Elderly Urinary Tract Infections

If a 30-year-old woman experiences painful burning when she urinates, it’s almost certain she has a urinary tract infection (UTI). But an elderly urinary tract infection rarely causes such clear symptoms and might not involve pain or discomfort at all. “As you get older your immune response changes; it’s part of normal aging,” says Anna Treinkman, a nurse practitioner at the Rush Alzheimer’s Disease Center in Chicago and president of the National Conference of Gerontological Nurse Practitioners.

Common Warnings Signs

A sudden change in behavior is, in fact, one of the best indicators of a urinary tract infection in older adults. Some common warning signs might include the onset of elderly urinary incontinence, confusion or not being able to do tasks the patient could easily do a day or two before. “Anytime there’s a change in an older adult… if one day they’re able to dress themselves or feed themselves and then there’s a sudden change, a red flag should go up in a caregiver’s mind,” Treinkman says.

UTIS: The Body’s Second Most Common Infection

Half of all women will develop a urinary tract infection in their lifetimes. Ranking as the body’s second-most common infection type, UTIs in women-and less often in men-account for about 8.3 million doctor visits each year, according to the National Center for Health Statistics. Typically, UTIs, also known as bladder infections, are easy to cure. But if left untreated, the infection can spread and develop into far more serious conditions. UTIs, for instance, are a leading cause of sepsis, a potentially life-threatening infection of the bloodstream.

“A bladder infection places stress on the body,” says Dr. Mary Ann Forciea, an associate clinical professor for the University of Pennsylvania Health System. That stress can result in confusion and abrupt changes in behavior in older adults with an elderly urinary tract infection. And for people suffering from Parkinson’s disease, Alzheimer’s disease, or other dementia, “any kind of stress, physical or emotional, will often make dementia temporarily worse,” Forciea says.

Urinary Tract Infection Causes & Symptoms

The kidneys, ureters, bladder and urethra work together to rid the body of urine: the kidneys remove extra liquid and waste from the blood in the form of urine, the ureters carry the urine from the kidneys to the bladder, and the bladder stores the urine until it is emptied through the urethra.

An infection can occur when bacteria cling to the opening of the urethra and begin to multiply. UTIs are thought to be much more common in women because the urethra is shorter in women than in men, giving bacteria-which live in the rectal area and also on a person’s skin-an easier route into the body.

ISCYSTITIS
The most common diagnosis is iscystitis, or the infection and inflammation of the bladder, which causes frequent and painful urination. However, other parts of the lower and upper urinary tract system can become infected. As a general rule of thumb: the higher up the infection in the urinary tract system, the worse it is.

URETHRITIS, PYELONEPHRITIS & TOPROSTATITIS
Other common causes of UTIs include the following:

• Urethritis: Burning urination is often the result of urethritis, the infection of the urethra. In men, urethritis can also cause penile discharge.
• Pyelonephritis: Pyelonephritis occurs when a bladder infection spreads to the kidneys. It can cause upper back and flank pain, shaking, chills, nausea and vomiting.
• Toprostatitis: UTIs in men can lead toprostatitis, or enlargement of the prostate gland, the male organ that produces semen, which is located just below the bladder.

Symptoms of a UTI include general discomfort, a feeling of being over-tired, blood in the urine and pain even when not urinating. Men might feel fullness in the rectum. Back and side pain can indicate the infection has reached the kidneys. An elderly person will rarely get a fever, but if an older patient has one it is considered an emergency. “It shouldn’t be taken lightly,” Treinkman says. “If they do have a fever, it’s a serious infection.”

Diagnosis & Treatment

In most cases, diagnosing and treating an elderly urinary tract infection is relatively straightforward: a simple urinalysis can confirm the infection’s presence and, for someone in good health, antibiotics are the first choice of treatment. UTIs often clear up in only a few days. But depending on the age and health of the patient–and the severity of the infection–the course of treatment can take weeks and perhaps involve hospitalization for the administration of intravenous antibiotics. A doctor might also decide to “culture” a patient’s urine to determine the type of bacteria that’s growing to prescribe the most effective antibiotic for the condition.

Older adults living in a group setting such as senior communities or nursing homes are more likely to be resistant to the antibiotics most often prescribed for UTIs such as amoxicillin or nitrofurantoin, and might require something stronger, as well as a longer course of antibiotics to combat an elderly urinary tract infection.

Forciea says people suffering from UTIs must drink plenty of fluids to flush the bacteria from their systems. Proper fluid intake makes it harder for bacteria to live and multiply in the urinary tract. She recommends older adults drink four to six 8-ounce glasses of water a day. Drinking cranberry juice or taking cranberry tablets can also make urine less inviting for bacteria, Forciea says.

If your loved one’s symptoms are consistent with a bladder infection, it’s recommended that his or her healthcare provider be called for an appointment the same day that the symptoms are recognized. If it appears the infection might involve the kidneys, call the healthcare provider immediately to consult on whether a trip to the emergency room is necessary.

Risk Factors & Prevention

Older adults at greater risk for getting an elderly urinary tract infection include:

• Those who require a catheter in the urethra and bladder
• Those who are diabetics
• Anyone with kidney stones
• Women who’ve gone through menopause

After menopause, women experience a change in the lining of the vagina and also produce less estrogen, which helps protect against UTIs. Hormone replacement therapy (HRT) can help protect postmenopausal women from UTIs, according to the American Urological Association, but HRT may increase other health risks and so may not be appropriate for all women.

All women who have had a UTI at least once before are also at increased odds of developing the infection again. About 20 percent of women who’ve had a UTI will experience a second one, and 30 percent of those women will get a third.

Diagnosing a UTI

Here are some common ways to diagnose a UTI:

• Home Test: A dipstick is held in the urine stream. Home tests are a convenient way for chronic UTI sufferers to quickly diagnose whether they have an infection. But they should only be used with the support and guidance of a patient’s physician.
• Ultrasound Exam – Ultrasoudns can help evaluate bladder and kidney problems as doctors are able to see whether there are abnormalities in the bladder that could be contributing to the infections.
• X-ray: Using a series of x-rays and a contrast dye to highlight abnormalities in the urinary tract can help pin-point abnormalities.
• CAT Scan: A CAT scan provides a detailed three-dimensional picture of the urinary tract.

The Importance of Water Intake

Treinkman says UTIs are also more likely to affect people who attempt to manage stress incontinence by limiting their water intake. “They might limit the water they drink so they don’t have to go to bathroom so much,” she says. “But it puts them at higher risk because there’s a greater chance of bacteria build up… You want to keep your urine clear.”

Drinking plenty of water is an important prevention tactic. Some other methods for women include:

• Urinating promptly after the urge arises
• Wiping front to back
• Emptying the bladder shortly before and after intercourse
• Avoiding use of feminine products such as deodorant sprays, douches and powders in the genital area that could irritate the urethra
• Taking showers instead of baths

Noticing a Change in Behavior

Most importantly, Treinkman says that caregivers can’t be too careful when they notice a change in behavior in an older adult, no matter how subtle. “Falls, confusion, new onset of incontinence in someone who had been getting to the bathroom, decrease in appetite,” she says, “any of these can be a sign of a urinary tract infection. It really requires a detective-like index of suspicion from the caregiver.”