UTIs Cause Behavioral, Not Physical Symptoms in Elders


Denise Altman's 81-year-old mother suffers from chronic depression, which often makes her sad and agitated. When her mom began acting confused on the phone and appearing glassy-eyed in person, Altman and her sister figured these symptoms were just a result of their mom's underlying mental health issue. The confusion would last a few days and was often followed by a fever. Then there was a breakthrough: their mother complained of painful urination. Finally, a doctor diagnosed Altman's mother with a urinary tract infection, or UTI. Unfortunately, the infection would reoccur, causing the sisters a great deal of concern.

Altman's sister began charting their mother's symptoms. Each time she suffered the confusion and fever, a UTI diagnosis came just days later.

"It took us a while, several months actually, to determine that when our Mom got into these states, it wasn't just the depression," recalls Altman. "It never occurred to my sister and me that the symptoms could be due to a UTI."

That's because older adults often present different symptoms of a urinary tract infection, explains Amanda Smith, M.D., medical director at the Byrd Alzheimer's Institute at the University of South Florida. In fact, UTI symptoms in older people are often largely behavioral.

What Is a UTI?

A UTI is an infection of the urinary tract, most commonly the bladder. For most people, the need to urinate frequently and/or urgently are two key symptoms of a UTI. So is a burning sensation when you go, and urine that is an off color or has an odor. Sometimes, a small amount of blood in the urine is visible. But in older adults, those symptoms are often missing. Instead, older adults may suffer from unexplained incontinence, vague fatigue or significant changes their behavior and mental status.

"Older people can get markedly confused, agitated or sleepy," says Dr. Smith. "Sometimes they can see things that aren't there, like bugs crawling on the ceiling. They can also have false beliefs and become paranoid."

According to Dr. Smith, a UTI is the most common cause of a sudden increase in confusion in an older person with dementia. The medical community isn't sure why older people have these heightened behavioral symptoms, although with dementia patients, the inability to communicate effectively may be part of the reason.

What Causes a Urinary Tract Infection?

In younger people, urinary tract infections are sometimes related to frequent sexual activity. But in older folks, hygiene changes may come into play, either because of confusion or physical limitations, such as arthritis or the effects of a stroke, which can make it difficult for a person to keep themselves clean.

UTI Warning Signs for Seniors

Caregivers play an important role in recognizing new health issues in a loved one. Dr. Smith suggests that caregivers be on the lookout for these six symptoms:

  1. The need to go to the bathroom frequently or urgently
  2. Complaints of discomfort while urinating
  3. Frequently touching themselves
  4. Cloudy, dark or foul-smelling urine
  5. A new onset of incontinence
  6. Any sudden change in mental status, such as lethargy, hallucinations, restlessness, violence or yelling that was not present before

Seeking Treatment for a UTI

Dr. Smith also warns caregivers to seek medical attention as soon as possible if their loved one becomes difficult to wake up, since this can be a sign of delirium, which is considered a medical emergency.

Urinary tract infections sometimes resolve on their own, but they are easily treated with antibiotics. When left untreated, UTIs can lead to chronic incontinence. This infection can also spread to the kidneys and cause serious damage. When that happens, patients often experience a fever and severe pain. More importantly, the infection could spread even further to the bloodstream and cause sepsis which can be fatal.

Once Altman recognized the behavioral symptoms that often accompany her mother's UTIs, she and her sister could be more vigilant about having their mother tested and prescribed medication.

"It's nice to have that early warning," she notes. "It's well worth sending in a specimen when the symptoms become apparent. Early treatment saves our mom days of feeling bad and being more confused than usual."

You May Also Like

Free AgingCare Guides

Get the latest care advice and articles delivered to your inbox!


The really sad thing about my mom's UTI problem is I have had her at one emergency room after the other, three different doctors and a specialist. God help any senior who makes it to their ninety's because you get the look. Anyone who has seen it on a doctors face knows what I mean. After the last UTI and another dose of anibiotics I found something in the health food store that works wonders. However if you try it do so on your own. I can only tell you it helped with her. It is called D-Mannose. Being at my wits end I gave it a try. It takes about 10 days to see a difference but it worked.(for now) No one should have to suffer because medical personnel think your parent has demenita, when it is a UTI.
This is an important topic-thanks for the useful article. As professional geriatric care managers, it is something we see a lot and have to help our clients/families monitor for. It is one of the first things we ask about when we see a significant change in someone's behavior. If you live at a distance from a loved one, even one who lives in assisted care or a nursing facility, this is one of the reasons a geriatric care manager can be useful in helping monitor this type of thing, review charts/appointments, communicate with you and be a liaison so things do not get missed: We offer a checklist for what to ask if you are considering hiring someone too:
katiex10, I agree about these nursing facilities being clueless. You would think that since UTIs bring on behavioral issues in seniors that these places would be aware of this type of thing. My Mom fell and had a compound fracture of the arm which was operated on in the hospital. Afterward they recommended "rehab" at a facility for a few weeks. At the hospital social workers recommendation, I chose a 5 star medicare rated facility. My normally mentally sharp Mom was not herself and didn't want to rehab or do much of anything. The physical therapist there kept howling about "sundowners" and said "old people get that way". I kept trying to convince them this behavior was NOT normal for my Mom and wondered if she had a UTI. Finally one of the nurses did test for UTI and by that afternoon my Mom was sent to the hospital by the nursing home doctor who luckily came in to witness this at that time, in an ambulance in a raging delirium where she kept yelling and flailing. This went on for about 2 days and then she was sleeping alot on the 3rd day and nearly normal again on the 4th day. It was absolutely frightening. To add to the horror, upon admittance to this hospital the intake nurse asked if I had seen the wound on her back....What wound??!!! Turns out that this 5 star facility left her lying there too long and a stage IV bedsore developed that caused later hospitalization for 6 weeks for osteomyelitis, (bone infection), That a simple UTI could cause such mental changes and all this, and the complete incompetency of the nursing facility is mind boggling. Needless to say I never sent her back there and she is now home with us.