As we age, our bodies become more susceptible to illnesses and infections. Urinary tract infections (UTIs) are one of the most common illnesses faced by older adults, and they are often difficult to diagnose as symptoms can be mistaken for the early stages of cognitive conditions such as Alzheimer’s disease or dementia.  Left untreated, a UTI may spread to the kidneys and lead to blood poisoning or sepsis, so it is important to investigate any behavioral changes in the elderly.

In younger adults, physical symptoms such as a strong urge to urinate and the need to urinate often, as well as burning and pain, typically signal a UTI.  Fevers, urine leakage, pain in the back/ sides, or blood in the urine are other telltale signs.   In the elderly, however, confusion, agitation, muscle weakness, sudden difficulty with familiar tasks, cloudy/foul-smelling urine and even falls may be signs of a UTI.

When the cause of an older patient’s symptoms is unknown, medical practitioners often choose to observe/monitor the situation before opting to prescribe antibiotics.   In younger adults, a urinalysis or urine culture can easily identify a UTI, but these tests are not always very helpful when dealing with the elderly.  Many older adults have bacteria present in their urine which can taint results; abnormal levels do not necessarily signal a UTI.    Urine should only be tested when symptoms are present, and, most importantly, antibiotics should only be given when a UTI is confirmed.

When to choose a course of antibiotics

Antibiotics should only be prescribed when symptoms are present such as fever, chills, discomfort in lower abdomen, and/or painful/burning urination.  If an older person does not have a UTI, antibiotics will not help, even when bacteria are detected in the urine.  It is important to note that antibiotics will not help prevent a UTI or help bladder control; they are not effective against viruses such as cold or flu, and can do more harm than good if taken inappropriately.

When to say no to antibiotics:

Taking antibiotics without experiencing symptoms can lead to negative and sometimes fatal results.   Serious side effects like dizziness, vomiting, allergic reactions, seizures, fever, renal toxicity and other adverse reactions can occur if they are taken unnecessarily.   While antibiotics are necessary at times to eliminate an infection, they also kill beneficial germs which can increase the risk for future infection and can lead to a potentially fatal and severe diarrhea caused by C. difficile.   Improper use of antibiotics can also promote the growth of stronger, drug-resistant bacteria which can limit the use of any future types of treatment and increase the risk of complications.

Steps to prevent UTIs in the elderly

  • Keep hydrated. Water can help rid the body of toxins that can cause infection.  Six to eight glasses of water daily is generally recommended.
  • Practice good hygiene. For women, wiping from front to back after a bowel movement can deter bacteria from entering the urinary tract.
  • Use the bathroom frequently. Urine stored too long in the bladder may increase the risk of infection.
  • Change incontinence pads frequently if they are being used.
  • Avoid caffeine and alcohol, which can irritate the bladder.

Caregivers and family members are often the best detectives when it comes to identifying a potential UTI.  Keeping a close eye on an elderly loved one, noting any behavioral changes and physical symptoms and reporting them to a medical professional can help nip a UTI in the bud and help prevent life-threatening complications.

By Christina Jones RN, BSN
Associate Director of Nursing, Gurwin Jewish Nursing & Rehabilitation Center

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