Caregivers Guide to Managing UTI’s in the Elderly

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You wake up and find dear old mom, preparing to give birth.  That’s right your 87-year-old mother thinks she’s 10 cm dilated and ready to push.  Maybe your sweet husband, that wouldn’t hurt a fly sudden wants to go 10 rounds in the boxing ring. Or suddenly grandma can’t seem to walk straight, sit up straight, or make it through a meal without snoozing. Does any of this sound familiar to you? Maybe none of it sounds familiar, but your gut is just telling you that something isn’t right with your loved one.  

These behaviors described above can oftentimes be symptoms of a urinary tract infection (UTI) in older adults. UTIs can really prove to be a stumbling block to aging adults, sometimes leading to irreparable cognitive and physical damage.  In the most severe cases, untreated UTIs can lead to severe infection, hospitalization, and even death. 

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What is a Urinary Tract Infection (UTI)?

A UTI is an infection of any or multiple parts of the urinary tract, which includes the kidneys, ureters, bladder, and urethra. Most infections commonly involve the bladder and urethra, which are considered to be the lower urinary tract. Infections of the upper urinary tract, which includes the kidneys and ureters are more uncommon but can be much more severe. 

What are the common symptoms of a UTI? 

UTI in the elderly can look very different than in a younger population. Commonly known symptoms,  like burning with urination, frequent urination, and urgency, may be present, but may not be the first symptoms in the elderly.

Common symptoms include:

• Confusion
• Disorientation
• Agitation or combative behaviors
• Falls and Poor motor skills
• Restlessness
• Dizziness
• Paranoia 
• Depression
• Decrease in alertness or sleeping more
• Loss of appetite
• Fever, including low-grade temperatures of 99 degrees or greater
• Increase in urinary incontinence
• Foul-smelling urine
• Painful urination
• Frequently toileting with or without results
• Cloudy or dark-colored urine
• Bloody in the urine
• Low abdominal pain or pressure

What to do if you suspect a UTI

If you notice any of these behaviors or symptoms and suspect a UTI:

• Contact the primary care provider as soon as possible. The provider may want to do an office visit or have you collect a urine sample for the lab.  
• Encourage fluids. Water and fruit juices, such as cranberry juice, which in large quantities is proven to help cleanse the urinary tract. Any fluid is good fluid, but try to avoid caffeinated and alcoholic beverages, as they can contribute to dehydration and bladder irritation. 
• Monitor temperature. High fevers may indicate a more severe infection or even sepsis. For temperatures over 100.4 contact PCP immediately or consider going to an urgent or emergent care center. 

Signs of Sepsis

• Temperature greater than 101 degrees
• Chills/shaking
• Heart rate greater than 99 beats per minute
• Respirations greater than 20 breaths per minute
• Systolic blood pressure ( top number) less than 100mm
• Decreased level of consciousness or responsiveness 

If one or more of these symptoms are present, seek immediate medical attention. Sepsis is serious for all ages but can be especially dangerous in an older population. 

What causes UTIs?

UTIs are commonly caused by bacteria and occasionally yeast. Risk factors include:

• Reduced mobility or prolonged bed rest
• Urinary tract obstructions or blockages, such as an enlarged prostate, kidney stones, or tumors
• Prolonged use of urinary catheters, which may make it easier for bacteria to get into your bladder
• Poorly controlled diabetes
• A weakened immune system
• Urinary Retention

How long does confusion last with UTI?

The confusion caused by infection is known as delirium and it can be complicated. The length of time it takes for the delirium to resolve can vary. Some will notice an improvement within 24 hours of the first dose of antibiotics. However, it may take up to 4-6 weeks to fully recover to their previous cognitive baseline.

What is the best antibiotic for UTI in the elderly?

Many people want to know what is the best antibiotic, and the simple answer is, whatever antibiotic the organism is susceptible to. When a urine sample is taken for analysis, if positive, it can be sent for a what is called a culture and sensitivity. The culture identifies the organism that is causing the infection. The sensitivity determines which antibiotics the organism is resistant to and which antibiotics the organism is sensitive to or susceptible to. If the organism is sensitive to an antibiotic and the person doesn’t have an allergy to that particular medication, it may be the best antibiotic for the job.  

How can to prevent UTIs in the Elderly?

• Encourage plenty of fluids. Fluids help flush the urinary tract and dilute urine. 
• Change briefs frequently, if incontinent. Stool contains E. Coli, one of the most common UTI causing organisms. Check out this post on Incontinence Care.
• Avoid caffeine and alcohol, as they can be bladder irritants and can cause dehydration. Caffeine can act as a diuretic, causing a loss of fluids. 
• Practice good wiping technique by wiping the genital from front to back, keeping bacteria from the rectum away from the lower urinary tract. 
• Good hygiene. Regular showers or bathing can decrease bacteria in the genital tract.  
• Empty bladder frequently. Allowing urine to be stagnant in the bladder promote bacterial growth
• Discuss supplements, such as cranberry capsules with PCP. Large concentrations of cranberry have been shown to prevent the adherence of bacteria to the urinary tract. 

Management for Recurrent UTIs

For many aging adults, recurrent UTIs become a concern. In these cases, further diagnostic testing and/or treatment may be necessary. Remember that you are your loved one’s advocate. Prepare a list of questions for the doctor to address your concerns. Here are some questions to get you started.

• What factors do you think maybe contributing to the recurring UTIs?
• What treatment approach do you recommend?
• If the first treatment doesn’t work, what will you recommend next?
• What are the risks if the infections continue to reoccur?
• Should further testing be done?
• Should we see a specialist?

Be familiar with some of the diagnostic tests and treatments that may be available. Some tests and treatments may include:

• Computerized  Tomography (CT) scan or Magnetic Resonance Imaging (MRI)- This type of imaging may highlight any abnormalities of the urinary tract that may be contributing to infections. 
• Cystoscopy- This is when a scope is passed through the urethra and bladder to find any abnormalities of the lower urinary tract. 
• Ultrasound- This can provide a close-up view of bladder, ureters, and kidneys, identifying any obstructions or possible abnormalities. 
• Prophylactic Antibiotics-  Low-dose Antibiotics such as Trimethoprim or Nitrofurantoin for chronic infection suppression may be recommended. While these antibiotics may reduce the frequency and severity of UTIs they are not a cure-all. 

In Summary

In summary, try to prevent infection with hydrations, frequent bladder emptying, and good hygiene practices. If you suspect an infection, contact the PCP as soon as possible for early intervention. Lastly, if the problem persists, don’t be afraid to advocate for your loved one, you may be the only voice they have. 

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Be Blessed,

Stephanie

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