Urinary Tract Infection in Older Women
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Urinary Tract Infection in Older Women

Urinary Tract Infections (UTIs) are one the most prevalent illness affecting women. Doctors estimate that 50-60% of women will experience at least one UTI in their lifetime. The incidence and severity of UTIs rise with age, making older women especially vulnerable to severe and recurrent UTIs.

Natural age-related health changes, weakening immune systems, physical changes post-childbirth, loss of mobility, and cognitive degeneration increase the likelihood of UTIs in older women. Like any infection, UTIs can appear quickly and progress rapidly. It’s vital that patients take appropriate preventative measures, monitor for signs of infection, and seek treatment.

What is UTI in Older Women?

A UTI is a bacterial infection that affects any part of the urinary tract, which includes the urethra, ureters, bladder, and kidneys. A geriatric UTI is an infection in someone over the age of 65. Studies report over 10% of women over 65 years old have experienced a UTI in the last 12 months. The occurrence rises every subsequent year.

The three types of UTIs are classified based on the part of the urinary tract. They vary in severity. Infections include:

  • Urethritis: The infection is in the urethra, the channel that carries urine from the bladder. Bacteria often enter the body through the urethra and spread through the urinary tract. These infections cause a burning sensation during urination and a cloudy-colored discharge.
  • Cystitis: The bacterial infection is in the bladder. These UTIs cause lower abdominal pain, the sudden need to urinate, painful urination, and milky or bloody urine.
  • Pyelonephritis: The infection has traveled across the ureters and reached the kidneys. This type is the most severe UTI and places patients at risk of systemic infection and renal damage. These UTIs cause fever, chills, nausea, vomiting, and upper back pain.

What are the Common causes of UTIs in Older Women?

Females are more susceptible to UTIs than men because their urinary tract is shorter and their urethra is closer to the anus. The proximity creates a pathway for bacterial spread. Older females have an elevated risk of UTIs because of age-related changes and overall health. Risks for older women include:

  • Diabetes: The metabolic disorder diabetes, which is more common as people age, can lead to urine retention, poor circulation, kidney problems, and a weaker immune system. These changes create prime conditions for bacteria to grow in urine stored in the bladder.
  • Immobility: Functional and mobility changes due to age-related conditions like arthritis and osteoporosis can limit older women’s ability to reach the bathroom. They may hold urine in when they have the urge to use the bathroom. This stress places pressure on the bladder and creates a pathway for bacteria to enter the body.
  • Pregnancy and Surgery: Older women are more like to have a history of urogynecological surgery to correct changes following pregnancy or aging. Operations to correct prolapsed bladders make some women more susceptible to UTIs.
  • Retention: As women’s bodies age, their bladder may retain urine. Changes in the nerves can prevent the brain from detecting that the bladder needs to empty. This stored urine allows bacteria to grow and spread through the urinary tract.
  • Incontinence: Many women develop incontinence as they age due to post-pregnancy anatomical changes. Soiling one’s clothes allows bacteria to grow on incontinence pads or briefs. It then enters the body. Individuals with bowel incontinence may be unable to avoid contact between their genitals and feces, allowing bacteria to enter the urinary tract.
  • Inpatient Treatment: Hospitalization and residing in a nursing home can often increase the risk of UTIs. If the elderly individual uses a catheter or clinical staff does not maintain proper hygiene for incontinent individuals, they are more susceptible to bacterial spread through the urinary tract.
    Recurrent UTIs in elderly female patients may present with the same symptoms every time or have a distinct presentation with each case.

Menopause and Hormones

After menopause, hormonal changes cause the vaginal tissue to become dryer and thinner. As a result, the urinary tract is more vulnerable to bacterial invasion, elevating the risk of UTI for elderly women. Vaginal dryness also suppresses the presence of healthy bacteria that help the vagina repel the germs that cause UTIs.

What are the early signs of UTI in Older Adults?

The symptoms of a UTI are the same for all ages. Older adults may have a faster onset and more severe symptoms. Individuals should monitor themselves or their loved ones and seek medical care to prevent UTIs from progressing. It’s possible to have one or multiple symptoms at once.

In addition, many seniors or their caregivers dismiss the symptoms of UTIs as normal changes or symptoms of another condition. Individuals should always consider the possibility of a UTI when assessing themselves or a loved one. The primary indicators of UTI include:

  • Changes in Bathroom Habits: A sudden change in urinary frequency and urgency regardless of liquid intake. Some individuals need to go to the bathroom multiple times over a short period, even if they haven’t had fluids. In other cases, individuals feel a sudden and intense need to use the bathroom. The urge can present so fast that the person may not have time to reach the toilet before they urinate.
  • Discomfort During Urination: Pain or a burning sensation while urinating. The feeling can be dull or present as an intense stabbing pain. Urination should never be uncomfortable. No matter how minor or brief, individuals should not dismiss the pain.
  • Body Pain: Many people experience pain or tenderness in the pelvis, lower back, or abdomen. This usually means the UTI has reached the bladder or kidneys. Abdominal pain should never be dismissed. Older adults may overlook discomfort as part of aging or consider it insignificant.
  • Cognitive or Mood Changes: Confusion or disorientation, which is most common in adults over 70, make UTIs dangerous for older adults. The rapid onset of cognitive dysfunction may be misunderstood as a sign of aging. For many older women, the disorientation is so pronounced that they are unable to articulate their urinary symptoms or remember to follow up with their physician. In addition, patients who are confused due to pre-existing conditions, like Alzheimer’s or Parkinson’s, may have their UTI symptoms overlooked or misidentified as part of their condition.

Later-stage UTI Symptoms

If the UTI goes unaddressed when the early signs are present, the infection will spread through the urinary tract, reaching the bladder and kidneys. The bladder stores urine before its released from the body. Once bacteria enter the bladder, they rapidly grow. The kidneys are a vital organ that filters the blood, removing waste material that is then released in urine. When a UTI reaches the kidneys, older adults are at enhanced risk of systemic infection, renal damage, and other complications.

Later-stage symptoms include:

  • Fatigue: Increased tiredness occurs in some adults with UTIs. This results from the body’s immune response to try and fight the bacteria as its spreads through the urinary tract.
  • Nausea: Nausea and other gastric symptoms may occur as part of the bacteria’s spread or due to pressure and pain in the abdomen.
  • Fever: Fever is a serious symptom and must be addressed quickly. Fevers are a byproduct of the body’s attempt to fight the infection.

UTIs and Sepsis in Older Adults

Sepsis is a systemic infection in which widespread inflammation leads to illness, organ failure, and possibly death. Any untreated infection could lead to sepsis. Nursing home and long-term care residents are especially susceptible to sepsis if their UTI goes undetected. Family members need to assess their loved ones during visits and communicate questions to the facility’s staff.

Urosepsis is sepsis caused by a UTI. It’s a relatively rare condition, but older females are more vulnerable to sepsis due to their weaker immune systems. Sepsis can be difficult to treat and elderly patients with underlying health issues are particularly vulnerable. Preventing, quickly diagnosing, and treating UTIs can avert this possibly life-threatening condition.

How Long Do UTI Symptoms Persist for the Elderly?

It is more difficult for the elderly to clear UTIs on their own due to concurrent medical conditions and weaker immune systems. Without treatment, symptoms will continue and worsen until the individual develops a serious illness and requires hospitalization. Once started on antibiotics, symptoms improve within a few days and the infection may resolve within one week. In serious cases, symptom improvement may take longer.

Each individual’s history of UTIs, baseline health, and concurrent medical conditions influence which symptoms occur and how long they last.

Treatment of UTI in elderly female

The earlier a UTI is detected, the shorter the treatment time will be. Doctors can usually diagnose a UTI with a brief examination and urine sample. The test allows them to determine the bacteria or fungus responsible for the infection. Antibiotic medications effectively eradicate the bacteria or fungus to resolve the UTI.

Antibiotics are only effective when patients take the entire prescription as ordered. Patients must take all the prescribed doses, even if their symptoms stop before they complete the course of antibiotics. Seniors may need reminders to take their medication, particularly if they have cognitive impairment.

Doctors advise patients with UTIs to drink plenty of water. Proper hydration helps flush the urinary tract to remove bacteria and fortifies underlying health.

Later-stage UTIs may require blood tests or imaging studies of the bladder and kidneys to properly diagnose the infection. These UTIs are also treated with antibiotics. Patients may require longer courses of antibiotics depending on the extent of the symptoms and comorbidities. UTIs rarely lead to hospitalization unless they go untreated and the patient develops sepsis.

Elderly females with two or more UTIs in six months or three or more UTIs in 12 months may require treatment with prophylactic antibiotics. Some individuals become more susceptible to UTIs with each infection, leading to chronic UTIs. Doctors may order low-dose antibiotics for daily consumption to manage the risk of UTIs for these individuals.

How to Prevent UTI Prevention in Older Women?

Older women can take many proactive steps to limit the occurrence of UTIs. Caregivers for older adults should monitor them for mood changes, which may indicate a UTI.

Preventative steps include:

  • Water: Drinking plenty of water to dilute bacteria present in the bladder and flush the urinary tract
  • Incontinence Care: Promptly changing incontinence pads or briefs when they are wet or soiled
  • Irritating Liquids: Reducing caffeine and alcohol consumption because they irritate the bladder
  • Urinating When Needed: Urinating when the urge occurs because holding urine pollutes the urinary tract and irritates the bladder
  • Avoiding using douches or feminine hygiene sprays: Women should avoid using douches or feminine hygiene sprays. This minimizes infection risk by allowing the body’s natural defense system to protect the vagina and urinary tract from invasive bacteria.
  • Wiping from front to back:  Wiping from front to back after urination reduces the risk of contamination by E. coli bacteria from the anus. Caregivers may need to remind older women with cognitive degeneration about proper hygiene.
  • Use low-dose hormonal vaginal cream: For some individuals, vaginal hormonal cream or low-dose estrogen suppositories may combat post-menopausal dryness and tissue loss.

Women should discuss treatment options with their doctors. Nursing home residents should be monitored for hygiene to ensure staff is maintaining proper incontinence care.

Natural Ways to Prevent UTIs in the Elderly

  • Push Fluids: Doctors recommend keeping hydrated to combat UTIs. Proper water intake clears the urinary tract, removing bacteria from the body before they can cause an infection.
  • Healthy Diet: A balanced diet, low in added sugar and processed foods, strengthens the immune system to help neutralize bacteria.
  • Cranberry Juice: Strong anecdotal evidence suggests that cranberries can prevent UTIs and improve symptoms. Studies are ongoing, but researchers believe cranberries block E. coli and other bacteria from adhering to the membrane that lines the urinary tract. Women should discuss relying on cranberries or over-the-counter supplements to prevent UTIs with their doctors. Cranberry products are not a treatment for UTIs. The only way to resolve an infection is to kill the bacteria that has entered the body.

Frequently Asked Questions(FAQ)

Can a UTI Cause Dizziness in Older Adults?

UTIs are a challenge for older adults because their symptoms often mirror other conditions. UTIs can lead to dizziness and unsteadiness. The sudden urge to urinate, combined with dizziness, increases the risk of a fall as women rush to the bathroom.

Can a UTI Cause Confusion in the Elderly?

Confusion is one of the hallmark signs of a UTI. Patients with UTIs may also feel fogginess, irritation, and delirium. Their confusion may stop them from seeking treatment because they misunderstand or forget their symptoms, allowing the UTI to worsen.

Can a UTI in Elderly Females Cause Dementia?

No. Dementia is a degenerative neurological disorder that alters cognition, memory, and personality. Symptoms of a UTI may mimic the signs of dementia, but research does not indicate UTIs cause dementia.

Can a UTI in Older Adults Cause Slurred Speech?

The cognitive impairment caused by UTIs may alter speech, but it is not a common symptom. If an elderly person or their caregiver observes slurred speech, they should seek immediate medical care. The symptom may indicate a neurological event, including a stroke.

Conclusion

UTIs are a common condition that will affect most women at some point in their lives. While UTIs are easily treated, they pose a threat to older women because of their weakened immune systems, comorbidities, and the tendency to dismiss their symptoms as another condition or part of aging.

Adults and their caregivers should monitor bathroom habits because changes may indicate the onset of a UTI. Post-menopausal women and those that have given birth are at elevated risk of UTIs due to biological and hormonal changes.

Maintaining overall health and wellness, practicing proper hygiene, and seeking treatment when symptoms present help prevent the occurrence of UTIs and minimize their effects when they do occur.

Sources

1. Cranberries and lower urinary tract infection prevention – National Library of Medicine

2. The Truth about UTIs in Older Adults – ConsultQD

3. Practical Management of Recurrent Urinary Tract Infections in Premenopausal Women – National Library of Medicine

4. Urinary Tract Infections in Adults – Urology Care

5. Sepsis and Urinary Tract Infections – Sepsis Alliance 

6. Kidney infection – Mayo Clinic

7. Symptoms of Urinary Tract Infections in Older Adults – Cleveland Clinic

8. UTIs in the Elderly – Seniorliving.org

9. Urinary tract infections – Office on Women’s Health

10. Urinary Tract Infections in Older Women – National Library of Medicine

11. Urinary tract infection in older adults – National Library of Medicine

12. Recurrent Urinary Tract Infections Management in Women – National Library of Medicine

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