Preventing UTIs in the Elderly
“Preventing UTIs in the Elderly” was written by Rachel Blowers. Rachel works at Asante Three Rivers Medical Center in Grants Pass, OR as an inpatient clinical dietitian. Reviewed/edited by Katie Dodd, MS, RDN, CSG, LD, FAND.
What is a UTI?
A urinary tract infection, also known as a UTI, is an infection involving the urinary system.
It is one of the most common bacterial infections affecting around 150 million people worldwide (1).
The urinary system consists of your kidneys, ureters, bladder, and urethra.
The functions of the parts of the urinary system are as followed (2):
- Kidneys: remove waste products from the body, balance fluids and electrolytes, regulate hormones for blood pressure control, manage the production of red blood cells
- Ureters: carry urine from the kidneys to the bladder
- Bladder: temporarily stores urine
- Urethra: allows urine to pass outside of the body
Causes of a UTI
The main cause of a UTI is bacteria entering and multiplying in the urinary tract. The bladder and urethra are the most common parts affected by a UTI.
There are different types of UTI’s based on the location of the infection.
- Bladder infection: also known as cystitis, is typically the most common type of UTI
- Urethra infection: also referred to as urethritis. Can occur when bacteria are spread from the rectum to urethra. Sexually transmitted infections may also be a cause of urethritis.
- Kidney infection: also known as acute pyelonephritis. This can be dangerous and potentially cause kidney damage if the infection lasts a long time (3)
Symptoms of a UTI
Symptoms may not always be present with a UTI. Some symptoms of a UTI may also differ depending on what part of the urinary tract is affected.
Some common symptoms of each type of UTI are (4):
Kidneys
- Back pain or side pain
- Fevers and chills
- Nausea and vomiting
Bladder
- Feeling of frequent urination
- Burning sensation while urinating
- Urine that appears red, pinkish, or cloudy
- Lower stomach pain
Urethra
- Burning sensation while urinating
Who can get a UTI?
UTI’s can happen at all ages and can affect both male and females.
Potential factors that may lead to an increased risk for a UTI (but not always the cause of a UTI) are:
- sexual activity
- prior UTI’s
- catheter use
- prior urinary tract issues
- a compromised immune system
- diabetes
- being overweight
- bowel and urinary incontinence
- a recent urinary tract procedure
- being female
- underlying medications (like VUR)
As we age, one may also be at more of a risk for a UTI. This is due to having a weaker immune system leading to an increased risk of infection.
UTI’s in Women
Women are at a higher risk for a UTI due to their anatomy. In women, the urethra is closer to the rectum.
Additionally, older women are more vulnerable to UTIs. This is because as women age, the muscles in the bladder weaken. This can cause urinary incontinence. Urinary incontinence puts older women at risk for infection when the bladder is unable to empty.
Being postmenopausal is another potential cause of a UTI in women. Changes in estrogen levels can result in a risk for infection (5).
UTI’s in Men
Although women have an increased risk of getting a UTI, men are also capable of getting them.
Men who are 50 and older may have a greater chance of contracting a UTI. As men age, the prostate gland may enlarge. This is known as benign prostatic hyperplasia, or more commonly referred to as BPH.
BPH can block urine flowing from the bladder, which prevents the bladder from emptying. This increases the chance of bacteria growing that may bring about an infection (6).
UTIs in the Elderly
As mentioned above, the elderly population are more at risk for UTI’s. And if left untreated, these UTIs can be potentially dangerous and life threatening.
Older adults may have a higher risk of getting a UTI due to:
- urinary incontinence
- having a urinary catheter
- cognitive impairments
- comorbidities
- having a weak immune system.
UTI Symptoms in the Elderly
Due to changes in the immune systems as people age, one’s body may not be able to detect an infection as quickly or it may respond differently to an infection.
The elderly may still experience UTI symptoms as mentioned above, but these are not as common. Symptoms to be aware of that may be a sign of UTIs in the elderly are listed below.
Possible Symptoms of UTIs in the Elderly:
- sudden onset of delirium
- agitation
- hallucinations
- behavioral changes
- poor coordination
- dizziness
- falling
Some of these symptoms may seem surprising. And wouldn’t seem like they are connected to a UTI. But a UTI is an infection, and it can present differently in the elderly.
One study found that elderly patients residing in a nursing home with advanced dementia, a change in mental status, was the only indication for a suspected UTI (7).
It is important to be aware of the symptoms of UTIs in the elderly as they may be the only symptom of a UTI in some cases.
Confusion and UTI’s
Confusion in the elderly caused by UTIs may be mistaken for signs of dementia and/or Alzheimer’s.
And, if someone already has cognitive problems, a UTI can exacerbate symptoms.
Dementia normally begins with small changes in a person’s day to day life that are subtle enough to affect their daily routine (8).
Delirium, on the other hand, typically occurs rapidly within a few hours or a day. And it can lead to mental disturbances that can cause a person to be unable to go about their normal daily life (9).
A review of studies about UTI’s between 1966 and 2012 found 5 studies that saw a connection to delirium and UTI’s in those 65 and older. Although further studies need to be done and there was room for error, it can be concluded that those with a UTI had higher rates of delirium than those without (10).
Again, there have been limited studies showing the connection between UTI’s and delirium. More studies would be valuable to dig deeper into this possible relationship.
Treating UTIs in the Elderly
General guidelines for treating UTI’s in all ages are antibiotic use and ensuring steps are taken to prevent future UTIs.
We know antibiotics are the most effective and frequently used treatment for UTI’s. However, recent studies have shown that the overuse of antibiotics has led to antibiotic resistance causing an increase the risk of infection (12).
UTI’s are commonly suspected in the elderly residing in a long-term care facility. Because of this, antibiotics may be given to these patients even if they are asymptomatic. This can further increase the potential of antibiotic resistance (13).
Always be sure to work with your health care team for individualized advice based on your situation. And if you are prescribed antibiotics, it is important to take the entire round of antibiotics as prescribed.
Preventing UTIs in the Elderly
When caring for loved ones, steps to help prevent a UTI are to maintain good hygiene, adequate water intake, and encouragement to go to the bathroom and assist if needed (11).
Personal Hygiene and UTIs
Genital hygiene is important for not only UTI prevention, but other bacterial infections.
General personal hygiene tips include wearing clean clothes, bathing, and wiping front to back can help reduce risk of bacteria spreading.
Adequate Fluids and UTIs
Adequate fluid status is important as it helps aid in urination, which can help flush bacteria out of the urinary system.
How much fluid the elderly needs greatly depends on current body size, weight, medications, activity level, and the environment.
Commonly used calculations for estimated fluid needs in the elderly include:
- 1 mL fluid per calorie (based on caloric needs)
- Urine output + 500mL/d (based on fluid balance)
You can learn more at our article Dehydration in the Elderly.
Regular Urination Schedule and UTIs
Urine consists of bacteria and, if held in the bladder for an extended amount of time, can lead to an increased risk of infection.
It is important to have a regular urination schedule throughout the day. This simply means, get up and use the restroom often. Don’t hold it for too long.
Some elderly people may not be able to mobilize as well and get to the bathroom, so it is important for caretakers to ask frequently if they need to go.
Myths about UTI’s
There are many myths surrounding UTI’s. It is important when you are researching information about a UTI for a loved one that you look at credible sources and speak to a health professional if you have further questions.
Some common myths are (14):
1) Drinking cranberry juice will cure a UTI.
This is one of the most common myths that one might hear. Cranberry juice may have some health benefits, but it is not a cure-all for UTIs. Check out our article Home Remedies for a UTI: Cranberry Juice where we discuss the science and facts about UTI and cranberry juice.
2) Only women can get UTI’s.
As previously mentioned, men are also able to get UTI’s although it is not as likely as women.
3) Cloudy urine and urine that smells indicate a UTI.
Although these can be signs of a UTI, it does not necessarily indicate one. These could be due to other infections or changes in the body. Nevertheless, as a caregiver, if you do notice changes in urine in the elderly it is important to get this looked at to be on the safe side.
4) Using genital products such as wipes, powders, and sprays can help prevent a UTI.
Genital products do not help prevent a UTI. These products could cause an imbalance of the pH balance, which can lead to an imbalance in bacteria levels and lead to an increased risk of infection.
5) A UTI can go away on its own.
Although a UTI may present as uncomplicated, it is important to go see a health care provider before a UTI possibly develops into a more serious infection.
UTIs in the Elderly: Conclusion
People of all ages can get a UTI, however, a UTI in the elderly can be more complex. There may be different or additional symptoms, such as confusion, that can make it more difficult to diagnose, allowing for the UTI to worsen.
It is important for caregivers and loved ones to be aware of UTI symptoms and follow prevention methods. This can help catch a UTI before it progresses and cause more serious complications.
References
- Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015;13(5):269-284. doi:10.1038/nrmicro3432
- Anatomy of the Urinary System. John Hopkin’s Medicine. https://www.hopkinsmedicine.org/health/wellness-and-prevention/anatomy-of-the-urinary-system. Accessed June 29, 2021.
- Bladder Health for Older Adults. National Institute on Aging. https://www.nia.nih.gov/health/bladder-health-older-adults. Reviewed May 16, 2017. Accessed June 28, 2021.
- Urinary Tract Infection Symptoms. Stanford Health Care. https://stanfordhealthcare.org/medical-conditions/womens-health/urinary-tract-infection/symptoms.html. Accessed June 29, 2021.
- Urinary Tract Infections. Office on Women’s Health. Reviewed by; Bavendam, G. T, Hundley, A. https://www.womenshealth.gov/a-z-topics/urinary-tract-infections. Updated: April 1, 2019. Accessed June 30, 2021.
- Urinary Tract Infections. Office on Women’s Health. Reviewed by; Bavendam, G. T, Hundley, A. Updated: April 1, 2019. https://www.womenshealth.gov/a-z-topics/urinary-tract-infections. Accessed June 30, 2021.
- Balogun SA, Philbrick JT. Delirium, a Symptom of UTI in the Elderly: Fact or Fable? A Systematic Review. Can Geriatr J. 2013;17(1):22-26. Published 2013 Mar 5. doi:10.5770/cgj.17.90
- What is dementia? Alzheimer’s Society. https://www.alzheimers.org.uk/about-dementia/types-dementia/what-dementia. Accessed June 30, 2021.
- Urinary tract infections and dementia. Alzheimer’s Society. https://www.alzheimers.org.uk/get-support/daily-living/urinary-tract-infections-utis-dementia. Accessed June 30, 2021
- Balogun SA, Philbrick JT. Delirium, a Symptom of UTI in the Elderly: Fact or Fable? A Systematic Review. Can Geriatr J. 2013;17(1):22-26. Published 2013 Mar 5. doi:10.5770/cgj.17.90
- Bladder Infection (urinary Tract Infection—UTI) in Adults. National institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-infection-uti-in-adults?dkrd=hiscr0045. Accessed July 1, 2021.
- Bebell, L. Antibiotic-resistant urinary tract infections are on the rise. Harvard Health Publishing. https://www.health.harvard.edu/blog/antibiotic-resistant-urinary-tract-infections-are-on-the-rise-2019101417982. Published October 14, 2019. Accessed July 1, 2021.
- Genao L, Buhr GT. Urinary Tract Infections in Older Adults Residing in Long-Term Care Facilities. Ann Longterm Care. 2012;20(4):33-38.
- Langner, J. Busting myths about urinary tract infections|Understanding UTI’s, Part 3. Stanford Medicine.https://scopeblog.stanford.edu/2020/05/28/busting-myths-about-urinary-tract-infections-understanding-utis-part-3/. Published October 28, 2020. Accessed July 5, 2021.