We often hear about older people suffering from urinary tract infections [UTIs] and the serious effects these can have on their mental as well as physical health. We thought it would be helpful to put together some information about this painful and distressing issue.
What are UTIs?
The second most common infection type in humans, a UTI occurs when germs get into the urethra and travel up into the bladder and kidneys. The most common kind of infection is ISCYCYSTITIS – inflammation and infection of the bladder, although other parts of the urinary tract can become infected. Generally the higher up the urinary tract the infection is, the worse it is.
URETHRITIS is an infection of the urethra; PYELONEPHRITIS occurs when an infection spreads to the kidneys and TOPROSTATITIS affects the prostate gland.
The most common sign of a UTI in younger people is frequent and painful urination. Blood may be visible in the urine and men may also experience penile discharge. There may be a sense of general discomfort, being overtired and/or stomach pain.
Because the immune system changes as we get older, elderly people’s bodies react differently to infection and the first signs of a problem may be increased signs of confusion, agitation or withdrawal [delirium] rather than pain. This can be particularly difficult to distinguish in patients who are living with dementia, when behavioural changes may appear to be part of the condition.
Change in behaviour is one of the best indicators of a UTI in older adults. Examples of other changes include urinary incontinence and/or not being able to do things that they would normally be able to do. Carers and family members should therefore always bear in mind that behavioural change in the elderly may indicate the presence of a UTI.
As with any infection, if an underlying UTI is unrecognized and untreated for too long, it can spread to the bloodstream and become a life-threatening sepsis.
Medical help should always be sought – especially if the patient has a temperature.
Who is Affected?
Because of different plumbing structures in men and women, women are 4 times more likely to experience UTIs than men. And women who have gone through menopause face a higher risk because they lack estrogen, which helps defend against the growth of bacteria in the urethra.
Having diabetes, kidney problems or a weakened immune system also puts people at risk for UTIs and catheters must be closely monitored in order to prevent infection.
Diagnosing a UTI
UTIs are typically diagnosed by a GP by urine test. A doctor might also decide to “culture” a patient’s urine to determine the type of bacteria that’s growing to prescribe the most effective antibiotic for the condition.
For persistent infections an ultrasound examination, X-rays and/or CAT scan may be used to identify the location, type and cause of infection.
Obtaining a Urine Specimen
The best time to obtain a urine sample is first thing in the morning, from the first time urine is passed that day.
For people living with dementia, it may be easiest to do a home test , where a dipstick is held in the urine stream. Home tests are a convenient way for chronic UTI sufferers to quickly diagnose whether they have an infection, but they should be used with the support of your GP. The advantage of using home tests is that they can be done by a familiar carer/family member in familiar surroundings – helpful if the older person is living with dementia.
Alternatively, if someone wears incontinence pads, a urine collection pack can be used to obtain a urine sample from the pad. Your GP will be able to help you to source these.
Antibiotics are the standard course of treatment for a urinary tract infection. If symptoms persist, a specialist may perform additional tests to determine the underlying cause.
It is extremely important that people suffering from UTIs drink plenty of fluids in order to flush the bacteria from their systems.
If someone does become very distressed or agitated they should be offered support and reassurance to keep them safe. In some cases, short-term treatment with antipsychotic drugs may be considered if non-drug approaches have been unsuccessful.
If a person has more than two episodes of urinary tract infection in three months, this is described as recurrent.
In these cases referral to a urologist for further investigations is recommended. Sometimes recurrent urinary tract infections may need to be managed with low-dose, long-term antibiotics.
UTIs and Dementia
Urinary tract infections can exacerbate dementia symptoms, but a UTI does not necessarily signal dementia.
As recognised by The Alzheimer’s Society, UTIs can cause distressing behaviour changes for a person with Alzheimer’s. These changes, referred to as delirium, can develop in as little as one to two days. Symptoms of delirium can range from agitation and restlessness to hallucinations or delusions.
As a person who is living with dementia may not be able to communicate how they feel, it is helpful to be familiar with the symptoms of UTIs and seek medical help to ensure they get the correct treatment.
It is also important to be aware that any infection could speed up the progression of dementia and so all infections should be identified and treated quickly.
How to Prevent UTIs in Older People
- Monitor fluid intake, encouraging older people to have six to eight glasses of fluid a day. Find out what fluids the person enjoys drinking and ensure that it is readily available. Using brightly coloured cups can prompt older people to remember to drink.
- Remind older people go to the loo several times a day, approximately every two to three hours
- Ensure that the good hygiene is maintained, including daily showers [preferably using unperfumed soap].
- The NHS recommends that people prone to UTIs wear cotton rather than synthetic underwear.
Most importantly, notice behaviour changes. Sudden falls, confusion or an onset of incontinence may warn of a possible UTI.