UTIs in the Elderly: Symptoms and Treatments Explained
UTIs or urinary tract infections in the elderly can cause serious health problems, making it all the more necessary to know the signs, the symptoms, and the treatment for UTIs in the elderly population.
What Are Urinary Tract Infections?
UTIs happen when bacteria enter the body through the urethra, which is the opening that carries urine from the bladder, and the immune system cannot fight off the bacteria. As a result, the bacteria multiply and can spread to the bladder and kidneys, causing an infection.
Typically, women are more susceptible to UTIs because the urethra is shorter, meaning bacteria doesn’t have to travel as far to reach the kidneys or bladder. However, seniors are also at a higher risk of a UTI because of weaker immune systems, chronic health conditions, urinary incontinence, reliance on catheters, or other factors.
UTIs can be treated with medication to kill off the bacteria. However, if left untreated, a UTI can cause kidney infections, kidney failure, sepsis, and other health problems. In fact, the infection can even spread into the bloodstream, leading to life-threatening infection and a long road to recovery. However, with proper care and attention, many UTIs can be avoided.
Why Are the Elderly More Susceptible to Urinary Tract Infections?
Seniors are more vulnerable for many reasons, including their overall susceptibility to infections due to a weakened immune system. According to the National Institutes of Health (NIH), the following conditions make older individuals more susceptible to UTIs:
1. Diabetes
Diabetes is a serious disease and healthcare problem, and it affects many older adults. People get diabetes when their blood glucose, also called blood sugar, is too high.
There are two main kinds of diabetes:
- In Type 1 diabetes, the body does not make insulin. Although older adults can develop this type of diabetes, it begins most often in children and young adults, who then have diabetes for life.
- In Type 2 diabetes, the body does not make or use insulin well. It is the most common kind of diabetes. It occurs most often in middle-aged and older adults, but it can also affect children. Your chance of getting type 2 diabetes is higher if you are overweight, inactive, or have a family history of diabetes. Women with a history of gestational diabetes (a type of diabetes that develops during pregnancy) also have a greater chance of developing type 2 diabetes later in life.
2. Urine retention
Weakening of the bladder and pelvic floor muscles can lead to incomplete emptying of the bladder and incontinence. Urinary retention is the inability to voluntarily urinate. Acute urinary retention is the sudden and often painful inability to void despite having a full bladder.
Chronic urinary retention is painless retention associated with an increased volume of residual urine.2 Patients with urinary retention can present with a complete lack of voiding, incomplete bladder emptying, or overflow incontinence. Complications include infection and renal failure.
3. Use of a urinary catheter
Urinary catheters are used to help alleviate the symptoms of urinary retention and urinary incontinence, both of which increase the likelihood of getting a UTI. Unfortunately, the use of urinary catheters can also increase the chance of getting a UTI since, if not properly sanitized, it can introduce unwanted bacteria into your organs.
4. Bowel incontinence
Types of bacteria that are normally found in stool, such as E. coli, are commonly responsible for UTIs. Bowel incontinence is an inability to control bowel movements, resulting in involuntary soiling. It’s also sometimes known as fecal incontinence.
The experience of bowel incontinence can vary from person to person. Some people feel a sudden need to go to the toilet but are unable to reach a toilet in time. This is known as urge bowel incontinence.
Other people experience no sensation before soiling themselves, known as passive incontinence or passive soiling, or there might be slight soiling when passing wind. Some people experience incontinence on a daily basis, whereas for others it only happens from time to time.
It’s thought 1 in 10 people will be affected by it at some point in their life. It can affect people of any age, although it’s more common in elderly people. It’s also more common in women than men
5. Urinary incontinence
Urinary incontinence means a person leaks urine by accident. While it can happen to anyone, urinary incontinence, also known as overactive bladder, is more common in older people, especially women. Bladder control issues can be embarrassing and cause people to avoid their normal activities.
In fact, urinary incontinence is often a symptom of UTIs, but the reason that it can actually cause UTIs or increase the risk of a UTI is that using urinary catheters is one of the most effective treatments for UTIs, and we have already discussed how that can increase one’s risk for UTIs.
6. Enlarged prostate
Benign prostate enlargement (BPE) is the medical term to describe an enlarged prostate, a condition that can affect how you pee (urinate). BPE is common in men aged over 50. It’s not a cancer and it’s not usually a serious threat to health.
Many men worry that having an enlarged prostate means they have an increased risk of developing prostate cancer. This is not the case. The risk of prostate cancer is no greater for men with an enlarged prostate than it is for men without an enlarged prostate.
However, enlarged prostates can increase the risk of a UTI since some of the common symptoms are a difficulty starting to pee and a difficulty emptying one’s bladder.
7. Immobility
Immobility (for example, those who must lie in bed for extended periods of time) is known to increase the risk of UTI, with older people being particularly at risk.
Urinary retention fosters infection so normal urinary flow is essential to flush bacteria such as Staphylococcus aureus and E. coli from the bladder. In addition, over-distension of the bladder can cause small cuts or tears in its epithelial lining, providing sites for opportunistic infection.
8. Surgery of any area around the bladder.
As with catheters, surgery around the bladder can open the door for opportunistic bacteria to infect the urinary tract, putting those at a much higher risk of a UTI.
9. Kidney stones
Kidney stones can develop in 1 or both kidneys and most often affect people aged 30 to 60. They’re quite common, with more than 1 in 10 people affected.
Kidney stones are usually found in the kidneys or in the ureter, the tube that connects the kidneys to your bladder. They can be extremely painful and can lead to kidney infections or the kidney not working properly if left untreated.
Moreover, they can increase the risk of UTIs because it creates a blockage in the urinary tract, which makes it more difficult for people with kidney stones to empty their bladder when peeing.
Common Symptoms of UTIs in Elderly People
1. Urine that appears cloudy or dark.
2. Bloody urine.
3. Strong or foul-smelling urine.
4. Frequent or urgent need to urinate.
5. Pain or burning during urination.
6. Feelings of pressure in the lower abdomen.
7. Low-grade fever.
8. Night sweats, shaking or chills.
Potential Symptoms of UTIs in Elderly People
Older adults may not exhibit any of the hallmark signs of UTI listed above because their immune systems are unable to mount a significant response to the infection. On top of the lack of noticeable symptoms, many seniors do not or cannot express their discomfort to their caregivers.
Since elders’ bodies respond differently to infection, it is important to look for atypical signs and symptoms. A marked change in mental state is one tell-tale symptom of UTIs in the elderly, but it is often mistaken for the early stages of dementia or Alzheimer’s disease.
Thus, it is incredibly important to check whether it is dementia or a UTI that is causing these symptoms since this could mean the difference between independence or home care or admittance into a nursing home. UTIs can cause the following symptoms in elderly people:
1. Confusion or delirium.
2. Agitation.
3. Hallucinations.
4. Other unusual behavioral changes.
5. Poor motor skills or loss of coordination.
6. Dizziness.
7. Falling.
How Is a UTI Diagnosed?
In older adults who have symptoms of a UTI, a simple urine test — called a urinalysis — can confirm infection. In some cases, the doctor requests a urine culture to identify the type of bacteria causing the infection and help determine the best antibiotic to treat it.
However, it’s important to know that older adults often have bacteria in the urine that don’t cause any symptoms. This condition is called asymptomatic bacteriuria, and it often resolves on its own without treatment without progressing to bladder infections or other common infections.
Doctors now recommend against doing a urine test to check for a UTI, unless patients have typical, bothersome UTI symptoms. This is to avoid the excessive use of antibiotics to treat infection, which can lead to antibiotic resistance.
How Are UTIs Treated in the Elderly?
Antibiotics are the first choice of treatment for UTIs. Mild UTIs often clear up in only a few days with the right antibiotic.
However, depending on the person’s age and health plus the severity of the infection, treatment for a UTI may take several weeks and a longer course of antibiotics. In more severe cases, older adults may need to be hospitalized to receive IV antibiotics.
If you think your loved one might have a urinary tract infection, see a doctor right away to avoid further complications. An urgent care clinic is a viable alternative if you cannot get an appointment with their primary care physician soon enough.
Urinalysis and/or a urine culture are typically required to diagnose a UTI, determine what kind of bacteria are present in the urine and select the most appropriate antibiotic for treatment. If caught early on, a course of antibiotics typically clears the infection in no time.
Keep in mind that older individuals are also prone to a related condition called asymptomatic bacteriuria, which is characterized by the presence of bacteria in the urine but the absence of any signs or symptoms of a urinary tract infection.
The estimated incidence of asymptomatic bacteriuria is 15 percent or greater in women and men between 65 and 80 years of age and continues to climb after age 80 to as high as 40 to 50 percent of long-term care residents.
Research shows that most patients with asymptomatic bacteriuria do not develop symptomatic UTIs, therefore antibiotic treatment is not beneficial. In fact, antibiotic use can result in adverse side effects, such as Clostridium difficile infection, and contribute to the development of resistant bacteria.
A senior’s physician will consider their symptoms (if any) and test results to differentiate between a UTI and asymptomatic bacteriuria and determine whether treatment is necessary.
Tips for Preventing UTIs in the Elderly
The following lifestyle and personal hygiene changes can significantly reduce a senior’s risk of developing a urinary tract infection.
1. Drink plenty of fluids. (Aim for two to four quarts of water each day unless this conflicts with a physician’s orders.)
2. Drink cranberry juice or use cranberry tablets, but NOT if the elder has a personal or family history of kidney stones.
3. Avoid or limit caffeine and alcohol, which irritate the bladder.
4. Do not douche or use other feminine hygiene products.
5. After toileting, always wipe from front to back (for women).
6. If incontinence is not an issue, wear breathable cotton underwear and change them at least once a day.
7. Change soiled incontinence adult diapers promptly and frequently.
8. Keep the genital area clean and dry.
9. Set reminders/timers for seniors who are memory impaired to try to use the bathroom instead of an adult brief.
Moving Forward, Keeping Healthy
UTIs are a bacterial infections that can be a huge problem for senior health. Not only do they cause some very annoying and painful symptoms, but they can also lead to much more serious symptoms.
While UTIs in young people do not cause dementia-like symptoms, the fact that UTIs do often bring about these symptoms in the elderly means that you or your family or loved ones need to take extra care to avoid UTIs or treat UTIs as soon as possible.