Urinary Tract Infections (UTIs) in Older Adults

A urinary tract infection (UTI) is characterised by burning discomfort and frequent urination. In elderly persons, these typical symptoms of UTIs can not appear. Adults over the age of 65, especially those who have dementia, may instead exhibit behavioural signs like bewilderment.

Although the link between UTI and disorientation has been proven, this link is still unidentified.

Understanding urinary tract infections

The urinary tract includes:

• the urethra, which is the opening that carries urine from your bladder
• the ureters
• the bladder
• the kidneys

When bacteria enter the urethra and your immune system doesn’t fight them off, they may spread to the bladder and kidneys. The result is a UTI.

According to a study, over 10.5 million doctor visits in the US occurred as a result of UTIs in 2007. Because women's urethras are shorter than men's, they are more susceptible than males to develop UTIs.

As you become older, your risk of UTI rises. UTIs make up more than one-third of all infections in nursing home residents, claims one study (Reliable Source). More than 10% of women over 65 say they had a UTI in the previous year. In women over 85, that percentage rises to approximately 30%.

As they age, men also have a tendency to get more UTIs.

Symptoms of a urinary tract infection in older adults

It may be hard to figure out that an older adult has a UTI because they don’t always show classic signs. This may be due to a slower or suppressed immune response.

Classic UTI symptoms include:

• urethral burning with urination
• pelvic pain
• frequent urination
• an urgent need to urinate
• a fever
• chills
• urine with an abnormal odor

When an older adult has classic UTI symptoms, they may be unable to tell you about them. That may be due to age-related issues such as dementia or Alzheimer’s disease. Symptoms such as confusion may be vague and mimic other conditions.

Other UTI symptoms may include:

• incontinence
• agitation
• lethargy
• falls
• urinary retention
• decreased mobility
• decreased appetite

Other symptoms may occur if the infection spreads to the kidneys. These severe symptoms can include:

• a fever
• flushed skin
• back pain
• nausea
• vomiting

Why do urinary tract infections occur?

Bacteria are typically the main cause of UTIs in people of any age. Although Escherichia coli is the main culprit, a UTI can also be brought on by other species.

Bacteria like Enterococci and Staphylococci are more frequent causes in elderly persons who use catheters or who reside in nursing homes or other full-time care facilities.

Risk factors for urinary tract infection in older adults

Certain factors may increase the risk of UTIs in older people.

Conditions common in older adults may lead to urinary retention or neurogenic bladder. This increases the risk of UTIs. These conditions include Alzheimer’s disease, Parkinson’s disease, and diabetes.

They often require people to wear incontinence briefs. If the briefs aren’t changed regularly, an infection may occur.

Several other things put older adults at risk for developing a UTI:

• a history of UTIs
• dementia
• catheter use
• bladder incontinence
• bowel incontinence
• a prolapsed bladder

In women

Postmenopausal women are at risk of UTIs because of estrogen deficiency. Estrogen may help protect the vagina and urethra from an overgrowth of E. coli. When estrogen decreases during menopause, E. coli may take over and trigger an infection.

In men

The following may increase the risk of UTIs in men:

• a bladder stone
• a kidney stone
• an enlarged prostate
• catheter use
• bacterial prostatitis, which is a chronic infection of the prostate

Diagnosing a urinary tract infection in older adults

Vague, uncommon symptoms such as confusion make UTIs challenging to diagnose in many older adults. If your doctor suspects a UTI, a urinalysis will likely be ordered along with other tests to determine the true cause of the symptoms.

Your doctor may perform a urine culture to determine the type of bacteria causing the infection and the best antibiotic to treat it.

There are home UTI tests that check urine for nitrates and leukocytes. Both are often present in UTIs. Because bacteria are often in the urine of older adults to some degree, these tests aren’t always accurate. Call your doctor if you take a home test and get a positive result.

Treating a urinary tract infection in older adults

Not every UTI requires treatment with antibiotics. For example, asymptomatic older adults in hospitals and residential care facilities are usually not prescribed antibiotics because of the risk of drug resistance and even more dangerous opportunistic infections. When indicated, antibiotics are the treatment of choice for symptomatic UTIs. Your doctor may prescribe amoxicillin and nitrofurantoin (Macrobid, Macrodantin).

More severe infections may require a broad-spectrum antibiotic such as ciprofloxacin (Cetraxal, Ciloxan) and levofloxacin (Levaquin).

You should start antibiotics as soon as possible and take them for the entire duration of treatment as prescribed by your doctor. Stopping treatment early, even if symptoms resolve, increases the risks of recurrence and antibiotic resistance.

Antibiotic overuse also increases your risk for antibiotic resistance. For this reason, your doctor will likely prescribe the shortest treatment course possible. Treatment typically lasts no more than 7 days, and your infection should clear up in a few days.

It’s important to drink plenty of water during treatment to help flush out the remaining bacteria.

People who have two or more UTIs in 6 months or three or more UTIs in 12 months can use prophylactic antibiotics. This means taking an antibiotic every day to prevent a UTI.

Healthy older adults may want to try over-the-counter UTI pain relievers such as phenazopyridine (Azo), acetaminophen (Tylenol), or ibuprofen (Advil) to ease burning and frequent urination.

Other medications are also available online.

A heating pad or hot water bottle may help relieve pelvic pain and back pain. Older adults who have other medical conditions shouldn’t use home remedies without first consulting a doctor.

How to prevent urinary tract infections in older adults

It’s impossible to prevent all UTIs, but there are steps that help lessen a person’s chance of infection. They can do this by:

• drinking plenty of fluids
• changing incontinence briefs frequently
• avoiding bladder irritants, such as caffeine and alcohol
• keeping the genital area clean by wiping front to back after going to the bathroom
• not using douches
• urinating as soon as the urge hits
• using vaginal estrogen

Proper nursing home or long-term care is critical in preventing UTIs, especially for people who are immobile and unable to take care of themselves. They rely on others to keep them clean and dry.

If you or a loved one is a nursing home resident, talk to management about how they manage personal hygiene. Make sure they’re aware of UTI symptoms in older adults and how to respond.