Addressing Urinary Retention Or Urinary Obstruction
Conditions such as prostate enlargement in older men and neurological damage due to diabetes, stroke or multiple sclerosis may lead to urinary retention. When this happens, a senior is unable to completely empty their bladder. Urine will accumulate and stagnate within the organ, eventually resulting in bacterial colonization and possibly UTI.
Urinary retention is diagnosed by measuring a seniors post-void residual, which is the amount of urine that remains in the bladder after urination. To obtain a post-void residual measurement, a catheter is inserted through the urethra and into the bladder after urinating to drain any leftover urine. Sometimes an ultrasound machine can be used to take this measurement. A residual of 100 mL or more indicates that the bladder is not emptying properly.
Another cause of incomplete voiding is urinary obstruction caused by a kidney stone stuck in a ureter . This blockage can contribute to recurrent UTIs and even kidney infections. Diagnostic imaging, such as an ultrasound or CT scan, can be used to diagnose a ureteral stone and treatment must usually be provided by a urologist.
Delirium With Utis In Older Adults
Have you noticed a change in the behavior of an older adult you care for? Perhaps this change has taken place over the span of several days, and includes symptoms such as confusion, restlessness, hallucinations or social withdrawal?
Before we jump to the conclusion that a loved one has the beginnings of dementia, we should have a physical exam performed by a physician. They instead might be suffering from delirium brought on by a urinary tract infection . In older adults, UTIs can become quite serious, so it is important that we have an assessment or checkup done as soon as possible.
UTIs happen when bacteria enter the urinary tract through the urethra, traveling to the bladder, then to the ureters and, finally, resting in the kidneys. The kidneys work to filter waste out of the blood and pass it through the urinary tract in urine. However, once bacteria infect the kidneys, they can infect the bloodstream and carry the infection all the way to the brain.
Besides delirium, other UTI symptoms to watch for in our loved ones are:
- Urine that appears cloudy or bloody or has a strong odor
- A frequent need to urinate
- Pain or burning with urination
Treatment is handled through a course of antibiotics. If the delirium is present and continues, a short-term course of antipsychotics may be needed.
Resources: Aging Care.com, American Medical Association;
How To Help Your Loved One Avoid Utis
We dont have enough research to support their effectiveness in UTI prevention, although their medical benefits cant be ruled out completely, says Dr. Goldman.
Instead, he recommends these tried-and-true prevention strategies:
- Encourage sufficient fluid intake
- Promote genital and urinary hygiene
- Ask the doctor about low-dose vaginal cream for postmenopausal women
Dr. Goldman says researchers are also studying D-Mannose for UTI prevention. The supplement, which has few side effects, sticks to bladder receptors that normally attract the E. coli bacteria usually responsible for UTIs.
Researchers also believe D-Mannose may keep bad bacteria from colonizing the digestive tract, which can harbor the bacteria responsible for UTIs in women.
Following these tips should help your aging relative stay healthy, productive and out of the hospital.
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How Can A Urine Infection Cause Confusion
It may seem an unlikely connection, but it can be explained. A bladder infection puts stress on the body, physically and emotionally. If the person already has Alzheimers or another form of dementia, this stress can result in more confusion and changes in behaviour. This then causes a sudden though often temporary decline.
Summary Of The Evidence
Following this review, it is evident that all of the studies which have explored the association between suspected UTI and confusion are methodologically flawed, due to poor case definition for UTI or confusion, or inadequate control of confounding factors introducing significant bias. Subsequently, no accurate conclusions about the association between UTI and confusion can be drawn. One study of acceptable quality shows an association between confusion and bacteriuria. However, this sample of patients in whom they tested bacteriuria and pyuria were patients already suspected of having a UTI, introducing a bias into their calculation . In summary, none of the 22 publications had sufficient methodological quality to enable valid conclusions.
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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.
Prevention Of Utis In The Elderly
Its important to address the issue in advance in the attempt to prevent UTIs in seniors. Several urinary tract infection prevention methods exist, including:
- Reminding the individual to drink plenty of water , as proper hydration keeps the urinary tract in good health
- Avoiding consumption of alcohol and caffeine as much as possible
- Encouraging the senior to use the restroom frequently, at least every three hours
- Promptly caring for soiled materials due to incontinence
- Wiping from front to back when using the restroom
- Promoting good hygiene, such as daily showers, and avoiding baths and special care should be taken if the senior citizen uses a urinary catheter
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Risk Factors For Urinary Tract Infections
1. Urinary tract infections are more common in elderly people. This is because urine tends to sit in the bladder for longer as we age, increasing the likelihood of bacterial contamination.
2. Urinary tract infections are more common in women than men around 50 per cent of women will have a UTI in their lifetime. This is because the opening to the urethra is much closer to the anus, which can increase the chance of bacteria entering, particularly if you dont wipe front-to-back.
3. Poor personal hygiene can be a risk factor for UTIs. This is a particular challenge for people with dementia, particularly if they have incontinence and need to wear pads.
4. As men get older, prostate problems can make it harder for them to empty their bladder. This can mean urine is held in there for longer and is at risk of developing bacteria.
5. Having a catheter inserted can increase the risk of developing urinary tract infections.
Can Sepsis Cause Dementia
A;study published in 2017;looked at more than 20,000 patients with no history of dementia who were admitted to the hospital with sepsis for the first time. The researchers found that patients who had sepsis were more likely to develop signs of dementia after discharge. The researchers also found that younger age didnt protect patients from developing dementia. In this study, some patients in their 20s were affected. And for all ages, the worse the sepsis, the greater the risk of developing dementia. Another study;;estimates that every year, there may be as many as 20,000 new cases of dementia caused by sepsis.
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Are Utis A Sign Of Dementia
Urinary tract infections can exacerbate dementia symptoms, but a UTI does not necessarily signal dementia or Alzheimers.
As the Alzheimers Society explains, UTIs can cause distressing behavior changes for a person with Alzheimers. These changes, referred to as delirium, can develop in as little as one to two days. Symptoms of delirium can range from agitation and restlessness to hallucinations or delusions.
Further, UTIs can speed up the progression of dementia, making it crucial for caregivers to understand how to recognize and limit risks for UTIs in seniors.
Physiological Changes Associated With The Ageing Lower Urinary Tract
Urinary incontinence increases with rising age. Ageing is associated with changes in the lower urinary tract which predispose an elderly to UI. As we age, bladder capacity and contractility reduce, with reduced ability to defer voiding once the urge to do so arises. The post-void residual urine volume increases with age. During the storage phase, detrusor shows increased uninhibited contractility .
Among the elderly postmenopausal women, the pelvic muscles show loss of volume and tone. The ligamentous and connective tissue support for the pelvic organs gradually fail because of ageing. The weakened pelvic floor increases the risk of pelvic organ prolapse causing cystocele, rectocele and uterine prolapse. Stage 3-4 prolapse of pelvic organs can cause UI. A weakened pelvic floor also allows a hypermobile urethra to slide downwards during sudden increase in intraabdominal pressure .
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Complications Of Utis In Seniors
A UTI that goes untreated in anyone can lead to complications. However, elderly individuals have a higher risk of complications from urinary tract infections than any other category of individual.
- Kidney damage. A typical UTI can become more difficult to treat and tolerate if it moves into the kidneys. In addition, it can cause scarring on the kidneys, which leads to potential for hypertension and kidney failure.
- . Because kidney function can be reduced, some of the waste the kidneys;would normally filter out and push from the body with urination may flow back into the bloodstream, leading to illness, which is difficult on the seniors immune system.
- . In the same process, the infection may enter the bloodstream, leading to blood poisoning that is a life threatening issue.
- Worsening dementia. While the symptoms of confusion that a UTI causes in the elderly may not directly lead to dementia, if the condition develops in a patient who already has dementia, a urinary tract infection could cause a quicker progression of dementia, leading to worsening overall health for the elderly patient.
What Causes Utis In The Elderly
Anything that introduces bacteria into the urinary tract or impedes the flow of urine and causes urine to stay in the bladder is very likely to cause a UTI.
Eighty five percent of all UTI infections are caused by Escherichia coli or E. coli bacteria.;Several other types of bacteria make up the other fifteen percent, but E.coli is by far the most prominent, and it can make its way into the urinary tract several different ways.
E. coli is found naturally where digestion occurs in the gastrointestinal tract, so it can sneak into the urinary tract. This commonly happens because the end of the gastrointestinal tract is the anus, and the beginning of the urinary tract is the urethra. The anus and the urethra are close to one another, especially on the female body.
Due to the proximity of the entry and exit of the above two pathways, poor hygiene can cause UTIs. ;Back-to-front wiping after a bowel movement can transfer bacteria into the urethra. Wearing soiled underwear or disposable undergarments too long can also introduce bacteria into the urinary tract. Bacteria in both cases is an infectious traveler that multiplies.
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How Are Utis In The Elderly Treated
Here comes some good news: after submitting to blood and urine tests and being diagnosed with a UTI, the treatment can be relatively easy. ;The majority of UTIs are cured by antibiotics and hydration to flush the bacteria out. This is much easier than in the past. UTIs were first documented in 1550 BC and up until the 1930s, they were treated by herbs and bloodletting!
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.
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Why Does A Uti Cause Confusion
In the elderly, UTIs accompanied by confusion are common. Older men and women experience this additional symptom of UTIs because as we age, our immune systems respond differently than they did when we were young. For example, instead of feeling pain, the elderly can exhibit signs of confusion, withdrawal, and/or agitation. As a result, UTI psychological symptoms are a real concern. In this article, we will discuss the symptoms of UTIs, risk factors, and how to treat a UTI.;
Some of the most common signs of a UTI include:
- Pain or burning sensation when urinating
- Strong and frequent need to urinate
- Foul smelling urine
How Is A Uti Diagnosed
In older adults who have symptoms of a UTI, a simple urine test called a;urinalysis; can confirm infection. In some cases, the doctor requests a urine culture to identify the type of bacteria causing the infection and help determine the best antibiotic to treat it.
However, its important to know that older adults often have bacteria in the urine that dont cause any symptoms. This condition is called;asymptomatic bacteriuria, and it often resolves on its own without treatment.
Doctors now;recommend against doing a urine test;to check for a UTI, unless patients have typical, bothersome UTI symptoms. This is to avoid the excessive use of antibiotics to treat infection, which can lead to;antibiotic resistance.
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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.
Bacteria In The Urine Isnt Necessarily A Problem
Elevated urinary bacteria doesnt cause any symptoms and can often be corrected by increasing fluid intake.
The condition occurs in about 6 to 16 percent of women over age 65, 20 percent of women over age 80, and 25 to 50 percent of women living in nursing facilities.
Doctors should not treat urinary bacteria with antibiotics unless there are multiple other signs or symptoms of a UTI. This can encourage antibiotic resistance and make future UTIs harder to treat, says Dr. Lathia.
The presence of antibiotic-resistant bacteria in the urine also increases the risk of serious complications, including C. difficile infection and death.
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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.
Table 2 Quality Assessment Criteria