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."