Understanding Urinary Tract Infections in the Elderly

Certain individuals are more prone to urinary tract infections than others. Women, for example, are more susceptible to UTIs because their urethra is shorter and closer to the anus. However, the elderly are the most likely to experience UTIs as a population group. Elderly people are more vulnerable to UTIs for many reasons, not the least of which is their overall susceptibility to all infections due to their suppressed immune systems, which come with age and certain age-related conditions.

A urinary tract infection (UTI) is a bacterial infection that occurs anywhere along the urinary tract. The parts of the urinary tract include:

• Kidneys (which process urine)
• Bladder (which stores urine)
• Ureters (the tubes that take the urine from the kidneys to the bladder)
• Urethra (the tube that empties urine out of the body from the bladder)
  
  

Certain individuals are more prone to urinary tract infections than others. Women, for example, are more susceptible to UTIs because their urethra is shorter and closer to the anus. However, the elderly are the most likely to experience UTIs as a population group. Elderly people are more vulnerable to UTIs for many reasons, not the least of which is their overall susceptibility to all infections due to their suppressed immune systems, which come with age and certain age-related conditions.

"In elderly men and women, bladder muscles have become weaker, which leads to increased residual urine volume, less-efficient bladder emptying, and incontinence. — Nursing magazine"

According to a recent issue of Nursing magazine, individuals tend to empty the bladder completely upon urination, which helps keep bacteria from accumulating within the bladder, thus reducing bladder infections. However, older adults have a higher risk of developing weak bladder muscles, and they often experience urinary incontinence, which is why so many are at risk of UTIs. In elderly men, an enlarged prostate can lead to obstructed urinary flow and urine stagnation. In older women, urinary incontinence can cause bladder prolapse due to weak supporting structures and lack of vaginal estrogen, especially after menopause. In either sex, no matter the cause, untreated stagnant urine becomes a breeding ground for the growth and colonization of bacterial buildup that causes urinary tract infections.

Signs and Symptoms of a UTI in The Elderly

Unfortunately, when the elderly experience urinary tract infections, they are often misdiagnosed with senior dementia or Alzheimer's disease. This is because a UTI can mimic symptoms of such conditions. In addition, according to Nursing magazine, between 30% and 40% of elderly patients with serious cases of this common infection don't exhibit the number one hallmark sign — fever. This is due to the inability of the immune system to mount a response to infection 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 be the result. The sudden onset of these risk factors should lead one to investigate a possible UTI. Caregivers should closely monitor older adults experiencing mental difficulties, compromised health conditions, medical conditions, and other severe symptoms of a UTI, such as:

• Fever
• Urine that appears cloudy
• Bloody urine
• Strong or foul-smelling urine odor
• Frequent or urgent need to urinate
• Pain or burning with urination
• Pressure in the lower pelvis

UTI Treatment and Prevention

Once properly diagnosed, antibiotics are the most common treatment for a urinary tract infection in older adults. UTIs are usually caused by gram-negative organisms, so broad-spectrum antibiotics are typically given. If the UTI is caused by catheterization, minimize the use of the urinary catheter and/or be sure it is removed and replaced more often. If your parent or loved one has to have an in-dwelling catheter, be sure to discuss the schedule for changing the catheter with your care facility and stick to that schedule carefully. Some catheters have a special design that minimizes the introduction of bacteria when it is inserted. Be sure to discuss different types of catheterization and their side effects with your healthcare provider.

Prevention of UTIs

The best way to treat urinary tract infections in the elderly, or anyone for that matter, is to try to prevent their occurrence by adjusting your daily living habits. Here are some long-term care ways to prevent or minimize recurrent UTIs:

• Avoid douches or other feminine hygiene products
• Avoid drinking 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 do not have a history of kidney stones
• Drink plenty of water
• Keep the genital area clean. If wearing adult diapers, see that they are changed regularly. Wear cloth undergarments.
• Always wipe from front to back (for women)

Avoid complications of UTIs such as sepsis, kidney infections, and bladder and urethra damage by sticking to the medical advice of your healthcare provider and following preventative measures.