Prevention Of Uti In The Elderly
Walking regularlyElderly patients who are sedentary increase their chance of UTIs, especially in nursing homes. Studies showed that individuals who cant walk or need help walking were more likely to be hospitalized for a UTI. Getting up to walk on regularly reduces this risk.
Preventive antibioticsA common option for preventing recurrent UTIs is a daily dose of antibiotics for up to six months to a year. This is controversial because while antibiotics decrease the number of UTIs while prescribed, some patients have recurrent UTIs once they stop the antibiotics. In addition, there is an increased risk of resistant bugs that require even stronger antibiotics.
Read aboutbacterial biofilms in case if your doctor prescribed antibiotics
Side effects of the antibiotics such as nausea and diarrhea, vaginal yeast infections and skin rashes are also common.
An alternative for women who have UTIs associated with sex is to take a single dose of antibiotics right after sex. This may decrease the number of antibiotics taken and the side effects. This antibiotic should be taken within 2 hours of sexual activity.
Vaginal EstrogenVaginal- not oral- estrogen reduces recurring UTIs in post-menopausal women.
After menopause, the loss of vaginal estrogen changes the vaginal flora, increases the risk of a dropped bladder, urine incontinence and poor bladder emptying, all factors that increase UTIs. Replacing estrogen locally can help all of these issues.
Cautions With Other Medicines
There are some medicines that do not mix well with nitrofurantoin.
Tell your doctor if you’re taking these medicines before you start nitrofurantoin treatment:
- indigestion remedies known as antacids, particularly those that contain magnesium
- certain medicines for gout, including probenecid or sulfinpyrazone
- cystitis remedies you can buy from a pharmacy
- antibiotics known as quinolones, including nalidixic acid, ciprofloxacin, levofloxacin, norfloxacin, ofloxacin and moxifloxacin
Typhoid vaccine given by mouth may not work properly if you’re taking nitrofurantoin. This does not apply to typhoid vaccines given by injection.
Tips For Preventing Utis In The Elderly
The following lifestyle and personal hygiene changes can significantly reduce a seniors risk of developing a urinary tract infection.
- Drink plenty of fluids.
- Drink cranberry juice or use cranberry tablets, but NOT if the elder has a personal or family history of kidney stones.
- Avoid or limit caffeine and alcohol, which irritate the bladder.
- Do not douche or use other feminine hygiene products.
- After toileting, always wipe from front to back .
- If incontinence is not an issue, wear breathable cotton underwear and change them at least once a day.
- Change soiled incontinence briefs promptly and frequently.
- Keep the genital area clean and dry.
- Set reminders/timers for seniors who are memory impaired to try to use the bathroom instead of an adult brief.
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How Do Antibiotics Treat A Uti
UTIs can be caused by many different types of germs including bacteria or fungi and in rare cases, even viruses. But bacterial UTIs are the most common.
If you have a bacterial UTI, the only way to treat it is by getting rid of the bacteria thats causing it. Thats where antibiotics come in. They either stop those bacteria from growing or directly kill the bacteria altogether.
Its worth noting that antibiotics only treat UTIs and other infections caused by bacteria. If you have a fungal or viral UTI, antibiotics wont help.
Antibiotic Prophylaxis And Risk Of Each Outcome
Of 4,043 men, 2,750 men had 10,722 clinical recurrences, with 9,387 recurrences during unexposed periods and 1,335 recurrences during exposed periods . Antibiotic prophylaxis was associated with a significantly lower risk of clinical recurrence , acute antibiotic prescribing and UTI-related hospitalisation . We found no significant association between antibiotic prophylaxis and all-cause hospitalisation. Risk estimates were consistent across all sensitivity analyses .
Of 15,653 women, 11,845 women had 60,124 clinical recurrences, with 51,748 recurrences during unexposed periods and 8,376 recurrences during exposed periods. Antibiotic prophylaxis was associated with a significantly lower risk of clinical recurrence , and acute antibiotic prescribing . These estimates were consistent across all sensitivity analyses. Antibiotic prophylaxis was associated with an increased risk of UTI-related hospitalisation in our main analysis . However, when we re-assessed the risk using a self-controlled case series design, the direction of effect reversed . We found no significant association between antibiotic prophylaxis and all-cause hospitalisation in our main analysis, but found an 8% risk increase in our self-controlled case series analysis .
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How Long Do I Need To Take Antibiotics To Treat A Uti
How long you take antibiotics for a UTI depends on how severe your UTI is and which antibiotic youre prescribed. Some medications like fosfomycin only require one dose, while a more severe UTI might require 14 days or more of treatment. Most require 3 to 7 days of treatment.
Within the first 1 to 2 days of starting your antibiotics, youll probably notice your UTI symptoms start to fade away. If your UTI is more severe or youve had symptoms for a while before starting antibiotics, it might take a few more days for you to notice improvement.
In any case, its important to take all the antibiotics youre prescribed, even if you start feeling better before finishing them. Stopping antibiotics early can lead to antibiotic resistance, which means the medication might not work as well as it should if you need it to treat an infection in the future. It can also mean your UTI might come back if you havent treated it completely.
Utis In The Elderly: Quick Facts
- UTIs are very common and only increase with age: Half of all women will have a UTI in their lifetime.
- UTIs are the most common infection in people over 65, whether they live independently or in nursing homes.
- UTIs cause 5% of all ER visits in the elderly.
- UTIs are more common in elderly women- about 30% of women per year1- at two to three times the rate of men.
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Do I Really Need To Take Antibiotics For A Uti
In most cases, it makes sense to start antibiotics if you know you have a bacterial UTI since this is the only way to treat it.
While it is possible for a UTI to go away on its own, this doesnt always happen. Plus, youll still have to deal with uncomfortable UTI symptoms like pain during urination while waiting to see if the UTI will go away. And if it doesnt, the infection can travel up your urinary tract and cause a more serious infection in your kidneys called pyelonephritis. If youre pregnant, have underlying health conditions, or are older than 65 years old, you should not try to treat a UTI without antibiotics.
How Long Will I Take It For
If you’re taking nitrofurantoin to:
- treat a urinary tract infection, then you usually need to take it for 3 to 7 days
- stop urinary tract infections coming back, you may need to take it for several months
- prevent an infection before having surgery, you’ll usually need take it on the day of the operation and for the next 3 days
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Why Are Seniors At Risk For Utis
Men and women older than 65 are at greater risk for UTIs. This is because both men and women tend to have more problems emptying their bladder completely as they age, causing bacteria to develop in the urinary system.
In older men, this often happens because of a common condition called benign prostatic hyperplasia , or an enlarged prostate gland. The enlarged prostate blocks the flow of urine and prevents the bladder from fully emptying.
As women age, the bladder muscles weaken and prevent the bladder from emptying completely, increasing the risk of infection. Women also produce lower amounts of estrogen after menopause. This creates an imbalance of good and bad bacteria in the vagina, which can lead to infection.
Other risk factors for UTIs in older adults include:
- Using a catheter to empty the bladder
- Having kidney stones, which can block the flow of urine
- Having a suppressed immune system, which lowers the bodys defense against infection
How Is It Diagnosed
If doctors suspect that a UTI is present, they will test a urine sample in the office or send it to a laboratory for a urinalysis.
A urine culture can confirm which bacteria are causing the infection. Knowing the specific type of bacteria allows the doctor to determine a suitable treatment plan.
A condition called asymptomatic bacteriuria is also common in older adults. ASB occurs when there are bacteria in the urine, but they do not cause any signs or symptoms of infection.
Although ASB is common in older adults, it does not typically require treatment, unless it causes other clinical symptoms.
The standard treatment for a UTI is antibiotics, which kill the bacteria causing the infection. Doctors will prescribe an antifungal medication instead if a fungus is causing the UTI.
It is essential that people take the antibiotic or antifungal medication precisely according to the prescription, even if they begin to feel better. Completing the entire prescription will help to destroy all of the infectious bacteria.
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Functionality And Age Should Have An Impact On Treatment Decisions
From the blog, Geripal devoted to optimal treatment of the elderly: Survival from severe sepsis: yes the infection is cured but not all is well the point is made that, in the elderly unlike those younger, whose bodies have more resources treatment does not equal back to how she was before. Instead, treatment that sounds so necessary and logical can lead to increased confusion, worsening dementia, and a more vulnerable immune system.
In my aunts case, several courses of antibiotics failed. A urinary stent was recommended: a tube, inserted under general anaesthetic, from kidney to peeing-tract. This has to be replaced every 6 months, every time the general takes away a bit more my aunts self.
Most medical healthcare professionals only fixed the infection sepsis and after recovery, discharged the patient. Then left the family to care and worry for the recovered family member, to cope with reduced ADL . When approached the follow up doctors, they said patient is elderly so is like this after a sepsis.
Certainly decisions of these sorts are never easy, and often theres no one right answer. But it can be helpful to have more context and to be able to think things through on a what if basis long before the crises is upon you.
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!
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Risk Factors For Utis In The Elderly:
For elderly women, a major risk for UTIs is low vaginal estrogen that happens after menopause. There are several reasons for this:
1. Low estrogen changes the vaginal flora, making it less acidic and reducing the number of good bacteria, like lactobacilli, which prevent infections.2. Low levels of estrogen thin vaginal tissues, possibly increasing the risk of UTIs after sex, the risk of cystocele and urine incontinence, all conditions associated with UTIs.
The frequent UTIs in elderly men is related to the increase in prostate problems with age.
Senior Uti Do You Know The Symptoms
Urinary tract infections, or UTIs, are the most common bacterial infection in older adults,affecting women more often than men.
UTIs can typically be treated effectively with antibiotics once diagnosed.Unfortunately, not all UTIs are treated quickly, and some aren’t even identified, particularly in seniors.
What is a UTI?
A UTI is an infection in the urinary tract. The urinary tract includes the kidneys, bladder, ureters and the urethra which carries urine out of the body. They are most commonly caused by bacteria but can also be a fungal infection.
A lower UTI is a common infection, affecting the lower part of the urinary tract, the urethra and urinary bladder. Infection of the urethra is urethritis while a bladder infection is cystitis. An upper UTI affects the kidneys.
What causes a UTI?
A typical bacterial UTI is caused by bacteria, often fecal bacteria, entering the urethra through the urethral opening where urine is released from the body. Usually, the body can fight off these bacteria and prevent infection. However, if the immune system is too weak, the bacteria multiply, causing infection.
Fungal UTIs usually stem from fungus in the bloodstream. Fungal UTIs are relatively uncommon, impacting mainly those with illnesses that compromised their immune system.
What are the symptoms of a UTI?
When typical, healthy adults get a UTI, the symptoms are usually easy to identify, and the infection is simple to diagnose:
If left untreated, a person may experience:
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How Are Utis Treated In Older Adults
Antibiotics are the first choice of treatment for UTIs. Mild UTIs often clear up in only a few days with the right antibiotic.
However, depending on the persons age and health plus the severity of the infection, treatment for a UTI may take several weeks and a longer course of antibiotics. In more severe cases, older adults may need to be hospitalized to receive IV antibiotics.
If your loved one has symptoms of a UTI, its important to make an appointment with their doctor right away. If symptoms are severe, call the doctor immediately to determine whether a trip to the emergency room is necessary.
How To Take It
Swallow nitrofurantoin tablets and capsules whole. Do not chew or break them.
There’s a liquid nitrofurantoin for people who find it difficult to swallow tablets.
If you’re taking nitrofurantoin as a liquid, it’ll usually be made up for you by your pharmacist. The medicine will come with a syringe or spoon to help you take the right amount. If you do not have a syringe or spoon, ask your pharmacist for one. Do not use a kitchen teaspoon as it will not give the right amount.
The dose of nitrofurantoin you need to take depends on whether it’s being used to treat or prevent a urinary tract infection, your age, and how bad the infection is.
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Diagnosing A Urinary Tract Infection In Older Adults
Vague, uncommon symptoms such as confusion make UTIs challenging to diagnose in many older adults. Once your doctor suspects a UTI, its easily confirmed with a simple urinalysis.
Your doctor may perform a urine culture to determine the type of bacteria causing the infection and the best antibiotic to treat it.
There are home UTI tests that check urine for nitrates and leukocytes. Both are often present in UTIs. Because bacteria are often in the urine of older adults to some degree, these tests arent always accurate. Call your doctor if you take a home test and get a positive result.
More severe infections may require a broad-spectrum antibiotic such as ciprofloxacin and levofloxacin .
You should start antibiotics as soon as possible and take them for the entire duration of treatment as prescribed by your doctor. Stopping treatment early, even if symptoms resolve, increases the risks of recurrence and antibiotic resistance.
Antibiotic overuse also increases your risk for antibiotic resistance. For this reason, your doctor will likely prescribe the shortest treatment course possible. Treatment typically lasts no more than 7 days, and your infection should clear up in a few days.
Its important to drink plenty of water during treatment to help flush out the remaining bacteria.
Role Of Urine Examination
Diagnosis of UTI in confused elderly patients can be difficult because of the non-specificity and frequently misleading symptoms and signs. Diagnosis of UTI in these patients is primarily based on examination of urine. In non-catheterized patients, a dipstick can be used to test for the presence of nitrites and leucocyte esterase as surrogate markers for UTI. Absence of nitrites and leucocyte esterase has > 90% reliability in ruling out UTI. While detection of nitrites in the urine of symptomatic non-catheterized patients may prompt initiation of treatment, the presence of leucocyte esterase is less reliable as an indicator of UTI . In catheterized patients, use of dipsticks is not recommended. If UTI is suspected, urines should be sent to the laboratory both for confirmation and antibiotic susceptibility tests.
In elderly patients, collection and examination of urine is a necessary adjunct to making an accurate clinical diagnosis of UTI presenting with signs of sepsis even if they have respiratory symptoms and signs, especially in the absence of new changes on CXR.
Given the difficulties in obtaining a specimen from confused or incontinent patients, we think there is a strong case for diagnostic inout catheterization after using a bladder ultrasound scanner if possible. The benefits of making an accurate diagnosis are likely to outweigh any risk from the procedure.
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