Urinary Tract Infection in the Elderly

Elderly Man in Baseball CapUrinary Tract Infection (UTI) is very common among the elderly and sick, especially those in a home care treatment plan. UTI is an infection in the urinary system caused by bacteria and, if left untreated, can lead to other serious problems like kidney failure or sepsis. Most UTI cases are in the bladder or urethra. The bacteria comes from improper cleaning methods after defecating, sexual intercourse, menopause, and use of specific birth control methods. You can also get UTI from a kidney stone, urinary tract abnormalities, a suppressed immune system, use of a catheter, and from a recent surgical procedure like a urinary exam.

UTI is easily treated and prevented but more challenging to do so with the sick and elderly because the symptoms can be misdiagnosed or even over-treated. For instance, the home test for UTI is the urine dipstick. Unfortunately, this method is not reliable with the elderly, and often the results are erroneously interpreted. The urine dipstick is unable to distinguish between asymptomatic bacteriuria (high bacteria count but not UTI caused by conditions like diabetes, spinal cord injury, etc.) and UTI.

With the high number of errors in UTI diagnosis, experts recommend that professional and experienced RNs be requested to handle the testing. These nurses will know about the protocol in collecting the urine sample, like checking the blood pressure, temperature and pulse of patient beforehand.  Interestingly in a study done among over 140 home care staff last 2017, the level of knowledge for primary symptoms was high but low with secondary symptoms. Moreover, symptoms like poor appetite, localized pain, and apathy are not common among UTI patients, except for the elderly because of their age.

Also essential is the urine culture and the transportation of the urine sample en route to the lab for processing.

Prevention and Treatment of UTI

The role of the family when there is an ailing elder in the house or family is to select a caregiver who has experience caring for geriatric patients under the guarded watch of a professional nurse who can oversee the home care plan and visit at least once a week.

UTI can be prevented with proper planning. First, the overall health of the patient must be understood, and a medical care plan must be agreed upon with the doctor. Periodic physical exam and lab testing will help determine if there is UTI or any new medical condition.

Second, for recurring UTI, the medical team should determine what the underlying factors are. The family will need to know with certainty what is causing the UTI, perhaps with the use of empirical data which a professional nurse can help gather. Aggressive treatment is only recommended for an acute UTI. For non-acute UTI, some of the procedures prescribed include pelvic floor rehab for prolapse, vaginal estriol for urethral atrophy, balanced diet, and hydration, IV if necessary.

Finally, it is critical that a detailed medical record be started and preserved for continuity and better organization.