Denise Altman’s 81-year-old mother suffers from chronic depression, which often makes her sad and agitated. When her mom began acting confused during conversations over the phone and appearing glassy-eyed in person, Altman and her sister assumed these were just symptoms of their mom’s underlying mental health issue. The confusion would last a few days and was often followed by a low-grade fever.

Finally, there was a breakthrough when their mother complained of painful urination during one of these odd spells. Altman took her mom to the doctor where she was diagnosed with a urinary tract infection (UTI). Unfortunately, the infection kept coming back, causing the sisters a great deal of concern.

Confusion + Fever in a Senior Can Equal UTI

Altman’s sister began charting their mother’s symptoms and noticed a distinct pattern. Each time she suffered the confusion and fever, a UTI diagnosis came just a few 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 Dr. Amanda Smith, 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, which can be very puzzling for family caregivers.

What Is a UTI?

A UTI is an infection of the urinary tract, most commonly the bladder. For most people, key symptoms of a UTI include the need to urinate frequently and/or urgently, a burning sensation while urinating, and urine with an unusual color or odor. Sometimes a small amount of blood in the urine is even visible. However, these symptoms are often missing in older adults. Instead, seniors may suffer from unexplained incontinence, fatigue, or sudden changes their behavior and mental status.

“Older people can get markedly confused, agitated or sleepy,” says Dr. Smith. “Sometimes they can hallucinate or see things that aren’t there, like bugs crawling on the ceiling. They can also experience delusions (false beliefs) and become paranoid.”

According to Dr. Smith, a UTI is the most common cause of a sudden increase in confusion in dementia patients. The medical community isn’t sure why older people have these heightened behavioral symptoms, although with dementia patients, the lower baseline for clear thinking and effective communication is likely a contributing factor.

What Causes a Urinary Tract Infection?

In younger people, urinary tract infections are sometimes related to frequent sexual activity, but in older folks, changes in personal hygiene often come into play. This can occur because of cognitive decline or physical limitations caused by conditions like arthritis, COPD or 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 being 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 that was not present before (e.g. lethargy, hallucinations, delusions, restlessness, violence or yelling)

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

Seeking Treatment for a UTI

Urinary tract infections sometimes resolve on their own, but they can easily worsen due to a senior’s compromised immune function. When left untreated, UTIs can lead to chronic incontinence. The infection can also spread to the kidneys and cause serious damage. When that happens, patients often experience a fever and severe pain. The infection could spread even further to the bloodstream and cause sepsis, which can be fatal. Therefore, timely testing and treatment with antibiotics is crucial.

Once Altman recognized the behavioral symptoms that often accompanied her mother’s UTIs, she and her sister were more vigilant about maintaining proper hygiene and pursuing tests and prescriptions to clear up the infection. Most family caregivers aren’t aware of the unique symptoms of UTIs in seniors, but this information is vital for speedy diagnosis and treatment.

“It’s nice to have that early warning,” Altman notes. “It’s well worth sending in a urine sample when the symptoms first become apparent. Early treatment saves our mom days of feeling bad and being more confused than usual.”

Many caregivers keep home test strips for UTIs (available at most drugstores) on hand in case their loved ones suddenly begin showing physical or behavioral symptoms. Keep in mind, though, that over-the-counter tests are not completely reliable. A urine culture performed by a laboratory is often necessary to determine the strain of bacteria that is causing the infection and the appropriate antibiotic that must be prescribed to treat it. In cases where infection is recurrent, doctors may prescribe regular preventative doses of broad-spectrum antibiotics.