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 vital organs and even lead to kidney failure. These common infections are also a leading cause of sepsis, a potentially life-threatening infection of the bloodstream.

Seniors Are Prone to UTIs

The population most likely to experience UTIs is the elderly. Older individuals are more vulnerable for many reasons, including their overall susceptibility to infections due to a weakened immune system. Elderly men and women also experience a weakening of the muscles of the bladder and pelvic floor, which can lead to increased urine retention (incomplete emptying of the bladder) 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 during urination
  • Feelings of pressure in the lower pelvis
  • Low-grade fever
  • Night sweats, shaking or chills

Lesser-Known UTI Symptoms in Seniors

Older individuals 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 different signs and symptoms. One tell-tale symptom of UTIs in the elderly is often mistaken for the early stages of dementia or Alzheimer's disease, according to National Institutes of Health (NIH). Indicators of infection in seniors include the following:

  • Confusion or delirium
  • Agitation
  • Hallucinations
  • Other unusual behavioral changes
  • Poor motor skills or loss of coordination
  • Dizziness
  • Falling

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

Why Do the Elderly Develop UTIs?

According to the NIH, the following conditions make older individuals 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
  • 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 to contain messes and prevent embarrassment associated with accidents, they can also introduce bacteria into the urethra. Below are some recommendations to help reduce this risk.

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

How to Reduce the Risk of UTIs

  • Drink plenty of fluids (2 to 4 quarts of water each day unless this conflicts with a physician's orders).
  • Drink cranberry juice or use cranberry tablets, but NOT if your elder has a personal or family history of kidney stones.
  • Avoid or at least limit caffeine and alcohol intake, which irritates the bladder.
  • Do not douche or use other feminine hygiene products.
  • Always wipe from front to back (for women).
  • Wear breathable cotton underwear and change 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. An urgent care clinic is a viable alternative if you cannot get an appointment with your loved one’s primary care physician soon enough. If caught early on, a simple course of antibiotics typically clears the infection in no time.

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My 67 yr old mother suffered a stroke and entered the nursing home for rehabilitation on june 9th, 2010. She was wheelchair bound with aphasia and feeding tube. I would visit her daily & it was a living nightmare for both of us. I could tell she was in a lot of pain & on numerous visits I would discover that she needed her brief changed. I would ask her where the pain was & she would grab my hand & place it on her side, lower back, & pelvic area. I complained to the staff numerous times & also complained to the 2 doctors that something was wrong. I also complained that Mom seemed very dehydrated & she had lost weight. The doctors at first refused to see her & I wouldn't take no for an answer...she was "seen" very briefly, was not examined. I was told she was fine. I new she wasn't. On july 4th, mom ended up in the ER with severe dehydration, renal failure, severe UTI which turned to severe sepsis. also thrush due to lack of oral cares. Mom died July 11th. Her doctor put on the death certificate that she died from CVA (stroke). I went to confront the doctor to have the death certificate amended to state the real cause of death (sepsis). He walked the other direction as fast as he could. The State Health Dept. investigated & ruled INCONCLUSIVE for neglect of health care. I will not give up until there is justice.
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!
We need to get this information out....I thought my mom had dementia, she was hallucinating, getting up at night, complained of back pain etc. After a fall she was in the hospital for 5 days, saw several doctors and NO ONE ordered a urine test. Once she was released to a Rehab, a CNA told me to insist on one as her urine was so strong. Was diagnosed with a raging UTI......and has never recovered. After 2 other falls she is now on hospice care. Wish I had known....