If you’re a caregiver for an elderly person, you may have known them to have had a urinary tract infection (UTI). Among older adults, UTIs are the second most common infection.
A UTI typically occurs when bacteria enter the urinary tract via the urethra, the tube your urine travels through from the bladder out of the body. Bacteria travel upward through the urinary tract, potentially infecting the bladder and sometimes the kidneys. Anyone can get one, but UTIs are more common among older people.
About 30% of older people with UTIs also experience episodes of confusion (formally called “delirium”), which means a loss of attention or awareness often combined with disoriented language, perception, memory and hand-eye coordination.
UTI-induced confusion is usually short-term and reversible, but patients who experienced it with their UTI have had longer hospital stays and more complicated recoveries.
Why UTIs Tend to Affect Older Adults
UTIs are more common in the elderly for a variety of reasons. Mainly, it’s because with age, the muscles in the bladder and pelvic floor weaken, making it easier for bacteria to enter the system and settle in. These weakened muscles can cause poor bladder control and urinary retention, which means urine is sitting in the urinary tract, providing a prime place for bacteria to grow.
Post-menopausal women in particular are prone to UTIs because the drop in estrogen levels weaken the urethra and disrupt the balance of bacteria-fighting acids. Older men who have an enlarged prostate can also be at a greater risk of UTIs, as they can have trouble emptying the bladder completely.
Other factors that contribute to UTIs in older people include:
- Weak Immune System: As people age, they often can’t fight off infections as well as they used to.
- Poor Hygiene: Improper wiping and leaks from incontinence, especially if underwear and pads aren’t changed regularly, can mean bacteria is lingering.
- Dehydration: Without enough water to create urine and flush out the system regularly, bacteria can stick around and grow in the urinary tract.
- Catheter Use: This tube is usually placed to help drain urine from the bladder, but it can also introduce bacteria and become the source of infection.
- Uncontrolled Diabetes: Sugar in the urine can foster bacterial growth as can diabetes-related immune suppression.
- Certain Medications: Opioids, cardiovascular drugs, NSAIDs, psychotropic drugs and other medications can contribute to UTIs.
Connection Between Confusion and UTIs
But why do elderly patients experience confusion with UTIs so often? Researchers have a few working hypotheses that center on the immune system and the brain.
Recent studies support the possibility that a specific immune response to the UTI spreads to the brain and does damage that results in confusion. Aging can make it possible for inflammation to injure otherwise healthy cells, and in the case of UTI-related inflammation, it can particularly affect the part of the brain that controls thinking and reasoning.
However, it’s important to realize that the research is ongoing with no definitive explanation for why UTIs cause confusion in older adults yet.
Identifying UTI Symptoms in the Elderly
UTIs in the elderly often lack obvious symptoms. An older person could have a UTI without a fever or burning during urination. It’s possible the only symptoms are confusion and agitation.
This can make diagnosis difficult. It’s even more challenging when the person can’t (or won’t communicate their symptoms clearly or if they have less obvious behaviors that can accompany UTIs.
Common UTI symptoms
- A strong, persistent urge to urinate
- Pain or burning during urination
- Frequent urination of small amounts
- Cloudy or dark urine
- Strong-smelling urine
- Pain or tenderness in the pelvis or lower back
- Fever
- Nausea
- Fatigue or lethargy
Behaviors to look for with a UTI
- Unexpected behavioral changes such as social withdrawal, agitation, diminished energy levels, disinterest in eating or drinking
- Disorientation, inability to perform familiar tasks, memory loss, hallucinations or falling down more often
- Sudden change in bathroom habits, such as incontinence when they usually have no trouble remembering to go or making it in time
Contact a health care professional if you suspect a UTI or if symptoms persist for more than two or three days.
Diagnostic and Treatment Challenges of UTIs in the Elderly
Diagnosing and treating UTIs in elderly patients, particularly those who already have cognitive issues, can present challenges for clinicians and caregivers and lead to diagnostic delays and misdiagnoses.
One problem is that urinalysis, the standard UTI diagnostic tool, is not as common for elderly patients. In some cases, incontinence or limited mobility can prevent the ability to get a clean midstream sample. And if the older adult is experiencing confusion or other cognitive challenges, they may not grasp the need for the test and refuse to cooperate.
Another issue when urinalysis is used is over-relying on it as the only diagnostic tool. Older adults, particularly women, often have bacteria present in their urine that are innocuous. That is, those particular bacteria don’t conclusively suggest a UTI is present. Physicians may consider the urinalysis results in ruling out other causes, but sometimes only a culture can identify specific UTI bacteria.
Once you have a definitive diagnosis of a UTI, it’s time to start treatment.
Antibiotics for UTIs: Benefits and Challenges
Antibiotics are the standard treatment for UTIs. However, older people are more susceptible to side effects from antibiotics, such as gastrointestinal issues, allergic reactions, dizziness and additional confusion. Older people can also be more likely to take multiple medications, which increases the risk of drug interactions.
Another danger with antibiotics is overusing them. If you take them frequently, you can build up antibiotic resistance. There are a limited number of antibiotics you can take before you’ve reached the maximum strength. This can lead to serious complications such as being unable to fight off the next infection.
It’s a good idea to ask questions when a doctor prescribes an antibiotic. You’ll want to make sure the health care provider is aware of all medications your loved one is taking in case there are any interactions or other effects. You may also want to ask if the antibiotic is a broad-spectrum or if you need to switch to one made specifically for the bacteria that’s causing the UTI after it’s identified by a culture.
Physicians may prescribe a wide range of antibiotics, from commonly used Amoxicillin to ones like Ciprofloxacin and Nitrofurantoin that are reserved for certain uses. It’s a good idea to discuss with your provider what side effects are considered common with the specific antibiotic you’re prescribed and what reactions are a cause for concern.
Managing Confusion During UTI Treatment
Here are a few simple things you can do to manage confusion during UTI treatment:
- Create a Safe Place: Keep your loved one in a comfortable and familiar environment to reduce anxiety and confusion.
- Find the Best Time of Day for medication: When is your loved one most alert? When do they seem most receptive to taking medicine?
- Explain Clearly and Simply: Tell the older person how the medication will help. Be specific: “Taking this pill will help get rid of the infection.” If your older loved one is a rule-follower or swears by their doctor, try encouraging them by saying, “Your doctor says you need to take this.”
What You Can Do to Prevent UTIs in Older People
The best approach to avoid infections and the complications of confusion and potential antibiotic resistance is proactive prevention. Of course, you don’t want your parents to develop UTIs. These steps may help lower their risk of getting one:
- Drink Plenty of Liquids (Especially Water): Check with your physician to see whether a condition such as heart failure requires your loved one to drink less.
- Consider Cranberry Juice: Many people turn to cranberry supplements or 100% cranberry juice to help prevent UTIs, but the research remains mixed. It’s also important to consult your provider because cranberry juice and supplements can impact the effectiveness of certain medications.
- Take Probiotics: Probiotics may reduce UTI frequency in postmenopausal women.
- Wipe From Front to Back: This helps prevent the spread of bacteria after urinating.
- Change Undergarments Frequently: Keeping underwear or incontinence briefs and pads fresh can help reduce bacterial growth.
- Consider Low-Dose Estrogen Vaginal Cream: It supports the presence of good bacteria and appears to lower UTI rates in older women.
Helping Your Loved One Manage a UTI
You can’t always protect your loved one from a UTI. That’s why early diagnosis and appropriate treatment are crucial. Diagnosis may be difficult. And when an older person develops a UTI, they may become confused. It’s not fully understood even among researchers why elderly patients get confused with UTIs, but it is a common symptom.
After the diagnosis, discuss treatment options with the doctor and your loved one. The treatment approach may depend on preexisting conditions. You may need to manage confusion and the infection at the same time.
By acting promptly, you can speed recovery, improving the health of your loved one and enhancing the quality of life for both of you.
BrightStar Care® Can Help Manage Confusion and UTI Treatment
BrightStar Care caregivers are trained to recognize signs of urinary tract infections in older adults and know how to handle it when elderly folks become confused. Whether you're looking for in-home care services or assisted living for your loved one or a reliable medical staffing partner for your organization, our experienced local care team members are ready to help. Find a location near you, contact us online or call (866) 618-7827 to learn more about how BrightStar Care offers A Higher Standard®.