Urinary Tract Infections in the Elderly Are Different

Urinary tract infections (UTIs) are different in older people. They are more common, but they are often over diagnosed and overtreated. The symptoms may be different than in younger adults. Some treatments don’t work, but some newer ones do.

uti in elderly women

UTIs are more common in women than men, and the risk increases more with age.

© mheim3011 | Getty Images

UTIs in the elderly are more common than in younger adults. UTIs in elderly women are more common than in men, but both men and women are at higher risk. UTIs in the elderly can cause confusion and changes in behavior. UTIs in the elderly can also be more serious and require hospital admission. A UTI that spreads into the blood stream, called urosepsis, can even be deadly.

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.

Why Are UTIs Overtreated in the Elderly?

The reason is a condition that is quite common in elderly men and women called asymptomatic bacteriuria. Up to 20 percent of older men and women may have this condition, and it occurs in up to 50 percent of elderly people in hospitals or nursing homes. Asymptomatic bacteriuria means you have bacteria in your urine without any other symptoms.

Asymptomatic bacteriuria is not dangerous. It may even be beneficial. Some studies show that low levels of asymptomatic bacteriuria may protect the bladder from more infectious bacteria. The danger of this condition is the unnecessary use of antibiotics. Multiple studies show that this does more harm than good. Antibiotic treatment may lead to antibiotic resistant bacteria that cause more dangerous and harder-to-treat UTIs.

Why Do Older Adults Have More UTIs?

One reason is that our body’s natural defense system – our immune system – becomes a little weaker with age. Another reason is that older adults may have long-term diseases that weaken the immune system or make it hard to maintain good bathroom hygiene. Having to be catheterized or have a catheter in place is a major risk, even up to two days after as catheter is removed. The biggest risk factor is a history of recurrent UTIs, which means a person has had three UTIs in the past year or two UTIs in the past six months.

When Do UTIs Need to Be Treated in Seniors?

Guidelines say that if an elderly person has bacteria in their urine and they have at least two symptoms of UTI, they should be treated. Some people assume that an older person who becomes confused (delirious) probably has a UTI. UTI can cause delirium in the elderly, but dehydration is a more common cause. These are the symptoms to watch out for at any age:

  • Fever or chills
  • Increased need to pass urine, called frequency and urgency
  • Pain while passing urine, usually described as burning, called dysuria
  • Tenderness in the lower belly (bladder pain), or tenderness in the back and flank (kidney pain)

Older adults may have any or all of these symptoms, but they may also have delirium, lethargy, incontinence, and loss of appetite. The good news is that once a diagnosis is made most UTIs will respond well to an oral antibiotic selected for E. coli and other common UTI bacteria.

Preventing UTIs in Older Adults

Avoiding dehydration and having good bathroom hygiene are effective preventive strategies. Two prevention strategies that many people try are cranberry juice and probiotics. A host of recent studies have not found that either of these strategies is effective. However, there are two new product that do seem to prevent UTIs, according to the studies:

  • D-Mannose is a type of sugar supplement that sticks to receptors in the bladder that coli bacteria use when they cause an infection. This supplement has few side effects and is supported by some research studies.
  • Xyloglucan is a natural substance extracted form tamarind seeds. It forms a protective film inside the bladder that seals bladder cells off from bacteria. Xyloglucan is combined with hibiscus extracts and gelatin in a product called Utipro Plus. Studies suggest that this product reduces the risk of UTI and also reduces symptoms like frequency, urgency, and incontinence.

Both D-Mannose and Utipro Plus are available at pharmacies without a prescription.

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Chris Iliades, MD

Dr. Chris Iliades is board-certified in Ear, Nose and Throat and Head and Neck Surgery from the American Board of Otolaryngology and Head and Neck Surgery. He holds a medical … Read More

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