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UTIs in the Elderly: Prevention, Symptoms and Treatment
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UTIs in the Elderly: Prevention, Symptoms and Treatment

February 12, 2019

Urinary tract infections (UTIs) are common in all people and account for more than 8 million doctor visits annually, according to National Institutes of Health data. But UTI risk increases with age, and older people are more vulnerable to contracting UTIs for several reasons, including their susceptibility to infections due to a weakened immune system. 

UTIs in the elderly are especially dangerous. If left untreated, a UTI can lead to acute or chronic kidney infections, a bacterial infection in the bloodstream called septicemia, or sepsis, a potentially life-threatening immune response to the bloodstream infection. Read on for more insight and best practices for preventing UTI in elderly patients.

Group of senior women sitting on a bench

How Do UTIs Happen?

A UTI happens when bacteria enter the urinary tract and multiply in the bladder. UTI infections in the elderly are more common because of underlying problems like a weakened immune system that can’t fight the bacteria, less-efficient bladder emptying, incontinence or bladder obstructions. Other conditions that make elderly people more susceptible to UTIs include:

  • Diabetes
  • Use of a urinary catheter
  • Enlarged prostate
  • Immobility
  • Surgery of any area around the bladder
  • Kidney stones

Why Symptoms of UTIs in the Elderly Aren’t Easy to Spot

It can be difficult to know if an elderly person has a UTI. Some elders who are frail or who have dementia or aphasia can’t communicate their discomfort to caregivers. In addition, the typical symptoms of a UTI (like frequent and painful urination) often don’t show up in elderly patients. Because their bodies respond differently to infection, it is important to look for other signs and symptoms of a UTI in the elderly, particularly sudden changes in behavior like these:
  • Confusion or delirium
  • Agitation
  • Hallucinations
  • Poor motor skills or loss of coordination
  • Dizziness
  • Falling
  • Lethargy
  • Decreased appetite
  • Back pain
  • Nausea or vomiting

How to Diagnose UTIs in the Elderly

Luckily, once a UTI is suspected, it is easy to confirm by urinalysis. While there are over-the-counter tests you can use at home, these check for bacteria that are often in the urine of older adults to some degree. A positive at-home test may not necessarily mean there is a UTI. If an at-home urine test shows a positive result, call your doctor immediately.

How to Treat UTIs in the Elderly

If a UTI in seniors is diagnosed, the likely treatment will be antibiotics. The infection should clear in a few days, but it is important to take the full course of the antibiotics prescribed. It is also important to drink plenty of water while taking the antibiotics to flush out the bacteria. To ease discomfort, over-the-counter pain relievers and a heating pad can be used.

Sometimes antibiotics are not the best choice for treating a UTI in the elderly, particularly if the person has an allergy to antibiotics or has problems with the side effects. In those cases, other remedies can be effective in preventing UTIs in seniors, including:

  • Hydration: Drinking plenty of water and cranberry juice can both help prevent and treat UTIs. Hydration dilutes urine and makes it more difficult for bacteria to cause infection. Cranberry juice contains antioxidants that have antibacterial properties.
  • Probiotics: Probiotics found in yogurt, sauerkraut, some cheeses and supplements can help lower the pH in urine, making conditions unfavorable for bacteria. Probiotics also produce hydrogen peroxide in the urine, a strong antibacterial agent.
  • Topical gels: For women, the lower levels of natural estrogen after menopause can be linked to more frequent UTIs. Topical hormone therapy in gels, cream or vaginal suppositories can protect against the bacteria that cause UTIs. In addition, over-the-counter creams are available to help treat the pain that UTIs can cause.
  • Good hygiene and toileting habits: UTIs are caused by bacteria from urine or stool. Good toileting hygiene and continence care can minimize the chances for infection. Soiled incontinence briefs should be changed as quickly and often as possible, and women should wipe from front to back. Indwelling catheters should be cleaned daily with soap and water. In addition, holding urine instead of urinating when the urge is felt can contribute to UTIs. Encourage your loved one to urinate frequently.

What Happens if a UTI Isn't Treated?

Not only will UTIs cause more serious symptoms in seniors as compared to younger people, but these infections can also cause severe complications in the elderly. Short-term complications may include confusion or delirium. These complications can be an early warning sign of a UTI in an elderly person, but can resolve once the infection is treated.

Hospitalization due to more serious complications of UTIs in the elderly can include:

  • Kidney damage: An untreated UTI can lead to kidney pain and damage, which can become permanent with chronic infections.
  • Septicemia and sepsis: An untreated UTI can spread bacteria to the bloodstream, which is called septicemia. Sepsis, the overwhelming immune response to the bacteria in the bloodstream, can lead to tissue damage, shock and death.
  • Recurrent infection: Untreated UTIs can cause recurrent infections.

How to Prevent UTIs in the Elderly

The following tips can help learn how to avoid UTIs: 

Drink the right beverages

Drinking plenty of water throughout the day will help prevent the buildup of bacteria that cause UTIs. Cranberry juice or cranberry juice blends or cocktail can help fight that bacteria. On the other hand, caffeine and alcohol should be limited as these beverages can irritate the bladder.

Urinate frequently

By drinking more water, the urge to urinate will become more frequent. Urinating more often prevents infecting bacteria from building up that cause UTIs in seniors.

Get moving

Elderly people who are sedentary have a higher risk for UTIs. Walking more frequently, even in small increments, helps in preventing UTIs in the elderly.

Pay Extra Care to Feminine Hygiene

Women should always wipe their perineal area from front to back to prevent bacteria from entering the urethra. In addition, feminine hygiene products like douches, sprays or scented powders should be avoided for the same reason.

Check Incontinence Briefs Frequently

People who wear incontinence briefs are at higher risk for UTIs because of the close contact of those products – and the urine and fecal matter they are designed to contain – with the urethra. Incontinence briefs should be checked every two hours and soiled briefs immediately changed. The wearer should be wiped and cleaned before a change of briefs. For seniors who wear briefs and who are memory impaired, set timers to remind them to use the bathroom rather than the brief.

Wear Gloves During Catheter Care

Catheters can increase the risk of developing a UTI by irritating the urethra and bladder and promoting the growth of bacteria. Gloves should be used during catheter insertion and perineal cleaning, which should happen at least twice daily.

As people age, the risk for UTIs increases, and UTIs in the elderly become more challenging to diagnose. Taking preventive action can reduce the risk of a UTI and the dangerous kidney and bladder issues that can occur.

Elmcroft assisted living and memory care communities provide safe and personalized care to residents that respects their privacy and safeguards their health. Elmcroft residents can be sure that appropriate UTI infection prevention and control methods are in place to help prevent UTIs and that associates are able to recognize early signs of potential infection in order to get residents prompt treatment.

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