Is It a UTI? In Elderly People, These Are the Signs and Symptoms to Watch For

What is a UTI?

A UTI starts when bacteria get into your urine and enter your urinary tract. Although your urinary system is designed to keep out bacteria, many of its defense mechanisms can weaken with age. As a result, older people are much more vulnerable to UTIs. Check out these facts on the impact of UTIs on elderly Americans:

• UTIs are the reason behind more than 8.1 million healthcare appointments annually in the U.S., and they cost the healthcare system an average of about $3.5 billion each year.
• A study in Aging Health found that over one-third of the infections experienced by nursing home patients are UTIs.
• The same study also found that more than 10 percent of females older than 65 and almost 30 percent of females older than 85 have had a UTI in the previous 12 months.
• Women have a higher lifetime risk of developing a urinary tract infection compared to men. However, according to a study in the World Journal of Urology, men are more often hospitalized due to UTIs than women.

"Urinary tract infection" is an umbrella term that can describe several medical problems. To fully understand the different types of UTIs and what causes them, it helps to know the anatomy of the urinary system. The four main parts are:

• Kidneys: Where urine is produced
• Ureters: Tubes that carry urine from kidneys to the bladder
• Bladder: The hollow organ that acts as a holding place for urine until it is excreted through urination
• Urethra: The tube that carries urine from the bladder to the outside of your body

The exact name of a UTI depends on the location of the infection:

• Cystitis is an infection in the bladder. The bacterium called E. coli is responsible for up to 90 percent of uncomplicated cystitis cases.
• Pyelonephritis is an infection in the kidneys.
• Urethritis is an infection of the urethra.
• Prostatitis is an inflammation of the prostate gland that can be caused by a UTI.

What causes UTIs? Risk factors and why they change with age

Since urine usually travels one way when it leaves the body, bacteria shouldn't enter the urinary system in ideal circumstances. However, the urethra is very close to the rectum and is surrounded by skin that harbors bacteria. And when those bacteria enter the urethra, infection often results. So it's not surprising that women have a higher risk for UTIs; their urethras are shorter, and bacteria don't have to travel as far to the bladder.

Several factors can make people of all genders more vulnerable to infections as they age. Some of the reasons why elderly people get UTIs at higher rates include:

1. Urinary retention

You are more likely to develop a UTI if you cannot completely empty your bladder when you pee (a condition called urinary retention). That's because stagnant urine is a breeding ground for bacteria.

Seniors are more likely to experience urinary retention. Some age-related reasons for this include:

• Bladder muscles become weaker and less flexible with age.
• Enlarged prostate glands in older men can prevent urine from flowing smoothly.
• Prolapsed bladders in women (a condition in which the bladder drops, sometimes into the vagina) can lead to difficulties in completely emptying the bladder.
• Kidney stones and constipation can block the flow of urine.

2. Incontinence

Both urinary and bowel incontinence can create conditions that lead to UTIs. Wearing pads or adult diapers to deal with incontinence can raise the risk if they aren't changed often enough.

3. Hormonal changes

In younger women, estrogen helps protect the balance of bacteria in the vagina and urinary tract. As estrogen declines with age, E. coli can grow unchecked because the number of "good" bacteria that fight E. coli also declines.

4. Obesity

People with higher body mass indexes (BMIs) have higher rates of UTIs. If you gain weight with age, you could be at greater risk for a UTI.

5. Prior infections

Your odds of acquiring a UTI increase if you've had one before. The Aging Health study found that women who have gone through menopause are four times more likely to develop a UTI if they've had one before than women who've never had a UTI.

6. Medical conditions

Because diabetics often have weakened immunity, they are at greater risk for UTIs. In addition, other medical conditions that are more common in older adults—such as Parkinson's, Alzheimer's, and multiple sclerosis—are linked to increased rates of UTIs because they can lead to bladder problems. "Neurogenic bladder" is the term used when disruptions in the way the brain communicates to the bladder cause problems like urinary retention.

7. Catheter use

Bacteria can enter the urinary system through a catheter. Catheter-acquired urinary infections from indwelling catheters (i.e., catheters that remain attached to the body) represent one of the most common causes of infections within long-term care facilities, according to research published in Antimicrobial Resistance and Infection Control.

Other factors that can lead to a UTI include having sexual intercourse (particularly with a new partner), poor hygiene, and the use of products such as scented deodorants or spermicides.

How do you know if you have a UTI?

Signs of UTI problems can change as we age. This shift is particularly frustrating for caregivers, who may miss important signs of an infection. But because UTIs can spread quickly in older adults, it's important to get a diagnosis as soon as possible.

It is important to know the symptoms of a UTI, including those experienced at any age and those more likely to be experienced by seniors.

UTI symptoms than can be experienced at any age include:

• Feeling an overwhelming need to urinate immediately
• A burning sensation when you pee
• Having to urinate a lot more frequently than usual
• Pain in the pelvic region

A UTI can also make you tired and generally uncomfortable.

Pain in your back or side can be a sign that an infection has spread to your kidneys. Other signs of a possible kidney infection include nausea, vomiting, fever, chills, and blood in your urine.

However, many of these symptoms can be experienced by seniors who don't have a UTI. In the elderly, symptoms like these are sometimes just part of aging. For example, age-related loss of elasticity in the bladder can lead to more frequent urination, even without a bladder infection. So even when you strongly suspect a UTI in yourself or someone close to you, only a doctor can make a definitive diagnosis.

Another complication in diagnosing a UTI in seniors is that older adults often don't display the typical UTI symptoms. In elderly people, for example, a sudden change in behavior can indicate a UTI. Some of these behavioral changes may include:

• Confusion
• Agitation
• Hallucinations
• Restlessness
• Delirium
• Lowered alertness
• Sudden unexplained incontinence
• Increased falls and other declines in physical functioning

However, it's often difficult for caregivers to connect strange behavior to a possible UTI. Elderly behavioral changes are often dismissed as a normal part of growing older. And many other factors can contribute to those changes apart from a UTI. In elderly people with dementia, communication difficulties make it even harder to determine a cause.

But it's important to address unexplained behavioral changes as soon as possible. That's because if a UTI goes untreated in elderly people, it can cause significant kidney problems. And UTIs can be fatal if they spread to the bloodstream.

How can a seemingly uncomplicated UTI become so serious? Sepsis is often to blame. Sepsis refers to an infection in the bloodstream, and it's one of the most severe UTI complications.

Some of the early warning signs of sepsis are fever, an increased heartbeat, and confusion. From that point, a person with sepsis can go into septic shock and develop dangerously low blood pressure, an altered mental state, and eventual organ failure. As a result, severe septic shock has a mortality rate of about 40 to 60 percent. In other words, people who are elderly can die from UTI complications if they go into septic shock.

What's the best way to treat a UTI?

Although some UTI symptoms may appear to get better, a urinary tract infection won't go away on its own. So if you suspect that you (or someone close to you) might have a UTI, you should talk to a doctor right away. When in doubt, keep this in mind: UTI bacteria can spread quickly. And a UTI can cause permanent damage if left untreated.

Visiting Your Doctor

Here's what happens when you visit a doctor for a suspected UTI: The physician may start by requesting and examining a urine sample. Your physician might also perform a urine culture to determine the type of bacteria responsible if an infection is detected. They may want to do some extra tests, particularly if you've had a chronic UTI. For example, you may need a cystogram, an x-ray of the urinary tract that can reveal whether you have blockages that prevent the smooth flow of urine.

Why Antibiotics Aren't Always Prescribed

For younger patients, if bacteria are present in a urine sample, the first treatment is generally antibiotics. However, when it comes to elderly patients, the diagnosis and treatment aren't always as clear-cut. That's partly because many elderly patients have bacteria in their urine even if they don't have a UTI. The scientific name for this is asymptomatic bacteriuria (ASB). This presence of bacteria becomes increasingly common with age. (According to the Aging Health study, up to 50 percent of female residents in long-term care facilities have ASB.)

Because ASB doesn't cause any physical problems, an antibiotic isn't usually considered to be necessary. That means a physician might not always prescribe antibiotics after a positive urine test.

Physicians are also reluctant to prescribe antibiotics if a patient doesn't have clear symptoms because of the medical community's wish to minimize unnecessary antibiotics prescriptions. Overuse of antibiotics has led to an increase in infections that are resistant to antibiotics, so it's important not to overprescribe them.

How do physicians know whether an elderly patient has a UTI and when to prescribe antibiotics? They typically consider other signs of a UTI, such as frequent or burning urination. But, as discussed above, older patients don't always have these "typical" UTI symptoms. Elderly dementia patients, in particular, may only have behavioral changes.

These factors can make diagnosing and treating a UTI in the elderly much more complex than it is for younger people. So if you're confused by a doctor's approach to treating UTI symptoms in yourself or a loved one, be sure to mention your concerns. Keep in mind that physicians are balancing many different factors when treating UTIs in seniors. Clear communication is the key.

A doctor may also prescribe antipsychotic medications if a patient experiences delirium or other mental health changes due to a UTI. But, as always, each situation is different. So open conversation is the best way to resolve any confusion about the best treatment options.

Recovering from a UTI: Self-care tips

It takes 24 to 48 hours to recover from a UTI's most painful symptoms for an uncomplicated infection. But it can take up to a week to stop feeling symptoms if your kidneys are affected.

If you are prescribed an antibiotic to treat a UTI, make sure you finish the full course of treatment. Bacteria can still be present after your symptoms have gone away. So if you stop taking the antibiotics as soon as you feel better, the infection can grow even worse, and the symptoms can return (often with a vengeance). Plus, the UTI bacteria could develop a resistance to the antibiotics. Recurrent urinary tract infections are often the result of patients not finishing their entire prescriptions.

What to Avoid

While you're recovering from a UTI and waiting for the antibiotic to clear up the infection, some simple steps can help ease any severe UTI symptoms. During this time, you don't want to stress your body or consume anything that will make it even more painful to pee. So when you have a UTI, you should not eat spicy foods, citrus fruits, or anything made with artificial sweeteners. Wine and soda can also irritate your bladder and should be avoided.

Similarly, because it also irritates the bladder, coffee is not good for UTI symptom relief. But, potentially, you can drink green tea for UTI prevention and treatment. Scientists have found that green tea may fight bacteria in the urinary tract.

The So-Called "Cures"

What about cranberry juice? If you've ever had a UTI, you've probably been advised to drink some as a cure. In fact, for centuries, people have turned to cranberry juice (and more recently, capsules of cranberry extract) for prevention of and relief from UTIs. And cranberries do contain substances that may prevent bacteria from sticking to the lining of the urinary tract. But scientific studies are mixed when it comes to actual results.

So it's best to discuss drinking cranberry juice as a preventive measure with your doctor, especially if you have other health issues. (In particular, cranberry juice can reduce the effectiveness of blood thinners, so be cautious if you take medications like Warfarin.)

And if you do try the so-called "cranberry cure," make sure you are not drinking cranberry cocktail, which is heavily sweetened. That said, because it is quite bitter, pure cranberry juice is more difficult to drink in the large amounts required to prevent UTIs. Diluting it with flat or sparkling water can help it be more tolerable/enjoyable.

Apple cider vinegar is also sometimes touted as a cure for UTIs. However, peer-reviewed studies have found that apple cider vinegar is not good for UTI treatment. Apple cider vinegar is very acidic, so drinking it when you have a UTI could make urinating extra painful.

D-mannose may be worth considering. It's a supplement that has recently received some attention for preventing and even treating UTIs. But if you'd like to learn more about it, it's best to talk to your physician.

Chronic or Recurring UTIs

Some seniors are surprised to find out that UTIs can reoccur after treatment. If you have a UTI more than two times in six months, you have what's considered to be a recurrent UTI. The more urinary tract infections you've had, the more likely you will have a recurring UTI.

A UTI recurs because conditions continue to make infection likely or the bacteria causing the UTI are not fully destroyed.

Plus, low estrogen levels might make you more vulnerable to a chronic UTI. Even conditions like celiac disease can lead to recurrent UTIs. In males, recurrent urinary tract infections can be due to a blockage, such as an enlarged prostate. As well, some people simply have a genetic tendency for chronic urinary tract infections.

If you experience repeated UTIs despite following preventive measures, consider talking to a urologist.

How to prevent UTIs

As a senior, you face more risk factors for UTIs. But you can take preventive steps to protect your urinary tract.

1. Don't fight the urge to pee.

If you've got to go, head to the bathroom. It's not healthy for your bladder to hold urine for long periods. During the day, you should urinate at least every three to four hours.

2. Stay hydrated.

Drinking 8 to 10 glasses of water a day can help keep bacteria at bay. Your urine should be clear and light-colored. If you have trouble keeping track of how much water you drink, a water bottle with measurements for both volume and time of day can be useful. If you can remember to drink a bit at every time interval, you can stay hydrated without chugging a lot at once.

Sometimes, people who have incontinence or urgency issues restrict their fluid intake in hopes of reducing their bathroom visits. But this practice won't protect your bladder health in the long run.

3. Practice good bathroom routines.

Women should wipe from front to back. And some evidence suggests that when women "squat" over the toilet to avoid touching the seat, they raise their risk for urinary retention because their bladder muscles don't relax. So it's best to sit right on the toilet seat. (It's extremely rare to catch anything from a toilet seat. But carry disinfectant wipes with you if you're nervous about it.)

4. Let your skin breathe.

For women, wearing cotton underwear and avoiding tight-fitting pants will help keep your urethra dry. Avoiding thongs is also a preventative measure worth considering, since they facilitate the transfer of bacteria. Additionally, there are minimalistic, leakproof underwear for women that wick away moisture and help keep you dry without a pantyliner, pad, or disposable, incontinence underwear.

For men, there are similar guidelines for avoiding a UTI. Wearing cotton underwear and breathable pants are a great start. There are now leakproof underwear for men that are discrete and provide a good option for guys who need a bit of protection but aren't fully incontinent. You can even get leakproof boxer shorts and boxer briefs that don't outwardly show any indication of the absorbent layer inside.

5. Urinate after sexual intercourse.

Doing this helps clear any harmful bacteria from your urethra that might have been introduced while having sex.

6. Stay clean.

Shower frequently if possible. Or if you need to take baths, try to keep your bathing time under 30 minutes. And don't use products like deodorant sprays near your genital area.

7. Change incontinence pads or adult diapers frequently.

The longer you leave soiled items in place, the more likely it is that bacteria will infect your urinary tract.

8. Ask your doctor about estrogen cream.

For women, topical estrogen supplements in the vagina can restore the balance of good and bad bacteria. However, even though very little topical estrogen is absorbed into the bloodstream, you should discuss estrogen's health risks with your doctor.

9. Try double voiding.

Peeing twice during one visit to the bathroom—which is sometimes called double voiding—can help prevent urinary retention. So when you've urinated and think you've finished, stand up and sit down a few times, then try to urinate again.

10. Be aware of best practices for avoiding catheter-acquired infections.

If you have an indwelling catheter (or if someone close to you does), it's a good idea to ask your healthcare provider every so often whether it's still necessary. As well, make sure your hands are always clean if you touch the catheter. And avoid pulling on it, kinking it, or twisting it. Also, make sure the drainage bag is always below the bladder.

UTIs in nursing homes: How to advocate for urinary health

Nursing home residents often face extra challenges in making lifestyle changes that reduce the risk of UTIs. So perhaps it's not surprising that UTIs represent the most common type of infection in nursing homes.

When choosing a potential nursing home, it's important to ensure that the facility takes adequate steps to reduce the risk. For example, some facilities use portable bladder scanners to ensure that patients' bladders have been completely emptied. These scanners have proven to be effective in reducing the number of UTIs. However, relatively few long-term care homes use them.

Here are some other UTI-prevention strategies to inquire about with a potential long-term care home:

• Is fluid intake encouraged? Dehydration in elderly nursing-home residents is an often-overlooked contributor to UTIs.
• Are indwelling catheters only used if medically necessary? Are they checked on a regular schedule and removed once they aren't needed? Proper use of catheters is a key component of preventing UTIs in the elderly. (The CDC has issued guidelines to reduce unnecessary catheter use.)
• Are residents kept clean and dry?
• What is the bathing schedule?
• Are residents encouraged to use the bathroom often?
• Are staff well-informed on current infection-control practices? Staff members must be aware of what causes a UTI in elderly people.
• Is there a policy on the frequency of changing adult diapers or incontinence pads?

Don't be afraid to discuss UTI prevention with staff at any nursing home you visit. After all, a simple infection can quickly become an emergency for seniors, and all nursing homes want to prevent serious illnesses.

Stay Informed

When it comes to UTIs, knowledge is your best defense. An awareness of what causes UTI problems, how to prevent infections, and the best ways to treat them can help you maintain good bladder health. Sure, UTIs can be more complex as we age. But having open conversations with your healthcare provider will help you stay healthier over the long run.