Urinary Tract Infections And Dementia In Elderly: Symptoms And Treatment
Written byEmily LunardoPublished onSeptember 28, 2016
Urinary tract infections are not only common among seniors, but among those with dementia, too. Furthermore, UTIs among the seniors are often misdiagnosed for dementia, or may be overlooked if a person has dementia, because UTIs in dementia can lead to delirium.
If a person already has dementia, it may be difficult for them to verbalize that something is going on to indicate a urinary tract infection. If an older person has a UTI, the delirium may also make it difficult for them to explain the problem. Caregivers and family members may notice changes in behavior or greater confusion pointing to a UTI.
Urine itself is sterile and does not contain bacteria. A urinary tract infection occurs when bacteria enter the urinary system. In patients with dementia, the risk of a UTI is higher, as their ability to take care of their personal hygiene diminishes.
Abnormal changes to the urinary system may also affect a persons ability to release urine. When urine sits in the bladder for too long, this increases the risk of a UTI, too. These problems may be caused by an enlarged prostate or prolapsed pelvic organ.
Catheters are actually a common cause of UTIs and should generally be avoided when possible.
How To Treat A Uti
The most effective way to treat a UTI is to take antibiotics prescribed by a doctor. If someone is experiencing confusion due to a UTI, they should see a doctor immediately. While antibiotics are effective they can lead to other symptoms such as yeast infections. Therefore, using prevention over treatment is desirable.
Drinking plenty of water is also important when experiencing a UTI. Additionally, consuming probiotics can help restore balance. Yogurt contains probiotics, which are naturally occurring, helpful bacteria. Probiotics help stop the harmful bacteriathat cause UTIs in the first placefrom spreading and multiplying. As a result, yogurt helps balance helpful and harmful bacteria in the urinary tract, and slows the spread of infection.
Preventing UTIs is an important part of keeping your family, patients, and/or yourself safe. In particular, elderly people can experience psychological symptoms as a result of the infections that cause UTIs. These symptoms are not only uncomfortable, they are also dangerous. The psychological symptoms of UTIs include confusion, which can lead to falls, dizziness, and loss of coordination. As a result, it is imperative to treat UTIs quickly.
Can An Older Person Have No Abdominal Pain
Pain nerve fiber function deteriorates with age, so older adults may have no pain, or it may feel diffuse rather than focal. Patients with prior abdominal surgeries may also have decreased pain perception. Over 30% of older patients with peptic ulcer disease have no pain. In patients with peritonitis, only 55% have pain, and 34% have rigidity.
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How To Prevent Utis In Seniors With Dementia
To help your senior loved one minimize risks for a urinary tract infection, follow these precautions:
- Monitor fluid intake, encouraging the senior to have six to eight glasses of water a day
- Prompt the senior to use the bathroom several times a day, approximately every two to three hours
- Ensure that the senior maintains good hygiene, including daily showers
Most importantly, notice behavior changes. Sudden falls, confusion or an onset of incontinence may warn of a possible UTI. Contact your loved ones physician for guidance or a check-up.
Has your senior loved one experienced a UTI? What effects did this have on his or her dementia? Please share your comments below.
Strengths And Limitations Of The Review
The strengths of this review are mainly due to its methodological quality that it utilised a broad search strategy, with no limits to age or date applied. This allowed for studies that were representative of an elderly population and without the explicit aim of reporting the relationship between confusion and UTI to be identified. Another strength of this review was the registration of a protocol with pre-specified objectives and methods. The use of a second reviewer independently assessing the quality of selected studies also increases the quality of the review. Limitations included limiting articles to English and being unable to assess the eligibility of the unobtainable full-texts. This review also did not attempt to include studies from the unpublished literature, introducing possible publication bias.
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Results Of Individual Studies
Among the included studies, the rate of confusion in patients with suspected UTI was most commonly reported followed by the rate of suspected UTI in patients with confusion . Some studies reported the rate of confusion in patients with bacteriuria and one study reported the rate of bacteriuria in patients with confusion. The majority of studies reported confusion as delirium , followed by a few reporting confusion , altered mental state , and mental status changes , with one study reporting both delirium and altered mental status . Twelve studies analysed the correlation between suspected UTI or bacteriuria and confusion .
Home Health Care Specialists Understand Urinary Tract Infections
Infections, including urinary tract infections, can damage nerves and brain cells. That can lead to temporary mental disorientation. The disorientation can be mistaken for the onset of dementia by those unfamiliar with the interaction between it and UTIs.
Temporary dementia can be successfully treated and potentially reversed if the cause is removed. Reversible dementia has much of the same symptoms as irreversible dementia, so testing is necessary to determine the cause.
Dementia due to infection may occur rapidly, which is a telltale difference between a reversible and an irreversible condition.
Home health care professionals are trained to observe and evaluate any changes in patients. Individuals with dementia arent always able to express whats happening in their minds and bodies. Pegasus caregivers have the ability to elicit information and understand what is or isnt significant.
If the individual already has dementia, a UTI can worsen it. That makes it even more important to find the cause for any disorientation. Treat the infection, and dementia may improve.
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Diagnosing Urinary Tract Infections
The difficulty lies in diagnosing and treating a UTI in seniors. Elderly individuals are susceptible to UTIs, especially if they must use a catheter. Its also easier for them to contract a UTI when theyre hospitalized for any reason.
Younger individuals often know as soon as they have a UTI. Various medical conditions can mask the condition in older individuals. If the person already has dementia, any disorientation is attributed to that rather than to a UTI.
- Nauseous or vomiting
Inexperienced family caregivers may not recognize the seriousness of these symptoms.
Dementia patients can experience those and similar symptoms without being aware of them. Some individuals are aware but unable to describe their symptoms. Without adequate communication, only the dementia is treated, and the UTI worsens.
When a UTI is not promptly treated, the bacteria moves to the kidneys and other organs. It can progress from a simple infection to a life-threatening condition.
An experienced caregiver knows the significance of any changes in symptoms, including when:
- Changes began
- How often changed symptoms occur
- How intense the changed symptoms are
They are also aware of any recent occurrence that could cause an infection.
Antibiotics are the first line of treatment, but home care also significantly aids in recovery. Expert home care also helps to prevent future infections.
Pegasus home health caregivers ensure that their patients:
- Consume adequate fluids
Detecting Dementia And Infections
There is a major interplay between dementia and infections, and it can go in a couple of different directions.
A bad infection in an elderly person may not cause the typical symptoms that younger people often experience. In fact, it can create more mental symptoms than physical, mimicking dementia.
Recognizing the signs of an infection in an elderly person can point to a different illness causing their dementia symptoms. In this case, a heavy duty course of antibiotics may reverse their symptoms completely and restore their full mental function.
Knowing the signs of dementia, you can also see how a person faces a risk for contracting secondary infections. Dementia can cause infection in different ways.
A person with dementia may not even remember falling, leaving them unknowingly injured. Falls can lead to broken bones. Broken bones left alone can sometimes lead to infection.
Their cognitive state also puts them at risk for unknowingly developing more typical infections, such as pneumonia or urinary tract infections. As their mental state declines, they may find it more difficult to recognize changes in themselves.
This means that easy to treat illnesses may progress into something more serious before anybody detects them. This can threaten a persons life.
If you care for somebody who suffers from dementia, you should regularly watch them for signs of infection. These include:
Preventing Utis In Older Adults
Women are more likely to get UTIs than men, which is important to know so you know to stay aware of sudden changes in behavior or the appearance of other UTI symptoms. According to the National Institute of Diabetes and Digestive and Kidney Diseases, at least 40 to 60 percent of women develop a UTI during their lifetime, and 1 in 4 women is likely to have a repeat infection. Not only do women have a shorter urethra, making it easy for bacteria to get into the bladder, post-menopausal women face a higher risk of UTI because they have less estrogen to help prevent the growth of bacteria in the urethra.
Having diabetes, kidney problems, or a weakened immune system increases the risk for UTIs in both women and men.
Many of the prevention tips listed in our UTI Prevention article apply to older adults too. If you are caring for an older parent or loved one, take note of the three tips emphasized by the Cleveland Clinic:
- Drink plenty of fluids
- Promote genital and urinary hygiene
- Ask the doctor about low-dose estrogen vaginal cream for postmenopausal women
Good hygiene includes showering or thoroughly washing the body each day and using the bathroom several times a day, wiping front to back each time.
How To Prevent Utis
To help your senior loved one minimize his or her risk of developing a UTI, take these precautions:
- Encourage your loved one to increase fluid intake, at least 6-8 glasses of water daily
- Monitor bathroom usage to ensure regular trips and quickly note any abnormalities
- Limit caffeine and alcohol intake
- Ensure good personal hygiene, including daily showers
Has your loved one with dementia had a UTI? How did it affect him or her? How did you determine the presence of an infection? Share your experiences with us in the comments below.
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Topical Estrogen Creams For Women
Topical estrogen creams are a viable treatment option for post-menopausal women who experience frequent UTIs. Natural estrogen levels plummet after menopause and low levels of this hormone have been linked to an increased risk of recurrent UTIs. Topical hormone therapy comes in gels, creams and vaginal suppositories and has been shown to help improve the female urinary tracts natural defenses against invasive bacteria. While it is not as well-known or widely used as other therapies, it may be worthwhile to ask your loved ones gynecologist or urologist about this treatment option.
Four Ways To Prevent Urinary Tract Infections
1. Make sure your loved one drinks plenty fluids six to eight glasses per day. Use cups they can see and hold easily and top them up regularly with drinks you know they enjoy.
2. Give as much assistance as they will allow with personal hygiene. Easy-to-reach wet wipes in the bathroom might help. If they have physical mobility issues which make it harder for them to wipe, there are plenty of products which could make the process easier.
3. Constipation can make it more difficult to empty the bladder, which may, in turn, make a urine infections more likely. Encouraging a healthy, varied diet will lessen the risk of constipation and reduce the chances of another urine infection.
4. Look out for dehydration, as that can increase the risk of urinary tract infections, too. If they struggle to drink fluids , you can still boost their fluid levels through food as well as drink . Thickening agents can also be added to some liquids to make them easier to swallow.
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Treating Utis In Seniors With Dementia
The first step to being treated for a UTI, or any infection, is a correct diagnosis. Nearly 30% 40% of seniors with a serious infection do not have a fever because of a weakened immune systems inability to respond to the infection. As the infection spreads into the bloodstream and crosses the blood-brain barrier, confusion and other cognitive impairments can occur. This can cause a cognitively healthy person to be diagnosed with dementia, letting the infection continue and resulting in severe health consequences.
If you suspect a loved one has a UTI, see a medical professional immediately. A simple urine test will be able to identify an infection. Doctors may also use an ultrasound exam, X-rays, or a CAT scan to diagnose a UTI. Antibiotics are the most common treatment method for UTIs.
Urinary Tract Infection: Diagnosis And Treatment In Seniors
The diagnosis of a UTI begins with a physical exam and urinalysis. The urine sample is cultured to see what sort of bacteria grow so that the correct treatment is offered. In addition, other testing may include a CT scan, x-rays, and an ultrasound.
Depending on whether the infection is caused by bacteria or a fungus, doctors will prescribe an antibiotic or antifungal medication to clear up the urinary tract infection. Its important to report all medications the senior is currently taking to the physician, so that the doctor doesnt prescribe anything that could cause an interaction or be detrimental to the patients health. In extreme cases, with infections that have progressed and are severe, intravenous antibiotics may be required.
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Surprising Link Between Dementia And Utis
Dr. David Williams
by ArtWithTammy / CCO
During the 30-plus years that Ive been writing Alternatives, Ive often shared bits of insight that were given to me by my parents. From the moment were born, we are constantly learning, and much of what we learn comes from our parents. What has surprised me personally, however, is just how much Ive continued to learn from them even during the end stages of their lives.
Before my father passed away a few years ago in his 90s, his body was failing to such a degree that we had to move him into a nursing home. His mind, though, was sharp as a tack until the very end. During my regular visits with him, I would always get an in-depth evaluation of the latest political events along with his predictions and thoughts about current sporting events.
It was also during those visits that I got a close firsthand look at many of the health issues confronting the elderly that cause them to need nursing assistance. Although the reasons were somewhat varied, two factors stood out.
For one, the large majority, like my dad, had physical limitations that kept them from living independently. Over time, a lack of any meaningful exercise had taken its toll on their bodies.
The second factor that stood out was the lack of mental stability. Im not talking about forgetting where you left the keys Im talking about more serious dementia.
Sundowning Symptoms And Sundowning Syndrome
Common symptoms of sundowning or sundowners syndrome include: confusion, agitation, anxiety, aggressive behavior, restless behavior, inability to sleep, pacing, combative behavior.
This presents a duo fold problem as a patient needs monitoring and attentive care during sundowner episodes the sundowning tends to occur at the end of the day for the caregiver when the caregiver is the most tired.
Patients with progressive neuromuscular diseases and an already compromised ability to walk or balance are at a physical risk of falling during sundowning episodes which causes safety concerns for the patient. While the cause of sundowning has not been found, the internal clock is disrupted and the consequences for the patient and caregiver can be profound physically, emotionally and financially.
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Study Design And Data Source
We retrospectively analyzed a 5% sample of national claims-level data from the Centers for Medicare and Medicaid Services from January 2016 to December 2016. We analyzed claims from beneficiaries aged 65 years or older with continuous enrollment in traditional Medicare Fee for Service plans who presented to a Medicare-certified ED. All analyses used the Medicare beneficiary as the unit of analysis.
Our study compared 2 cohorts: a UTI cohort and a comparison group of beneficiaries without a documented UTI. Inpatient and outpatient claims associated with an ED visit between January 2016 and December 2016 were included as a qualifying encounter. Of 380,059 eligible beneficiaries, UTI was identified based on the presence of a claim in 2016 with select International Classification of Diseases, Tenth Revision diagnosis codes. UTI diagnosis was determined by the presence of an ICD-10 code within any of the 3 diagnosis fields for UTI including cystitis or pyelonephritis based on the Agency for Healthcare Research and Quality’s Prevention Quality Indicator classification for UTI Diagnosis . The no-UTI cohort consisted of beneficiaries without the presence of a documented UTI ICD-10 diagnosis.
The Bottom Line
This study found that patients with dementia had higher odds of being diagnosed with UTI in the ED, compared to patients without dementia. These patients had lower prevalence of genitourinary symptoms and signs.
Quality Assessment / Risk Of Bias
Two review authors assessed the risk of bias of included studies independently, with any discrepancies being resolved by consensus, or through discussion with a third reviewer , if necessary. The risk of bias was assessed using a modified version of the assessment checklist developed by Downs and Black . Quality items that pertained to interventions and trial studies were removed as they were not deemed to be appropriate for the studies included in this review. An additional five quality items were added to the quality assessment to determine if studies described the criteria used for confusion, UTI and bacteriuria, and if their criteria for UTI and confusion were valid and reliable. Criteria for confusion were deemed valid and reliable if accepted criteria were utilised, including: the Confusion Assessment Method, the Organic Brain Syndrome Scale or the Diagnosis and Statistical Manual criteria . Similarly, criteria for UTI were deemed valid and reliable if established criteria for UTI were utilised, including: the McGeer Criteria, the revised McGeer Criteria, the Loeb Criteria, or the Revised Loeb Criteria . The modified checklist finally consisted of 14 quality items, grouped into: reporting, internal validity, external validity and criteria . The risk of bias for each quality item was reported as low risk of bias, high risk of bias, unclear risk of bias or not applicable.