Urinary tract infections (UTI) aren't just a nuisance ￿ they can cause serious health problems. A urinary tract infection happens when bacteria in the bladder or kidney multiplies in the urine. Left untreated, a urinary tract infection can become something more serious than merely a set of uncomfortable symptoms. UTIs can lead to acute or chronic kidney infections, which could permanently damage the kidneys and even lead to kidney failure. UTIs are also a leading cause of sepsis, a potentially life-threatening infection of the bloodstream.

Elders Are More Likely to Get UTIs

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 According to the National Institutes of Health (NIH). Younger people 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.

Symptoms of UTIs

• The typical signs and symptoms of a UTI include:
• 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
•  Low-grade fever
•  Night sweats, shaking, or chills
  
  

Elderly people with serious urinary tract infection don't exhibit the hallmark sign of fever because their immune system is unable to mount a response to infection due to the effects of aging. In fact, elders often don't exhibit any of the common symptoms ￿ or don't express them to their caregivers.

UTIs in the elderly are often mistaken as the early stages of dementia or Alzheimer's, according to NIH, because symptoms include:

•  Confusion or delirium-like state
•  Agitation
•  Hallucinations
•  Other behavioral changes
•  Poor motor skills or dizziness
•  Falling
•  Restlessness
•  Frequent, urgent urination
•  Cloudy, dark or foul-smelling urine
•  New onset of incontinence

Sometimes, these are the only symptoms of a UTI that show up in the elderly￿no pain, no fever, no other typical symptoms of a UTI.


Why Do the Elderly Develop UTIs?

According to NIH, the following conditions make the elderly more susceptible to UTIs:

•  Diabetes
•  Urinary retention (unable to empty the bladder, even if your loved one has just used the bathroom)
•  Use of a urinary catheter
•  Bowel incontinence
•  Enlarged prostate
•  Immobility (for example, those who must lie in bed for extended periods of time)
•  Surgery of any area around the bladder
•  Kidney stones

How to Reduce Risk of UTIs

People with incontinence are more at risk for UTIs because of the close contact that adult briefs have with their skin, which can reintroduce bacteria into the bladder. Some recommendations to help reduce this risk include the following:

•  Change the briefs frequently
•  Encourage front-to-back cleansing
•  Encourage client to shower, keeping private area clean
•  Set reminders/timers for those who are memory-impaired to try to use the bathroom instead of the adult brief

Other ways to reduce the chance of UTIs:

• Drink plenty of fluids (2 to 4 quarts each day).
• Drink cranberry juice or use cranberry tablets, but NOT if your elder has personal or family history of kidney stones.
• Avoid caffeine and alcohol, because these irritate the bladder
• Always encourage client to wipe from front to back (women)

Please become familiar with this information so that, as a caregiver, it can be shared with family, facility, and/or FTHC Care Directors.

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