Urinary Tract Infections In Older Women
UTIs In The Elderly

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Urinary Tract Infections

Contents

• Why are UTIs common in the elderly?
• What are the symptoms?
• How are they treated?
• Prevention

Main Topic:   Urinary Tract Infections




Urinary tract infections in older women

Urinary tract infections (UTIs) affect women of all ages, but they are particularly common in the elderly. In fact, UTIs are the second most common type of infection in older women.

UTIs occur when bacteria multiple in the urinary tract. Typically the amount of bacteria in our system increases with age, especially in females. It is thought that all women, if they live long enough will develop a UTI. As people live longer, the rate of UTIs is increasing rapidly.

There are some important differences in the prevalence of UTIs in the young and the old. At any point in time, up to 33 percent of women under 65 will have a UTI. This increases to 50 percent after the age of 80.



Why Are UTIs more Common In The Elderly?

The main reason is that the elderly have a less robust immune system which makes them vulnerable to all infections, not just UTIs.

Additionally, bacteria is more likely to build up in the urinary tract system where the patient:
 
Is dehydrated

Suffers urinary or fecal incontinence

Takes strong medications

Has weakened bladder muscles. This leads to urine being retained in the bladder and poor bladder emptying, so bacteria are not excreted out of the body.

Is confined to bed or a chair. This has been shown to increase the risk, probably because the patient is less likely to empty their bladder frequently.



Has 'foreign bodies' in their system, such as urinary stones or an indwelling urinary catheter. Both provide a surface for bacteria to cling to becoming a constant source of reinfection (recurrent urinary tract infection).
 

Has weak kidneys. The kidneys produce urine, if the kidneys can't acidify the urine as much as they once did, it makes it easier for bacteria to thrive.


Suffers other conditions which increase the chance of UTIs such as: diabetes, cirrhosis of the liver, prolapse of the uterus, vaginitis, or any debilitating illness.



What Are The Symptoms Of UTIs in Elderly Women?

Very often elderly patients do NOT display classic symptoms of urinary tract infections. Classic symptoms include:

* The need to urinate frequently although there is little urine to come out.
* Painful, burning sensation when urine is passed.
* Urine may have a cloudy appearance and have a strong smell. Occasionally there may be a little blood in the urine.

If the upper urinary tract is infected (known as a kidney infection) it can cause:

* Increased need to urinate at night.
* Severe back pain.
* Vomiting and nausea.
* Fever & chills.

Mostly symptoms in the elderly are non-specific, such as:

* General feeling of unwellness.
* Confusion, dizziness, falling more frequently than normal.
* Apathy, agitation and occasionally hallucinations.

Note
: UTIs in the elderly are often mistaken as the early stages of dementia or Alzheimer's.


Why Do Older Women Have Different Symptoms?

Mainly because the way our body reacts to infection changes with age. There is some evidence for example that inflammatory response to bacteria lessens in old age.


How Are UTIs Treated In The Elderly?

If an elderly patient displays symptoms, they will be treated in much the same way as a younger person (see urinary tract infections treatment)). If the patient shows non-specific symptoms, then the doctor may take a wait-and-see approach. Doctors are careful about prescribing drugs to the elderly because they're probably taking drugs for other conditions, so the risk of side effects or drug interactions is higher.

See also: Natural treatment for urinary tract infections.


How To Reduce The Risks Of Recurrent Infections

People with incontinence are more at risk of recurrent infections because of the close contact that adult briefs have with their skin. This increases the risk that bacteria will be reintroduced into the bladder. To reduce the risk of recontamination:

* Change the brief often.
* Encourage wiping the genital area front to back.
* Keep the genital area clean.
* Set reminders/timers for memory-impaired adults to use the bathroom rather than the adult brief.




Interesting Statistics

Studies show that the risk of contracting a UTI is higher in elderly patients whose living circumstances change. The prevalence of UTIs is highest in long-stay geriatric patients and lowest in those living at home.
(Source: Bacteriuria in the elderly according to age. Brocklehurst et al).

Hospital acquired infections in older people is common, with an estimated 10 percent of patients acquiring infection in hospital. About 12 percent show symptoms within the first 7 days of admission, but 46 percent only develop symptoms up to 12 months later.
(Source: Study Bacteriuria in non-catherised elderly patients in the first eight days of hospital stay. Choudhury and Brocklehurst 1990).

Related Articles on: UTIs

For more on UTIs, see the following:

Urinary tract infections diagnosis: What a doctor does!
Books on urinary tract infections: Useful reference guides.
Interstitial cystitis: An expert guide.

 

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