Urinary Tract Infection in Elderly
Many elderly adults in modern society tend to suffer from infections of the urinary tract, and this is somewhat burdensome for caregivers. Caregivers may experience caregiver burnout and/or fatigue as they try to care for their loved ones with urinary tract infections. Thus, it is crucial to be aware of the causes, signs and symptoms, and prevention mechanisms for elderly adults with urinary tract infections. It is also important to remember that assisted living caregivers are trained on how best to support elderly residents with urinary tract infection, in order to help alleviate the burden from the shoulders of the family caregivers.
Urinary tract infections, also referred to as UTIs, are more common in older adults who are 65 years and above. In fact, urinary tract infections are the second most common cause of hospital admissions in community-dwelling senior citizens of age 65 and older. There has been a sudden rise in the number of seniors diagnosed with urinary tract infections, particularly more so among women affected than men. Within the past few years, more than 10% of women over 65 years have been diagnosed with urinary tract infections, with the number increasing to over 30% among women over 80 years of age.
These dear elderly ones can still enjoy more valuable time with loved ones and families if they are taken early for medical care, as urinary tract infections are treatable. Schedule an appointment with your healthcare provider to discuss the signs and symptoms, management options, and how assisted living facilities may support your loved one with a urinary tract infection. It is also important to remember that the earlier older adults receive proper urinary tract infection care management, the more likely they will be to prevent further complications and progression of the UTI.
Signs and Symptoms of Urinary Tract Infections
In simple terms, a urinary tract infection is the infection of the urinary tract. The urinary tract includes the urethra (the opening that passes urine to the outside), the ureter, the bladder, and the kidneys. Bacterial or fungal infections at the urethra can get transmitted to other parts of the urinary tract. If immunity is low, as is commonly seen in the older senior citizens, then an elderly loved one could come down with urinary tract infection signs and symptoms. These older adult urinary tract infection signs and symptoms, however, may differ from the urinary tract infection symptoms exhibited by younger adults, making it difficult to diagnose based on symptoms. The symptoms of urinary tract infection could also be easily confused with other age-related conditions based on a similar presentation. When you notice your elderly loved ones, especially those who have dementia or Alzheimer’s disease express some behavioral symptoms like confusion, agitation, or lethargy, then it is also important you visit your healthcare provider so they may assess whether these signs and symptoms may also be due to a urinary tract infection. With the help of well-trained senior caregivers at assisted living facilities, many of these symptoms are noticed early to prevent further distressing moments for the senior residents.
Seniors experiencing UTI symptoms are to be considered with priority because if they are left unnoticed or untreated for a long time, the symptoms could get worse, causing more confusion, agitation, decreased appetite, frequent falls, or even death. The long-term consequences of urinary tract infections may include neglect of personal care, wandering, loss of mind, or even psychotic symptoms.
Urinary tract infections could be challenging to predict in seniors, as classic symptoms are often absent in the elderly. As such, UTIs could be due to a slower or suppressed immune state associated with aging. So, this requires a high index of suspicion to select these non-classical symptoms and also to distinguish them from other medical conditions that may also be present with a similar presentation. These urinary tract infection signs and symptoms also vary from person to person, and not every senior would present the same way or with the same severity of symptoms.
Please contact your healthcare professional if you notice any of the following changes in your loved elderly ones:
- The classic symptoms of urinary tract infections tend to include urethral burning with urination, frequent urination, urgency (a strong desire to urinate), fever, abnormal color and odor, the fullness of bladder, pain, hematuria (passage of blood in urine)
Senior citizens are more likely to experience these symptoms with delirium, confusion, or behavioral changes.
- The non-classical urinary tract infection symptoms often experienced by the elderly that could suggest the case of a urinary tract infection could include changes in behavior, such as incontinence, lethargy, decreased mobility, loss of appetite, restlessness, social withdrawal, hallucinations, agitation, confusion.
- And if the infection is severe to involve the kidneys, the older adults may present with fever, flushed skin, lower back pain, nausea, and vomiting.
Why there is variation in the symptoms exhibited in the elderly with urinary tract infections is still not entirely clear. One school of thought believed that as one ages, the blood vessels supplying the brain become weaker and could allow the passage of infection to the mind; and therefore, disrupt the normal functioning of the brain. However, it is encouraged to have a urine test at every clinic visit.
Causes of Urinary Tract Infections in Elderly Senior Citizens
The leading cause of urinary tract infections is bacterial organisms, of which Escherichia coli is mostly indicated. E. coli, as it is often referred to, is commonly found in stool and can enter the urinary tract through the urethra.
However, other organisms are known to cause urinary tract infections in the elderly, especially those older adults hospitalized with a urinary catheter. Studies have shown that urinary tract infection is most commonly diagnosed among senior citizens who had an extended stay in a nursing home, so if your loved one needs nursing home care, then it is pivotal you ensure that the nursing home in your area utilizes best practice infection prevention and control methods.
Various Predisposing Factors Increase the Risk of Urinary Tract Infections in The Elderly Adults
Common healthcare conditions associated with old age such as dementia, Alzheimer's disease, and Parkinson's disease may contribute to a reason for why an elder adult could find it difficult to control when they urinate. As a result, this may lead to neglect of self-care, poor hygiene, or urinary retention. Many of the organisms, especially E. coli, thrive and multiply in significant numbers when there is urine retention in an unclean environment. Similarly, these older adults may also be at an increased risk of incontinence. Thus, you may consider encouraging your elderly loved one to wear incontinence briefs. If the incontinence briefs are not changed frequently, then the older adults may be predisposed to an infection. Fortunately, assisted living facility caregivers are available to support seniors with their activities of daily living (ADLs) and ensuring proper hygiene to reduce infections.
Additional factors that increase the risk of senior citizens affected with UTI may include:
- The Declining State of the Immune System: As one ages, there are a lot of changes the body undergoes, especially concerning the diminishing response of the body soldiers to infections. This makes the seniors more susceptible to infections as the numbers of cells and the efficiency of the immune system reduce drastically.
- Prolonged Hospitalization: Many illnesses associated with older age could warrant for an extended hospital stay. Also, invasive procedures in the hospital could be related to urinary tract infections, primarily if proper infection prevention and control measures are not implemented.
- Previous Urinary Tract Infection: As such, an elderly adult with a poorly treated previous urinary tract infection is at a higher risk of having another episode.
- Presence of Urinary Catheter: A urinary catheter is a bag connected via the urethra to the bladder to drain and store urine. Infrequent change, fixing of this catheter, or prolonged usage of the catheter also predisposes elderly adults to urinary tract infections.
- Chronic Illnesses and Comorbidities: As we have discussed, elderly adults with comorbidities, when an older adult has two or more chronic conditions, may be at an increased risk of developing a urinary tract infection. Also, diabetes mellitus is one of the leading causes of diseases in the elderly. Poorly managed diabetes can also suppress the immune system, thereby increasing susceptibility to urinary tract infections in the elderly.
Women may be at increased risk of a UTI for the following reasons:
- Estrogen Deficiency: Lack of estrogen in a female senior is believed to increase the risk of urinary tract infections. Estrogen plays an essential role in protecting the urethra and vagina from the overgrowth of E. coli. At menopause, when the level of estrogen has significantly declined, there is an overgrowth of E. coli, which may then trigger a urinary tract infection.
- Pelvic Organ Prolapse: Herniation of one or more of the pelvic organs like the uterus, vagina, bladder, or rectum can predispose an older woman to a urinary tract infection. Organ prolapse is more likely to be found in Caucasian postmenopausal women. Women with pelvic organ prolapse may be at an increased risk of developing urinary tract infections.
The urinary tract infection risks factors for male seniors may include:
- Kidney Stones and Bladder Stones: Kidney stones and bladder stones along the urinary tract can occur among older men. This obstruction of the urine outflow tract often causes pooling of urine and provides a suitable medium in which organisms can grow and thrive.
- Urethral Strictures: Narrowing of the outflow tract can cause a full bladder, and difficulty in voiding urine. Stones occluding the urinary tract may cause urethral strictures.
- Enlarged Prostate: This is an age-related condition, as prostates usually increase in size as a man ages. This may be due to the increase in the levels of sex hormones, however, causing difficulty in urination.
- Bacterial Prostatitis: The proximity of the prostate to the urinary bladder could easily transmit infections to the bladder when the prostate becomes infected by bacteria.
- Catheter Use: Prolonged use of a catheter to drain urine from the bladder is a risk factor for urinary tract infection.
Caregivers need to be conscious of the above risk factors and any behavioral or cognitive changes that are suggestive of urinary tract infections. When these changes are noticed early, this could prevent complications, such as kidney damage and sepsis. Sepsis is a life-threatening condition whereby the bloodstream or the entire body is overwhelmed with infections. This could be fatal as it could lead to septic shock or even sepsis mortality. Sepsis on its own could lead to other complications like chronic pain disorders, organ dysfunction, or amputations.
Prevention of Urinary Tract Infections in Elderly Adults
Preventive measures can be adopted to reduce the risk of urinary tract infections. It is worthy of note that not all urinary tract infections are preventable. Precautionary steps are usually advised, especially for the elderly adults who are at a higher risk of getting infected.
Consider the following strategies to help your elderly parent prevent a urinary tract infection:
- Stay Hydrated: Water is said to be a cleansing solvent, and water helps in staying hydrated. We are recommended to drink eight 8-ounce glasses of water daily.
Water keeps the body system active, and also flushes small stones that may later calcify to form bigger stones, which could then obstruct the outflow tracts. Staying hydrated could also help clear the mind and reduce the frequency of confusion.
- Drink Cranberry Juice: Some urologists believe that an ingredient in cranberry juice helps senior citizens prevent the growth or adherence of bacteria to the bladder, reducing the chance of getting infected. However, there is no scientific-proven evidence for this belief.
- Avoid Alcohol and Caffeine: Alcohol and Caffeine are referred to as bladder irritants in the elderly adults. Alcohol is detrimental to a senior’s health. Alcohol use can lead to more confusion, hallucinations, or change in typical behaviors. Chronic use of alcohol could damage vital organs of the body, which further worsen a senior’s immunity.
Caffeine, on the other hand, is a stimulant that can cause a reduction in the quality of sleep and also reduces appetite. Loss of appetite leads to a reduction in the amount of nutrients available for the body to fight infections.
- Proper Personal Hygiene: Maintaining proper personal hygiene is one way to longevity at old age — use of loose, breathable, and cotton underwear that is easily replaced. Constant changing of underwear or incontinence pads, cleaning from front to back after using the toilet are cheap but vital preventive measures.
- Urinating Alarms: Alarms may be beneficial in reminding a senior to void, to avoid an extended stay of urine in the body, or for hygiene.
- Voiding of Urine When the Urge Comes Along: Holding of urine or keeping a full bladder for a longer time could create a suitable environment for bacterial growth.
- Vaginal Estrogen Cream for Women: For a female senior citizen, vaginal estrogen cream can be used if they are prone to urinary tract infections.
- Support and Care: Research has shown that elders who are bonded with their families and feel loved are less at a risk of urinary tract infection. The availability of appropriate and sufficient care is necessary to meet the needs of these seniors.
If you are no longer able to continue providing your elderly loved one the medical care they need, then do not worry, for assisted living facility caregivers are well trained and available to support you to ensure your elderly loved one receives optimal senior care and enjoys a quality life as they age in place at the assisted living facility.
Control of Urinary Tract Infections
For seniors that are immobile and can no longer take the best care of themselves, assisted living facilities may be a better option in ensuring that they are always dry and clean, and that proper preventive measures are followed. Senior caregivers at assisted living facilities are well trained about how to help elderly adults prevent and manage urinary tract infections. The senior caregivers will also accompany the elderly adults to visit their healthcare professionals.
The seniors may need to visit their healthcare provider to discuss the best care plan options. As urinary tract infection symptoms can present differently in each senior, the healthcare provider will be able to assess whether the older adult shows such a symptom.
If the elderly adult does not have a urinary tract infection, then the meeting with a specialist will help remove any doubt and give clarity about the possibility of having such an infection. A specialist also carefully investigates to rule out other conditions with similar presentations to avoid overtreatment or a wrong diagnosis. The healthcare provider may request blood and urine tests to diagnose appropriately. The good news, however, is that urinary tract infections are relatively treatable in elderly adults. Many urinary tract infections are often managed with antibiotics and sufficient hydration that helps to flush out these microorganisms. A gynecologist may need to review if the cause of the urinary tract infection is due to pelvic organ prolapse or due to postmenopausal symptoms. Alert your doctor if you notice any unusual changes in the elderly adult’s usual activities for early and prompt diagnosis.
When to Consider Assisted Living Facilities for Urinary Tract Infections?
The occurrence of urinary tract infections in the elderly further suggests low immunity in fighting diseases. This may further propel other health conditions in a senior. These changes, as a result of the break down of their health, may take a toll on the elderly adult's families and caregivers. Are you a caregiver to a senior adult who frequently gets urinary tract infections?
Consider the following recommendations for how to help your older adult with a urinary tract infection. Carefully address and avoid caregiver fatigue or burnout while providing care to an older adult.
- Emotional Support: The responsibility of having to take care of an elderly loved one with a urinary tract infection could be cumbersome, especially when changes in behavior are present. You should not neglect other pleasurable activities you always enjoyed because of your caregiving responsibilities. Your social life should always be checked. You sure deserve to be happy. Talking to someone about the challenges, struggles, and the sheer volume of work could go a long way in getting yourself together. The senior caregivers at your local assisted living facilities are happy to open their hearts and compassionately care for your loved one. Also, the senior caregivers at assisted living facilities are well trained about how to provide the emotional support to your seniors as they overcome the urinary tract infection.
- Consult the Elderly Ones About Important Affairs: Deciding about the health care options that may be best for a loved one should not be a decision you take all by yourself. You can discuss with your seniors about their condition, why you feel assisted living facility care may be beneficial, and then together, you can ensure you identify the best senior care and living option for your elderly loved one. This promotes bonding, makes the senior feel valued, and loved.
- Educate Yourself about Urinary Tract Infection: Education is power, and the more knowledgeable you become about a condition, the better prepared you will be. Ensure your elderly loved one is not subjected to unintended elderly neglect or abuse of any kind.
How to Find the Best Assisted Living Facility for an Elderly Adult with Urinary Tract Infections?
Finding the best assisted living facility for a loved one involves both conscious and deliberate efforts. You should be aware of the care your loved one needs, the services the facility offers, the location and proximity to you and your family, the environment, the compassion of the staff, and the management expertise of the administrators. The pattern of disease presentation varies and having a team of staff who are trained to identify early symptoms or changes is crucial.
Objectives to look out for when identifying whether the assisted living facility's staff can cater to the needs of a loved one with urinary tract infection include:
- Ability to maintain or promote a better quality of life
- How knowledgeable the caregivers are about the urinary tract infections signs and symptoms, risk factors, and strategies for prevention of UTIs
- Ability to discern when to present the senior for proper medical care, provision of transportation to healthcare appointments, and medication management
- Providing support, care and spending quality time each day with the seniors
An assisted living facility may help reduce the risk of recurrence of urinary tract infections if appropriate measures are taken. Dietary monitoring, garden walks, and socialization interactions to bond with other seniors in the assisted living facility may promote good health and add more quality life to your elderly loved one.