What Family Caregivers Should Know About UTIs in Older Adults

UTIs can cause unusual behavioral symptoms in older adults you may not initially recognize

What Family Caregivers Must Know About UTIs in Older Adults

If your loved one suddenly becomes confused and disorientated, your first concern might be dementia. But if the changes are sudden, it’s more likely the diagnosis is a urinary tract infection (UTI).

Urinary Tract Infections (UTIs) can cause some unusual symptoms in older adults and can cause serious health complications if left untreated.  

A UTI is an infection caused by bacteria that enters the urinary tract through the urethra. Left untreated, the infection may spread from the bladder to the kidneys, which can increase the risk of kidney failure.

Steve Lin, Licensed Practical Nurse and Healthcare Director at Highgate at Vancouver, shares what family caregivers should know about the symptoms of UTIs in older adults, UTI treatment, and UTI prevention.

UTI Symptoms in the Elderly 

Urinary tract infections are among the most commonly diagnosed infections in older adults. Among women over age 85, the incidence rate is almost 30%. Seniors are more susceptible to UTIs for many reasons, including a weakened immune system and poor hygiene habits. Some conditions also make older individuals more vulnerable to UTIs, too: diabetes, incontinence, immobility, kidney stores, and dementia to name a few.  

Family caregivers play an important role in recognizing new health issues in their loved ones, Lin says:

“The symptoms in each person can be a little bit different. It’s super individual. So someone who is caring for a loved one at home may not initially recognize the signs that indicate a UTI in their loved one. Not everyone will show [symptoms] the same way.”

Common UTI Symptoms

Some of the typical UTI symptoms include: 

  • The need to go to the bathroom frequently or urgently
  • Complaints of discomfort while urinating
  • Pain in the lower abdominal area
  • Frequently touching themselves
  • Cloudy, dark, or foul-smelling urine
  • New or worsening incontinence
  • Low-grade fever
  • Night sweats, shaking, or chills

Common Overlooked UTI Symptoms Among Seniors 

In the elderly, it can be more difficult to recognize UTIs because they may present as fever accompanied by sudden changes in cognition or behavioral symptoms. Some of the lesser-known UTI symptoms older adults exhibit include:

  • Confusion or delirium
  • Agitation
  • Hallucinations
  • Other unusual behavioral changes
  • Poor motor skills or loss of coordination
  • Dizziness
  • Falling
  • Nausea or vomiting
“When someone has a UTI, the kidneys aren’t working the way they’re supposed to, so toxins get left in the bloodstream,” Lin says. “Those toxins can affect balance and cognition. That’s why confusion is one of the signs. And especially among the elderly, it can affect their balance and their gait, which can cause falls.”

And again, if your loved one experiences rapid changes in thinking or behavior, it’s more likely a UTI or dehydration than dementia. Dementia is a progressive disease, and changes do not usually occur in a sudden manner. 

A Note on Dementia and UTIs

If your loved one has dementia or memory loss, they may be unable to tell you that they’re experiencing a burning sensation when urinating or that they have abdominal cramping or back pain. Plus, someone with dementia is more at risk of contracting a urinary tract infection because they may not be as capable of managing personal hygiene like they used to be.

“The challenge with someone with dementia is they can’t tell you they have pain or something is off,” Lin says. “And you’re not able to notice the confusion. So you have to be mindful: What other symptoms do they normally exhibit? Are they needing to use the bathroom more frequently? If you suspect a possible infection, monitoring the characteristics of the urine can help. Is the urine cloudy? Can you see any particles or sediments? Is the odor of the urine foul or different from the usual?”

UTI Diagnosis and Treatment

If your loved one is exhibiting signs of UTI, make an appointment with a health care provider. Although there are home test strips for UTIs that family caregivers can pick up at a drugstore to keep on hand, over-the-counter tests are not completely reliable.

Most UTIs are treated with antibiotics, but your loved one’s health care provider should perform a urine culture to determine the type of bacteria causing the infection and the best antibiotic to treat it, as well as consider your loved one’s health status and other medications. Medication isn’t always required. 

“At home, the best thing to do is to push fluids,” Lin says. “Sometimes that is sufficient to clear out the urinary tract if caught early enough.”

Tips for Family Caregivers for Preventing UTIs in Older Loved Ones

There are many things you can do at home to help your loved one prevent a urinary tract infection or to minimize the recurrence of UTIs.

1. Practice Proper Hygiene

Proper toileting and continence care can minimize the likelihood of an infection. If incontinence is not an issue, ensure your loved one wears breathable cotton underwear and changes them at least once a day. If necessary, remind your loved one that women should always wipe from front to back. This blog, “How to Talk to an Aging Parent About Hygiene,” has some tips for addressing personal hygiene with a loved one in a way that doesn’t result in hurt feelings.

If incontinence is an issue, always change soiled incontinence briefs promptly and frequently to keep the genital area clean and dry. It may work to set timers for seniors who are memory impaired to try to use the bathroom instead of a brief.

If a loved one isn’t taking proper care of themselves, there could be many reasons why. It is critical that you first understand why your loved one is not bathing or changing their clothes regularly. This Personal Hygiene Checklist will help you identify what the difficulties are for your loved one and adjust the way you talk about and approach bathing and hygiene.

2. Maintain Sufficient Fluid Intake

Drinking plenty of fluids is key to preventing UTIs. Aim for two to four quarts of water each day,  unless this conflicts with a doctor’s orders, and avoid or limit caffeine and alcohol, which irritate the bladder.

Cranberry juice has been used as a natural treatment for preventing bladder infections for generations, but it’s not clear whether cranberry juice really works for preventing bladder infections in the larger population. Don’t push cranberry juice if your loved one has a personal or family history of kidney stones.

“At Highgate, we encourage our residents to drink during and in between meals,” Lin says. “Care partners refill residents’ hydration cups when they are in their rooms. We also assist with reminders if the family provides beverages like Powerade or Gatorade. But overconsumption of sodas, juices, and coffees is not good hydration.”

3. Empty the Bladder Frequently

Going to the bathroom as soon as there is a need can help clear out any lingering bacteria and reduce the occurrence of UTIs. 

“Frequent toileting and refreshing ensure that our residents are clean, dry, and comfortable,” Lin says. “This helps to keep UTIs away.”

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