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Urinary Tract Infections

Urinary tract infections (UTIs) among the elderly are sadly all too common. At best they are uncomfortable and mildly inconvenient. At worst if left untreated UTIs can cause serious health problems including kidney failure, or even sepsis.

A UTI occurs when bacteria in the bladder or kidneys multiplies in the urine. There are physical symptoms, many similar to those in younger people.  In more serious cases symptoms may also include rapid changes of behaviour.

Older people are more susceptible to UTIs,  but when diagnosed, they are treatable.  

utis in the eldertly

In this Guide to UTIs we explain what to look out for, how to treat a UTI, and how to try and prevent them in the first place.

What are the symptoms of UTIs in the elderly?

There are two types of UTI with common and more severe physical symptoms. With the latter there may also be changes in behaviour to look out for.

Lower UTIs are infections of the bladder and/or the urethra (the tubes which carry urine out of the body), and can have the following symptoms:

  • Burning, painful sensation when peeing
  • Frequent, intense urge to pee even when there’s little urine to pass
  • A feeling that the bladder is not completely emptied
  • Blood in the urine
  • Cloudy or smelly urine
  • Lower tummy pain
  • Loss of bladder control
  • A mild temperature

Higher UTIS occur higher up the urinary system, as infections of the kidneys and/or the ureter (the tubes connecting the kidneys to the bladder). These are more serious and can lead to kidney damage if they are untreated.  Symptoms include:

  • A high temperature, or feeling hot and shivery
  • feeling sick or being sick
  • pain in the lower back or sides of the tummy
  • Night sweats or chills

Changes in behaviour - signs of a UTI

Elderly people may not exhibit any of the physical signs of UTI listed above because their immune systems don’t respond to the infection.

On top of the lack of noticeable symptoms, some, particularly those with Dementia, may not be able to communicate their discomfort.

what is dementia

A rapid and marked change in mental state is one tell-tale symptom of UTIs in the elderly, but it is often mistaken for the early stages of dementia or Alzheimer’s disease. Indicators of infection include the following symptoms, especially if they appear suddenly (within 48 hours):

  • Confusion
  • Agitation
  • Hallucinations
  • Loss of co-ordination
  • Dizziness
  • Falling

It is thought that these types of behaviour occur because the immune system reacts differently – as it declines – in older people. Stresses placed on the body changes the reduced immune response, and presents as confusion or worse.

These types of behaviour may be the only symptoms so it is crucial to keep an eye out for them. 

Delirium can be a diagnosis of a collection of these, and other behavouir changes and symptoms, as a result of a UTI. It is often confused with Dementia symptoms.  Again, if undiagnosed it can have serious consequences.  Our guide to Delirium includes what to look  out for, and how to treat it.  

How to treat a UTI?

A short course of antibiotics should help a mild UTI to clear up within a few days. Depending on the person’s age and health plus the severity of the infection, treatment for a UTI may however take several days or weeks and a longer course of antibiotics.  In severe cases, a stay in hospital may be required for IV antibiotics to be administered.

Why are UTIs common in elderly people?

Older people are more vulnerable to UTIs for many reasons, but primarily because there is a greater tendency for problems emptying the bladder completely, causing bacteria to develop in the urinary system.

In older men this is often due to an enlarged prostate which blocks the flow of urine and prevents the bladder from fully emptying. 

In women bladder muscles weaken leading to difficulties emptying the bladder fully.  In addition, a lack of oestrogen can lead to an imbalance of bacteria which in turn leads to infection.

Not drinking enough fluids can also lead to UTIs.  If there isn’t enough fluid passing through the urinary system then bacteria can build up, leading to UTIs.

There are also some conditions that are more susceptible to UTIs:

UTIs in the elderly
  • Diabetes
  • Use of a catheter
  • Bowel incontinence (Types of bacteria that are normally found in stool, such as E. coli, are commonly responsible for UTIs.)
  • Urinary incontinence
  • Immobility (those who are bed-bound or lie in bed for extended periods of time)
  • Surgery of any area around the bladder
  • Kidney stones

How to prevent UTIs?

There are some practical things that can be done to prevent, or hopefully at least to reduce the instances and severity of UTIs, which include:

  • Drinking enough fluids (6-8 glasses every day) including cranberry juice
  • Personal hygiene – particularly wiping front to back
  • Cotton underwear or incontinence underwear that is changed regularly
  • Go to the loo when needed, not waiting

UTIs can be absolutely miserable. They can also occur frequently partiuclarly if someone is less able to look after themselves than they used be.  If you are worried about an elderly relative then call the Doctor or dial 111.  Don’t delay.