Urinary tract infections in the elderly can result in confusion and delusions. Learn about UTIs in the elderly and how to maintain a healthy urinary tract to avoid infections and stay healthy.
What is a Urinary Tract Infection (UTI)?
A urinary tract infection results from bacteria entering the kidney, bladder, and urethra. For most adults, symptoms include frequent urination, burning when urinating, and pain in the back or pelvis. Cloudy urine or having blood in the urine is a possible sign of a bladder infection or urinary tract infection that can result in confusion in the elderly.
Sometimes, UTIs have no symptoms.
According to
Wojszel signs of a UTI in the elderly include:
- 28.9% confusion
- 20% low blood pressure (hypotension)
- 11.1% a rapid heartbeat (tachycardia)
- 11% a fever
In the elderly, urinary tract infection confusion is sometimes related to delirium. Urinary tract infections in the elderly can result in dehydration and electrolyte imbalances.
Disorganized thinking and an inability to focus on conversations and information can be
signs of delirium.For the elderly with memory loss who are diagnosed with a UTI and memory loss, the level of confusion resulting from a bladder infection can last for days, if not weeks, due to associated medical complications.
Many elderly with urinary tract infections are hospitalized and may be sent to a nursing home for a full recovery before returning home. The
CAM-ICU Confusion Assessment Method is an assessment used by staff in hospital intensive care units where the rate of delirium can range from 40-87%.
Treatment is usually through antibiotics, although frequent antibiotics can cause other health complications.
Medical Care for UTIs
Urinary tract infections (UTIs) are the most common infections affecting 50-60% of adult women. (1) A high number of doctor visits are associated with the diagnosis and treatment of urinary tract infections.
For older adults, urinary tract infections account for 15.5% of hospitalizations and 6.2% of deaths due to infectious diseases and repeated emergency room and office visits each year, according to
Dutta et al. (2) and
Wojszel. (4) Mental confusion and an inability to concentrate can be an early sign of a urinary tract infection in the elderly.
Taking antibiotics too frequently can result in bacteria becoming resistant to treatment, making infections harder to treat or requiring more potent antibiotics. Taking antibiotics affects helpful bacteria in the gut, leading to digestive issues and lowered immunity.
C. diff (Clostridium Difficile) in the Elderly
Antibiotics can cause nausea, diarrhea, and skin rashes in some individuals. C. diff or Clostridium Difficile is a common bacterium that causes diarrhea in the elderly.
The elderly taking antibiotics can be diagnosed with a C. diff infection. Symptoms include a temperature, loss of appetite, stomach pain, and generally not feeling well.
C. diff infections spread quickly in older adult communities and nursing homes.
Hospitalized elderly with Clostridium difficile are often discharged to a long-term care facility, which can increase the spread of C. diff in nursing homes. In an article by
Jump et al., 67% of people with nursing home-onset C. difficile infections were discharged from a hospital in the previous four weeks to a long-term care facility (3)
Assisted living, memory care, and nursing home communities will often close their doors during the winter months if a significant number of residents are being treated for C. diff.
Related Health Conditions for UTIs and the Elderly
Elderly persons with a combination of chronic diseases are more likely to be diagnosed with a urinary tract infection. Conditions contributing to frequent UTIs include diabetes, an enlarged prostate gland in men, malnutrition, depression, dehydration, and general physical weakness.
The
Barthel Index of Physical Disability is an assessment upon admission to the hospital or nursing home to determine an older adult’s physical independence level. A decline in the ability to perform activities of daily living can be an early sign of physical weakness related to a urinary tract infection in the elderly.
Link Between Physical Fitness and Urinary Tract Infections in Women
A study that assessed body mass index (BMI), grip strength, quadriceps torque, and walking speed was used to evaluate women aged 70 or older who had new or repeated urinary tract infections.
While these factors did not influence women who already experienced urgency urinary incontinence (UUI) urinary incontinence, women had increased odds of a new or persistent stress urinary incontinence (SUI) if they demonstrated a 5% or more significant decrease in grip strength, a 5% or more significant increase in BMI, or a 5% or greater decrease in fat mass.
Managing weight and increasing muscle strength can reduce the risk of stress urinary incontinence. The study confirms a relationship between physical disability and weakness and the risk of urinary tract infections.
According to the study by
Suskind (5), low
Norton-Scale scores indicating an ability to manage daily activities independently and a low value of the
Barthel Index of Physical Disability were predictors of urinary tract infections for persons admitted to hospitals and long-term care facilities.
More frequent urinary tract infections in the elderly seem to worsen the ability to perform activities of daily living (ADLs). Infections such as pneumonia, dehydration, and electrolyte disorders can increase mental confusion. Low blood pressure and a rapid heartbeat are often identified in the elderly diagnosed with urinary tract infections.
Tips to Prevent Urinary Tract Infections by Keeping the Bladder and Kidneys Healthy
The kidneys and bladder work together as part of the
urinary tract system to filter blood, store urine, and remove waste from the body. The kidneys also regulate blood pressure, help produce red blood cells, and maintain electrolytes.
As adults age, the urinary tract system can be affected by many factors. Bladder infections can result in confusion and physical weakness. Pelvic floor muscles become weak, and urine can leak. Both men and women suffer from urinary tract infections and urinary incontinence.
Tips to keep the bladder and kidneys healthy include:
- Manage diabetes, high blood pressure, and heart disease.
- Quit smoking or don’t smoke, and limit alcohol intake.
- Urinate every 3 to 4 hours. Do not hold urine in your bladder longer than necessary. Fully empty the bladder.
- Drink lots of water to stay hydrated, flush toxins from your body, and maintain healthy blood pressure. Dehydration can contribute to urinary tract infections in the elderly and cause the blood to have higher sodium levels, raising blood pressure.
- Strengthen your pelvic floor muscles through Kegel exercises.
- Wear cotton underwear.
- Maintain a healthy weight. Persons who are overweight may be at higher risk for urinary incontinence and leaking.
- Monitor foods and liquids. Spicy, citrus-based foods contain a lot of sugar or artificial sweeteners, and dairy products can make your bladder more active. Carbonated beverages, alcohol, and caffeine can increase the frequency of urination.
- Eat plenty of high-fiber foods to avoid constipation, which places pressure on the bladder.
Steps to Manage Urinary Incontinence and Urinary Tract Infections
By paying attention to factors that impact the urinary tract system, it is possible to manage and
avoid urinary tract infections, confusion, and delusions in the elderly. If you are caring for an aging loved one or are suffering from frequent urinary tract issues, consulting a medical specialist can offer solutions.
Seeing a urologist or a urogynecologist is a thoughtful step for any adult experiencing frequent urinary tract infections, urinary stress incontinence, or urgency urinary incontinence. Some medications to treat urinary incontinence, like
Gemtesa, can increase mental confusion, lead to falls, and have other cognitive side effects on the elderly.
Frequent urinary tract infections are common in elderly persons diagnosed with dementia or Alzheimer’s disease. Urinary tract infections and frequent pneumonia can also be associated with failure to thrive and
increasing healthcare needs of the elderly.Paying attention to changes that happen with aging is the best way to be proactive about health concerns so that you and your loved ones can continue to live the best life possible.
Do You Have Questions about Caring for Aging Parents? Schedule a 1:1 Consultation with Caregiving Expert, Pamela D Wilson.
Sources:
1) Medina, Martha and Edgardo Castillo-Pino.
An Introduction to the Epidemiology and Burden of Urinary Tract Infections. Ther Adv Urol 2019, Vol. 11: 307 DOI 10.1177/1756287219832172.
2 Dutta, C, PashaK, Paul S, et al. (December 8, 2022)
Urinary Tract Infection Induced Delirium in Elderly Patients: A Systematic Review. Cureus 14(12): e 32321. DOI 10.7759/cureus.32321
3 Jump, L.P. and Curtis J. Donskey.
Clostridium difficile in Long-Term care Facility: Prevention and Management. Curr Geriatr Rep. 2015 March; 4(1): 60-69. Doi 10.1007/s13670-014-0108-3.
4 Wojszel, Z.B, and Malgorzata Tocqynska-Silkiewicz. Urinary Tract Infections in a Geriatric Sub-Acute Ward—Health Correlates and Atypical Presentations. Eur Geriatr Med 9, 659-667(2018).
https://doi.org/10.1007/s41999-018-099-25 Suskind, A.M. et al. Urinary Incontinence in Older Women: The Role of Body Composition and Muscle Strength: From the Health, Aging, and Body Composition Study. JAGS 65:42-50, 2017.
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