Monday, January 30, 2023

Bladder Infection In Older Adults

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Urine Infection In Older People

Bladder Infections: To Treat or Not to Treat in Older Adults?

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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.

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Urine Infection in Older People

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Epidemiology Of Asymptomatic Bacteriuria

Asymptomatic bacteriuria is rare in younger people, but over the age of 75 years, it is found in 7â10% of men and 17â20% of women. A study among nursing home residents reported up to 25%-50% had ASB at any given time. Prevalence of ASB is 100% in patients with long-term indwelling catheters and about 3%â5% with short-term use.

How Centric Healthcare Can Help

It has been well-established by medical researchers that older adults have a greater risk of getting UTI than the rest of the population. At the same time, demographers are projecting that the population of our state and our country continues to age dramatically. Therefore, the impact of UTI on our health will continue to grow.

Listed below are some of the services offered by Centric Healthcare that can help you and your loved one prevent and manage UTI.

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Senior Home Care Services

Centric Healthcare offers a wide range of specialized short-term and long-term senior home care services developed to meet the unique care needs of seniors while protecting their dignity. We work with you to create a customized care plan for you or your loved one. The care plan can be designed to address UTI risk factors and encourage preventive behaviors. Services are provided in-home, avoiding the infection risks associated with care facilities, nursing homes, and similar communal living arrangements.

Various Predisposing Factors Increase The Risk Of Urinary Tract Infections In The Elderly Adults

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Common healthcare conditions associated with old age such as dementia, Alzheimer’s disease, and Parkinson’s disease may contribute to a reason for why an elder adult could find it difficult to control when they urinate. As a result, this may lead to neglect of self-care, poor hygiene, or urinary retention. Many of the organisms, especially E. coli, thrive and multiply in significant numbers when there is urine retention in an unclean environment. Similarly, these older adults may also be at an increased risk of incontinence. Thus, you may consider encouraging your elderly loved one to wear incontinence briefs. If the incontinence briefs are not changed frequently, then the older adults may be predisposed to an infection. Fortunately, assisted living facility caregivers are available to support seniors with their activities of daily living and ensuring proper hygiene to reduce infections.

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Treating Utis In The Elderly

If you think your loved one might have a urinary tract infection, see a doctor right away to avoid further complications. An urgent care clinic is a viable alternative if you cannot get an appointment with their primary care physician soon enough. Urinalysis and/or a urine culture are typically required to diagnose a UTI, determine what kind of bacteria are present in the urine and select the most appropriate antibiotic for treatment. If caught early on, a course of antibiotics typically clears the infection in no time.

Keep in mind that older individuals are also prone to a related condition called asymptomatic bacteriuria, which is characterized by the presence of bacteria in the urine but the absence of any signs or symptoms of a urinary tract infection. The estimated incidence of asymptomatic bacteriuria is 15 percent or greater in women and men between 65 and 80 years of age and continues to climb after age 80 to as high as 40 to 50 percent of long-term care residents.

Research shows that most patients with asymptomatic bacteriuria do not develop symptomatic UTIs, therefore antibiotic treatment is not beneficial. In fact, antibiotic use can result in adverse side effects, such as Clostridium difficileinfection, and contribute to the development of resistant bacteria. A seniors physician will consider their symptoms and test results to differentiate between a UTI and asymptomatic bacteriuria and determine whether treatment is necessary.

Older Adults Dont Need Powerful Antibiotics For Utis

Treatment for UTIs should begin with narrow-spectrum antibiotics, say Dr. Lathia and Dr. Goldman.

These drugs are less likely to lead to antibiotic resistance and problematic side effects than broad-spectrum antibiotics.

Today, amoxicillin is commonly prescribed as first-line treatment for UTIs in older adults.

Other common narrow-spectrum must be used with caution when patients have chronic kidney disease or take blood pressure medication, as many older adults do or because their side effects can be serious in older adults.

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Who Is Affected By Utis And How Are They Treated

Women are more commonly affected by them than men. Around half of women will need treatment for at least one UTI during their lifetime.

If treated with the right antibiotics, UTIs normally cause no further problems and the infection soon passes. Though complications are uncommon, they can be serious and include kidney damage and blood poisoning, which can be fatal.

How Can I Help Prevent A Uti

Out of hospital management of UTIs in elderly patients
  • Urinate when you feel the urge. Do not hold your urine. Bacteria can grow if urine stays in the bladder too long. It may be helpful to urinate at least every 3 to 4 hours.
  • Urinate after you have sex. This will help flush away bacteria that can enter your urinary tract during sex.
  • Wear cotton underwear and clothes that are loose. Tight pants and nylon underwear can trap moisture and cause bacteria to grow.
  • Drink cranberry juice or take cranberry supplements. These may help prevent UTIs. Your healthcare provider can recommend the right juice or supplement for you.
  • Women should wipe front to back after urinating or having a bowel movement. This may prevent germs from getting into the urinary tract. Do not douche or use feminine deodorants. These can change the chemical balance in your vagina. You may also be given vaginal estrogen medicine. This medicine helps prevent recurrent UTIs in women who have gone through menopause or are in peri-menopause.

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Are Frequent Utis A Sign Of Diabetes Or Is A Uti A Symptom Of Diabetes

A review from 2005 found that an astounding 50% of people with diabetes have some type of dysfunction of their bladder- thats half of every man and woman with diabetes. There are quite a few theories which we have already discussed, but again, most of the newer theories and research have only been conducted on rats.

Another fact this review highlights is that women who have Type 1 diabetes have a higher risk for kidney infections , which can potentially damage the kidneys function long term. This may lead to the need for a kidney transplant as the damage becomes severe.

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How Do You Get A Urinary Tract Infection

Because of the differences in anatomy, women are much more likely to get UTI than men. The opening of a womans urethra is located in close proximity to her vagina and anus which can both be potential sources of infection. The female anatomy creates more opportunities for fungi and bacteria to enter the urinary tract through the urethra. In addition, the length of the female urethra is shorter than a males, allowing an infection to spread more quickly from the urethra to the bladder and on up through the urinary tract.

Beyond anatomical differences, sexual activity and menopause also make women more vulnerable to UTIs than men. Sexual intercourse increases the potential for fungi and bacteria to enter a womans urethra. Frequent intercourse and intercourse with multiple partners increase the potential for infection even more. 80% of pre-menopausal women with UTI report having had sexual intercourse within the previous 24 hours. Post-menopausal womens bodies produce lower levels of estrogen than pre-menopausal women. Estrogen may be helpful in preventing the overgrowth of E. coli bacteria in the urethra and vagina. As a womans estrogen levels decrease, E. coli may be allowed to grow unchecked and cause an infection.

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Antibiotic Management Of Urinary Tract Infection In Elderly Patients In Primary Care And Its Association With Bloodstream Infections And All Cause Mortality: Population Based Cohort Study

  • Myriam Gharbi, honorary research associate12,
  • Joseph H Drysdale, student3,
  • Rosalind Goudie, research assistant124,
  • Mariam Molokhia, clinical reader5,
  • Alan P Johnson, professor of epidemiology and public health16,
  • Alison H Holmes, professor of infectious diseases1,
  • Paul Aylin, professor of epidemiology and public health12
  • 1NIHR Health Protection Research Unit, Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
  • 2Department of Primary Care and Public Health, Imperial College London, London, UK
  • 3Medical School, St Georges University of London, London, UK
  • 4Nuffield Department of Population Health, University of Oxford, Oxford, UK
  • 5Department of Primary Care and Public Health Sciences, Kings College, London, UK
  • 6Healthcare-Associated Infections and Antimicrobial Resistance Division, National Infection Service, Public Health England, London, UK
  • Correspondence to: P Aylin p.aylinimperial.ac.uk
    • Accepted 16 January 2019

    Strategies For Preventing Utis In Older Adults

    Urinary Tract Infections in Older Women: A Clinical Review

    According to Dr. Goldman, theres no shortage of old wives tales about UTI prevention. For example, cranberry juice/extract is commonly used to prevent UTI recurrence. Probiotics have also become popular for restoring the healthy bacteria in the bladder. According to the Cochrane Library, there isnt enough medical research to support the efficacy of either cranberry juice or probiotics in preventing UTIs, notes Dr. Goldman. However, their medical benefits cannot be ruled out completely.

    The following strategies can help promote urinary tract health in older adults:

    • Use low-dose hormonal vaginal cream
    • Practice proper genital-urinal hygiene
    • Maintain sufficient fluid intake

    In addition, D-Mannose is a relatively new supplement that is being studied for its potential ability to prevent UTIs while causing few side effects. According to Dr. Goldman, D-Mannose sticks to the receptors in the bladder that would normally attract E. coli, the most common bacteria that causes UTIs. By sticking to these receptors, D-Mannose helps prevent E. coli from staying in the bladder, which may help reduce the risk of UTIs. D-Mannose works similarly in the bowels and is thought to prevent pathologic bacteria from colonizing the gastrointestinal tract, which is where the bacteria that cause UTIs in women may originate.

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    Why Are Seniors Susceptible To Utis

    Older individuals are vulnerable to UTIs for several reasons. The biggest culprit is an immune system weakened by time that increases susceptibility to any infection. Also, the elderly may have a diminished ability to take care of themselves. Reduced cognitive abilities and lower energy levels are issues that cause decreased hygiene and increased bacteria in seniors too. Becoming less communicative, often due to the same diminished cognitive capabilities, can be a contributing factor as well.

    Urine overstaying its welcome in the bladder is common in elderly populations, and can foster bacteria that spreads and turns into a UTI. There are several reasons this may occur. One is that seniors may lower fluid intake during the day to avoid the embarrassment and inconvenience caused by bladder control issues. This leads to less frequent urination and a pool of urine being held in the bladder much longer. Also, aging men and women undergo a gradual weakening of the muscles of the bladder and pelvic floor, or a prolapsed bladder, leading them to retain more urine and to experience incontinence.

    Urinary Tract Infection In Elderly

    Many elderly adults in modern society tend to suffer from infections of the urinary tract, and this is somewhat burdensome for caregivers. Caregivers may experience caregiver burnout and/or fatigue as they try to care for their loved ones with urinary tract infections. Thus, it is crucial to be aware of the causes, signs and symptoms, and prevention mechanisms for elderly adults with urinary tract infections. It is also important to remember that assisted living caregivers are trained on how best to support elderly residents with urinary tract infection, in order to help alleviate the burden from the shoulders of the family caregivers.

    Urinary tract infections, also referred to as UTIs, are more common in older adults who are 65 years and above. In fact, urinary tract infections are the second most common cause of hospital admissions in community-dwelling senior citizens of age 65 and older. There has been a sudden rise in the number of seniors diagnosed with urinary tract infections, particularly more so among women affected than men. Within the past few years, more than 10% of women over 65 years have been diagnosed with urinary tract infections, with the number increasing to over 30% among women over 80 years of age.

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    What Are The Symptoms Of A Urine Infection

    • Infection in the bladder usually causes pain when you pass urine. You pass urine more frequently. You may also have pain in your lower tummy . Your urine may become cloudy, bloody or offensive-smelling. You may have a high temperature .
    • Infection in the kidneys may cause you to feel generally unwell. There may be a pain in your back. This is usually around the side of the back , where each kidney is located. You may have a high fever. You may feel sick, or be sick .

    In some older people the only symptoms of the urine infection may be becoming confused or just feeling generally unwell.

    The confusion is caused by a combination of factors such as having a fever and having a lack of fluid in the body . The confusion should pass when the infection has been treated.

    How The Urinary Tract Works

    Signs & Symptoms of Urinary Tract Infections | Dr Sudeep Singh Sachdeva

    Urine is made by your two kidneys, one on each side of the tummy . Urine drains down tubes called ureters into the bladder. There it is stored and passed out through a tube called the urethra, when you go to the toilet.

    In the average adult patient there should be a urine output of: 0.5-1 ml/kg/hr. This means that an average 70 kg man should produce 35-70 mls an hour. However urine output decreases in older patients and the target urine output should be 0.25-0.5 ml/kg/hr. This means that a 70 kg man who is aged over 65 years should produce 17.5-35 mls per hour.

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    How Common Are Utis In The Elderly

    According to a recent review in the journal Drugs in Context, UTIs are more common in women at any age because they have a shorter urethra, which is the tube that carries urine out of the bladder. This allows bacteria from the rectum to move up the urethra and infect the bladder. The majority if UTIs are caused by bacteria called E. coli. E.coli do not cause infections in the colon or rectum, but they do in other parts of the body like the bladder or kidneys.

    UTIs increase with age in both men and women. After age 65, about 10 percent of women will experience a UTI, by age 85 almost 30 percent will get a UTI. For both older men and women, the risk of infection is much higher if they are living in a nursing home or a long-term care facility.

    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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    Managing Urinary Symptoms And Utis In Older Adults

    Summary

    There are a lot of old myths out there about managing urinary tract symptoms and UTIs in older adults. For example, we once thought that the lower urinary tract was sterile, but we now know it has its own microbiome, which may even provide protection against infections. So giving antibiotics for a positive urine culture or unclear symptoms may actually cause more harm than good.

    On todays podcast, we are gonna bust some of those myths. Weve invited some very special guests to talk about the lower urinary tract Christine Kistler and Scott Bauer.

    First, we talk with Christine, a researcher and geriatrician from the University of North Carolina, who recently published a JAGS article titled Overdiagnosis of urinary tract infections by nursing home clinicians versus a clinical guideline. We discuss with her how we should work-up and manage urinary tract infections

    Then we chat with Scott Bauer, internist and researcher at UCSF, about how to assess and manage lower urinary tract symptoms in men. We also discuss Scotts recently published paper in JAGS that showed that older men with lower urinary tract symptoms have increased risk of developing mobility and activities of daily living limitations, perhaps due to greater frailty phenotype.

    Eric: Welcome to the GeriPal podcast. This is Eric Widera.

    Alex: This is Alex Smith.

    Eric: And Alex, who do we have on the podcast with us today?

    Chrissy: Thank you so much for having me. I am so excited to be here.

    Eric: Yes.

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