Before learning how to prevent UTI in elderly persons, it is important to understand what they are in the first place. A UTI is short for Urinary Tract Infection. It is a kind of infection that can occur along one’s urinary tract and it is brought about by bacteria. The urinary tract includes the following parts:
- The kidneys: they are responsible for the processing of urine
- The bladder: this is the area where urine is stored before it is expelled from the body
- Ureters: these are tubes which serve the purpose of transporting the urine from your kidneys all the way to your bladder
- Urethra: this refers to a tube through which urine is emptied from one’s body
As with most infections, there are people who are at a higher risk of contracting UTIs. Because of how women are created, they are a bit susceptible to the UTIs than the male counterparts.
This is because they have a much shorter urethra and it happens to be in close proximity to the anal area. Generally, seniors are more likely to develop UTIs than any other age group. There are many reasons which make this group vulnerable to such infections.
The main thing is the fact that they have an immune system which is already suppressed and this is something that happens to us as we age. There are many other issues related to age that put them at the top of the list.
In seniors, the bladder muscles tend to be weaker and this is progressive. This causes the urine residual volume to be much higher. It also leads to incontinence as well as insufficient emptying of the bladder.
Normally, adults are able to compliantly empty their bladders when they urinate and this is something that helps to reduce the possibility of accumulation of bacteria in our bladders. Because of the fact that muscles weaken as we age, more urine is retained and this can lead to the development of infections within the bladder.
In men, there is the issue of an enlarged prostate that can obstruct the flow of urine as well as stagnation. There is also the issue of bladder prolapse caused by weakness of the structures which are meant to give the much-needed support may lead to such an effect as well.
Regardless of whether you are male or female, stagnated urine is an issue because it offers a perfect place for the colonization and growth of all sorts of bacteria which are a potential cause of infections.
Types of UTIs
UTIs are very uncomfortable and the symptoms associated with them are quite painful as well. You may find that you have to go to the bathroom more than you usually do. There are many more symptoms of UTIs as outlined above. Some of the common types of UTIs include:
Cystitis: this is usually a bladder inflammation and it happens to be one common cause of UTI. This is a kind of UTI that is evident in women and the infection may affect the bladder surface only. The infection is acute and brief.
Urethritis: this is the inflammation of one’s urethra just as the name suggests. This is a kind of infection that is usually contracted through sexual contact with someone who has infections that are sexually transmitted.
Urethritis can also come as a result of trauma to the urethra or because of catheterization. Use urethritis home remedy with precaution and under guidance from a doctor. Urethritis treatment without antibiotics can also be suggested when the infection is not too intense.
Pyelonephritis: Sometimes, bacteria can easily spread from your bloodstream and into the kidneys. In such a case, you may have symptoms such as pain on the side or back just under the ribs, fever, vomiting, or nausea. Kidney infections happen to be very serious in comparison to bladder infections.
Why do I keep getting UTI?
UTIs are a common cause of doctor visits and it happens to be more rampant in women because of where the female urinary system is located. If you happen to have 3 or even more UTIs within a year, then you have what is called recurrent UTI and it has to be addressed as soon as possible by a qualified doctor.
What causes it?
The main cause of UTIs is bacterial infections. The bacteria that live within the rectum and colon usually cause the infection. When introduced into the urethra, it multiplies and can travel to one’s bladder, when urine flows from your bladder; it also washes some of the bacteria out.
The fact that women have got a urethra that is much shorter than men make it easier for them to get UTIs than men.
Factors that contribute to getting UTIs
There are some factors that make it more likely for one to get a UTI and they include:
- Reduced estrogen levels
- Diabetes
- Pregnancy
- Immune suppression
- Use of spermicide
- Sexual contact
- Catheterization
Estrogen: this is a hormone that occurs naturally and it helps in the prevention of UTIs in women. When women reach menopause, the levels of this hormone drop significantly and this is together with some other good bacteria that live within the vagina.
It is such good bacterium that helps in the prevention of intestinal bacteria thriving within the vagina. It is such things that make elderly women more prone to contracting UTIs.
The symptoms
So, how do I know if I have a UTI? One of the things that are rather unfortunate is the rate at which UTIs are misdiagnosed with Alzheimer’s disease and senior dementia. This is due to the fact that they have symptoms that are very similar.
About 40 percent of elderly people with such serious infections may not develop a fever, which is one of the signs because the immune system is not able to make a response to the infection because of aging effects.
The bacteria within the urine spread to one’s bloodstream and can make it across an elderly person’s brain barrier. In such a position, you may notice confusion as well as other difficulties that are cognitive in nature. If such symptoms are noticed, it is important to monitor other signs that could indicate the presence of a UTI including:
- Lower pelvis pressure
- Burning or pain as they urinate
- Urgent or frequency of urination
- A foul or strong smelling urine
- Blood in urine
- Cloudy urine
When it affects women, there are some atypical signs that you could possibly notice. These may include the inability to handle some very basic tasks that may not have been an issue previously. Confusion can also be visible. Simple tasks like dressing and feeding can be an issue and if any of these are witnessed, then you should seek medical attention.
Prevention and treatment
When a proper diagnosis has been made, the best way to treat UTIs in the elderly person is the administration of antibiotics. The main causes of UTIs are gram-negative organisms. For this reason, one is given broad-spectrum antibiotics.
There is also the chance that a UTI could be caused by the simple act of catheterization. If this is the case, then you need to use the catheter less. You can also ensure that it is replaced or removed as often as possible.
If you are taking care of an elderly person who needs a catheter, which is indwelling, you should talk to a doctor as well as the support staff to have it changed according to a schedule.
There are different kinds of catheters and some are created in a way that they can minimize bacteria entry into the bladder. It is important to find out whether the patient really needs the catheter. Understanding the pathophysiology of UTI helps in the treatment.
Prevention
As with all other kinds of diseases and infections, the best way to deal with a UTI is to prevent it from happening in the first place. You can prevent the occurrence or the recurrence of the UTIs in the following ways:
⇒ Avoid douching or any other hygiene products meant for the genital area. This is very common in women.
⇒ Avoid taking any fluids which cause irritation to the bladder like caffeine and alcohol. It’s good to appreciate the ill effects that such drinks can have on the elderly.
⇒ Cranberry juice or any supplements with cranberry should be taken. This is recommended for persons who do not have any kidney stone history within their families.
⇒ Water is also very important. Take lots of water since all bodily functions require water to some level. Urination is one of the functions of the body. This aids in the successful elimination of wastes from the bladder and proper functioning of the kidneys.
⇒ It is also very important that seniors and all people in general, keep their genitals as clean as possible. If a senior person needs to use adult diapers, it is very important that they get changed as regularly as possible. The undergarments should be cotton since it is absorbent and keeps the area dry.
⇒ For the elderly women, as a general rule, it is always important that you wipe starting from the front to the back. This is because of how close the urethra is to the anal region.
The other key thing in avoiding UTIs is not forcing the elderly to wait before they can use the bathroom. If an elderly person happens to say that she has to use the bathroom, then she should be assisted immediately if she is not able to do it on her own.
A full bladder can be a cause of an infection within the urinary tract. A bedpan should be provided so that elderly persons don’t have to struggle too much.
The other important thing about preventing UTIs is training. Staff members who are within homes that provide assisted living should be trained well, so that they can see all the different symptoms and signs of the infection.
Knowing all the dangers associated with UTIs should motivate us to take it more seriously. Assisted living homes need to have adequate staffing so as to make sure that every patient is well taken care of. By being alert and as observant as possible, UTIs can be reduced incredibly.
Facts that you need to note
Around 40% of seniors who are ailing will not show any fever signs even when they have a very serious infection. This is because of their already suppressed immune system. This means that you will need to be extra alert when you are caring for an elderly person.
It is possible for UTIs to be mistaken for adult dementia or Alzheimer’s disease.
Elderly people are more prone to contracting UTIs.
It is possible to minimize or prevent the occurrence of UTIs in elderly persons.
Also important to note is the fact that if UTIs are not treated, they can easily spread to other body parts. This can lead to sepsis and ultimately death. It can be tricky to diagnose a UTI and therefore, you should be very careful about where you get an elderly person medical help.
Can men get UTI?
Yes. Men can also get UTI and the elderly are at a higher risk because of issues such as an enlarged prostate.
Information that can help when caring for elderly persons
Caring for the elderly is not an easy thing, but it is always important to note any changes in their health so as to get them help as soon as possible. There are some things that can help you care for the elderly better. Some of the things to know include:
Just because an elderly person appears to be confused does not mean that they have a UTI. Most people assume that a senior has a UTI if they happen to show signs of confusion. This includes non-medical, and medical people.
However, it is important to know that aging in itself causes more confusion as well as delirium. This is more common in people who have cognitive impairment, those that are malnourished, or persons that dependent.
There are many factors that can lead to delirium and they include dehydration. This means that more tests should be carried out if an elderly person appears to be confused. Never make the assumption without some sort of clear evidence. If positive nitrates in urine are detected, then one may have a UTI.
⇒ 1. Finding bacteria within an elderly person’s urine is not necessarily an issue. Usually, there are bacteria everywhere and some of it is helpful to the body. When the bacteria become too much, then a problem may arise. When urinary bacteria population becomes too elevated, but without any symptoms, increasing the intake of fluid can actually correct the issue naturally.
This is something that happens to women who are over sixty-five years of age. It is not advisable for bacteria’s within the urinary tract to be treated with any antibiotics unless there are other signs of UTI present.
By using antibiotics, it can encourage resistance and this can make it harder to treat them should they arise in the future. Having bacteria that are resistant to antibiotics is very risky and can lead to some serious complications that can include C. Difficile infection and even death.
⇒ 2. Seniors also get other kinds of symptoms when there is a UTI. Apart from confusion, you need to look out for other signs and symptoms in elderly persons as outlined above. You may even notice some tenderness in the senior’s lower abdomen or just above their pubic bone.
When two or more symptoms are present and the urine culture comes out positive, then the UTI is confirmed and treatment should commence immediately.
⇒ 3. Sometimes an underlying issue can lead to the development of UTIs. There are many conditions that older adults can have and they can contribute to UTI development or sometimes similar symptoms can be seen.
Usually, in older men, obstruction in the bladder can cause UTIs. By concentrating in the UTI alone, you fail to deal with the issue that is underlying which is the obstruction. So as to help an elderly person completely, the underlying issue should also be addressed.
⇒ 4. Seniors do not necessarily have to use, powerful antibiotics so as to treat The UTIs. When elderly persons are concerned, treatment should start with antibiotics that are of a narrow spectrum. These are drugs that may not cause any resistance in future and also there are fewer side effects when compared to the broad-spectrum options.
Amoxicillin is a common prescription given to elderly persons when there is a UTI. Even the narrow-spectrum drugs need to be used cautiously especially if the patient happens to have kidney disease or anyone who is using blood pressure meds. These are things that are common to seniors. The side effects can also be greater in elderly persons.
⇒ 5. You should work hard to help your loved one not contract a UTI. Probiotics and cranberry juice have been said to help seniors prevent UTIs. While there is no harm in trying, the way they help cannot be explained clearly and there is still inadequate evidence to show that they actually help. It is, however, important to apply strategies such as more fluid intake and general hygiene.
It is also important to speak to the doctor about vaginal cream for women who are past menopause. Sometimes it helps in the rejuvenation of the vaginal skin and it supports good bacteria. Supplements should also be taken with caution and it is always important to ask an expert before giving anything to the elderly since it can cause some serious issues.
When you follow the above tips, you should be able to actually assist an elderly person and help them to stay as healthy as possible and be productive.
Challenges
One of the most significant challenges that clinicians face in diagnosing the symptoms of UTIs in the elderly, especially if they reside within care facilities on the long-term. This is because there are very few genitourinary symptoms to associate with.
These are necessary for making a proper diagnosis but are not too evident in elderly persons like younger people. UTI and dementia have often been confused, especially for elderly persons who have the latter in the advanced stages. When the mental status of an elderly person changes, UTI is often suspected.
The other thing you note with elderly persons is the fact that localized genitourinary symptoms may be quite infrequent or they may be completely non-existent. This means that elderly persons may still be treated using antibiotics even if the criterion set is not really met.
There are other components that are usually considered for purposes of diagnosing UTIs. There are non-specific symptoms that can be used before antibiotics are prescribed.
According to multiple studies conducted, it is important to actually combine different clinical features. This should include changes in one’s mental status. Such things need to be investigated even further and if possible, they should be included in the algorithm used to make a diagnosis by clinicians.
Management
As we have identified previously, when nonspecific symptoms are present, identifying who gets antibiotics or not can be a challenge. When there are uncertainties, Clinicians usually use empiric antibiotics. By so doing, there seems to be overuse of the anti-microbial and when this is done, there is more incidence of bacterial resistance.
How long does a UTI last untreated?
If an elderly woman has nonspecific symptoms, it is important for the clinicians to encourage such persons to drink more water until more tests are done for proper diagnosis. When a delay is made, usually the women don’t need to use antibiotics in the long run.
Even with no antibiotics, some positive results can be witnessed if adequate amounts of fluids are taken in a weeks’ time. However, it is important to assess other criteria because UTIs can be deadly and can spread if not treated on time.
It is important to be very careful when you are administering antibiotics to seniors. The dose and the duration of use should also be carefully thought out. It is important to aim at the organism that is actually causing the infection so that the side effects can be minimized.
There are older adults in long-term facilities who may have renal insufficiency and this makes it necessary to make some adjustments to the most common dosages by using a glomerular filtration rate which is estimated.
Ask your doctor how to relieve UTI pain at night.
Mobility and UTIs
Decreased mobility in the elderly has shown a great increase in the rate of being hospitalized for UTIs. When an elderly person is not able to walk or move around, UTIs may be more common than usual.
When a resident is able to walk around independently and without any significant assistance, the chances of being hospitalized for UTIs are greatly reduced. This means that when elderly people are able to improve or maintain their mobility within long-term care facilities, they actually protest against any hospitalization related to UTI.
Conclusion
The main thing when it comes to prevention of UTIs is to make some behavioral modifications. Ensure the bladder is emptied wherever the need arises and concentrate on a healthy diet especially among older adults.
Proper hygiene should always be observed and more especially in elderly persons with less mobility and those that are incapable of taking care of themselves. Keep the genital area dry. Always note that prevention of UTIs is better than cure. UTI home tests are available, but a doctor should give a proper diagnosis.
