The classic symptoms of a urinary tract infection (UTI) are burning pain and frequent urination. UTIs may not cause these classic symptoms in older adults. Instead, older adults, especially those with dementia, may experience behavioral symptoms such as confusion.

Understanding urinary tract infections

The urinary tract includes:

  • the urethra, which is the opening that carries urine from your bladder
  • the ureters
  • the bladder
  • the kidneys

When bacteria enter the urethra and your immune system doesn’t fight them off, they may spread to the bladder and kidneys. The result is a UTI.

UTIs are responsible for around 8.1 million doctor visits per year. Women are four times more likely to get UTIs than men because their urethras are shorter than men’s urethras.

Your UTI risk increases with age. More than one-third of all infections in people in nursing homes are UTIs. Over 10 percent of women over age 65 report having a UTI within the past year. That number increases to almost thirty percent in women over 85. Men also tend to experience more UTIs as they age.

Symptoms of a urinary tract infection in older adults

It may be hard to figure out that an older adult has a UTI because they don’t always show classic signs. This may be due to a slower immune response.

Classic UTI symptoms include:

  • urethral burning with urination
  • pelvic pain
  • frequent urination
  • an urgent need to urinate
  • a fever
  • chills
  • foul-smelling urine

When an older adult has classic UTI symptoms, they may be unable to tell you about them. That may be due to age-related issues such as dementia or Alzheimer’s disease. Symptoms such as confusion may be vague and mimic other conditions.

Non-classic UTI symptoms may include:

  • incontinence
  • agitation
  • lethargy
  • falls
  • urinary retention
  • decreased mobility
  • decreased appetite

Other symptoms may occur if the infection spreads to the kidneys. These severe symptoms can include:

  • a fever
  • flushed skin
  • back pain
  • nausea
  • vomiting

What causes a urinary tract infection?

The main cause of UTIs, at any age, is usually bacteria. Escherichia coli is the primary cause, but other organisms can also cause a UTI. In older adults who use catheters or live in a nursing home or other full-time care facility, bacteria such as Enterococci and Staphylococci are more common causes.

Risk factors for urinary tract infection in older adults

Certain factors may increase the risk of UTIs in older people.

Conditions common in older adults may lead to urinary retention or neurogenic bladder. This increases the risk of UTIs. This includes Alzheimer’s disease, Parkinson’s disease, and diabetes. These conditions often require people to wear incontinence briefs. If they’re not changed regularly, an infection may occur.

Several other things put older adults at risk of developing a UTI:

  • a history of UTIs
  • dementia
  • using a catheter
  • bladder incontinence
  • bowel incontinence
  • a prolapsed bladder

In females

Postmenopausal females are at risk of UTIs because of estrogen deficiency. Estrogen may help protect the vagina and urethra from an overgrowth of E. coli. When estrogen decreases during menopause, E. coli may take over and trigger an infection.

In males

The following may increase the risk of UTIs in males:

  • a bladder stone
  • a kidney stone
  • an enlarged prostate
  • catheter use
  • bacterial prostatitis, which is a chronic infection of the prostate

Diagnosing a urinary tract infection in older adults

Vague, uncommon symptoms such as confusion make UTIs challenging to diagnose in many older adults. Once your doctor suspects a UTI, it’s easily confirmed with a simple urinalysis. Your doctor may perform a urine culture to determine the type of bacteria causing the infection and the best antibiotic to treat it.

There are home UTI tests that check the urine for nitrates and leukocytes. Both are often present in UTIs. Because bacteria are normally in the urine to some degree, these tests aren’t always accurate. Call your doctor if you take a home test and get a positive result.

Treating a urinary tract infection in older adults

Antibiotics are the treatment of choice for UTIs in older adults and younger people. Your doctor may prescribe amoxicillin and nitrofurantoin. More severe infections may require a broad-spectrum antibiotic such as ciprofloxacin and levofloxacin.

You should start antibiotics as soon as possible and take them for the entire duration of treatment. Infection should clear up in a few days. Stopping treatment early, even if symptoms resolve, increases the risks of recurrence and antibiotic resistance.

It’s important to drink plenty of water during treatment to help flush out the remaining bacteria.

People who have two or more UTIs in six months or three or more UTIs in twelve months can use prophylactic antibiotics. This means taking an antibiotic every day to prevent a UTI.

Healthy older adults may want to try over-the-counter UTI pain relievers such as AZO, acetaminophen, or ibuprofen to ease burning and frequent urination. A heating pad or hot water bottle may help relieve pelvic pain and back pain. Older adults who have other medical conditions shouldn’t use home remedies without first consulting a doctor.

How to prevent urinary tract infections in older adults

It’s impossible to prevent all UTIs, but there are steps that help lessen your chance of infection. You can do this by:

  • drinking plenty of fluids
  • changing incontinence briefs frequently
  • avoiding bladder irritants such as caffeine and alcohol
  • keeping the genital area clean by wiping front to back after going to the bathroom
  • not using douches
  • urinating as soon as the urge hits

Cranberry juice has shown mixed results in preventing UTIs. More research is needed.

Proper nursing home or long-term care is critical in preventing UTIs, especially for people who are immobile and unable to take care of themselves. They rely on others to keep them clean and dry. If you or a loved one is a nursing home resident, talk to management about how they manage personal hygiene. Make sure they’re aware of UTI symptoms in older adults and how to respond.

The takeaway

A UTI can cause confusion and other symptoms of dementia in older adults. Taking preventive steps and looking out for UTI symptoms should help prevent infection. If your doctor diagnoses a UTI early, your outlook is good.

Antibiotics cure most UTIs. Without treatment, a UTI can spread to the kidneys and the bloodstream. This may lead to a life-threatening blood infection. Severe infections may require hospitalization for intravenous antibiotics. These can take weeks to resolve.

Get medical attention if you suspect that you or a loved one has a UTI.