead to septic shock and eventually death.
Sepsis can cause other complications including organ dysfunction, amputations, and chronic pain disorders. Even if a person has treatment for sepsis, complications may occur.
If doctors suspect that a UTI is present, they will test a urine sample in the office or send it to a laboratory for a urinalysis.
A urine culture can confirm which bacteria are causing the infection. Knowing the specific type of bacteria allows the doctor to determine a suitable treatment plan.
A condition called asymptomatic bacteriuria (ASB) is also common in older adults. ASB occurs when there are bacteria in the urine, but they do not cause any signs or symptoms of infection.
Although ASB is common in older adults, it does not typically require treatment, unless it causes other clinical symptoms.
The standard treatment for a UTI is antibiotics, which kill the bacteria causing the infection. Doctors will prescribe an antifungal medication instead if a fungus is causing the UTI.
It is essential that people take the antibiotic or antifungal medication precisely according to the prescription, even if they begin to feel better. Completing the entire prescription will help to destroy all of the infectious bacteria.
If a UTI is causing serious delirium or confusion, doctors will use antipsychotic medication until the infection clears. Antipsychotic medicines reduce distress, agitation, and the risk of injury in someone with these types of symptoms.
More advanced cases of UTI, such as those that lead to sepsis, septic shock, or kidney infection, may require hospitalization and intravenous antibiotics.
It is common for someone with sepsis or septic shock to have other medical complications that also require medical care.
Taking steps to prevent a UTI is vital for people who have a higher risk of getting one, including older adults.
Methods of preventing a UTI include:
- drinking plenty of fluids
- avoiding caffeine and alcohol
- wiping from front to back after going to the toilet
- promptly changing incontinence pads or underwear when wet
People in a nursing home or long-term care facility often depend on others to take preventive measures against UTIs for them. It is essential that the staff are aware of how to prevent UTIs and understand the signs and symptoms of these infections.
Vaginal estrogen may be suitable for helping people reduce their risk during and after menopause if they are prone to UTIs.
It is important for family members to ensure that older adults have sufficient, appropriate care to meet their needs.