Symptoms of a UTI may include:
- a more urgent need to urinate
- increased urination
- burning, pain, or discomfort when urinating
- feeling pressure in the lower abdomen or pelvis
- cloudy, thick, or odorous urine
- the bladder not feeling empty after urination
- fever
- pain in the lower abdomen, flank, or back
- blood in the urine
- fatigue
- nausea
- vomiting
Older adults are more likely to experience confusion, delirium, or behavior changes in addition to the typical UTI symptoms above.
Symptoms in seniors
Doctors should check for a UTI in any older adults who have a sudden change in behavior or become increasingly confused.
Changes in behavior that may indicate a UTI include:
- restlessness
- hallucination
- social withdrawal
- agitation
- confusion
Why are symptoms different in seniors?
Doctors are not sure why additional symptoms such as confusion or delirium occur in older adults.
One theory is that the blood vessels that supply the brain are weaker and may be more likely to allow the infection to pass to the nervous system.
Causes
Bacteria or fungi that have entered the urinary tract are responsible for causing UTIs.
Many UTIs occur due to E. coli, a type of bacteria that is commonly present in stool and can enter the urinary system through the urethra.
Other organisms that are capable of causing a UTI may be present in older adults who have a catheter or reside in a hospital or care facility.
In fact, UTIs are most common in residents of long-term care facilities such as nursing homes.
What are the risk factors for seniors?
Factors that increase the risk of older adults developing a UTI include:
- changes in the immune system
- exposure to different bacteria in the hospital or care facility
- other health conditions, such as incontinence
- having had a prior UTI
- changes in the way the urinary system works, including prostatic hypertrophy in males
- presence of a urinary catheter, which is a tube that connects the bladder to a bag outside of the body to allow urine to drain
It is important for caregivers to be aware of these risk factors and observe any cognitive changes that could indicate a UTI.
Complications
UTIs are common, but they can potentially lead to severe complications without treatment.
Kidney damage
An untreated UTI can spread to the kidneys and cause kidney damage or disease.
Kidney infections are serious and require intravenous antibiotics and hospitalization.
Sepsis
Another complication of UTIs is sepsis.
Sepsis is a life-threatening condition in which the infection spreads to the bloodstream and then throughout the body. Untreated sepsis can lead to septic shock and eventually death.
Sepsis can cause other complications including organ dysfunction, amputations, and chronic pain disorders. Even if a person has treatment for sepsis, complications may occur.
How is it diagnosed?
If doctors suspect that a UTI is present, they will test a urine sample in the office or send it to a laboratory for a urinalysis.
A urine culture can confirm which bacteria are causing the infection. Knowing the specific type of bacteria allows the doctor to determine a suitable treatment plan.
A condition called asymptomatic bacteriuria (ASB) is also common in older adults. ASB occurs when there are bacteria in the urine, but they do not cause any signs or symptoms of infection.
Treatment
The standard treatment for a UTI is antibiotics, which kill the bacteria causing the infection. Doctors will prescribe an antifungal medication instead if a fungus is causing the UTI.
It is essential that people take the antibiotic or antifungal medication precisely according to the prescription, even if they begin to feel better. Completing the entire prescription will help to destroy all of the infectious bacteria.
Antipsychotic medications
If a UTI is causing serious delirium or confusion, doctors will use antipsychotic medication until the infection clears. Antipsychotic medicines reduce distress, agitation, and the risk of injury in someone with these types of symptoms.
Intravenous antibiotics
More advanced cases of UTI, such as those that lead to sepsis, septic shock, or kidney infection, may require hospitalization and intravenous antibiotics.
It is common for someone with sepsis or septic shock to have other medical complications that also require medical care.
Can it be prevented?
Taking steps to prevent a UTI is vital for people who have a higher risk of getting one, including older adults.
Methods of preventing a UTI include:
- drinking plenty of fluids
- avoiding caffeine and alcohol
- wiping from front to back after going to the toilet
- promptly changing incontinence pads or underwear when wet
People in a nursing home or long-term care facility often depend on others to take preventive measures against UTIs for them. It is essential that the staff are aware of how to prevent UTIs and understand the signs and symptoms of these infections.
It is important for family members to ensure that older adults have sufficient, appropriate care to meet their needs.
