By Board Certified Urologist, Dr. Yana Barbalat
Urinary tract infections (UTIs) in the elderly are extremely common, sometimes difficult to recognize, and can be difficult to treat.
Unfortunately, both elderly men and women suffer from UTIs at an almost equal rate. Seniors are predisposed to UTIs for many reasons. Some of the common causes include incomplete bladder emptying, increased incidence of diabetes with older age, increased incidence of autoimmune and neurologic conditions, prostate enlargement in men, low vaginal estrogen levels in post-menopausal women, and increased incidence of urinary and bowel incontinence with age.
Symptoms and Treatment
UTIs are often difficult to recognize in the elderly. That’s because some elderly patients do not have symptoms of burning or urgency with urination, as younger patients do. Elderly patients sometimes present with confusion and change in mood when they have a UTI, and no other symptoms at all. This makes it very difficult to diagnose elderly patients because there are also many other (non-UTI) causes for confusion in the elderly. Some seniors already have baseline urgency, frequency, and incontinence (even without a UTI), so family members cannot rely on that as a symptom of a new UTI.
Finally, some elderly patients are treated for UTIs with antibiotics when they do not have any symptoms at all. The American Urological Association DOES NOT recommend treating patients for UTIs, even when urine cultures are positive, if they have absolutely NO symptoms of a UTI. That is because some people are simply “colonized” with bacteria, meaning the bacteria exists in the bladder without causing any harm. However, there are some exceptions to the American Urological Association guideline, so it’s important to speak to your doctor for their recommendation regarding antibiotic use. Over treatment with antibiotics can lead to antibiotic resistance, diarrhea, yeast infections, and severe inflammation of the colon.
Here are some tips on managing recurrent UTIs in elderly family members:
- Make sure your family member stays well hydrated. Hydration prevents urinary tract infections.
- If there is any bowel or urinary incontinence, make sure that your family member is kept clean and does not sit and move around in soiled underwear or diaper.
- Make sure that your family member is emptying their bladder well. Stagnant urine is much more likely to get infected so it’s important to pee to completion. This is something that your physician can determine and help with.
- Make sure your family member empties their bladder on a regular basis, every 2-3 hours, or so.
- Make sure that blood sugars are well controlled in patients with diabetes. Bacteria love sugar!
- Daily use of cranberry products containing at least 36 mg of PACs have been shown to prevent urinary tract infections and may be a great prevention strategy for UTIs.
- Vaginal estrogen in post-menopausal women may help prevent UTIs. Speak to a doctor about vaginal estrogen as a prevention option.
- Do not overuse antibiotics, in general. Overuse of antibiotics leads to difficult to treat infections due to antibiotic resistance. This is particularly common in elderly patients. Speak to a doctor prior to any decisions on antibiotic use.
UTIs in the elderly are tricky for everyone involved! However the good news is, these infections ARE preventable and having a caring and involved family, as well as a comprehensive health care team is key!