Urinary tract infections (UTIs) are unpleasant, to say the least, but they're also common — and even more so as we age.
Twenty percent of women over age 65 develop a UTI (compared to 11 percent in the general U.S. population) and close to 10 percent of postmenopausal women say they had a UTI in the last year, according to January-December 2019 research in Therapeutic Advances in Urology. (Note: While LIVESTRONG.com strives to use more accurate and inclusive language, "women" was the term used by the study authors.)
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A UTI refers to an infection of the urinary system, including the kidneys, ureters, bladder and/or urethra, according to Mayo Clinic. The most common type of UTI is a bladder infection, which is the result of an overgrowth of bacteria in the bladder, per the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Here's what causes UTIs in older adults along with the best treatment and prevention options.
Symptoms of UTI in Older Adults
General symptoms of UTIs include:
- Burning while urinating
- Abdominal pain
- Urine urgency
- Urine frequency
However, older adults may also have more abnormal symptoms that you wouldn't otherwise associate with a UTI, says Shikta Gupta, MD, a geriatrician with Montefiore Medical System in the Bronx. These symptoms can include:
- Lethargy, sleepiness or difficulty waking up
- Loss of appetite
Because this infection can affect a person's mental state and cause vague symptoms, many older adults won't realize there's something wrong. "They just may not feel like themselves, but that can happen for a lot of other reasons," Dr. Gupta says.
If you're a caretaker, it's important to talk to a doctor if you notice any of these signs or symptoms in the person you're caring for.
Why Older Adults Are More Prone to UTIs
Older adults are at higher risk for UTIs for several reasons, according to a July 2020 review in Drugs in Context. These include:
- Normal changes to their immune system that leave them with weaker defenses to fight off things that can make them sick, including bacteria
- A greater chance they have a chronic disease, such as diabetes, which leaves them more vulnerable to infection
- Greater likelihood of health care-acquired infections
- Living in a nursing home
- Wearing a catheter, especially for those living in a nursing home
In addition, a decrease in estrogen in postmenopausal women allows for more bacterial growth, Dr. Gupta says. Plus, weakening pelvic floor muscles or an enlarged prostate may prevent people from emptying their bladder when urinating, and when urine lingers in the bladder, bacteria can grow.
How to Treat a UTI in Older Adults
To diagnose a UTI, you'll need to have a urinalysis done, which is a simple urine test. For any age, treating a UTI is the same: A prescription for antibiotics.
"The key is to find out which one they should take. Antibiotic resistance of these bacteria has risen," Dr. Gupta says.
As the NIDDK points out, treatment depends on several factors, including severity of the infection and whether you're prone to UTIs.
Antibiotic overuse is a driving factor behind antibiotic resistance. That's why it's so important to have a urinalysis done to ensure that it is, in fact, a UTI; it should not be diagnosed based on symptoms alone, Dr. Gupta says.
When you start antibiotic treatment, be sure to take the entire prescribed course of the antibiotics or make sure that the older adult is doing so, if you're a caretaker. "After one to two doses, patients look so much better. But even if there's a lot of improvement, you have to complete the course of antibiotics," Dr. Gupta says.
Not taking the antibiotics as prescribed — i.e. stopping them before you're supposed to — also increases the risk of resistance.
How to Prevent UTIs in Older Adults
There are certain people who tend to have recurrent UTIs, which is defined as having two UTIs in six months or three in a year, according to the Office on Women's Health. If that's the case for you or someone you're caring for, follow these habits to lower the likelihood of developing another infection:
1. Drink Plenty of Water
Aim for six to eight glasses of water per day "to keep your bladder irrigated, which decreases the risk that bacteria will sit in the bladder," Dr. Gupta says. When bacteria sit in the bladder, there's an opportunity for them to grow.
2. Mind the Wiping Direction
If you have a vagina, make sure you wipe front to back so as not to drag fecal bacteria from your rectum to your urethra (the tube that runs from the bladder out the vagina).
3. Ask About a Vaginal Estrogen Cream
"Estrogen helps prevent overgrowth of the bacteria that causes UTI," Dr. Gupta says. For those in menopause, a topical cream restores protective estrogen to keep bacteria count down. She recommends using it two to three times per week. Talk to your doctor to see if this is a good option for you.
4. If You Gotta Go, Go
Don't wait to go to the bathroom. As soon as you have that gotta-pee feeling, do it. Otherwise, urine sits in your bladder, which can encourage bacterial growth.
Caretakers can help their elderly adults by using "timed toileting," which means bringing them to the bathroom on a regular, timed schedule, Dr. Gupta says.
5. Avoid Certain Drinks
Prone to UTIs? Decrease or eliminate caffeine, alcohol and sugary drinks, all of which are considered bladder irritants, Dr. Gupta says. (It's also a good idea to avoid caffeinated foods like chocolate.)
6. Consider Cranberry
Cranberry has a reputation as a healthy natural product for UTIs, as it may prevent bacteria from sticking to the urinary tract where it can grow. However, Dr. Gupta points out that the evidence is limited and inconsistent.
What is clear is that cranberry cannot treat a UTI. "Cranberry is not a replacement for antibiotics — ever," she stresses.
However, for people with chronic UTIs, cranberry may decrease recurrent UTIs by one-third, and in those who have a catheter, it may decrease the risk by half, according to a September 2021 meta-analysis in PLOS One. Though it's no guarantee, it's worth trying.
Dr. Gupta advises drinking 8 to 10 ounces of cranberry juice per day. Go for 100 percent cranberry juice rather than a cranberry juice cocktail or a cranberry juice blend, to limit added sugar. Keep in mind that drinking juice also adds calories into your diet.
The PLOS One study also found that cranberry juice was more effective than cranberry tablets or capsules, possibly because the juice helped people stay hydrated.
7. Change Incontinence Products Often
If your loved one is incontinent, change adult diapers or pads often so they do not sit in wet products, Dr. Gupta says.
Complications of UTIs in Older Adults
If not treated, a UTI infection can travel up to the kidneys, causing a kidney infection, Dr. Gupta says.
"Kidney infection causes much worse morbidity and can land an older adult in the hospital," she adds.
When there's a delay in treatment or if left untreated, a UTI can lead to an infection in the bloodstream called sepsis, which is life-threatening, according to a February 2019 study in The BMJ.
When to See a Doctor
If you notice any of the symptoms of a UTI, including the less obvious signs of an infection in an elderly person, such as confusion, agitation or decreased appetite, don't wait: Schedule an appointment with a doctor so you can get treatment as soon as possible.
- Therapeutic Advances in Urology: "An introduction to the epidemiology and burden of urinary tract infections"
- Mayo Clinic: "Urinary tract infection (UTI)"
- National Institute of Diabetes and Digestive and Kidney Diseases: "Definition & Facts of Bladder Infection in Adults"
- Drugs in Context: "Urinary tract infections in the elderly: a review of disease characteristics and current treatment options"
- National Institute of Diabetes and Digestive and Kidney Diseases: "Treatment for Bladder Infection in Adults"
- PLOS ONE: "Consumption of cranberry as adjuvant therapy for urinary tract infections in susceptible populations: A systematic review and meta-analysis with trial sequential analysis"
- The BMJ: "Antibiotic management of urinary tract infection in elderly patients in primary care and its association with bloodstream infections and all cause mortality: population based cohort study"
- Office on Women's Health: "Urinary tract infections"
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