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She is quite aware of the difference in her thinking and reasoning abilities. She has had two neuropsychs in two years, first one dxed mild cog impairment, due to a small stroke a few years back; this year (just a few weeks ago) follow-up testing showed no progression.

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This information has been so helpful.
My Dad will be 95 in just a few days. He did not have to use any appliance to see or hear or help to walk. His mind was sharp and he took care of himself, the house and his wife. At 80 years old he was jogging 5 miles a day. 2 years ago he had a TIA that put him in the hospital for 2 days. He recovered quickly. In October of 2016 he had another TIA that was much worse than the first and kept him in the hospital for 2 weeks then a NH for another 2 weeks for speech and occupational therapy. Due to catheterization in the hospital he developed an undiagnosed UTI. He was home 6 hours from the NH when he collapsed and was sent back to the ER. They put him on antibiotics. He is in a rehab center at this point and can barely speak. On pureed foods.
I believe it should be a standard practice that before a patient is released from a hospital and has been given use of a catheter; they should be given a test for a UTI. It would improve the health of so many lives. If not a standard practice; remember to ask for a test before leaving the hospital!
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Did they do a culture to test for what kind of bacteria is causing the uti? If they do that, they can tell what antibiotic will clear it.
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My mom has been on antibiotic since Thursday night and this is Monday night and she is still in the foggy stage of an uti. She is taking kafflax(?) should we try another antibiotic? I think she went about 2 to 3 weeks before it was diagnosed at a nursing home while recovering from a pelvic fracture.
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Chiming in here...any luck using the Azo UTI test strips? I bought a box as I thought my mom might have a UTI. I can't really get the test stick between her legs and she uses a raised toilet seat. I was able to get my hand under the seat and blindly wave the stick around until it got saturated. But by the time I got my hand pulled out from under the seat, I think more time elapsed than I was supposed to count. Can't get a cup under the seat to get a clean "catch." Thanks for any feedback and all the good suggestions posted already.
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Whilst my father is 80, 4 weeks ago he could answer 90% of the general knowledge questions on the Mastermind TV programme! Now, after a severe UTI, he forgets his children's names. This is not normal progression old age memory loss and I am shocked at how an UTI can impair the mind to this extent and at such speed. The doctor assures us that after the antibiotics have cleared up the infection, he should recover in 3 to 4 weeks. I sincerely hope so!
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LadeeC, sounds like it to me as well. :(
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We got the D-Mannose today. Based on her physicality (she's sleeping lots and her speech is less than stellar .. two early warning signs), I'd say she's already got another one started. I'll let you know how it goes.
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Something you might look into is Hipprex. Someone here suggested it, it's an antibacterial that may help prevent UTIs, I believe its action is that it eliminates through urine, so it would essentially be an antibacterial IN the urine. I asked the infectious disease guy about it, and he said it can be effective, yes, but still inappropriate for my mom because she's been so over-antibiotic'd.

But it might be appropriate in your situation...
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LadeeC, you've got your hands full. In some ways, I'm glad my mom's UTIs aren't e coli, at least I continue to know that hygiene isn't an issue I have to address with her (yet). And if e coli WERE her issue, you can bet I'd be trying D-Mannose in a heartbeat (or cranberry, and go through the Coumadin adjustments).

Home health has told me that findings that Coumadin and cranberry interact have been debunked. Her doctor's office has read the same research and disagrees, but they're now open to the idea of adjusting Coumadin to the interaction, where they never were before. As I say, though, it wouldn't be helpful to my mom, so why add yet another pill or drink to the mix, she already takes so many pills and potions already. I cringe every time a new prescription is written or supplement suggested. :-)

Good luck, I hope you find the D-Mannose helpful. When I first heard about it, I thought, this is what I've been looking for, but then I read that it seems to only be effective against e coli. Others have suggested there's research showing it's effective against other organisms, but I haven't found those studies. Yet. I keep looking. :-)
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Oreosmeow .. yeah, good point(s) .. I hadn't found the reference to coumadin, yet. It hasn't been on our battleground, thankfully. Thank you.

Here we're dealing with e-coli almost exclusively; and almost no amount of correct cleansing (we're fanatical about it: we don't wipe mid to anything: we wipe from left to right since we have access beneath the toilet seat; use a different cloth or wipe at each of the anus, vagina and urethra) or pad/diaper placement (I keep a panty liner directly under her rectum to - hopefully - catch the errant and always present leakage from the anus, due to a prolapsed rectum - before we got a hold of her, she used to reach in and dig out her own constipation). Oh... and don't forget the explosive, uncontrollable bouts of diarrhea. *sighs*

Plus her system is so fragile, that all it takes is one lousy bacterium to find its way into the bladder, and poo-f* .. that's it. She's got a raging infection, again.

Also, after her stroke, part of the bladder no longer functions as well, so voiding completely is rare and is a contributing factor: unvoided urine is much more susceptible to infection.

The bottom line for me is, if there's something out there that the traditional medicines don't know about or acknowledge, I'm willing to do the research, and run some tests. With input from the doc, of course. As far as I know there's nothing to contra-indicate, with the possible exception of her sugar levels. We already monitor, so we'll be able to track how it effects her diabetes.

* (intentional spelling)
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D-Mannose and cranberry can both be great IF the bacterium you're dealing with is always/mostly always e coli. My mom has yet to get a UTI caused by e coli.

Also, cranberry interferes with Coumadin/Warfarin, so it's vital that you get the doctor's okay before starting it - at a minimum, INRs will have to be checked frequently at the beginning, so that the Coumadin dose can be adjusted to accommodate the interference. And then, you have to continue to give the cranberry faithfully.

So, know what bacteria you're dealing with first - we've (doctor and I) made the decision to not give cranberry or D-Mannose since (a) it won't help and (b) we'd have to through a whole new round of Coumadin adjustments.

(and if it's consistently e coli you're dealing with, that can often be addressed somewhat successfully by hygiene changes, ie, wiping front-to-back instead of back-to-front)
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Here's some 'food for thought' .. I'm constantly researching for one reason or another, especially when I'm feeling uncertain of something, wish for easily found verification of my premise, or I just wanna learn more. So, when I was posting here, the other day, I wanted to confirm that sugars do, indeed, contribute to UTIs.

Whilst researching, I stumbled onto an article about D-Mannose (a simple sugar in many fruits, mostly derived from cranberries). Very briefly, apparently D-Mannose binds to the e-Coli from the bowels and allows it to flush right out of the bladder.

Most of the literature is by alternative health practitioners, though I did find references, along with anecdotal comments on WebMD.

Just puttin' it out there for consideration. Maybe this is the next, best way to avoid (or treat? *crosses fingers*) UTIs. I'm gonna go out and get some. I hope others find it and follow up. Love to know how it goes, if you try it.
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Hi Gals/guys(?) - such great sharing of info - really helping me. Thanks LadeeC re the urine tests. Of course having to get urine via cathetar is a risk - wasnt thinking as I can still get a mid stream from Mum. Rosebud I also dont hate you for your comments. The reality is that we are all at different stages. My Mum has loads of potential and lots of good and quality life ahead of her if we can control the UTIs (yes an uphill and possibly and eventually losing battle). I assume I will at sometime in the future think about it as well depending on Mum's quality of life and her potential for improving. She is not in pain, not depressed just suffering memory loss and the frustration this brings. However, I find myself slightly stressed out - is her cognition changing, is this a sign - should I get a urine test etc?? I know i need to relax but after the last month of her so ill and seeing her back to nearly her old self we are probably being overly watchful. I have to tell you I am so fortunate to have an incredible partner. He goes up to Mum's house every morning first thing (so I can take it easy in the AM as I spend hours there during the day and evening) and he makes her a cup of tea, some toast and gives her her morning medications, chats to her, writes on the whiteboard beside her bed the date and day and what is going to happen that day. How wonderful he is. We are doing renovations to have her come and live with us soon so life will be easier and she will have a much better chance of being as good as she can. And we have a better chance of catching those damn UTIs. Thanks all - its made me feel so good to know there are others going through this.
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We were given the premarin cream, and it indeed helped to keep her more supple. I'm not terribly convinced that it's helped to keep it 'tight'. In the 1+ year she's been on it, she's become increasingly incontinent. Your mileage may vary.
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My mom uses vagifem insertable tablets to address the problrm of vaginal atrophy, ehich has cut down on the number of utis that she's had in the past year
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My mom gets regular UTIs. In addition, she has chronic cystitis. Joy. So, when she complains of pain on urination, which is it? UTI or chronic cystitis?

In addition, she has a long-standing wound that heals up, opens again, heals, etc. She recently contracted MRSA and has had VRE. The wound care doc sent us to an infectious disease specialist to review her care and antibiotic history as she felt there was a good chance that all the antibiotics given through the years have lead to the MRSA.

His answer: NO MORE ANTIBIOTICS for UTIs unless she's running a fever (I need to find out what to do when one results in cognitive difficulties - I truly can't imagine living with that for longer than a day or two or three).

He prescribed Premarin Vaginal cream as it helps (a) the urination pain and (b) "tightens" things up "down there" so bacteria is less likely to enter the urinary tract. I gotta tell you, this is a joy (NOT) to administer BUT after I did it a couple of times, my mom recalled how to insert a tampon from long, long ago and now she can do it. I just stand by to hand her the applicator, then look the other way.

So far...so good. She still complains of the pain (going to ask her primary care about trying the AZO painkiller, see if that would be okay for her) BUT we've had two clear urinalyses in the past month. I would love to take away that pain that the chronic cystitis causes her and (hence the AZO, if not that, then small doses of narcotics throughout the day - helps her wound pain as well), but if the Premarin is helping to keep her from getting the UTIs, then I'm all for it.

The problem will be convincing her that it's helping her - so far, the docs and I have been saying it'll help with the pain - it's not - so now we have to try to get her to understand that it's keeping her from getting sick.

AND, the infectious disease specialist is now consulted on any and all antibiotics to be given to her, in an attempt to stop over-antibiotic-ing her, and to try to keep her from picking up these super-bugs.
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Wow, thanks to you both ~ Danna24 & LadeeC ~ for your comforting answers to my post. It's really helpful to know there are people out there in the same or similar situation. I don't know if there has been anything in my life up til now, that has been more challenging than what this situation is requiring of me. It certainly has been an incredible lesson. I guess that's one of the only thoughts that gets me thru it all ~ knowing what an amazingly intense lesson in life all of this is, and I try to be grateful for that. Hugs to EVERYONE who is facing any of these kinds of 'speed bumps' in your life!
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I don't hate Rosebud's comment at all. Last week my husband and I watched as his mother suffered a stroke and was placed in the care of hospice with a DNR and withhold treatment request. She had lost her ability to swallow so trying to give her anything to drink choked her . for a little over a week we watched her slowly slip away with the assistance of sublingual morphine to comfort her demise. I'm not sure what was worse, the prolonged waiting for it to be "over" or the anguish on her children's faces as they watched her life ebb away. I don't know if keeping the elderly "alive" just for the sake of keeping them "alive" cuts it in these cases. Watching this with my mother-in- law just didn't seem humane to me. Maybe I'm wrong, but I don't want to lie there for however long it takes without food or water until my organs shut down. I'm just saying ...
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Rosebud .. I don't hate your suggestion/question, at all. The family has discussed this very real option. No one's ready for it, in our case, because Edna still laughs a lot, really doesn't complain about much of anything .. until she's in the hospital. That's gut wrenching. But .. when the time comes .. and it surely will, withholding treatment - probably through hospice - is viable (and doesn't violate her DNR requests). Unless something else takes her down first. *sighs*
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Everyone will probably hate me for this answer, but as I mentioned in a previous comment, why do we keep bombarding elderly dementia patients with antibiotics for UTI's? My 81 y.o. mother sleeps 20+ hours a day, eats, pees, poops, and when she's awake all she does is complain about pains here and there (which change almost daily) that the doctor can't find a cause for. What kind of life is that? If it was me, I would rather let the UTI turn into a kidney infection, and then just go the way the universe probably would have wanted me to go. (Kind of like DNR?) Before antibiotics were around (I agree, they're great for some things, despite the negative side effects on one's GI tract!) in the "old days" people didn't live to be 95 ~ because the Universe helped them in a natural way to their next life, and most likely shortening their suffering. If my mother gets another UTI I'm not going to refuse her having antibiotics, but I do think this is a very strange and sad scenario for people at the end of their lives. I love my mom with all my heart, but it's heartwrenching to see her this way.
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My mom has passed away, but my memories are SO clear about her UTI's. Her cognition was slipping a little, but she had no dementia or memory loss. When she developed a UTI, suddenly she would be off her rocker. She would think she was back in Iowa, be unable to stand and, a feature of every UTI she ever had, she would talk to dead people, from her best friend and her mother, to JFK and popes. I always had to take her to the ER, she would be admitted to the hospital and have IV antibiotics. Two days later, without fail, she was back to reality, albeit weak as a kitten, and would spend 6 weeks in rehab. One memorable, horrible time, she developed a C. Diff infection in the hospital. All the tips to prevent a UTI are good, but sometimes they break through.
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Just to catch you all up on this, my mom had a stroke 4 dsys after I posted this. We have no way of knowing if her initial confusion and word finding was a tia in addition to the uti.
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Jools .. *one* of the reasons they hesitate, especially in clinical situations is that the introduction of the catheter carries its own risks. c-Diff and Pseudomonas aeruginosa (or P Aeruginosa) bacteria seem to thrive in clinical environments. They're highly resistant to antibiotics and often fatal in already compromised systems.

Urine can be caught mid-flow or taken by catheter. If the patient is perceived to be bedridden, they'll typically take it by catheter. A 'straight cath' pull usually gives the most accurate readings, since it's being drawn directly from the bladder. The chances of other contaminants being present in a 'catch' is always possible.

So .. with that background, if you want, you can INSIST on a urinalysis and if you're concerned with the introduction of the the resistant superbugs, tell them you'll do the catch (if you can, and are unfamiliar with the process, have the visiting nurse supervise) and take it to the lab yourself.

And, yeah .. it takes a few days for the cultures to breed and get the test results, but we've learned that treating with an inappropriate antibiotic is completely counterproductive. It just encourages other superbugs. *sighs*
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Thanks LadeeC for your list of some of the key signs of a UTI in your Mum. Yes we saw the physical weakness and given your experience we will watch for it as a major sign for my mother that it might be a UTI.

Re the issue of antibiotics. One of the huge problems is administration of antibiotics prior to a culture being taken particularly for the elderly and where a UTI is suspected. Mum spent two weeks in hospital with not a real recovery, then a recurrence where we ended up taking her to the ED. I said to the ED doctors and nurses that they were not to bring an antibiotic near her until they took urine and blood for cultures. The upshot is that for about 4 weeks she was on antibiotics that had little or no chance against the specific bacteria she was fighting. She started improving about 3 days on the right antibiotics and needed two courses. This is the second time I have seen assumptions made on antibiotics in an older person that nearly cost them their life. (The bug Mum had has a 61% fatality rate in older women and boy was she ill).

I cant understand the hesitation in taking a urine sample by clinicians or nursing support. Its not costly and besides the normal dip stick that identifies if there is blood and white cells in the urine (not a definitive but pretty good inidication of infection) there is another dip stick can indicate pretty definitively that there is an infection (but not the type). That at least ensures that an analysis on the exact bacteria can be done in 24 hrs and the right antibiotic delivered. Given the incredible impact of UTIs on further cognitive damage Im going to talk to her doctor about regular urine tests. Certainly we have been told if we notice any change at all straight in for a urine test. On the issue of ongoing prophylactic antibiotics we have been told this is an option but not a great one - lots of issues with this apparently. And YES BGills probiotics are absolutely a must. While yogurt etc is great we use a one a day major dose of probiotics in capsule form - here it is called "Inner Health Plus" Easier to get Mum to take one or two of these a day than get her to eat the amount of yogurt etc needed.

Excellent discussion and so useful to hear about other's experiences and opinions.
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I don't have an answer, but want to thank you for posting this, as I had no idea it could have such severe consequences. My 96 yr old mother has regular UTI
and I will try to be more aware and talk to her and her dr about solutions.
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I forgot to mention the use of probiotics, like acidophilus, or yogurts, especially after the use of antibiotics. Antibiotics will kill off beneficial bacteria in your system as well as the bad, and it's important to repopulate the good bacteria as quickly as possible. Some claim regular use of probiotics can drastically reduce recurrence of UTI's, and it makes sense since it's the good bacteria that are keeping the bad in check.
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Side effects from the antibiotics used to treat a UTI can contribute to the fog. Some antibiotics can be better tolerated than others, it really varies from person to person. If you read the possible side effects for the various antibiotics out there, you might be very surprised to see possible symptoms which can include the very impairment we're all trying to avoid. My best advice is to keep track of which antibiotics are used for treatment, note any changes in behavior while on them, and how long that behavior persists. Doctors are usually willing to avoid using these particular antibiotics when they're not well tolerated, if only they are aware of the change in behavior. It can sometimes be difficult to find an effective antibiotic that is also well tolerated.
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Ferris .. UTIs are indeed a contributing factor to failing cognition .. whether it's officially called dementia or not, frankly I don't care, lol. It ends up amounting to the same thing.

Jools .. we have almost exactly the same issue: stroke, followed slowly by vascular dementia along with recurrent, persistent UTIs. We've learned her signs at early onset of them: she weakens, physically first, then shows signs of aphasic speech, often accompanied by muscle twitches/tics. Rarely does she present with other symptoms like fever, burning while urinating, etc. So, we had to learn HER signs/symptoms.

We also follow a strict regime with diet, supplements to help keep her bladder flushed, exercise, hygiene, etc.

And yet, the UTIs keep coming back .. and with each one, after the 'fog' clears, there's some small decline, compared with prior to the infection and treatment. It *does* help to add some cognitive exercises to her regime: logic questions, memory questions, hand-eye coordination, etc. I turn every normal daytime activity into an 'opportunity' to learn or a physical therapy type routine.

An aside: among her other conditions, she has diverticulosis. Normally, this just means we control flare ups with diet. Very recently, one of them bled out. Wanna know scary?? Ugh. Simultaneous to the GI bleed, she had another UTI and while they were testing and diagnosing she began her antibiotics; . She ended up needing a transfusion because of the blood loss. After her hospital release, within less than two days, her cognitive functions improved SO much, I felt like we'd gone back two years. Dunno if it was the transfusion and/or this specific round of meds, but I'll take it.
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Oh my... I could write a book on this topic and I think I would be correct. my mom has had chronic UTIs for probably 20 years. however, they have gotten very bad in the last 3-4 years. she has been hospitalized a couple times because they get so bad (mostly because the dr doesn't get on it quick enough) that she has to have 5 to 10 days of IV antibiotic treatment. I CAN ALWAYS TELL when she has one. there is a difference in her thinking process, her countenance and her physical abilities (or lack thereof) she has home healthcare so I always call her nurse and/or her dr as soon as I notice a change. they have not always agreed with me, then usually what happens is a couple weeks later she's so bad that they agree, and THEN get the culture. right now she is on her 2nd 10 day round of antibiotics. the changes are sometimes rather subtle, yet again, I can always tell. Mom has a suprapubic catheter that she's had for approximately 4-5 years so that makes the battle to keep the UTIs at bay even more difficult. since Mom's last hospitlization, I have really been pushing the water and also, cranberry juice and I do think it's made a difference. at least now her dr believes me when I TELL HIM that she has a UTI and orders a urine sample be collected. I didn't know until a few years ago how much a UTI affects their cognition; wish someone would have told me. hang in there.
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People progress with dementia at different speeds. Since she has already been diagnosed with dementia, a UTI is hardly the "cause". You don't say what medications she is taking and as I nurse, I would recommend calling her doctor to inform him/her of her abrupt memory loss. Dementia patients do not understand that they are having memory loss, so it must be something else. Best wishes.
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