Can UTI Cause Confusion In The Elderly?

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Written by: Jessica Guht
Jessica Guht
Categorized as UTI
Jessica Guht
Categorized as UTI

A UTI (Urinary Tract Infection) can be a common issue amongst the older population. This is because we become more susceptible to certain health conditions as we age. UTIs are common amongst the elderly, but can be present with a wide range of symptoms.

The most common symptoms of a UTI tend to be frequent urination and a burning pain. That being said, individuals may not always show the most common signs of a UTI and can experience various symptoms, such as lethargy and confusion. Those with dementia may be more prone to cognitive symptoms, including confusion. 

While there is a link between delirium and confusion with UTIs, it remains a complex and multifaceted topic that requires further exploration. Currently, the reason for this link remains unknown. 

In this article, we will be delving into the relationship between UTIs and confusion in the elderly, exploring the possible factors, symptoms, and contributing factors that may play a role in this phenomenon. Understanding these dynamics can aid in better recognizing and addressing UTIs amongst the elderly population, potentially leading to improved care and quality of life.

Table of Contents

Urinary Tract Infections Explained

The urinary tract consists of several components, including the urethra, which serves as the passage for urine from the bladder, the ureters (carry urine from the kidney to the bladder), the bladder (stores urine), and the kidneys (removes waste and additional water to make urine).

When bacteria get into the urethra and are not effectively fought off by the immune system, they can spread to the kidneys and bladder, resulting in a urinary tract infection (UTI).

According to a 2015 published study, UTIs caused approximately 10.5 million visits to doctors in the US. It has been found that women are more susceptible to UTIs compared to men due to the shorter length of their urethras.

The risk of developing a UTI increases with age. Based on one trusted study, more than a third of infections occurring in individuals residing in care homes are UTIs. Additionally, over 10 percent of women over the age of 65 reported having a UTI within the last year, and this percentage rises to nearly 30 percent for women 85 years or older.

UTIs are also common in males. As men age, they can also experience a higher incidence of UTIs.

Urinary Tract Infection Symptoms in Older Individuals

It can be challenging to identify a urinary tract infection (UTI) in older adults, as they may not always exhibit typical symptoms. This could be attributed to a suppressed or slower immune response.

Some typical UTI symptoms include:

When older adults experience these common UTI symptoms, they may have difficulty communicating them due to factors like Alzheimer’s disease or dementia. Unfortunately, symptoms such as confusion can be unclear and resemble other conditions.

Additional UTI symptoms may include:

  • Incontinence
  • Urinary retention
  • Fatigue and lethargy
  • Agitation
  • More prone to falls
  • A decrease in appetite
  • A decrease in mobility

If the UTI extends to the kidneys, other severe symptoms may arise, including:

Common Causes of Urinary Tract Infections

Bacteria are typically the primary cause of urinary tract infections (UTIs) regardless of age. Escherichia coli is commonly identified as the main culprit, although different organisms can also be responsible for causing UTIs.

In older individuals who use catheters or reside in nursing homes or care facilities, the prevalence of UTIs is often attributed to bacteria like Staphylococci and Enterococci. These organisms are more commonly associated with UTIs in this particular population.

How to Diagnose a UTI in Older Individuals?

Diagnosing urinary tract infections (UTIs) in older adults can be challenging due to the presence of undefined and uncommon symptoms, including confusion. If a UTI is suspected by the doctor, they are likely to order a urinalysis and further tests to determine the underlying cause of the symptoms.

One of the tests commonly performed is a urine culture, which helps identify the specific bacteria triggering the infection and determines the most effective antibiotic for treatment.

There are home UTI kits available that check for the presence of leukocytes and nitrates in the urine, both of which are often indicative of UTIs. However, it is important to note that bacteria can be present in the urine of the elderly to some extent, which can affect the accuracy of these tests. 

If you take a home test and receive a positive result, it is advisable to contact your doctor for further evaluation and guidance.

Steps to Prevent UTIs in Older Adults

To reduce the risk of urinary tract infections, there are several preventive measures one can take, including:

  • Staying hydrated by consuming an adequate amount of fluids.
  • Avoiding bladder irritants like caffeine and alcohol.
  • Regularly changing incontinence briefs or pads.
  • Maintaining proper hygiene by wiping from front to back after using the bathroom.
  • Urinating promptly when you need to go.
  • Avoiding the use of douches.
  • Considering the use of vaginal estrogen for appropriate cases.

For individuals residing in nursing homes or long-term care facilities, ensuring proper care is crucial in preventing UTIs, especially for those who have limited mobility and are dependent on others for assistance. It is important to communicate with the management of the facility regarding personal hygiene practices. 

Additionally, make sure they are knowledgeable about UTI symptoms in older adults and are prepared to respond accordingly.

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In Summary

UTIs in older adults can lead to confusion and dementia-like symptoms. Preventive measures and vigilance for UTI symptoms are crucial in avoiding infections, whilst early diagnosis by a doctor can improve prognosis.

Most UTIs can be cured with antibiotics. Without treatment, UTIs can progress to bloodstream and kidney infections, posing life-threatening risks. Severe cases may require hospitalization for intravenous antibiotics, which can take weeks to resolve.

Sources:

  • Sinawe H, Casadesus D. Urine Culture. 2023 May 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32491501.
  • Queremel Milani DA, Jialal I. Urinalysis. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557685/
  • Bono MJ, Leslie SW, Reygaert WC. Urinary Tract Infection. 2022 Nov 28. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29261874
  • Urinary Tract Infections (UTIs) in Older Adults. Healthline. Available from: https://www.healthline.com/health/uti-in-elderly 
  • Bladder Infection (Urinary Tract Infection—UTI) in Adults. National Institute of Diabetes and Digestive and Kidney Diseases. Available from: https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-infection-uti-in-adults
  • Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015 May;13(5):269-84. doi: 10.1038/nrmicro3432. Epub 2015 Apr 8. PMID: 25853778; PMCID: PMC4457377.
  • Balogun SA, Philbrick JT. Delirium, a Symptom of UTI in the Elderly: Fact or Fable? A Systematic Review. Can Geriatr J. 2013 Mar 5;17(1):22-6. doi: 10.5770/cgj.17.90. PMID: 24596591; PMCID: PMC3940475.

Content on the DrHouse website is written by our medical content team and reviewed by qualified MDs, PhDs, NPs, and PharmDs. We follow strict content creation guidelines to ensure accurate medical information. However, this content is for informational purposes only and not a substitute for professional medical advice, diagnosis, or treatment. For more information click here.

Always consult with your physician or other qualified health providers about medical concerns. Never disregard professional medical advice or delay seeking it based on what you read on this website.

If you are experiencing high fever (>103F/39.4C), shortness of breath, difficulty breathing, chest pain, heart palpitations, abnormal bruising, abnormal bleeding, extreme fatigue, dizziness, new weakness or paralysis, difficulty with speech, confusion, extreme pain in any body part, or inability to remain hydrated or keep down fluids or feel you may have any other life-threatening condition, please go to the emergency department or call 911 immediately.

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