Last Update: April 4, 2013
If a 30-year-old woman experiences painful burning when she
urinates, it's almost certain she has a urinary tract infection
(UTI). But an elderly urinary tract infection rarely causes such
clear symptoms and might not involve pain or discomfort at all. "As
you get older your immune response changes; it's part of normal
aging," says Anna Treinkman, a nurse practitioner at the Rush
Alzheimer's Disease Center in Chicago and president of the National
Conference of Gerontological Nurse Practitioners.
Common Warning Signs
A sudden change in behavior is, in fact, one of the best
indicators of a urinary tract infection in older adults. Some
common warning signs might include the onset of elderly urinary
incontinence, confusion or not being able to do tasks the patient
could easily do a day or two before. "Anytime there's a change
in an older adult… if one day they're able to dress themselves or
feed themselves and then there's a sudden change, a red flag should
go up in a caregiver's mind," Treinkman says.
UTIs: The Body's 2nd Most Common Infection
Half of all women will develop a urinary tract infection in
their lifetimes. Ranking as the body's second-most common infection
type, UTIs in women-and less often in men-account for about 8.3
million doctor visits each year, according to the National Center
for Health Statistics. Typically, UTIs, also known as bladder
infections, are easy to cure. But if left untreated, the infection
can spread and develop into far more serious conditions. UTIs, for
instance, are a leading cause of sepsis, a potentially
life-threatening infection of the bloodstream.
"A bladder infection places stress on the body," says Dr. Mary
Ann Forciea, an associate clinical professor for the University of
Pennsylvania Health System. That stress can result in confusion and
abrupt changes in behavior in older adults with an elderly urinary
tract infection. And for people suffering from
Parkinson's disease, Alzheimer's
disease, or other dementia,
"any kind of stress, physical or emotional, will often make
dementia temporarily worse," Forciea says.
Urinary Tract Infection (UTI) Causes and Symptoms
The kidneys, ureters, bladder and urethra work together to rid
the body of urine: the kidneys remove extra liquid and waste from
the blood in the form of urine, the ureters carry the urine from
the kidneys to the bladder, and the bladder stores the urine until
it is emptied through the urethra.
An infection can occur when bacteria cling to the opening of the
urethra and begin to multiply. UTIs are thought to be much more
common in women because the urethra is shorter in women than in
men, giving bacteria-which live in the rectal area and also on a
person's skin-an easier route into the body.
The most common diagnosis is iscystitis, or the infection and
inflammation of the bladder, which causes frequent and painful
urination. However, other parts of the lower and upper urinary
tract system can become infected. As a general rule of thumb: the
higher up the infection in the urinary tract system, the worse it
Urethritis, Pyelonephritis and Toprostatitis
- Urethritis - Burning urination is often the
result of urethritis, the infection of the urethra. In men,
urethritis can also cause penile discharge.
- Pyelonephritis - Pyelonephritis occurs when a
bladder infection spreads to the kidneys. It can cause upper back
and flank pain, shaking, chills, nausea and vomiting.
- Toprostatitis - UTIs in men can lead
toprostatitis, or enlargement of the prostate gland, the male organ
that produces semen, which is located just below the bladder.
Other symptoms of a UTI include general discomfort, a
feeling of being over-tired, blood in the urine and pain even when
not urinating. Men might feel fullness in the rectum. Back and side
pain can indicate the infection has reached the kidneys. An elderly
person will rarely get a fever, but if an older patient has one it
is considered an emergency. "It shouldn't be taken lightly,"
Treinkman says. "If they do have a fever, it's a serious
Diagnosis and Treatment
In most cases, diagnosing and treating an elderly urinary tract
infection is relatively straightforward: a simple urinalysis can
confirm the infection's presence and, for someone in good health,
antibiotics are the first choice of treatment. UTIs often clear up
in only a few days. But depending on the age and health of the
patient--and the severity of the infection--the course of treatment
can take weeks and perhaps involve hospitalization for the
administration of intravenous antibiotics. A doctor might also
decide to "culture" a patient's urine to determine the type of
bacteria that's growing to prescribe the most effective antibiotic
for the condition.
Older adults living in a group setting such as senior
communities or nursing homes are
more likely to be resistant to the antibiotics most often
prescribed for UTIs such as amoxicillin or nitrofurantoin, and
might require something stronger, as well as a longer course of
antibiotics to combat an elderly urinary tract infection.
Forciea says people suffering from UTIs must drink plenty of
fluids to flush the bacteria from their systems. Proper fluid
intake makes it harder for bacteria to live and multiply in the
urinary tract. She recommends older adults drink four to six
8-ounce glasses of water a day. Drinking cranberry juice or taking
cranberry tablets can also make urine less inviting for bacteria,
If your loved one's symptoms are consistent with a bladder
infection, it's recommended that his or her healthcare provider be
called for an appointment the same day that the symptoms are
recognized. If it appears the infection might involve the kidneys,
call the healthcare provider immediately to consult on whether a
trip to the emergency room is necessary.
Risk Factors and Prevention
Who's at risk?
Older adults at greater risk for getting an elderly urinary
tract infection include:
- Those who require a catheter in the urethra and bladder
- Those who are diabetics
- Anyone with kidney stones
- Women who've gone through menopause
After menopause, women experience a change in the lining of the
vagina and also produce less estrogen, which helps protect against
UTIs. Hormone replacement therapy (HRT) can help protect
postmenopausal women from UTIs, according to the American
Urological Association, but HRT may increase other health risks and
so may not be appropriate for all women.
All women who have had a UTI at least once before are also at
increased odds of developing the infection again. About 20 percent
of women who've had a UTI will experience a second one, and 30
percent of those women will get a third.
Diagnosing a UTI
Here are some common ways to diagnose a UTI:
Home tests - A dipstick is held in the urine
stream. Home tests are a convenient way for chronic UTI sufferers
to quickly diagnose whether they have an infection. But they should
only be used with the support and guidance of a patient's
Ultrasound exam - Ultrasoudns can help evaluate
bladder and kidney problems as doctors are able to see whether
there are abnormalities in the bladder that could be contributing
to the infections.
X-rays - Using a series of x-rays and a
contrast dye to highlight abnormalities in the urinary tract can
help pin-point abnormalities.
CAT scan - A CAT scan provides a detailed
three-dimensional picture of the urinary tract.
The Importance of Water Intake
Treinkman says UTIs are also more likely to affect people who
attempt to manage stress incontinence by limiting their water
intake. "They might limit the water they drink so they don't have
to go to bathroom so much," she says. "But it puts them at higher
risk because there's a greater chance of bacteria build up... You
want to keep your urine clear."
Drinking plenty of water is an important prevention tactic. Some
other methods for women include:
- Urinating promptly after the urge arises
- Wiping front to back
- Emptying the bladder shortly before and after intercourse
- Avoiding use of feminine products such as deodorant sprays,
douches and powders in the genital area that could irritate the
- Taking showers instead of baths
Noticing a Change In Behavior
Most importantly, Treinkman says that caregivers can't be too
careful when they notice a change in behavior in an older adult, no
matter how subtle. "Falls, confusion, new onset of incontinence in
someone who had been getting to the bathroom, decrease in
appetite," she says, "any of these can be a sign of a urinary tract
infection. It really requires a detective-like index of suspicion
from the caregiver."