Urinary Tract Infection (UTI) is one of the most common infections affecting older adults. When promptly and properly treated, UTI is easily managed and rarely develops complications. But, when left untreated, UTI can lead to serious health consequences which can include permanent kidney damage. In rare instances, an infection can enter the bloodstream through the kidneys and lead to a life-threatening condition called sepsis. Therefore, early recognition of symptoms, testing, diagnosis, and treatment of UTI is important.

What is Urinary Tract Infection?

UTI is a fungal or bacterial infection in any of the 4 parts of the urinary tract. The urinary tract includes the urethra, the bladder, the ureters, and the kidneys. The urethra and bladder are called the lower urinary tract, and the ureters and kidneys comprise the upper urinary tract. An infection will most commonly begin in the urethra and move up through the rest of the urinary tract. The majority of UTI cases are diagnosed and treated while still in the lower tract. When fungi or bacteria enter the urethra, the body’s own immune system will fight against them, and will usually kill them before an infection takes hold. If, for some reason, the body is not able to fight them off on its own, a UTI results.

Generally, a person who gets UTI will have one or more of the following risk factors:

1. Decreased urine flow (This can be caused by urinary tract abnormalities present since birth and blockages such as a kidney stone or enlarged prostate.)

2. Decreased fluid intake

3. Bowel incontinence (85% of UTI cases found in the bladder are the result of E. coli bacteria infection. E. coli is present in the stool.)

4. Weakened immune system (This can be the result of diabetes and other conditions that reduce the body’s ability to fight infection.)

5. Catheter use

6. A recent medical procedure involving the urinary tract

7. History of UTI

8. Dementia

How Do You Get a Urinary Tract Infection?

Because of the differences in anatomy, women are much more likely to get UTI than men. The opening of a woman’s urethra is located in close proximity to her vagina and anus which can both be potential sources of infection. The female anatomy creates more opportunities for fungi and bacteria to enter the urinary tract through the urethra. In addition, the length of the female urethra is shorter than a male’s, allowing an infection to spread more quickly from the urethra to the bladder and on up through the urinary tract.

Beyond anatomical differences, sexual activity and menopause also make women more vulnerable to UTIs than men. Sexual intercourse increases the potential for fungi and bacteria to enter a woman’s urethra. Frequent intercourse and intercourse with multiple partners increase the potential for infection even more. 80% of pre-menopausal women with UTI report having had sexual intercourse within the previous 24 hours. Post-menopausal women’s bodies produce lower levels of estrogen than pre-menopausal women. Estrogen may be helpful in preventing the overgrowth of E. coli bacteria in the urethra and vagina. As a woman’s estrogen levels decrease, E. coli may be allowed to grow unchecked and cause an infection.

Why the Elderly are Vulnerable to UTI

Studies have found that as both women and men age, their chances of getting UTI increases dramatically. UTI is the most commonly diagnosed infection in long-term care facilities and they account for more than 33% of all nursing home-related infections. Elderly women become especially susceptible to UTI. 10% of women older than 65 have reported having UTI in the past 12 months, and that rate jumps to nearly 30% for women older than 85.

Seniors are more vulnerable to UTI for many reasons. The human immune system naturally weakens as it ages. Because the elderly are more prone to develop other illnesses as they grow older, their immune systems are further weakened by multiple conditions with which they struggle. So, when fungi or bacteria enter the urethra of older adults, their immune systems are less likely to fight them off and prevent infection.

In addition to their increased susceptibility to infection, older adults may experience a decreased ability to properly care for themselves. Decreases in their cognitive abilities and energy levels may result in poor hygiene and improper self-care. They may even lose their ability to communicate their care needs to their loved ones and caregivers. As a result, their care needs may go unnoticed until an infection has already taken hold.

Social dynamics can also affect the relationship between UTI and age. Over time, many seniors experience a weakening of the muscles that control urination. This can lead to bladder incontinence and cause enough embarrassment that seniors choose to drink less in order to decrease their need to urinate. The lack of healthy fluid intake and the forced retention of urine in the bladder both increase the risk of UTI. An older adult’s inability to urinate regularly can sometimes require a catheter to be used. The use of a catheter also increases the risk of UTI.

What are the Symptoms of Urinary Tract Infection?

Classic symptoms of UTI include:

1. Frequent and urgent need to urinate

2. Bladder incontinence

3. Burning sensation when urinating

4. Urine with an unusual color

5. Urine with a strong odor

6. Fever

7. Chills

8. Pelvic pain or pressure

9. Lower back pain

10. Decreased appetite

11. Nausea and vomiting

Sometimes it is difficult to identify UTI in older adults because they don’t always present the classic symptoms. Non-classic symptoms of UTI in the elderly include:

1. Restlessness

2. Agitation

3. Confusion or disorientation

4. Hallucination

5. Poor motor skills

6. Dizziness

7. Decreased balance

8. Social withdrawal

9. Depression

The symptoms of UTI in older adults related to changes in mood, cognition, and behavior are well-documented, but they often mimic symptoms of other conditions like dementia or stroke. This coupled with the fact that the elderly may not be able to tell you when they are experiencing classic symptoms of UTI make it important for their loved ones and caregivers to take prompt action when an abrupt change in mood or behavior is observed. Medical professionals can test for UTI and can determine whether or not a bacterial or fungal infection is present in the urinary tract, or if the changes are the result of some other condition. Tests for UTI are usually performed through urinalysis.

When people go to a healthcare provider to test for UTI, they will be asked to provide a urine sample. The medical professional will then either use a “dipstick” or “strip” test on the urine sample while the patient waits in the office, or the sample will be sent out to a lab for a urine culture. The in-office test is less expensive and the results come back almost immediately. However, what these tests may provide in terms of convenience, they lack in accuracy and in the ability to identify medications designed to target and kill the specific strain of fungi or bacteria causing the infection. The results of a urine culture may take several days to come back, but they are much more accurate and allow the medical professional to select the most appropriate and effective medication for treatment.

The good news is that if UTI is diagnosed early enough, treatments are usually easy and effective. Depending on the source of infection, antibiotics or antifungal medications are used with great success against UTI. Drinking plenty of fluids while taking the medication will also help flush the infection out of the urinary tract. It is important to take the antibiotic or antifungal medication exactly as it is prescribed, even after UTI symptoms go away. Taking all of the medication will help kill all of the infections. Centric Healthcare’s trained and caring professionals can help ensure that their clients take all medications as prescribed and drink appropriate amounts of fluids.

How to Prevent Urinary Tract Infections in the Elderly

With a proper understanding of UTI, its potential causes, and risk factors; there are some simple things that all of us can do to help prevent infections in our urinary tracts. Some of the most practical preventive behaviors are:

1. Drink plenty of fluids daily, especially water

2. Urinate as soon as the urge hits

3. Urinate immediately after sexual intercourse

4. Wipe from front to back after a bowel movement

5. Avoid bladder irritants like caffeine and alcohol

6. Avoid irritating feminine hygiene products like deodorants, douches, and powders

7. Drink cranberry juice (Some urologists claim that an ingredient in cranberry juice helps prevent E. coli bacteria from adhering to the bladder wall. Although studies on this have not been conclusive, the American Urological Association has determined that there is some evidence to recommend cranberry juice for the prevention of recurrent UTI in women.)

In addition to the suggestions listed above, here are some preventive behaviors specifically for avoiding UTI in seniors:

1. Establish and follow a regular urination schedule, using alarms if necessary

2. Take enough time to empty the bladder completely when urinating

3. Wear cotton underwear and loose-fitting pants

4. Change incontinence pads and underwear immediately after they are soiled

The prevention of UTI in older adults boils down to two words: better care. Remember, as people age, they sometimes lose the ability to care for themselves in ways that we all take for granted when we are younger. This makes it essential for loved ones and professional caregivers to be vigilant, look for unmet care needs, and respectfully provide that care when necessary.

How Centric Healthcare Can Help

It has been well-established by medical researchers that older adults have a greater risk of getting UTI than the rest of the population. At the same time, demographers are projecting that the population of our state and our country continues to age dramatically. Therefore, the impact of UTI on our health will continue to grow.

Listed below are some of the services offered by Centric Healthcare that can help you and your loved one prevent and manage UTI.

Senior Home Care Services

Centric Healthcare offers a wide range of specialized short-term and long-term senior home care services developed to meet the unique care needs of seniors while protecting their dignity. We work with you to create a customized care plan for you or your loved one. The care plan can be designed to address UTI risk factors and encourage preventive behaviors. Services are provided in-home, avoiding the infection risks associated with care facilities, nursing homes, and similar communal living arrangements.

Home Health Aides

Seniors sometimes need help with everyday tasks. Many of these tasks relate directly to UTI risk factors and preventive behaviors. Centric Healthcare offers home health aide services that can help with toileting, bathing, personal hygiene, dressing, scheduling, and many other daily tasks that can be customized to help promote good urinary tract health. Receiving this assistance is not always easy for seniors who used to do these things for themselves. Therefore, as with everything Centric Healthcare does, these services are provided with the utmost professionalism, compassion, and respect.

Private Duty Nursing Services

Sometimes, seniors need help with more than daily living tasks and require a licensed medical professional. Centric Healthcare offers the services of private duty nurses who attend to your or your loved one’s medical needs in your home. Examples of our services that can assist in the treatment and prevention of UTI include assistance with catheter care, medication administration, and a trained eye that can help identify self-care needs and watch for classic and non-classic UTI symptoms.