Urinary tract infections (UTIs) are one of the most common infections in adults. According to the Urology Care Foundation, 60% of women and 12% of men will have a UTI during their lifetime.
Fortunately, health care providers can easily diagnose and treat most UTIs quickly. But for the elderly, UTIs present some special challenges.
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UTIs in the Elderly
A UTI is an infection in the urinary tract. It occurs when bacteria enter the urinary tract, typically through the urethra. Left untreated, bacteria can move into the bladder and the kidneys.
Why do elderly people get UTIs?
Elderly people are prone to getting UTIs for several reasons. Those with dementia or in long-term care facilities are especially susceptible to UTIs. Here are some reasons why:
- Catheter use. A catheter is a tube placed in the bladder to drain urine from the body when someone cannot completely empty their bladder on their own. Having this foreign body in the bladder can be a source of infection.
- Dementia. Older adults with dementia may not be able to clearly communicate what they’re feeling, so a UTI may go unnoticed at first.
- Dehydration. If the person isn’t drinking enough water, they don’t produce enough urine. Consequently, bacteria won’t get flushed out of the urinary tract. Dehydration can mimic or worsen existing dementia.
- Diabetes. Sugar may be present in the urine due to poorly controlled diabetes. Certain types of diabetes medicines may promote the growth of bacteria.
- Incomplete bladder emptying. This may be a result of enlarged prostate in men, urethral stricture, or pelvic floor dysfunction. Neurologic conditions such as multiple sclerosis or spina bifida also may cause incomplete emptying of the bladder.
- Poor hygiene. If the genital area is not clean, a UTI can develop.
- Urinary or fecal incontinence. Frequent incontinence leads to more bacteria in the genital area. People wearing adult incontinence briefs are vulnerable to infection if they are not promptly cleaned up and changed on a regular basis.
- Weakened immune system. An older adult’s immune system may not be able to fight off the bacteria.
UTI Symptoms in the Elderly
In younger people, the most common UTI symptoms are painful urination and an increased need to urinate. But UTI symptoms in older adults tend to be different.
UTI symptoms in the elderly can include:
- Increased confusion.
- Sleep issues.
- Difficulty urinating.
- Change in urine smell.
- Darker urine color.
UTI and confusion
There sometimes are no clear physical symptoms of a UTI in older adults. But researchers do see a connection between having a UTI and confusion.
An elderly person with a UTI may have abrupt and puzzling behavioral changes. In someone with dementia, dementia symptoms may suddenly get worse.
Those symptoms can develop in as little as one to two days. If someone has confusion triggered by a UTI, it will not get better until the UTI is treated. Fortunately, antibiotics can cure most UTIs.
How Do Health Care Providers Treat UTIs in the Elderly?
If you or your loved one has symptoms of a UTI, a health care provider should order a urinalysis and urine culture. This will show if bacteria are present. Depending on your symptoms, the provider may order other tests. These tests include blood work, a renal/bladder or abdominal ultrasound, an x-ray, or a CT scan to locate the source of the infection.
If the diagnosis is a UTI, your health care provider will prescribe antibiotics. Symptoms should improve after a few days of treatment.
Left untreated, a UTI can spread to the bloodstream. At that point, the infection can be life threatening.
It is common for elderly patients to have bacteria in their urine without actually having signs or symptoms of an actual infection. This is called asymptomatic bacteriuria and antibiotics are not effective.
If your loved one has increased confusion or lethargy while taking antibiotics for a UTI, talk to their doctor. Their health care provider should recognize that it may be asymptomatic bacteriuria and consider other reasons for the change in behavior.
Preventing UTIs in the elderly
Here are steps you can take to protect yourself or your loved ones from UTIs.
- Stay hydrated.
- Use the bathroom when needed (don’t hold urine). Encourage a bathroom break every two to three hours.
- Practice good hygiene of the genital area and change adult incontinence briefs frequently.
- Be aware of unusual behavioral changes.
- Get routine health exams, especially if you have an existing condition like diabetes or enlarged prostate.
If you notice a sudden change in your loved one’s behavior and suspect a UTI, call your health care provider right away.
Urology Care Foundation, Urinary Tract Infections in Adults, Link
Urology Care Foundation, Understanding UTIs Across the Lifespan, Link
Alzheimer's Association, Sudden Change in Behavior? Urinary Tract Infection Could Be the Cause, Link
CDC, FAQ about Catheter-associated Urinary Tract Infections, Link
National Institute of Diabetes and Digestive and Kidney Diseases, Bladder Infection (Urinary Tract Infection) in Adults, Link
National Institutes of Health, Urinary Tract Infection in Older Adults, Link
The UPMC Department of Urology offers a wide variety of specialized care for diseases of the male and female urinary tract and the male reproductive organs, including erectile dysfunction, kidney stones, urinary incontinence, prostate cancer, and more. We have a multifaceted team of physicians and researchers working together to provide the best care to both children and adults. Our team is nationally renowned for expertise in highly specialized technologies and minimally invasive surgical techniques. To find a provider near you, visit our website.