UTIs in Seniors

What Are UTIs?

A UTI is a bacterial or fungal infection in any part of the urinary system, including the urethra, bladder, ureters, or kidneys. The infection starts at the opening of the urethra. When left untreated, it advances to the bladder, then ureters, and finally the kidneys, where permanent damage can take place. This can lead to kidney failure. If the infection reaches the blood, the patient’s risk for sepsis increases. Early detection and treatment by a professional are therefore essential.

If your senior parent is very disoriented, lethargic, and not wanting to eat, your first thought might not be “this is due to a urinary tract infection.” After all, UTIs usually present as painful or frequent urination, burning, or abdominal pressure in younger people. In seniors, though, this infection manifests more atypically as confusion and delirium. The good news is that the delirium is usually reversible if seniors are properly treated. The problem is that a UTI’s symptoms mimic those of other more serious conditions like dementia. If an older patient can’t report their symptoms clearly and signs point to other conditions, diagnosing UTIs can be challenging.2

Why Do Seniors Get So Many UTIs?

Older individuals are vulnerable to UTIs due to age-related factors. With age, our immune system might become compromised. Our bladder and pelvic floor muscles weaken, which causes urine retention and incontinence. This in turn means the potential for bacteria increases if urine stays in the urinary tract. Seniors often get UTIs through catheters in nursing homes or other full-time care facilities. Due to cognitive decline and neurological conditions, senior adults might not even be aware of their symptoms.

Older adults usually need more frequent health care visits, which increases their risk of exposure to a UTI in a facility like a hospital or nursing home. Older adults are also at greater risk if they have poor hygiene — namely, if they don’t wipe themselves from front to back after sex or after going to the bathroom, if they wear soiled underwear, or if they wear disposable undergarments for too long.

They’re also at risk if they’re diagnosed with incontinence. If your parent has bladder-control issues, they might reduce fluid intake during the day to avoid their urinating problem. With less frequent urination and more retention, urine sits in the bladder. A prolapsed bladder makes matters even worse.

Certain health conditions that older adults face, such as diabetes, kidney infections, and kidney stones, also make it more difficult to urinate. Besides slowing the urination process, diabetes increases glucose in the urine, which also increases the likelihood of a UTI.

What Causes UTIs in Seniors?

On a simple level, once E. coli bacteria — the most common bacterial cause of UTIs — makes its way from the bowel or bladder to the urinary tract, one can get a UTI. Our senior loved ones can be more vulnerable to UTIs due to other conditions they may deal with as they age, such as diabetes, vaginal atrophy, or prostate hyperplasia.

What Are the Symptoms of UTIs in Seniors?

Signs to look out for to determine if a loved one might have a UTI include classic symptoms as well as those specific to seniors:

• Delirium
• Frequent falls
• Drowsiness
• Lethargy
• Aggression
• Agitation or restlessness
• Behavioral change
• Decreased mobility
• Lack of appetite
• Urgent need to urinate or increased frequency of urination
• Pain, burning, or discomfort when urinating
• Pain in the lower abdomen or back
• Pressure in the pelvic area
• Cloudy urine (or urine with an odor)
• Fever
• Blood in urine
• Nausea
• Vomiting

Symptoms that are similar to those of a UTI can also be indicative of other serious conditions. These include vaginitis, kidney stones, sexually transmitted infections (STIs), and bladder cancer. That’s why it’s imperative to get diagnosed and treated as soon as possible.

Why Are Symptoms Different for Seniors?

Determining why UTI symptoms in seniors are different from traditional symptoms is tricky. Cognitive impairment can be at play and limit a senior’s ability to recognize a problem, allowing the issue to worsen and negatively affect their body. Many symptoms also relate to their behavior. When it comes to seniors, whether they’re in assisted living centers, nursing homes, or at home, changes in behavior can end up being missed, dismissed, or attributed to other illnesses.

Seniors, unlike those in other age groups, tend to experience delirium when they get UTIs. Recent research with lab mice may reveal why. A team discovered that Interleukin-6, a protein in the immune system, can contribute to the delirium and disorientation that’s often found in older patients with UTIs. Blocking the actions of that protein can reduce such symptoms.7

How Do You Treat UTIs?

If you suspect your loved one might have a UTI, request that your doctor take a urine sample and send it to the laboratory for analysis. A urine culture will reveal if bacteria is causing an infection. Bacteria in the urine not causing any symptoms could be asymptomatic bacteriuria (ASB) which is often found in older adults and typically doesn’t require treatment.

Because older adults’ immune systems may be less effective at identifying and attacking infections, UTI symptoms could potentially progress to a dangerous level. UTIs can lead to sepsis, a life-threatening condition in which the infection spreads to the bloodstream and throughout the body. Sepsis can cause organ dysfunction or failure. Untreated sepsis can lead to septic shock and eventual death.

UTIs shouldn’t be underestimated, but once a UTI is diagnosed, the treatment is usually relatively easy. Most UTIs are treated with antibiotics and hydration. If the UTI causes severe confusion or delirium, some doctors will prescribe antipsychotic medications. When accompanied by complications like sepsis or kidney infection, the patient might require hospitalization and intravenous use of antibiotics.

Some medical specialists worry about overtreatment and antibiotic resistance. They suggest that, rather than a urine culture, medical practitioners should conduct a full clinical assessment. According to one study of older adults admitted to hospitals for UTIs, most cases were asymptomatic, yet patients received inappropriate treatment in the form of antibiotic therapy.8

How Can UTIs Be Prevented in the Senior Population?

Here are some helpful tips for seniors to reduce their chance of getting a UTI:

• Practice good hygiene.
• After using the toilet, wipe from front to back to keep bacteria away.
• Empty your bladder before and after sexual activity.
• Don’t hold urine for too long.
• Avoid constipation.
• Urinate frequently.
• Drink lots of water to flush your kidneys and prevent bacteria from populating.
• Maintain a healthy diet.
• Consider taking probiotics.
• Choose breathable underwear.
• Control blood sugar.
• Take care of yourself with good sleep, nutrition, and exercise.