What Caregivers Should Know About UTI's In the Elderly

UTI's can be deadly for senior citizens. Caregivers should be aware of the signs and symptoms. 

Urinary tract infections, also called UTI's, in the elderly are bad news.  For the average person, a bladder/kidney infection can be nothing more than a brief nuisance, or it can cause major discomfort and require medicine and rest.


For the elderly, a UTI is an emergency that requires immediate treatment. The elderly are at higher risks of developing UTI's, but don't exhibit the same symptoms as younger sufferers. Because of the apparent lack of signs and symptoms, the entire body can be affected before an infection is even suspected and diagnosed.


Here are some things caregivers should know about UTI's, and how they exhibit themselves in seniors.

What is a UTI and What Causes It? 

When bacteria makes it's way into the urethra, bladder, or kidneys, a urinary tract infection can occur.


Usually, the infection is caused when E. coli bacteria enter the urethra and travel to the bladder. From there the infection can spread to the kidneys.


Urinary tract infections can affect all or different parts of the urinary tract system:

• Cystitis--is the term for an infection in the bladder. 

• Urethritis--is an infection in the urethra

• Ureteritis--is an infection of the ureter tubes

• Kidney infection--when the infection affects the kidneys. 

When the kidneys and ureters (not urethra) are affected, it is called pyelonephritis.


Although both women and men can suffer from urinary tract infections, women are more susceptible. Part of this is due to the urethra being shorter in women, making it easier for bacteria to travel to the bladder.


Women who are sexually active are more likely to get a UTI, both because intercourse can push bacteria towards the urethra, and because the use of some contraceptive methods can irritate the urethra.


Not urinating frequently can also lead to UTI's. Women may not empty their bladders as often as needed for many reasons. Some of these reasons may include: inadequate bathroom breaks at work, difficulty walking to the bathroom, inconveniently located restrooms, clothing that is difficult to remove or just simply being too busy to remember.


 When they do get the chance, they may not have time to completely relax and empty the bladder. They may compensate by not drinking, which can exacerbate the issue.


Women are also more likely to refuse to use a bathroom that is dirty. Lets face it, men have it a lot easier (and cleaner) when they need to urinate.


As women age, the lining of the urinary tract weakens and thins. This can lead to more irritation and more susceptibility to UTI's after menopause.


In men, UTI's become more frequent after the age of 50. As men age, the prostate can enlarge. This can obstruct urine flow, leading to retained urine in the bladder.


If women suffer UTI's more often, then men suffer them more severely. Almost all cases of male urinary tract infections will require hospitalization.


In both elderly men and women, some risk factors that can increase the chance of  an urinary tract infection include:

• Catheterization
• Immobility
• Dehydration
• Diabetes
• Kidney stones
• Bladder prolapse
• Poor hygiene habits
• Certain medications

Incontinence can also contribute to the risk for bladder infections. This is especially true for those who must wear adult diapers.


Adult diapers, no matter how often they are changed, can allow  fecal matter to enter the urinary tract very easily, even after minimal contact. Likewise, elderly persons who cannot (or will not)  efficiently clean themselves after toileting may introduce bacteria accidentally to the urethra.

Signs and Symptoms of Urinary Tract Infection in The Elderly

The elderly can present with all the same symptoms as a younger person.


However, they may show none of the "normal" signs or symptoms. Instead they may experience flu-like symptoms. Younger people will rarely present with flu like symptoms with a UTI.


The signs and symptoms of UTI for all ages include:

• Painful urination
• Burning when urinating
• Burning sensation in genitals
• Lower abdominal ache or cramps
• Urgency or frequent need to urinate
• Cloudy or foul smelling urine
• Blood in urine
• Tenderness in back, under the ribs (kidneys)
• Sensation that urethra is swollen or raw (urethritis) 
• Painful intercourse (women, from urethral irritation)
• Fever and chills
• Nausea
• Symptoms of UTI in the elder may include: 
• Confusion
• Dizziness
• Nausea and vomiting
• Shortness of breath
• Cough
• Fatigue
• Malaise
• Confusion

UTI's and Dementia

Urinary infections can cause worsened behaviors in those with dementia. The dementia may seem to become worse practically overnight.


A person who has not been diagnosed with dementia, or who is in very early stages, may suddenly exhibit symptoms of progressive dementia.

This can include cognitive difficulties, confusion, delirium, hallucinations, and anxiety.


Existing dementia behaviors may increase in frequency too. Sundowning may be worse, the person may either have unusual insomnia or excessive sleepiness.


If an elderly person suddenly begins to show signs of anxiety, agitation, confusion or delirium, especially if coupled with any other symptoms such as fever, nausea, cough, or dizziness...contact a doctor or take your loved one to the hospital as soon as possible.


It is better to be safe than sorry. Don't assume it is simply the dementia "taking a turn for the worse", especially if the onset is very sudden.


This is especially important if your loved one is unable to communicate to you how they feel. They may simply become irritable or withdrawn, or the may say they just feel tired.

Dangers of Untreated Urinary Tract Infections in the Elderly

In a person of any age, an untreated UTI can enter the kidneys and create scarring and further illness. Sepsis can occur if the infection spreads.


In the elderly, the immune system is already weaker. If they have a pre-existing medical condition such as high blood pressure or diabetes, the infection can cause this issue to worsen, since the immune system is suddenly overburdened.


An untreated UTI could also lead to permanent incontinence.


If an elder with dementia has an untreated UTI, they can suffer dehydration, vertigo, falls, and injuries, all which can further affect their dementia.

Preventing and Treating UTI's in The Elderly

If a urinary tract infection is suspected, a doctor will take a urine sample and sometimes a blood test. The infection may be treated with a simple round of antibiotics.


If infections are recurring or if the doctor suspects an obstruction, a CT scan or other imaging test may be used. A cystoscopy may also be ordered. (this involves a tube with a lens being run into the bladder to check for abnormalities.


In some cases a catheter may have to be used to collect a clean sample. If so, this may cause further agitation in someone with dementia. It can also lead to further infections. Ask if there any other options before agreeing to allow catheter use on a loved one under your care.


Many infections can be prevented with some simple tips and rules. First off all, make sure that the elderly stay hydrated! This can be a difficult struggle if they are embarrassed about incontinence. Always provide their favorite drink in a readily accessible area.


To to make access to bathrooms as easy as possible. Offer a bed pan if that will help reassure them and convince them to drink more fluids. If adult diapers or pads are used, change them frequently, clean the perineum between changes.


All linens such as towels, bed pads and underwear that come in contact with even a small amount of urine should be sanitized frequently to kill bacteria.


Water is best for flushing the urinary tract, but any fluids that they enjoy drinking will help keep infections at bay. Encourage them to drink glasses of water in between other beverages as well.


Remember that although cranberry juice is thought to help prevent infections, it can also irritate infections that are already present in some people.


Other preventions include:

• Teaching good hygiene
• Emptying the bladder frequently--don't wait until it is uncomfortable
• Remind those with dementia to use the toilet frequently
• Sexually active seniors should urinate immediately after intercourse
• Avoid perfumed soaps, deodorants, toilet papers and douches. 
• Provide wet wipes to make cleaning up easier after toileting

It is not advisable to try to treat a urinary tract infection in the elderly with a home remedy. Consult with a physician  before implementing any care plan.


Also remember that excessive fluid intake may place some elderly persons at risk depending on their pre-existing medical conditions and their medication.


Check with the doctor about any concerns and make sure you understand all complications and considerations. Every elderly person is different, and their unique health status will help your doctor decide which treatment option and preventative measures are the safest and most effective.