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.
Strengths And Limitations Of This Study
A major strength of this study is the use of individual patient level data for adults older than 65 years extracted from a large nationwide general practice records database and linked to hospital and mortality records. This provided the opportunity to track the care pathways of a vulnerable population with a diagnosis of UTI in the community with a 60 day follow-up. The linkage with mortality data from the Office for National Statistics minimised possible bias in the risk estimates of all cause mortality among older adults treated in a routine care setting.
The large sample size of about 160000 patients with more than 300000 distinct UTI episodes substantially increased the power of the analyses, especially for rare severe adverse events in older adults . As the base population is representative of the English general population, our results are generalisable to the entire English population of elderly patients.
The main limitations of our study are common to observational studies using routinely collected electronic health record data, and include unmeasured and residual confounders, missing data and potential biases, such as confounding by indication, misclassification biases, or inconsistencies in coding within and between practices and over time.
What Is Asymptomatic Bacteriuria
Asymptomatic bacteriuria means having significant quantities of bacteria in the urine, but no clinical signs of inflammation or infection.
In other words, in asymptomatic bacteriuria, a urine culture will be positive.
When bacteria are present in the bladder but not provoking an inflammatory reaction, this can also be called bacterial colonization of the bladder.
How Common Is Asymptomatic Bacteriuria
Asymptomatic bacteriuria is more common in older adults than many people including practicing clinicians may realize:
- In women aged 80 or older, 20% or more may have this condition.
- In healthy men aged 75 or older, 6-15% have been found to have bacteria with no UTI symptoms.
- Studies of nursing home residents have found that up to 50% may have asymptomatic bacteriuria.
This condition also affects 2-7% of premenopausal women, and is more common in people with diabetes.
Asymptomatic bacteriuria becomes more common as people get older, in part because it is related to changes in the immune system, which tends to become less vigorous as people age or become frailer.
Studies have found that in older adults, asymptomatic bacteriuria does sometimes go away on its own, but it also often comes back or persists.
How To Prevent Utis In Seniors
Older adults can help prevent UTIs by drinking plenty of fluids to flush the bacteria from their systems, Forciea says. She recommends older adults drink four to six 8-ounce glasses of water a day. Forciea further notes that drinking cranberry juice or taking cranberry tablets also can make urine less inviting for bacteria.
Use these strategies to help prevent UTIs in elderly women:
- Urinating promptly after the urge arises
- Wiping front to back
- Emptying the bladder shortly after sex
- Taking showers instead of baths
If your loved one has frequent UTIs or other challenges that require help with daily tasks, consider talking to one of our Senior Living Advisors about home care or senior living options that can improve their quality of life.
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Urinary Tract Infections And Dementia
Urinary tract infections are a type of infection common among older people. If a person with a memory impairment or dementia has a UTI, this can cause sudden and severe confusion known as delirium.
Urinary tract infections and dementia
Bladder Infection Symptoms In Women
Would you recognize any of these?
At 22 years old, I found myself in bed one day, ditching work with an on-and-off-again fever of 104 degrees F. Besides the standard feverish chills and sweats, nothing else seemed wrong with me, so I attributed my temperature to the flu.
But one day of fever turned into three, which turned into five. Id never had a fever that turned on and off like a light switch, so I finally decided to call the doctor. When I described symptoms, he immediately had me pee in a cup and diagnosed me with the one condition Id never considered: a bladder infection.
Id had a few other bladder infections in my life, but they were always accompanied by a searing sensation when I urinated, so it never crossed my mind. What I know now: Theres more than one way to experience a bladder infection .
Women are, unfortunately, about 30 times more likely than men to get a bladder infection because our urethras are shorter and closer to our vagina and anus, making it easier for infection-causing bacteria to make their way into the urinary tract, according to the U.S. Department of Health and Human Services.
While theres no normal when it comes to toilet habits, if youre going more than eight times a day, or more than twice an hour, thats probably too much, says Shepherd.
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Are Utis The Same In Older Women As Younger Women
Although women can get UTIs at any age, they can affect older women differently. UTI symptoms can be different or more severe in older women. Sometimes older women can have a UTI and be asymptomatic.
In addition to the general symptoms listed above, older women should be aware of these additional symptoms:
- Delirium or hallucination
- Agitation and restlessness
- Social withdrawal
Older women are also more likely to have an underlying medical condition thats triggering their recurrent UTIs or causing UTI-like symptoms. For example, pelvic organ prolapse can cause symptoms that are very similar to UTIs, such as a frequent urge to urinate or pain and pressure in the lower abdomen.
Since these conditions cant be treated with the antibiotics often prescribed for UTIs, its important to have a comprehensive medical exam. At Alpenglow Gynecology, we rule out underlying causes or conditions that may be causing your UTI symptoms.
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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Other Symptoms Of Utis
If the person has a sudden and unexplained change in their behaviour, such as increased confusion, agitation, or withdrawal, this may be because of a UTI.
These pages explain what a UTI is, the different types of UTIs, their symptoms and treatments, and gives tips on how they may be prevented.
Utis Secondary To Chronic Disease
Diabetes Mellitus: UTIs affect millions of people each year and are responsible for billions of dollars in health care spending. Elderly people with diabetes are thought to be at increased risk for UTIs, presumably secondary to immunologic, neurologic, or anatomical abnormalities.19 In the geriatric population, there is a fivefold increase in a diabetic patients susceptibility to UTI complications. Risk factors include duration of diabetes, high glycosylated hemoglobin level, glycosuria, and pyuria.20
A critical step in the infection process is the adhesion of pathogenic bacteria to the bladder mucosa. The high prevalence of gram-negative pathogens such as E coli and Klebsiella may be due to the pathogens ability to adhere to the urinary tract mucosa.21 This increased adherence in the presence of glycosuria and decreased functionality of neutrophils in diabetic patients results in an increased incidence of UTI. The low urinary pH caused by bacterial metabolism does not inhibit bacterial growth in this population.
Asymptomatic bacteriuria in the diabetic patient requires special assessment. Women with type 2 diabetes and asymptomatic bacteriuria have been found to have an increased risk of developing a UTI during 18-month follow-up .22
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Institutionalized Older Adults & Catheterized Patients
Similar to other populations, the diagnosis of symptomatic UTI in nursing home residents requires the presence of genitourinary symptoms in the setting of a positive urine culture. In older adults who are cognitively intact, the diagnosis of symptomatic UTI is relatively straightforward. However, nursing home residents often suffer from significant cognitive deficits, impairing their ability to communicate, and chronic genitourinary symptoms , which make the diagnosis of symptomatic UTI in this group particularly challenging. Furthermore, when infected, nursing home residents are more likely to present with nonspecific symptoms, such as anorexia, confusion and a decline in functional status fever may be absent or diminished . In the setting of atypical symptoms, providers are often faced with the challenge of differentiating a symptomatic UTI from other infections or medical conditions. The high prevalence of bacteriuria plus pyuria in this population often leads to the diagnosis of UTI. Although bacteriuria plus pyuria is necessary for diagnosis of a laboratory-confirmed UTI, alone it is not sufficient for making the diagnosis of symptomatic UTI. To date, universally accepted criteria for diagnosing UTI in this population do not exist, making it difficult for providers to distinguish a symptomatic UTI from other conditions in the presence of new nonspecific symptoms.
Urine Infection In Older People
In this series
If you have a urine infection, you have germs in your bladder, kidneys or the tubes of your urinary system. Urine infections are more common in older people, and there is more likely to be an underlying cause.
In this article
Urine Infection in Older People
In this article
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Why Do Utis Cause Confusion In The Elderly
The immune system of an older adult reacts differently to infection compared to younger people.
A bladder infection places stress on the body, says Dr. Mary Ann Forciea, an associate clinical professor at the University of Pennsylvania Health System in Philadelphia.
That stress can result in confusion and abrupt changes in behavior in older adults with a UTI. And for seniors with Alzheimers disease or other types of dementia, any kind of stress, physical or emotional, will often make dementia temporarily worse, Forciea says.
Simple Ways To Prevent A Uti In Elderly Women
Urinary tract infections, or UTIs, are more than a painful medical condition. Left untreated, these infections can spread through the body. The leading cause of sepsis, an untreated UTI can ultimately result in death. For caregivers of elderly patients, learning how to recognize a UTI can be tricky as the symptoms are varied. Fortunately, there are three easy ways to avoid the onset of the infection to begin with.
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Signs You May Have A Urinary Tract Infection
Note that all symptoms listed in the table below may be experienced in any one person.
|Symptoms of a UTI in the bladder may include:|
|Cloudy, bloody, or foul-smelling urine|
|Pain or burning during urination|
|Strong and frequent need to urinate, even right after emptying the bladder|
|A mild fever|
|Very bad abdominal pain|
Prevention And Diagnostic Concerns
Doctors recommend similar UTI preventive measures for older adults as for younger adults: Drink plenty of water, urinate before and after sexual activity, use the restroom regularly and always wipe from front to back. Sedentary elderly adults living in assisted living should be encouraged by caregivers to use the restroom frequently.
Treatment of a strong course of antibiotics is also similar to the treatment for younger people, but this assumes that the older patient is otherwise healthy.
Many doctors worry that older adults are over-diagnosed and over-treated for UTIs. That’s because urine testing in elderly patients can be more complex bacterial levels in their urine tends to be higher than normal anyway. Dr. Paul Mulhausen, a Des Moines geriatric physician, told the Inquirer he worries that UTI symptoms might be similar to those of more serious problems medication issues, strokes, internal bleeding or other infections including pneumonia. Extra precautions should be taken to ensure a correct diagnosis, he said.
Moreover, Mulhausen believes over-prescription of antibiotics is also concerning. The Centers for Disease Control has warned the medical community against over-prescribing antibiotics because of the building of antibiotic resistance and potential adverse drug reactions. This is especially a concern in an older population that already may take a variety of medications for other ailments.
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Ways To Prevent A Uti
Antibiotics and natural medicines are available to help clear up UTIs, but there are preventative measures you can take to help ensure your body is able to stave off infections that tend to occur through the normal course of life. Read on to see three ways weve discovered through careful research to help prevent urinary tract infections in older women.
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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Role Of Urinary Testing In Diagnosing Symptomatic Utis In Older Adults
The utility of urinary dipstick testing, urinalysis, and urine culture is challenging in the older adult because of the high prevalence of bacteriuria and pyuria that may not be clinically important. As in the case of Mrs M, all urinary studies to evaluate for leukocyte esterase, nitrites, pyuria, and bacteriuria over a 2-year period were positive.
The urinary dipstick, although easy and convenient, has variable test characteristics. Sensitivity and specificity for urinary dipstick testing to evaluate for leukocyte esterase, nitrites, or both vary in older adults by the age of study participants, clinical suspicion of UTI, and laboratory definition for UTI used . The sensitivity and specificity for a positive dipstick test in older patients with was 82% and 71% , respectively. Other studies of elderly patients showed the negative predictive value for dipstick testing ranges from 92% to 100%., Urinary dipstick analysis should be performed in the out-patient setting primarily to rule out and not to establish a diagnosis of UTI. In a patient with a low pretest probability of UTI, if the dipstick is negative for leukocyte esterase and nitrites, it excludes the presence of infection and mitigates the need to obtain urinalysis and urine culture . High false-positive rates limit dipstick testing effectiveness. Further urinary studies are warranted for patients with a high pretest probability of UTI.
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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Practical Tips On Urine Bacteria And Possible Utis In Older Adults
Given all this, what should you do if you are worried about bacteria in the urine, or a possible UTI?
Here are my tips for older adults and families:
- Realize that asymptomatic bacteriuria is common in older adults.
- If you keep having positive urine cultures despite feeling fine, you may have asymptomatic bacteriuria.
- Know that treatment of asymptomatic bacteriuria is not going to help, and might lead to harm.
- Unless you are having symptoms, its pointless to try to eradicate bacteria from the bladder. Studies show that this increases your risk of getting a real UTI later on, and that youll be more likely to be infected with bacteria that are resistant to antibiotics.
- Antibiotic treatment also affects the good bacteria in your gut and elsewhere in the body. Research to help us understand the role of the bodys usual bacteria is ongoing, but suggests there can be real downsides to disrupting the bodys bacteria. So you dont want to use antibiotics unless theres a good reason to do so.
If youre caring for an older adult who has dementia or is otherwise prone to delirium:
- Realize that it can be tricky to determine whether the person is experiencing UTI symptoms.
- The doctors should still attempt to do so before checking a urine culture or treating any bacteria found in the urine.
You can even share these peer-reviewed articles: