All About Urinary Tract Infections (UTIs) in the Elderly

Certain individuals are more prone to UTIs than others. For example, women’s anatomy makes them more susceptible to UTIs because their urethra is shorter and closer to the anus. But as a group, the population most likely to experience UTIs is the elderly. 

Here, we’ll gain a better understanding of why older adults are far more likely to develop UTIs, common symptoms to look out for, and what you can do to prevent infections or seek appropriate care.

What is a Urinary Tract Infection and Why Does it Affect Older Adults?

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, tubes that take the urine from the kidneys to the bladder

• Urethra, the tube that empties urine out of the body from the bladder

As mentioned, certain individuals are more prone to urinary tract infections than others. This often depends on their anatomy or their lifestyle, habits, and hygiene. A UTI can develop when bacteria from the gut is spread to the urinary tract, which can occur while toileting, having sex, or even as a result of dehydration. However, the elderly are the most likely to experience UTIs as a population group. Those older than 65 are more vulnerable to UTIs for many reasons, including their susceptibility to catching 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"

Younger individuals tend to empty the bladder completely upon urination, which helps keep bacteria from accumulating, thus reducing bladder infections. However, older adults have a higher risk of developing weakened 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

Common symptoms of UTI aren’t the same in younger versus older adults. Signs of urinary tract infection in women can also be very different than in men. 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. According to Nursing magazine, between 30 and 40 percent of elderly patients with serious cases of this common infection don't exhibit the number one hallmark sign — a fever. This is due to the inability of the immune system to mount a strong response to infection, largely because of 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 may 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

• Frequent urination and a strong urge to go

• Pain or burning with urination

• Pressure in the lower pelvis

• Lower back pain or pain in the lower abdomen

Risk Factors for Urinary Tract Infections

There are certain risk factors that apply to both men and women, including: a weakened immune system, the inability to completely empty the bladder, catheter use, and diabetes. Older adults in senior living settings have a much higher prevalence of getting a UTI than other populations — one NIH study reports that more than one-third of all infections in nursing home residents are UTIs. Another study reports that among geriatric individuals, there’s a 51.3% prevalence of UTIs in women vs. 48.6% in men. What causes UTIs in women and men? It all depends on their risk factors:

Risk Factors for UTIs in Women

• Anatomy: Women naturally have a shorter urethra than men, making it easier for bacteria to travel to the bladder. 

• Urinary incontinence: Although urinary incontinence affects both men and women more significantly in older age, women have a higher likelihood of experiencing the issue, which can increase the risk of bacteria entering the urethra. 

• Menopause: After menopause, estrogen levels decline, causing the sphincter and tissue walls of the bladder to become weakened, which can make them more susceptible to infection. 

Risk Factors for UTIs in Men 

• Enlarged prostate: An enlarged prostate can block the flow of urine, leading to urinary retention. This can increase the risk of getting a UTI. 

Causes of a UTI

Urinary Tract Infections are primarily caused by bacteria entering the urinary tract (most commonly, E. coli). Although E. coli typically lives in the colon, it can travel from the anus to the urethra, and then up into the bladder, causing an infection. This process can happen by: 

• Improper wiping habits (wiping from the back to the front)

• Sexual activity that can push bacteria further up

• Birth control methods containing spermicides containing nonoxynol-9

• Urinary catheters

• Incomplete emptying of the bladder

• Diabetes

• Certain medications

• A weakened immune system

• Lack of hydration, which causes more bacteria to build up

Diagnosis of UTIs 

Although UTIs can be difficult to diagnose for elderly patients, your doctor will perform a thorough examination and questionnaire. They’ll ask about your medical history and perform a physical examination to check the abdomen and genitals for tenderness or pain. Then, a urine sample will be collected.A urinalysis will be performed, a test that detects and analyzes any possible infection in the urine. These urine tests can also be used to identify the specific bacteria causing the infection. Depending on what the urine culture shows, further imaging tests may be ordered to check for underlying abnormalities. 

In some more advanced cases, a physician may perform a cystoscopy, in which a local anesthetic is applied and a flexible tube is inserted into the urethra to better examine the bladder for infection and other conditions. 

UTI Treatment and Prevention

Preventing UTIs is possible for most older adults, especially those who have supportive and attentive caregivers or loved ones. Good hygiene is the ultimate first step, but there are many other steps (noted below) one can take to keep UTIs at bay.

Unfortunately, even your best efforts at prevention can be in vain, and a UTI will develop. Once properly diagnosed, a course of antibiotics is 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, but there are some exceptions. 

UTI Caused by Catheterization

If the type of UTI is the result of catheterization, minimize the use of the intermittent 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.

What Happens if You Leave a UTI Untreated?

Leaving a UTI untreated can cause serious health complications, including: 

• Pyelonephritis or kidney infection, the most common complication

• Urethritis or inflammation of the urethra

• Sepsis, a life-threatening condition where the body responds improperly to an infection that can cause organ damage

• Delirium and confusion in older adults, especially those with dementia

• Urinary retention problems

• Kidney damage or lasting damage to the urinary system

• Cystitis, inflammation of the bladder caused by bacteria

• Blockages in the bladder, urethra, or elsewhere in the urinary tract

It’s extremely important to get an early diagnosis and treat the UTI promptly when caring for an aging loved one. 

The Role of Caregivers in UTI Treatment

Caregivers can play a vital role in preventing UTIs among their loved one or patient. This includes: 

• Encouraging older adults to drink plenty of fluids throughout the day to help flush out bacteria

• Having the elderly individual go to the bathroom one more time after they just went to encourage bladder emptying (known as double voiding)

• Educating on proper wiping hygiene (from the front to the back)

• Ensuring regular catheter monitoring

• Encouraging regular fiber intake

• Consuming cranberry juice or cranberry supplements, as this may help keep bacteria from adhering to the bladder wall

• Bladder training

• Being on the lookout for any early signs of a UTI

• Encouraging the patient to see a urology specialist if the infection does not resolve or worsens (or if they suffer from chronic infections)

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 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 by sticking to the medical advice of your healthcare provider and following these preventative measures.

The Best Incontinence Products For Those With UTIs

It’s important to keep skin hygiene and incontinence care in mind for UTI-prone individuals. That’s why the following types of products are best for those with a UTI.

Barrier Creams

The best barrier creams help protect the skin barrier and avoid skin irritation or bacteria build-up.

• Remedy Essentials Barrier Ointment

• Calmoseptine Ointment

Gentle Cleansing Wipes

Gentle cleansing wipes with non-toxic ingredients can be used to clean any skin irritants that can lead to infections.

• Dry Direct Extra Soft Cleansing Wipes

Absorbent Pads & Adult Diapers

These products help elderly individuals stay clean, comfortable, and worry-free when it comes to their incontinence issues.

• Dry Direct Ultimate Protective Underwear 

• Dry Direct Super Overnight Underwear

How Parentgiving Can Help 

Parentgiving understands the needs of older adults and their families. We offer a wide array of top-rated products for fecal and urinary incontinence, as well as educational resources. Explore our vast selection of adult diapers and incontinence products to support your urinary tract health.

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Authored By: Parentgiving Admin