Elderly and UTIs

Elderly and UTIs

Urinary tract infections increase dramatically in older adults, both in frequency and severity and in both women and men alike.  The classic symptoms of a urinary tract infection (UTI) in most patients are burning pain and frequent urination, however, UTIs may not cause these classic symptoms in older adults. Instead, older adults, especially those with dementia, may experience behavioral symptoms such as confusion or delirium.   Furthermore, when an older adult has classic UTI symptoms, they may be unable to tell you about them, due to age-related issues such as dementia or Alzheimer’s disease.

Confounding factors in detecting UTIs, in the elderly, may lead these infections to go unnoticed and spread to the kidneys, which can lead to serious fever and illness, requiring hospitalization.  If this goes untreated, the infection can spread to the blood and be life-threatening.

Doctors should check for a UTI in any older adults who have a sudden change in behavior or become increasingly confused. Changes in behavior that may indicate a UTI include:

  • Restlessness
  • Hallucination
  • Social withdrawal
  • Agitation
  • Confusion

There are several common reasons the elderly develop UTIs:

  • Bladder Incontinence: Urinary incontinence is a common problem among the elderly and may be a risk factor for UTIs. As urine leaks out of the bladder, it can provide an environment for bacteria to grow and then travel up into the urinary tract.
  • Bowel Incontinence: Bowel incontinence, also called fecal incontinence, is a loss of bowel control that results in involuntary fecal elimination. Severity can range from an infrequent involuntary passage of small amounts of stool to a total loss of bowel control.
  • Reduced Hormone Levels: In women, menopause leads to a slowed production of estrogen. Estrogen has been shown to protect the vagina and urethra from bacterial growth. As production of estrogen decreases, E. coli and other bacteria may be able to more easily establish themselves.
  • Reduced Mobility: As we age, we may become less mobile, with many elderly and nursing home residents wheelchair bound. If an individual requires assistance to shower, this may lead to a decrease in shower frequency, leading to increased UTI risk.
  • Dementia: Dementia or Alzheimer’s disease can decrease a person’s ability to communicate symptoms and make maintaining good general hygiene a challenge.
  • Diabetes: Diabetes can decrease one’s immune system, making it more difficult to fight an infection. In addition, diabetes can lead to nerve damage. Nerve damage in the bladder can decrease bladder control and increase incontinence. If poorly managed, those with diabetes can have high amounts of sugar in the urine, which bacteria can eat to grow.
  • Catheter use: For various reasons, it may be necessary to have chronic or occasional catheter use in older adults. If so, this is a major risk factor for Urinary Tract Infections, as new bacteria can be introduced, and bacteria can establish protective biofilms on the indwelling catheters.

Risk factors for UTIs in elderly men:

UTIs are relatively uncommon in younger men, but as men age, UTIs become much more common. There are certain risk factors that are unique to aging men.

  • Kidney or bladder stones: Blockages of the urinary tract can increase risk for UTIs by altering the flow of urine and allowing for increased growth of bacteria. While both men and women can develop kidney/ bladder stones, they are more common in men than women.
  • An enlarged prostate: Similarly, an enlarged prostate can push against the urethra, restricting the flow of urine. The force of urine pushing bacteria out of the urethra is one of the main defences against colonizing bacteria.
  • Bacterial Prostatitis: Chronic bacterial prostatitis is a rare condition that causes recurring infections in the prostate and results in swelling, inflammation, and frequent urinary tract infections (UTIs).

 

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Ways to Prevent UTIs in the Elderly Population:

 A UTI can cause confusion and other symptoms of dementia in older adults. Taking preventive steps and looking out for UTI symptoms should help prevent infection.

  • Prevent your bladder from getting too full: Empty your bladder when needed. Empty it completely each time. This will help to reduce your chances of developing two common problems that increase your risk for UTI.
  • Eat healthy and exercise: A healthy diet and exercise are two of the best ways for everyone to boost their immune system. A healthy immune system helps you to fight off infections.
  • Stay hydrated: Drink plenty of liquids, especially water (recommended 6-8 glasses of water daily) and drink alcohol and caffeinated drinks only in moderation.  Drinking water helps dilute your urine and ensures that you’ll urinate more frequently — allowing bacteria to be flushed from your urinary tract before an infection can begin.  
  • Maintain proper hygiene: Staying clean is a good way to prevent the spread of bacteria. Always wash and clean properly both before and after bladder and bowel management and after accidents. Incontinence briefs should be changed frequently.
  • Avoid constipation: Try to avoid becoming constipated as this can prevent the bladder from emptying properly, which in turn can cause a UTI. Eating foods high in fibre, drinking plenty of liquids and exercising can help to prevent constipation.
  • Watch for early signs of infection: It is necessary to be on the lookout for UTI symptoms and be aware that a sudden change in behavior could be the only indicator. If you notice a big change in lucidity in yourself or someone you care for, consult a physician—confusion can be a symptom of a UTI.
  • Adopt infection control measures with catheter use: When a urinary catheter is being used, follow good infection prevention measures – your healthcare professional will be able to advise on proper techniques.
  • Consider adding URIEXO® to your daily routine: URIEXO® can aid in reducing the number of UTI recurrences.

Use of Antibiotics in the Elderly:

In addition to having unusual symptoms, UTIs in older adults can be recurring and dangerous, leading to frequent hospitalizations and cycles of antibiotics use. Preventing UTIs before they start is even more important in the elderly, however, as we age, we should be more conscious of consuming antibiotics.  While antibiotics cure most UTIs, it is very important that antibiotics be used sparingly in the elderly. If antibiotic-resistant bacteria develop, future Urinary Tract Infections, as well as other infections, can be very difficult to treat and can even result in death. Your doctor may have to try several antibiotics and this, in turn, increases the risk of complications. The resistant bacteria can also be passed on to others.

Furthermore, antibiotics can also cause side effects, especially in older adults. Side effects include fever, rash, nausea, vomiting, diarrhea, ruptured tendons, nerve damage, and kidney failure. Using antibiotics can also lead to vaginal yeast infections and other infections, including ones that can cause severe diarrhea, a hospital stay, and even death in older people.  Finally, older adults often take other medicines that can interact dangerously with antibiotics. As a result of the risk of using antibiotics in the elderly, doctors are increasingly becoming more careful about treating UTIs too quickly with antibiotics if symptoms do not develop.

 

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