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Urinary Tract Infections in the Elderly:  Signs, Symptoms, and Prevention.

Classic signs of UTI (the ones that you are likely already aware of) include frequent urination, burning pain, and foul smelling urine.  However the signs and symptoms for urinary tract infections in the elderly can be quite unusual and unexpected.  Older adults may not experience any of the hallmark symptoms due to weakened immune systems that are not able to put up a fight against the invading infection.   If you are a caregiver for an elderly person then it’s extremely important to recognize the unusual signs you may encounter.  Read on to learn all about the signs, symptoms, and prevention of urinary tract infections in the elderly.

Urinary tract infections (UTIs) occur when bacteria enters the body through the urethra (the opening through which urine flows.)  Bacteria can then spread to the bladder and kidneys.  Older adults are more prone to UTIs than anyone else.  Women are more commonly affected, but they occur in men as well.  The burden of UTIs will likely grow in the coming years due to the increasing population of older adults.  Early diagnosis is vital.  I’d argue that prevention is even more important.

 

Your elderly love one may have a urinary tract infection if they have any of these “non-classic” symptoms

 

  • Incontinence:

    • losing control of the bladder.  Having “accidents” when they are normally always able to make it to the toilet to urinate.

 

  • Urinary retention:

    • difficulty emptying the bladder fully or difficulty urinating at all.

 

  • Agitation:

    • increased anxiety and nervousness.  This can present as verbal outbursts or other forms of acting out.

 

  • Confusion:

    • increased forgetfulness, lack of awareness.

 

  • Lethargy:

    • extreme fatigue, tiredness, low energy.

 

 

  • Decreased mobility:

    • Sudden onset of weakness and difficulty with tasks such as getting up from a chair or out of bed.

 

  • Hallucinations:

    • seeing or hearing things that aren’t there.

 

  • Decreased appetite:

    • lack of interest in food, skipping meals.  (FYI:  medical documentation often uses the word “anorexia” when referring to decreased appetite.  If you ever run across that word in your loved ones medical forms, don’t be confused.  It doesn’t mean that they have an eating disorder.  It simply means that they have been experiening a loss of appetite.)

 

If your elderly loved one is experiencing any of the above symptoms, take action.  UTIs are typically not an emergency requiring a 911 call, but reach out to your loved one’s primary care physician or visit an Urgent Care clinic.

 

What might happen if you don’t recognize or choose to ignore the signs and symptoms of UTI?

Once the infection has spread to the kidneys, your loved one is likely to experience back pain, fever, nausea, and vomiting.  If left untreated, permanent damage and kidney failure can occur.  If it goes on too long, it can spread to the bloodstream and cause sepsis.  Sepsis is a potentially life threatening infection.  Now you’re dealing with an emergency situation.

 

Circumstances that increase the likelihood of UTI development in the elderly include:

  • Past history of UTIs
  • Dementia
  • Diabetes
  • Immobility:  including the inability to get to and from the toilet without assistance
  • Catheter use:  at home or in the hospital
  • Bladder or bowel incontinence:  loss of control over urine or feces requiring the use of adult diapers
  • In women:  Prolapsed bladder (a bulge of the bladder into the vagina)
  • In men:  Enlarged prostate

If any of the bullet points above describe your loved one, pay extra attention to signs and symptoms that may be indicative of a UTI before an emergency such as a fall (with Heaven forbid…a broken hip) occurs.

 

Now for the most important part of this article!

Here are some practical tips to prevent UTIs in your elderly loved one.  Help them to do the following things:

  • Drink plenty of water

    • If your doctor has you on a fluid restriction then drink as much as allowed)

 

  • Wear breathable, cotton underwear.

    • Change into a clean pair daily.

 

  • Do not sit/lay in a wet adult diaper.

    • They need to be changed frequently to avoid the growth of bacteria that will enter the urethra.

 

  • Avoid “bladder irritants.”

    • These are foods and beverages that irritate the bladder.  Some of these include coffee, acidic fruits, carbonated drinks, and alcohol.

 

  • Keep the genital area clean.

    • Do we have time for a whole separate blog post on this topic?  I’ll earmark it for the future.  For now I’ll point out that it is REALLY important for women to wipe from front to back.  I’ve found that there is a HUGE generational difference when it comes to wiping.  I grew up learning to wipe from front to back, but I’d bet that 99% of elderly women I work with in the hospital wipe from back to front.  If you are a caregiver for an elderly woman and you have to help with toileting and wiping, then be sure to wipe your loved one from front to back.  At the very least, utilize 2 separate wipes; one for the front and one for the back.  If your loved one is able to clean themselves after toileting then instruct them on this topic.
    • Aside from wiping when toileting, frequent cleansing/bathing is incredibly important as well.  If showering with soap and water is not an option, then at least utilize wet cleansing cloths.   And again, cleanse from front to back!  And no douching!  A fantastic option is an inexpensive, easy to install bidet that you can purchased from Amazon.  Click here to check it out for yourself. 
      • Disclaimer:  I get commissions for purchases made through links in this post.
    • Sorry if you’re experiencing a serious case of T.M.I. but this stuff is really important!

 

  • Urinate as soon as nature calls.

    • Don’t try to hold it.  If your loved one is unable to tell you when they need to use the bathroom then help them to get on a schedule.  For example, remind them to use the bathroom at the beginning of every even hour (10:00, 12:00, 2:00, etc) even if they don’t tell you that they need to go.  If your loved one lives in a nursing home, work with the staff to make sure that they are set up on an appropriate toileting schedule.

 

Important side note:  If your loved one has had multiple UTIs in the past, and you’ve discovered a hallmark symptom (such as verbal outbursts) that indicates the presence of a UTI, note it.  In the future, call the doctor as soon as the hallmark symptom begins.  If your loved one lives in a nursing home, be sure to communicate the hallmark symptom with the nursing home staff so they can take immediate action.

 

I’m sure that your idea of fun is NOT having a long discussion about pee, infections, and proper wiping techniques.  It’s not exactly fun for me to write it either, but it’s vitally important for keeping older adults safe, comfortable, and out of the hospital.  Comment below with any strange or unusual symptoms that your loved one experienced when they had a UTI.  Together we can create an even longer list of things to make identification and early intervention easier than ever.

 

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