UTIs: Symptoms, Causes & Prevention in the Elderly

Senior woman in wheelchair look worried with her hands on her forehead

The basics about UTIs can be found in one of our first blogs, Health Wise – Urinary Tract Infections in the Elderly. Because UTIs continue to be a very common, serious and frequently undiagnosed illness in the elderly, today’s blog provides additional information about UTI symptoms in the elderly, causes and prevention.

The most common reason UTIs often go undiagnosed in the elderly is because the symptoms don’t mirror typical symptoms of UTIs. What can be an easy cure (antibiotics) might not be administered, because your first thought could be that your elderly loved one has a much more serious condition, like dementia or other permanent behavioral changes.
The most commonly recognized symptoms of UTIs are frequent urination, burning pain, cloudy urine, a fever and lower back pain. Because many senior citizens’ immune systems have been weakened by time and are not functioning at optimal levels, they have increased susceptibility to any infection. Their bodies do not recognize or try to fight the infection; thus, no fever, but producing UTI symptoms in the elderly that can be very different:

  • Disorientation, confusion or a delirium-like state
  • Hallucinations: hearing or seeing things that aren’t real
  • Agitation, depression or other behavioral changes
  • Decreased motor skills and/or dizziness that causes frequent falls

Why these symptoms frequently are the result of a UTI in an elderly is something of a mystery. However, as all infections can lead to dehydration which, by itself, can produce these types of symptoms, that may be one reason. Dehydration is common in the elderly for a variety of reasons. If any of these symptoms come on suddenly, an immediate visit to the doctor is called for. Make sure it includes a urine test to determine whether or not a UTI is the cause. A urine test can also help to determine the type of bacteria that is causing the infection and which antibiotic will be the most effective way to treat it.

Anything that introduces bacteria into the urinary tract or blocks the flow of urine and causes urine to stay in the bladder is very likely to cause a UTI. Eighty five percent of all UTI infections are caused by E. coli bacteria. If not treated quickly, it can travel to the bloodstream causing Sepsis, a life-threatening condition. Older individuals are more vulnerable to UTIs for several reasons:

  • Not communicating or even recognizing symptoms of illness
  • Decreased personal hygiene, such as wearing soiled or disposable underwear too long, or a woman wiping back-to-front
  • Urine staying in the bladder for a longer than normal period of time, which can be caused by:
    • Lowering fluid intake to avoid the embarrassment of bladder control issues, leading to less frequent urination and a pool of urine being held in the bladder
    • A weakening of the muscles of the bladder and pelvic floor, or a prolapsed bladder, causing an elderly person to retain urine longer and to experience incontinence
    • Ailments that make it harder to pass urine: diabetes, kidney infections, kidney stones, enlarged prostate

In addition to slowing the process of urinating, diabetes raises glucose in the urine, which also increases the likelihood of a UTI. The inability to urinate properly can necessitate a catheter, which may be difficult for a non-professional to keep sanitary.

Focusing on how to keep an elderly person’s bladder healthy can help to avoid a very troubling illness. Here are some tips you may not have thought of:

  1. Keep to a schedule, setting an alarm to remind the person or caregiver every 3 – 4 hours that it’s time to urinate.
  2. Make sure the person wears and frequently changes loose, cotton or disposable underwear and loose fitting clothes that allow air to keep the area dry.
  3. Women should wipe from front to back especially after a bowel movement.
  4. Encourage your loved one to drink enough fluids. Water is the best fluid for bladder health. Ask your healthcare provider how much water is healthy for your loved one. Limit alcohol and caffeine.
  5. Take enough time to fully empty the bladder when urinating.In an elderly person, urine might not come in a steady stream but in several shorter ones.
  6. Help the person to be in a relaxed position while urinating.Relaxing the muscles around the bladder will make it easier to empty it. For both women and men, sitting on the toilet seat may make it easier to relax.
  7. You can keep home test strips for UTIs (available at most drugstores) on hand in case your loved ones suddenly begin showing physical or behavioral symptoms. However, over-the-counter tests are not completely reliable. A urine culture performed by a laboratory is necessary to determine the strain of bacteria that is causing the infection and the appropriate antibiotic that must be prescribed to treat it. In cases where infection is recurrent, doctors may prescribe regular preventative doses of broad-spectrum antibiotics.

As people age, they can lose certain self-care abilities that we all might take for granted. A family caregiver or a home care professional can be very helpful, because better health is often the result of better care. Dakota Home Care provides home companion care and respite care services that can help you care for your loved one. Because every situation is different, we assign experienced Home Health Aides and nurse managers to assess and provide in-home care for our clients as well as support and education for their families. We work with you and your healthcare team to draft and implement an individualized plan for care and wellness. To receive a free consultation for home companion care services, call (877) 691-0015. 


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