Urinary Tract Infections in the Elderly

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By Glenn Ellis

When bacteria enter the urethra and your immune system doesn’t fight them off, they may spread to the bladder and kidneys. The result is a urinary tract infection, or UTI.

UTIs are responsible for around 8.1 million doctor visits per year. Most urine infections are caused by germs (bacteria) traveling from the skin up the tubes of the urinary system. In men, this distance is farther, and the end of the urine tube is farther away from the germs of the guts. So men tend to get urinary tract infections less commonly than women. Women are four times more likely to get UTIs than men because their urethras are shorter.

Your UTI risk increases with age. More than one-third of all infections in people in nursing homes are in the urinary tract. More than 10 percent of women over age 65 report having a UTI within the previous year. That number increases to almost 30 percent in women over 85. Men also tend to experience more UTIs as they age.

UTIs become more common with age because you are more likely to have conditions that make it easier for germs to get access to your urinary system. In men, enlarged prostate glands prevent proper emptying of the bladder, which encourages UTIs. In women, after menopause the tissue around the lower end of the urinary tube (urethra) gets thinner and drier. This means the germ-repelling function works less well.

Having said that, many urine infections happen to people without these problems, just as they do in younger people.

Interestingly enough, UTIs in elderly people are often misdiagnosed as senior dementia or Alzheimer’s disease, because a UTI can mimic symptoms of such conditions. Also, according to Nursing magazine between 30 percent and 40 percent of elderly patients with serious infections don’t exhibit the hallmark sign of fever because the immune system is unable to mount a response due to the effects of aging. As the bacteria in the urine spread to the bloodstream and cross the blood-brain barrier, confusion and other cognitive difficulties can result. A sudden onset of these symptoms should lead one to investigate possible UTI. An elderly person who is experiencing signs of mental difficulties should also be closely monitored for other signs of a UTI.

The classic symptoms of a urinary tract infection are burning pain and frequent urination. UTIs may not cause these classic symptoms in older adults. Instead, older adults, especially those with dementia, may experience behavioral symptoms such as confusion.

Antibiotics cure most UTIs. Without treatment, an infection can spread to the kidneys and the bloodstream, which may lead to a life-threatening blood infection. Severe infections may require hospitalization for intravenous antibiotics and may take weeks to resolve.

The best way to treat UTIs in the elderly, or anyone for that matter, is to try to prevent their occurrence. Here are some ways to prevent UTIs or minimize their recurrence:

• Don’t use douches or other feminine hygiene products.

• Don’t drink fluids that tend to irritate the bladder, such as alcohol and caffeine.

• Drink cranberry juice or take cranberry supplement tablets, but only if you or your family does not have a history of kidney stones.

• Drink lots of water.

• Keep the genital area clean.

• If wearing adult diapers, change them regularly.

• Wear cloth undergarments.

• Always wipe from front to back (for women).

A UTI can cause confusion and other symptoms of dementia in older adults. A bladder infection places stress on the body, which can result in confusion and abrupt changes in behavior in older adults. And for people suffering from Parkinson’s disease, Alzheimer’s disease or other dementia, physical or emotional stress will often make dementia temporarily worse.

Urinary tract infections can exacerbate dementia symptoms, but do not necessarily signal dementia or Alzheimer’s. UTIs can cause distressing behavior changes for a person with Alzheimer’s. These changes, referred to as delirium, can develop in as little as one to two days. Symptoms of delirium can range from agitation and restlessness to hallucinations or delusions.

Further, UTIs can speed up the progression of dementia, making it crucial for caregivers to understand how to recognize and limit risks for UTIs in seniors.

Taking preventive steps and looking out for symptoms should help prevent infections. If your doctor diagnoses a UTI early, your outlook is good. Get medical attention if you suspect that you or a loved one has a UTI.

Source: The Philadelphia Tribune

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