Urinary Tract Infections - Understanding This Important Health Issue in Seniors

When most people hear the term urinary tract infection (or UTI), they don't automatically think of a life-threatening illness. UTIs are viewed as a minor health issue, no more serious than the common cold. Often, a doctor visit isn’t even needed since it’s easy to self-diagnose and treat.

However, for seniors, urinary tract infections are much more serious. If untreated, the consequences can be life-threatening. UTIs are among the most commonly diagnosed infections in older adults, according to Aging Health. For women over age 65, the incidence rate is over 10 percent. However, statistics often don’t consider the rate of UTI misdiagnosis in hospitalized older adults, which may be as high as 40 percent.

Seniors, caregivers, and their loved ones should know the warning signs, symptoms and treatment of this common infection. Recognizing a UTI and getting treatment quickly could prevent needless suffering -- and ultimately, save a senior’s life.

What is a Urinary Tract Infection?

A UTI is a bacterial infection of the urinary system. Anything that introduces bacteria into the urinary tract, prevents the flow of urine, or causes urine to sit in the bladder will cause a UTI. 85% of all UTIs are caused by E. coli, found naturally where digestion occurs in the gastrointestinal tract. The proximity of these tracts makes it easy for infections to occur when there is poor hygiene.

UTIs usually occur in the bladder or urethra, but more serious infections involve the kidney. The infection typically starts low in the urethra and moves up the ureters and into the bladder, and then goes to the kidneys. It eventually can move into the blood system if unchecked. Once the infection is in the circulatory system, it can become very dangerous and lead to sepsis, making early detection critical.

Why are Seniors Susceptible to UTIs?

Older individuals are vulnerable to UTIs for a few overlapping reasons. They may not have the energy levels or cognitive abilities to take care of themselves. This results in decreased hygiene or poor bathroom habits, which then leads to infection.

Urinary retention is also common. Holding urine in the bladder fosters the bacteria that turns into a UTI. Seniors may reduce their fluid intake during the day to avoid the hassle and embarrassment of bladder control issues. Older adults also have gradual weakening of the bladder and pelvic floor, leading to urinary retention and incontinence.

Seniors are also more likely to have medical conditions that affect the urinary tract, such as diabetes, kidney infections and kidney stones. The use of a catheter in older adults can be difficult to keep sanitary, creating another vulnerability.

Signs and Symptoms of UTIs in Seniors

For seniors, the most common (and most surprising) indicator of a UTI is change in behavior. This could be a subtle or major change. Whether it’s an increase in falls, aggression, confusion, issue with going to the bathroom, memory loss or a decrease in appetite, all these behavioral changes could be signs of an undiagnosed UTI. For seniors who are already struggling with serious cognitive illnesses such as Alzheimer's, dementia or Parkinson's, a UTI can make their behavior more severe.

Other symptoms of a UTI include:

• General discomfort
• Fatigue
• Issues urinating
• Pain when urinating
• Pain in the pelvic region even when not urinating
• Cloudy urine
• Blood in the urine
• Back and side pain
• Strong smelling urine
• The inability to do everyday tasks
• Fullness in the rectum for men
• Fever

While some seniors may report pain or discomfort while urinating, behavior changes are the number one indicator. It is also important to note that many of the symptoms of UTIs in seniors can mimic the symptoms of Alzheimer's disease or dementia. All seniors experiencing these signs and signals should rule out a UTI first before jumping to more serious conclusions.

How to Prevent UTIs in Seniors

Proper nutrition and drinking plenty of fluids can go a long way in helping seniors prevent the onset of UTIs, but this isn’t the only step in preventing these infections. The good news is there are many things a senior can do to prevent the onset of UTIs. While these steps won't necessarily guarantee that a senior won't get a UTI, they can lessen the chances considerably.

The National Institute on Aging offers several great tips to help keep your bladder healthy. A healthy bladder means less UTIs. We’ve summarized below:

• Drink plenty of clear fluids - Most healthy people should try to drink six to eight, 8-ounce glasses of fluid each day. Water is the best fluid for bladder health. However, check with your doctor if you have any health conditions that affect fluid intake.
• Limit alcohol and caffeine – These liquids are dehydrating, which subtracts from the water you’re drinking each day.
• Do pelvic floor muscle exercises - Also known as Kegel exercises, these help hold urine in the bladder. Daily exercises can strengthen these muscles, which keeps urine from leaking when you sneeze, cough, lift, laugh, or have a sudden urge to urinate.
• Use the bathroom often – Don’t hold it! Try to urinate every 3 to 4 hours. Holding urine can weaken your bladder muscles. Keeping urine in the bladder too long allows bacteria to grow.
• Take your time – Make sure you’ve fully emptied your bladder. As noted above, you don’t want urine to stay in your bladder too long.
• Relax – Especially for women, make sure your muscles are relaxed to fully empty your bladder.
• Wipe from front to back – Also for women, it is essential to wipe from front to back to prevent E. coli from entering the urethra.
• Urinate after sex – Both men and women should urinate after sex to flush out any bacteria.
• Wear cotton underwear – This will allow air to the urethra to keep it dry.

What about cranberry juice? While this has been an old wives’ tale for many generations, most physicians will only say “it can’t hurt.”

Diagnosis and Treatment of UTIs in Seniors

While UTIs can have a number of scary side effects, there are many effective treatments available. When a senior is experiencing the symptoms of a UTI, they need to visit the doctor right away for diagnosis. Typically, with a urine test, blood test, ultrasound or even an x-ray, most doctors can quickly determine the cause.

In most situations, a round of antibiotics is given to treat the UTI. Some seniors may have to change their catheter routine, start new hygiene practices or even take additional medications in order to get their UTI under control. Typically, treatments last between 10 to 14 days. Symptom relief can be felt within the first 48 hours. In more serious cases, a senior may need to be hospitalized overnight or use an IV to rehydrate the body while administering antibiotics.

However, seniors and their caregivers should be careful about overuse of antibiotics. According to the Cleveland Clinic, if the senior is exhibiting behavior changes and has a low level of bacteria in the urine with no other symptoms, simply increasing fluid intake can help restore the patient’s bacterial balance. There is always a danger of resistance to bacteria if antibiotics are prescribed too frequently.

The most important thing to remember is that UTIs are treatable. Often, the serious side effects, including the behavior changes associated with this condition, will subside quickly after the right treatment is administered.

As you can see, the caregiver’s role in detecting UTIs can have a dramatic effect on a senior’s quality of life. This type of infection can impact virtually any senior in any situation, whether they’re receiving home care, getting treatment at a hospital or living in an assisted living community. What matters is that someone is paying close attention to a senior’s hygiene habits and changes in behavior.