UTIs in the Elderly

Urinary tract infections, commonly shortened to UTIs, are the most common form of infection experienced by the elderly population. It is, as the name suggests, an infection of the urinary tract, most commonly the bladder. For most people, the symptoms of a UTI will be expressed as the need to urinate frequently and urgently, a burning sensation felt in the urethra during urination, and urine with an unusual color or odor. Sometimes, a small amount of blood can be visible in the urine as well.

Puzzlingly, however, these symptoms are often missing in older adults. Or, in the case of those with dementia or Alzheimer’s, they may be unable to articulate them at all. The signs of a urinary tract infection in older adults are often largely behavioral, which can make an accurate diagnosis difficult. Instead of the commonly expected symptoms, a senior suffering from a UTI may experience unexplained incontinence, fatigue, or sudden and abrupt changes to their behavior or mental status. A UTI is the most common cause for a sudden increase in confusion in dementia patients, although the medical community is still unsure as to why. It is likely that the lower baseline of clear thinking and effective communication is a contributing factor.

For younger people, UTIs are most associated with frequent sexual activity, but in older adults, the most significant factor is usually a change in personal hygiene. For many seniors, the changes that aging brings about with physical and cognitive declines can make this task difficult. Physical limitations due to conditions like arthritis, a stroke, or COPD can limit the ability of a senior to manage incontinence care, or keep themselves clean after using the toilet.

Caregivers can play an important role in recognizing new health issues in the elderly adults they provide care for. While you should always be on the lookout for any changes in behavior, or any new complaints of discomfort out of the ordinary, looking out for the symptoms of a UTI can help to resolve the issue quickly, without any delay caused by addressing the symptoms rather than the disease. Physical symptoms will include:

• Increased need to use the restroom, both in frequency and urgency
• Discomfort or burning felt during urination
• Lower abdominal pain
• Frequent touching or adjusting of the genital area
• Cloudy, dark, or foul-smelling urine
• New, or worsened incontinence
• Fever
• Chills

While a senior may experience some, or all of the physical symptoms, they may be unable to adequately express themselves, and you could have to rely on the psychological effects. The main effect of a UTI among seniors is delirium. Delirium is a mental state in which a person is confused, disoriented, and unable to think or remember clearly. The following symptoms may be commonly seen in seniors with UTIs, and they may experience some or all of them, or experience different symptoms over time.

• Sudden changes in mental status
• Confusion
• Memory loss
• Difficulty concentrating
• Lethargy
• Hallucinations
• Delusions
• Restlessness
• Violent behavior
• Changing levels of consciousness

UTIs sometimes resolve on their own, but they can more easily worsen. It can cause chronic incontinence, or spread up through the urinary tract and damage the kidneys. Timely testing and treatment with antibiotics is crucial.