Urinary Tract Infections in Older Persons: A Comprehensive Report

This report provides a comprehensive overview of urinary tract infections (UTIs) in older persons. It begins by defining UTIs and outlining the risk factors, including sexual activity, certain birth control methods, and menopause, which commonly affect women. The report then details different types of UTIs, such as cystitis, pyelonephritis, and urethritis, along with their respective symptoms and potential complications like recurrent infections and kidney damage. A significant portion of the report focuses on the unique presentation of UTIs in older adults, who may exhibit non-classical symptoms like confusion, agitation, and decreased appetite. The report further explores conditions and factors that increase the risk of UTIs in the elderly, such as diabetes, Parkinson's disease, dementia, and catheter use. It also examines the implications of UTIs on safety, communication, and the potential for delirium and cognitive decline. The report discusses diagnostic methods, including urinalysis and urine culture, and outlines treatment and management strategies involving antibiotics and supportive therapies. Finally, the report concludes with preventative measures, such as drinking plenty of water and maintaining proper hygiene, to reduce the risk of UTIs in older adults.

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Urinary Tract Infections in Older Persons
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URINARY TRACT INFECTIONS IN OLDER PERSONS
Urinary Tract Infections in Older Persons
Urinary tract infections (UTI) occur when bacteria attack the urinary tract via the urethra
and they begin multiplying in the bladder. Urinary tract infections commonly affect women
affecting the bladder and the urethra (Bardsley, 2017). This is because in women, the urethra is
usually shorter therefore, shortening the distance traveled by bacteria to reach the bladder. There
are several other risk factors that contribute to the development of urinary tract infections. These
according to Beveridge et al (2011) include sexual activity; women who are sexually active have
increased chances of having UTIs, some types of birth controls; the use of diaphragms and
spermicidal agents puts a woman at a higher risk, menopause; circulating estrogen declines after
menopause which results in changes in the urinary tract thus putting the women at a higher risk
of being infected.
There are different types of urinary tract infections in accordance with the particular parts
that get affected. One of them is acute pyelonephritis that affects the kidney. The symptoms
include pain on the upper back and on the side, nausea and vomiting. Another type of Urinary
Tract Infection is cystitis that affects the bladder (Bardsley, 2017). The symptoms include pelvic
pressure, blood in urine, frequent painful urination and lower abdomen discomfort. Finally, there
is urethritis which affects the urethra. Its symptoms are burning sensation during urination and
discharge.
When urinary tract infections are not treated early enough, various complications may
arise like recurrent infections, urethral narrowing where there is recurrent urethritis especially in
men, permanent kidney damage, delivery of premature infants or of low birth weight in pregnant
women and sepsis (Beveridge et al, 2011). Urinary tract infections in older persons may present
hard to find out because they do not show the common signs and symptoms. This can be

URINARY TRACT INFECTIONS IN OLDER PERSONS
attributed to their slower immune system. Some of the non-classical symptoms of urinary tract
infections in older adults include incontinence, agitation, falls, decreased mobility, urinary
retention, lethargy and decreased appetite (Bardsley, 2017). Other severe symptoms could be
vomiting, flushed skin, back pain, fever and nausea when the infection spreads into the kidney.
There are certain conditions and factors that put the older persons at risk of UTIs.
Conditions common in older persons like diabetes, Parkinson’s disease and Alzheimer’s disease
may lead to neurogenic bladder which increases the risk of urinary tract infections (Beveridge et
al, 2011). Dementia, use of a catheter, history of UTIs, bowel incontinence, prolapsed bladder
and bladder incontinence are also risk factors for UTIs in older persons.
Confusion and Behavior Change
As one gets older, changes take place in the immune system causing it to respond to the
infection differently. Older persons may have increased signs of agitation, withdrawal and
confusion (Ninan, 2013). Behavior changes can be caused by Urinary Tract Infections in
person’s with Alzheimer’s disease. These distressing changes in behavior are known as delirium
and can range from restlessness and agitation to hallucinations. Delirium is a mental dysfunction
that manifests with neuropsychiatric abnormalities than can occur within hours or days
(Davidson et al, 2013). It is marked by decreased awareness and attention. Some symptoms
include disorientation, illusions, clouded consciousness, hallucinations, dysphasia, tremor and
motor abnormalities. Delirium that presents with increased motor movement is referred to as
hyperactive delirium while the one that presents with low motor movement referred to as
hypoactive delirium (Huh, 2016). Older persons more often experience hypoactive delirium.
Sometimes Urinary Tract Infections also can increase the progression of dementia. Dementia is
referred to as severe reduced mental ability thus interfering with one’s daily life (Nicolle, 2013).

URINARY TRACT INFECTIONS IN OLDER PERSONS
Some of the symptoms may include difficulty in thinking and language, problem solving,
memory loss and reduced ability to do everyday activities. It is progressive as damage of the
brain cells continue.
Safety and Communication Implications
Delirium can increase the risk dementia and cognitive decline in older persons. Possible
complications arise from these two conditions that affect the normal behavior of the older
persons ((Huh, 2016). They may lose the ability to function or take care of themselves. They also
lose the ability to interact well in their environment. Acquiring infections from the hospital is
likely to occur as the patient stays longer in the hospital or in the nursing homes. The
medications used may also present some side effects when treating the disorder (Bardsley, 2017).
Since their perception is affected, they may become agitated, fearful, have combative behavior
and could start wandering.
Confusion and behavior change brought about by Urinary Tract Infections makes the
patient vulnerable. Their safety is compromised due to impaired judgment and confusion (Ninan,
2013). When left alone, they can wander and get lost or have an accident. They are unable to
take care of themselves like properly maintain their hygiene. This makes them vulnerable to
other infections and diseases like water-borne diseases (Nicolle, 2016). Some become
dysfunctional and cannot cook or look for proper food and can lead to malnutrition. The patients
may also compromise the safety of the people close to them or their family members especially
in an attempt to restrain the patient and he/she becomes violent.
Communication is also implicated. When confusion and behavior change arises,
communication becomes a challenge especially with the family members when they are not

URINARY TRACT INFECTIONS IN OLDER PERSONS
aware of the presentation of the illness and how to communicate during such conditions (Nicolle,
2016). The patient will not be aware of his/her condition and as a result cannot explain what is
going on with him/her. During diagnosis, communication may also pose as a challenge and
hindrance. Delirium always compromises the ability of the patient to communicate their
symptoms (Huh, 2016). Difficulty in communication results from cognitive changes that affect
the patient’s perception and attention or consciousness which are the main symptoms of
delirium. This therefore, requires specialist intervention in order to understand the condition of
the patient.
Diagnosis of UTIs in older persons
Diagnosis of UTIs can easily be done through urinalysis and a urine culture can be done
to determine the causative bacteria in order to prescribe the best antibiotic. Ultrasound
examination, X-rays, and CAT scan can also be used in diagnosis (Nicolle, 2016). Symptoms of
confusion can pose a challenge in diagnosis of older persons. Confusion and behavior change is a
sign enough to diagnose Urinary Tract Infections as they are symptoms that may develop in
older persons with the infections. Further diagnosis can be done by a psychiatrist in order to
manage the mental disorders like delirium and dementia that may arise in older persons upon
infections of the urinary tract (Nicolle, 2013). Mental status assessment and neurological
examinations will be necessary in the diagnosis of the mental disorders.
Treatment and Management of UTIs in older persons
Antibiotics are the recommended treatment of UTIs in both old and young people. Some
of these antibiotics include amoxicillin, ciprofloxacin and levofloxacin. They are prescribed
according to the severity of the infection (Huh, 2016). When UTIs lead to confusion and
behavior changes in older persons, it is important to manage these mental disorders. This

URINARY TRACT INFECTIONS IN OLDER PERSONS
includes pharmacological management supportive therapy. The patient may be required to stay
in hospital for close monitoring. They should be allowed to sleep between 10 p.m. and 6 a.m.
undisturbed so that they maintain a normal sleep cycle (Nicolle, 2016). Techniques like
reorientation or memory cues like family photos maybe are helpful. Keeping the patient a stable,
well- lit and quiet environment reduces the risk of delirium by 53%. It is encouraged that the
patient gets support from the family and familiar nurses (Davidson et al, 2013). Focus on the
usefulness of interventions like daily interventions, physical or occupational therapy and
avoidance of sensorial deprivation significantly reduces the development of delirium in older
persons.
Care givers should avoid physical restraints as these patients may become violent and
pull out intravenous fluids or climb out of the bed reducing compliance to medication. To
manage the behavioral changes, there should be psychiatric consultations (Beveridge et al,
2011). Preventing all the UTIs is impossible but measures can be taken to reduce the chances of
being infected. It is recommended that one drinks plenty of water; at least 8 glasses of water a
day, avoiding bladder irritants, urinating as soon as the urge comes; approximately every two to
three hours and keeping proper hygiene of the genitalia (Osamwonyi & Foley, 2017). Older
adults who are unable to take care of themselves and could be immobile are advised to stay in
nursing home with proper care to help prevent UTIs.
Conclusion
In conclusion, older persons are vulnerable and prone to various infections and conditions
that put them at a higher risk of being infected with Urinary Tract Infections. This is due to
changes in their immune system which responds slowly. Mental disorders of confusion and
behavior change arising from UTIs can be reversed as they are not permanent. This is through

URINARY TRACT INFECTIONS IN OLDER PERSONS
treating the underlying cause which is the urinary tract infections and also supportive therapy to
manage the developed delirium and possibly dementia. UTIs cannot be prevented but chances of
contracting it can be reduced greatly.

URINARY TRACT INFECTIONS IN OLDER PERSONS
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URINARY TRACT INFECTIONS IN OLDER PERSONS
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