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Understanding Urinary Tract Infections in the Elderly

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

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

Certain individuals are more prone to UTIs than others. For example the anatomy of women makes them more susceptible to UTI’s because their urethra is shorter and closer to the anus. But as a group, the population most likely to experience UTIs is the elderly. Elderly people are more vulnerable to UTIs for many reasons, not the least of which is their overall susceptibility to all infections due to the suppressed immune system that comes 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,  individuals usually tend to empty the bladder completely upon urination, which helps to keep bacteria from accumulating within the bladder. But elderly men and women experience a weakening of the muscles of the bladder, which leads to more urine being retained in the bladder, poor bladder emptying and incontinence, which can lead to UTIs. In elderly men, an enlarged prostate can also lead to obstructed urinary flow and urine stagnation, while in women, bladder prolapse due to weakness of supporting strucures can have the same effect. In either sex, no matter the cause, stagnant urine becomes a breeding ground for the growth and colonization of the bacteria that cause UTIs.

Signs and symptoms of UTI in the elderly
Interestingly enough, the elderly with a UTI are often misdiagnosed with senior dementia or Alzheimer’s disease, because a UTI can mimic symptoms of such conditions. Also, according to Nursing magazine between 30% and 40% of elderly patients with serious infection don't exhibit the hallmark sign of fever due 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 blood stream and cross the blood-brain barrier, confusion and other cognitive difficulties can be the result. 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 such as:

  • 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
The most common treatment for a UTI in the elderly, once properly diagnosed, is antibiotics. UTIs are usually caused by gram-negative organisms, so broad-spectrum antibiotics are usually given. If the UTI is caused by catheterization, minimize the use of the catheter, and or be sure it is removed and replaced more often. If your parent has to have an in-dwelling catheter, be sure you discuss with the physician and the nursing staff what the schedule for changing the catheter is and that it is followed carefully. Some catheters have a special design that minimizes the introduction of bacteria when it is passed. Be sure to investigate these if catheterization will be an ongoing requirement.

Prevention of UTIs
The best way to treat UTIs in the elderly, or anyone for that matter, is to try to prevent their occurrence. UTIs can be prevented or their recurrence minimized by:

  • Not using douches or other feminine hygiene products
  • Not drinking fluids that tend to irritate the bladder, such as alcohol and caffeine
  • Drinking cranberry juice or taking cranberry supplement tablets, but only if you or your family does not have a history of kidney stones
  • Drinking lots of water
  • Keeping the genital area clean. If wearing adult diapers see that they are changed regularly. Wear cloth undergarments
  • Always wiping from front to back (for women)


     
  • Between 30-40% of In the elderly patients with serious infection do not exhibit signs of fever.
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  • UTIs can mimic the symptoms of Alzheimer’s disease or senior dementia.
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  • The elderly are particularly susceptible to UTIs.
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  • UTIs can be prevented or minimized in the elderly.