Key takeaways:
Urinary tract infections (UTIs) are common in older adults, but they can cause unexpected symptoms like confusion, agitation, fatigue, or sudden behavior changes.
UTIs in older adults are more likely to be missed or diagnosed late because they cause unusual symptoms.
Older adults are at higher risk for serious complications, so it’s important to seek medical care and start antibiotics as soon as possible.
Urinary tract infections (UTIs) are one of the most common reasons people seek medical care. And the risk of developing a UTI goes up as you get older.
UTIs in older adults can quickly lead to more serious infections. So it’s important for older adults to start antibiotic treatment as soon as possible to avoid these complications.
But spotting a UTI can be tougher than you think. Older adults may not experience common UTI symptoms like pain and burning with urination. Instead, they may experience seemingly unrelated symptoms, like confusion, agitation, and behavior changes.
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Here’s what to know about the most common UTI symptoms in older adults.
What are some common UTI symptoms in older adults?
Older adults often experience common UTI symptoms like:
Burning and pain while urinating (peeing)
Feeling the need to urinate more often
Having an urgent need to urinate
Blood in the urine
Cloudy, discolored, or bad-smelling urine
Fever
Back pain
But they can develop other symptoms, too, like:
Incontinence (“accidents”)
Confusion
Fatigue
Agitation
Speech or language changes
Frequent falls
Dizziness
Decreased appetite
These symptoms don’t always look like a typical UTI. So, many older adults and caregivers may not recognize them as signs of a UTI. And older adults who have trouble communicating may not be able to let someone know they’re feeling these symptoms.
This can lead to delays in seeking medical care and starting antibiotic treatment. Delayed treatment increases the chance of worsening infection and risk of serious complications, such as kidney infections.
What are some risk factors for UTIs older adults?
As people get older, they’re more likely to develop a UTI. And UTIs are the second most common reason for hospitalization in adults over age 65.
Older adults are at higher risk for developing UTIs for many reasons, including:
Medication side effects: Some of these medications can cause urine retention, which is when urine sits in the bladder longer than usual. When urine sits in the bladder longer, there’s more time for bacteria to grow and cause a UTI.
Enlarged prostates: Older males are more likely to develop enlarged prostates. An enlarged prostate can lead to urine retention and increase the risk of a UTI.
Lower estrogen: After menopause, estrogen levels drop. This causes changes in the vagina that make it easier for bacteria to get into the bladder and cause a UTI.
Weaker immune systems: As people get older, their immune systems take longer to respond, which increases the risk of developing an infection. Older adults are also more likely to have weakened immune systems, either from medical conditions or as a side effect of treatment for medical conditions.
More exposure to bacteria: Older adults are more likely to receive care at a hospital or long-term care facility. So they’re also more likely to get exposed to bacteria that can lead to infections from medical procedures.
Memory changes: Older adults may experience memory lapses and hold their urine for longer than usual. This gives bacteria time to grow in the bladder and cause an infection. Adults who develop dementia are even more likely to forget to go to the bathroom and are at the highest risk for developing a UTI.
Trouble getting to the bathroom: Older adults who have trouble getting to the bathroom are more likely to hold in their urine and develop an infection.
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What are common complications from UTI in older adults?
Untreated UTIs can lead to serious health complications, like sepsis and kidney injury.
Sepsis
Sepsis is a life-threatening condition that can develop when someone has an infection. UTIs are the most common reason older people develop blood infections, which can lead to sepsis. Adults with UTIs who develop sepsis need care in a hospital. But even with the right care, they’re more likely to die from their infection. Early UTI treatment can lower the risk of developing sepsis.
Kidney injury
Older adults with UTIs can develop acute kidney injury, especially if they have diabetes or chronic kidney disease. This is a medical condition where the kidneys aren’t able to filter the blood and create urine normally.
People with acute kidney injury need care in a hospital. Some people can recover from acute kidney injury. But others develop long-term damage to their kidneys.
Early UTI treatment can lower the risk of kidney injury for some people.
How do you diagnose UTIs in older adults?
A urine sample can show whether an older adult has a UTI. There are three main tests that can help determine if someone has a UTI:
Urine dipstick: This test offers immediate results and can be done in any medical setting. The results aren’t the most accurate or detailed. Still, it can be a helpful first step.
Urinalysis: This test offers more details about signs of a urine infection. It can also offer information about the kidney’s general health. This test usually has to be done in a laboratory, and the results can take several hours to come back.
Urine culture: This is the most accurate way to determine if someone has a UTI. A urine culture also shows what organism is causing the infection and which antibiotics will best treat it. This test is also done in a laboratory, and results take several days to come back.
Your healthcare team will collect a urine sample and perform either a urine dipstick, urinalysis, or both to look for signs of a UTI. They’ll send the sample for a urine culture if either of these tests show signs of a UTI. They’ll also prescribe antibiotic therapy if there are signs of a UTI on these tests.
If the urinalysis or urine dipstick don’t show signs of a UTI, your healthcare team may still recommend antibiotic therapy if your symptoms are concerning for a UTI. Or they may recommend following up in 1 or 2 days.
Your healthcare team may change your treatment plan once your urine cultures come back. They may recommend antibiotic therapy or change your antibiotic therapy based on the urine culture results.
How do you treat UTIs in older adults?
Older adults who develop a UTI need treatment with antibiotics.
While younger adults can take a “wait and see” approach, older adults should start taking antibiotics right away. That’s because older adults are at higher risk for developing serious complications from a UTI, like sepsis.
The best antibiotic for a UTI depends on which bacteria is causing the infection. This means the exact antibiotic may be different from one case to the next. However, the length of treatment is usually the same. In most cases, older adults need to take antibiotics for 7 to 14 days to cure a UTI.
Older adults can take over-the-counter (OTC) treatments for UTIs to help with symptom relief. But these treatments won’t cure a UTI or prevent complications. So it’s important to take them in addition to — and not instead of — antibiotic treatment.
Can you prevent UTIs in older adults?
It’s not always possible to prevent UTIs. But there are some things you can do to help keep your kidneys healthy, like:
Staying hydrated by drinking enough fluid throughout the day
Taking regular bathroom breaks
You can also talk with your healthcare team about medications and supplements that may help lower the risk of future UTIs. These include things like:
Vaginal estrogen
D-Mannose
Cranberry products
Methenamine hippurate
Probiotics
Glycosaminoglycans
These treatments aren’t right for everyone. Your healthcare team can help you decide if they’re safe for you.
When should an older adult seek care for a UTI?
Seek your healthcare team right away if you’re over age 65 and you think you might have a UTI. It’s important to start treatment early to prevent complications — even if you only have mild symptoms.
If you’ve noticed that an older loved one isn’t acting like themselves, take them to see a healthcare professional. Keep in mind that older adults may not develop a fever when they have an infection. But symptoms like incontinence, irritability, and trouble sleeping may provide clues that they have a UTI.
The bottom line
Urinary tract infections (UTIs) are common in older adults, but they don’t always look the way people expect. Instead of classic urinary symptoms like burning and pain, an older person may develop incontinence or seem confused, agitated, or “not themselves.”
UTIs can quickly lead to serious complications in this age group. Because of this, it’s important to seek medical care right away — even if symptoms seem mild or unusual. Early treatment can help prevent more serious illness and support a faster recovery.
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References
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