Do you know that a sudden altered mental state can be caused by infection?
Often the only presenting symptom in the elderly with an infection is a change in mental status or decline in functioning. Cognitive impairment in the elderly makes it very difficult to suspect a urinary tract infection is brewing. Urinary tract infections are the most common cause of bacteremia (bacteria in the blood) in older adults. Blood is normally a sterile environment, so infections in the bloodstream are potentially life-threatening.
Is a normally rational senior suddenly exhibiting “squirrely” behavior?
Altered Mental status is often the only symptom of UTI’s in the elderly. This change in mental status is frequently mistaken as early stages of dementia. Behaviors demonstrated may be increased confusion, agitation, hallucinations, increased aggression, falls, and poor motor skills and dizziness.
If the individual already has dementia, and manifests an acute change in mental status over a span of hours or days, suspect delirium, which is reversible, whereas dementia is not. The elderly typically do not experience symptoms of pain, frequency, low grade fever, or burning with a UTI. The only change is the “squirrely” behavior or altered change in mental status!
Why are UTI’s common in the Elderly?
The Elderly population is more susceptible to all infections due to their suppressed immune system which happens with aging and certain medical conditions. The elderly also experience a weakening of their bladder muscle leading to incomplete emptying when urinating. Typical side-effects of incomplete emptying of the bladder are, retention of urine in the bladder, incontinence, and an environment for growth of bacteria because the bladder is not emptied completely.
Medical conditions that can cause UTI’s are use of a urinary catheter, bowel incontinence, enlarged prostate, immobility especially for those who lie in bed for extended periods, kidney stones, and diabetes.
How do I prevent UTIs?
- Drink lots of water, up to 8 glasses per day. Drinking lots of water dilutes the urine and causes frequent urination and flushing the bladder of harmful bacteria to prevent UTIs.
- Drink cranberry juice daily to prevent UTIs. Research about cranberry juice is not conclusive, but recent research is leading to the belief that certain substances in cranberries create a Teflon-like coating which prevent E. coli from adhering to the bladder wall.
- Maintain proper perineal hygiene by wiping from front to back to prevent bacteria in the anal region from spreading to the vagina and urethra.
- If you wear depends or pads for incontinence change them often. Depends or briefs are in close contact with the skin, which can reintroduce bacteria into the bladder.
- If the person is memory impaired take them to the toilet regularly to prevent incontinence in the brief.
If you witness an altered change in mental status or even a subtle behavior change in your senior, take them to the doctor for examination. Be sure to suggest collection of a urine specimen to check for a UTI. If they have dementia, describe the unusual behavior to the doctor or hospital ER staff.
Want to find out more?
Common Infections in Older Adults
Urinary Tract Infections in the Elderly
Cranberries for UTI Prevention
Urinary tract infection (UTI)
Helen Trowsdale, President of AA Care Services, is a nurse administrator with over 30 years of experience as a BSN, psychiatric nurse, and geriatric care manager with adults as well as pediatrics in hospitals, private duty home health care agencies, and residential home health care. Her team of caregivers are dedicated to serving their clients with home care in San Antonio, New Braunfels, and Austin; providing clients with consistent, quality care while minimizing the number of caregivers in the home. Learn more about AA Care Services.