Urinary Tract Infections in the Elderly


Urinary tract infections (UTIs) aren't just a nuisance—they can cause serious health problems. A UTI happens when bacteria in the urethra, bladder or kidneys multiplies in the urine. If left untreated, a UTI can lead to acute or chronic kidney infections, which could permanently damage these organs and even lead to kidney failure. UTIs are also a leading cause of sepsis, a potentially life-threatening infection of the bloodstream.

Urinary Tract Infections in the Elderly

The population most likely to experience UTIs is the elderly. Older individuals are more vulnerable for many reasons, not the least of which is their overall susceptibility to infections due to a weakened immune system that comes with age and certain age-related conditions.

Younger people tend to empty their bladders completely upon urination, which helps to keep bacteria from accumulating. However, elderly men and women experience a weakening of the muscles of the bladder, which can lead to increased urine retention, poor bladder emptying and incontinence. These things all contribute to infection.

Typical Symptoms of UTIs

  • Urine that appears cloudy or dark
  • Bloody urine
  • Strong or foul-smelling urine
  • Frequent or urgent need to urinate
  • Pain or burning with urination
  • Pressure in the lower pelvis
  • Low-grade fever
  • Night sweats, shaking, or chills

Lesser-Known UTI Symptoms in Seniors

Elderly people with serious UTIs may not exhibit the hallmark sign of fever because their immune system is unable to mount a response to the infection. In fact, elders often don't exhibit any of the common symptoms listed above – or don't express them to their caregivers.

UTIs in the elderly are often mistaken for the early stages of dementia or Alzheimer's, according to National Institutes of Health (NIH), because symptoms include:

  • Confusion or delirium-like state
  • Agitation
  • Hallucinations
  • Other behavioral changes
  • Poor motor skills or dizziness
  • Falling

These are often the only symptoms that may present in the elderly, so it is crucial to keep an eye out for these sudden changes in mental state.

Why Do the Elderly Develop UTIs?

According to the NIH, the following conditions make the elderly more susceptible to UTIs:

  • Diabetes
  • Urine retention (inability to empty the bladder completely, even if your loved one has just used the bathroom)
  • Use of a urinary catheter
  • Bowel incontinence
  • Enlarged prostate
  • Immobility (for example, those who must lie in bed for extended periods of time)
  • Surgery of any area around the bladder
  • Kidney stones

How to Reduce Risk of UTIs

People with incontinence are at an increased risk for UTIs because of the close contact that adult briefs and other incontinence products have with their skin, which can reintroduce bacteria into the urethra. Some recommendations to help reduce this risk include the following:

  • Change briefs promptly and frequently
  • Encourage front-to-back wiping and cleansing
  • Keep the genital area clean
  • Set reminders/timers for those who are memory-impaired to try to use the bathroom instead of an adult brief

Other ways to reduce the chance of UTIs include:

  • Drinking plenty of fluids (2 to 4 quarts each day unless this conflicts with a physician's orders)
  • Drinking cranberry juice or use cranberry tablets, but NOT if your elder has a personal or family history of kidney stones
  • Avoiding caffeine and alcohol, which irritate the bladder
  • Do not douche or use other feminine hygiene products
  • Always wiping from front to back (for women)
  • Wearing cotton underwear and changing them at least once a day

If you think your loved one might have a urinary tract infection, see your doctor right away to avoid further complications.

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After having my Mom with me for 6 months under Hospice Care, incontinent, unable to walk, no upper body strength to sit up straight, unable to feed herself, unable to roll over in bed, hallucinating, refusing to eat and drink sometimes, I came to realize what a huge job it is just to take care of one person and they are so short staffed in nursing homes, there's no way people are going to get the personal one-on-one care that is needed to take care of all their needs. No one has time to make sure an individual is getting enough liquids or not sitting around in a soiled diaper too long. I really feel if you put your loved one in a nursing home, you have to plan to be totally involved to pick up the slack but we all know it's a lot easier said than done. A lot of us still have to work and take care of our own needs and there are just not enough hours in the day. We need our government to realize that they could save a lot of money by paying for families to take care of their loved ones at home (and using visiting nurses to help) where they would get more personal care, instead of paying more money to nursing homes where they get the minimum amount of care just to keep them going. A lot of families place their loved one in a nursing home just because they can't afford to take care of them themselves. It's a crazy system we have!
Cranberry juice, and other antioxidants will not cure it, tho'. Especially with frail seniors. It is not expensive to eat defensively. It is education. But once a client has an infection many cannot fight it. I have a palliative client discharged with pneumonia, and the pneumonia has come back. He is coughing up yellow and green chunks. He is in a retirement home. The extra eyes are important. Hospice institution is critical in such care. / hospice volunteer
Its a sad story for the people who don't have anyone to take care of them. I would never put my husband back in a NH. they don't have enough help. He didn't get enough to drink when he was there. Thank God he is back home.