Urinary tract infections (UTIs) aren’t just a nuisance in the senior population—they can cause serious health problems. A UTI occurs 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 vital organs and even lead to kidney failure. UTIs are also a leading cause of sepsis, an extreme and potentially life-threatening bodily response to an infection.
Why Are the Elderly Prone to UTIs?
Older individuals are more vulnerable for many reasons, including their overall susceptibility to infections due to a weakened immune system.
“As you get older, your immune response changes; it’s part of normal aging,” explains Anna Dowd, APN, a gerontological nurse practitioner in the greater Chicago area and past president of the National Conference of Gerontological Nurse Practitioners.
According to the National Institutes of Health (NIH), the following conditions make older individuals more susceptible to UTIs:
- Urine retention (Weakening of the bladder and pelvic floor muscles can lead to incomplete emptying of the bladder and incontinence.)
- Use of a urinary catheter
- Bowel incontinence (Types of bacteria that are normally found in the bowel, such as E. coli, are commonly responsible for UTIs.)
- Urinary 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
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. While these products can help contain messes and prevent embarrassment associated with accidents, they can also introduce bacteria into the urethra. Women are more prone to UTIs because the female urethra is much shorter, allowing bacteria to travel to the bladder more easily.
Typical Symptoms of UTI
- Urine that appears cloudy or dark
- Bloody urine
- Strong or foul smelling urine
- Frequent or urgent need to urinate
- Pain or burning during urination
- Feelings of pressure in the lower abdomen
- Low-grade fever
- Night sweats, shaking or chills
Lesser-Known UTI Symptoms in Elderly Individuals
Older adults with UTIs may not exhibit any of the hallmark signs listed above because their immune systems are unable to mount a significant response to the infection. On top of the lack of noticeable symptoms, many seniors do not or cannot express their discomfort to their caregivers.
Since elders’ bodies respond differently to infection, it is important to look for atypical signs and symptoms. A marked change in mental state is one tell-tale symptom of UTIs in the elderly, but it is often mistaken for the early stages of dementia or Alzheimer’s disease, according to the National Institute on Aging (NIA).
Indicators of infection in seniors include the following symptoms, especially if their onset is sudden:
- Confusion or delirium
- Other unusual behavioral changes
- Poor motor skills or loss of coordination
Acute behavioral and/or functional changes are often the only symptoms that present in the elderly, so it is crucial for family caregivers to keep an eye out for these sudden changes in behavior and mental state.
Tips for Preventing UTIs in the Elderly
The following lifestyle and personal hygiene changes can significantly reduce a senior’s risk of developing a urinary tract infection.
- Drink plenty of fluids (Aim for two to four quarts of water each day unless this conflicts with a physician’s orders).
- Drink cranberry juice or use cranberry tablets, but NOT if the elder has a personal or family history of kidney stones.
- Avoid or limit caffeine and alcohol, which irritate the bladder.
- Do not douche or use other feminine hygiene products.
- Always wipe from front to back (for women).
- If incontinence is not an issue, wear breathable cotton underwear and change them at least once a day.
- Change soiled incontinence briefs promptly and frequently.
- Keep the genital area clean and dry.
- Set reminders/timers for seniors who are memory impaired to try to use the bathroom instead of an adult brief.
Treating UTIs in the Elderly
If you think your loved one might have a urinary tract infection, see a doctor right away to avoid further complications. An urgent care clinic is a viable alternative if you cannot get an appointment with your loved one’s primary care physician soon enough. Urinalysis and/or a urine culture are typically required to diagnose a UTI, determine what kind of bacteria are present in the urine and select the most appropriate antibiotic for treatment. If caught early on, a course of antibiotics typically clears the infection in no time.
Keep in mind that older individuals are also prone to a related condition called asymptomatic bacteriuria, which is characterized by the presence of bacteria in the urine but the absence of any signs or symptoms of a urinary tract infection. The estimated incidence of asymptomatic bacteriuria is 15 percent or greater in women and men between 65 and 80 years of age and continues to climb after age 80 to as high as 40 to 50 percent of long-term care residents.
Research shows that most patients with asymptomatic bacteriuria do not develop symptomatic UTIs, therefore antibiotic treatment is not beneficial. In fact, antibiotic use can cause adverse side effects, such as Clostridium difficile infection, and contribute to the development of resistant bacteria. A senior’s physician will consider their symptoms (if any) and test results to differentiate between a UTI and asymptomatic bacteriuria and determine whether treatment is necessary.
Source: Bladder Infection (Urinary Tract Infection—UTI) in Adults (https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-infection-uti-in-adults?dkrd=hiscr0045); Urinary tract infection in older adults (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3878051/); StatPearls: Asymptomatic Bacteriuria (https://www.ncbi.nlm.nih.gov/books/NBK441848/)