UTIs & Dementia In Older Adults: First Signs, Causes, & More

Cognitive impairments in dementia patients further complicate the detection and treatment of these infections.

This blog explores why dementia patients are at a higher risk for developing UTIs, the unique challenges they face, and practical strategies for caregivers to prevent and manage UTIs effectively.

UTIs occur when bacteria enter the urethra and cause an infection of any part of the urinary system. After the age of 35, the immune system begins to weaken, and the warning signs of an infection dwindle, making it more difficult to notice UTI symptoms.

Older people with dementia are not able to understand or recognize their UTI symptoms, and age brings decreased immune system signs / symptoms, leading to twice the risk of not recognizing a UTI when it’s first developing.

Older individuals, particularly those with dementia, are at a higher risk of developing UTIs for a few reasons. Risk factors include:

Those with dementia have difficulty recognizing symptoms of a UTI, which can delay diagnosis and treatment. Forgetting to hydrate, forgetting to urinate, incontinence, and difficulty with personal hygiene may occur in people with dementia.

Immobility or reduced mobility can limit the ability to ambulate to the bathroom, and weakened immune systems can make it difficult to fight off UTI infections.

People with dementia can resist assistance with toileting and personal hygiene. Also, prolonged use of incontinence products creates a warm, moist environment, the perfect breeding ground for bacteria growth, raising the risk of UTIs.

The typical symptoms of a UTI include:

• Burning sensation or pain when urinating.
• Feeling a strong and sudden urge to urinate frequently.
• Needing to urinate more often than usual, especially at night.
• Urine color that’s cloudy, bloody, red, pink, brown, or has a strong odor.
• Pain in the lower abdomen or back.
• Fever, nausea, vomiting, chills.

However, in older adults with dementia, symptoms can be atypical. This is because symptoms don’t occur until the very last moment since some warning signs are more present in younger and cognitively intact individuals. Symptoms for those that have dementia could include:

Sudden changes in mental health and decline in cognition are some of the first warning signs of UTIs in older adults and individuals with dementia. Mental and cognitive changes can make it difficult to determine between a UTI and worsening dementia, so caregivers must pay attention to the signs their loved one is exhibiting.

If your loved one is showing signs of increased confusion, delirium, agitation, hallucinations, lethargy, loss of appetite, or sudden worsening of incontinence symptoms, they may have a UTI.

It may be challenging to diagnose a UTI due to limited verbal and cognitive function in your loved one, making it difficult to discuss any symptoms. Aggressiveness could also make testing for a UTI or obtaining a urine specimen difficult.  

If you believe your loved one has developed a UTI, speak with their healthcare professional or specialist, such as a urologist. Their provider may be able to conduct a urinalysis and send for a urine culture. 

However, a urinalysis can sometimes be difficult to correctly diagnose a UTI, as people in long-term nursing facilities often have the presence of bacteria in the urine, with or without symptoms. Catching a urine specimen may also be problematic if your loved one has incontinence.

Treating a UTI is only necessary when a urine culture is positive and UTI symptoms are present. Oral antibiotics would be the best route. However, it can be challenging to get dementia patients to take them orally. Oral antibiotic resistance can also occur, so getting them intramuscularly or intravenously can be difficult.

Lifestyle changes for UTIs in dementia patients include hydration, avoiding constipation, ambulation, practicing good hygiene, using probiotics, regular toileting, and managing comorbidities.

Monitor your loved one’s cognitive decline and urinary symptoms on an ongoing daily basis. Keep hydration levels up, and use appropriate staffing for hygiene and toileting habits when applicable. You can also apply local hormone creams to vulva owners, implement regular changes of incontinence products, and manage comorbidities.

The keys to preventing UTIs in your loved one are consistency and getting the cooperation of your loved one.

Leaving UTIs untreated can lead to a worsening decline of cognitive function, increased risk for hallucinations, delirium, delusions, pyelonephritis, and increased risk of sepsis, bladder damage, kidney damage, and even death.

Complicated UTIs require IV antibiotics, and hospitalization should be pursued at that time.  Individuals with complicated UTIs are at risk for sepsis, septic shock, and pyelonephritis.  Hospitalization may also occur if the patient is not improving with oral antibiotics and needs to switch to IV antibiotics.

One of the best resources caregivers and family members can use when caring for a loved one with dementia is Aeroflow Urology. Dementia and incontinence are closely linked because many individuals with dementia develop bladder and bowel control conditions. When this happens, your loved one will require incontinence products, such as adult briefs, adult pull-ons, or bladder control pads. These can be costly out of pocket, but your loved one may be able to get them for free through their insurance plan with us!

From there, you’ll need to provide us with a prescription for incontinence products, and you’ll be sent a personalized list of incontinence supplies to choose from that are 100% covered by their insurance!

Speaking to your local hospital can also be helpful when caring for someone with dementia, and you can also use local or regional support groups and other resources in the community. Aside from these resources, you may use:

• The Alzheimer’s Society.
• Alzheimers.gov.
• Alzheimer’s Association.

The range of cognitive, physical, social, environmental, and emotional concerns associated with dementia can make prevention and treatment of UTIs in those with dementia difficult. You need all hands on deck to optimize treatment modalities for the best care!

Disclaimer

Information provided on the Aeroflow Urology blog is not intended as a substitute for medical advice or care from a healthcare professional. Aeroflow recommends consulting your healthcare provider if you are experiencing medical issues relating to incontinence.