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Health Topics

Urinary tract infections in older adults


June 7, 2023

These infections can affect the elderly differently than younger adults. What to know.

Urinary tract infections (UTIs) typically cause burning or stinging pain during urination, and also tend to create the need to get to the bathroom more often than usual. Occasionally, they can also cause pain in the lower back or a fever. This type of infection starts in the bladder, but we tend to feel them “downstream,” upon peeing (for what may feel like the millionth time in a day when a urinary tract infection is occurring).

Urinary tract infections can affect the kidneys and ureters (the tubes carrying urine from the kidneys to the bladder), and more commonly the bladder and the urethra (which carries urine from the bladder to the outside of the body). Here’s what to know about UTI infections in older adults.

Other UTI symptoms in older adults

Older adults — age 65 and older —  or their caregivers should know that urinary tract infections can also cause other symptoms that are different from what younger adults experience. Depending on the person, a urinary tract infection can lead to fatigue, mental “fogginess,” feeling unmotivated or irritable, disorientation, a loss of appetite and/or a sense that they “just don’t feel like themselves,” said Dr. Anne Gifford, a geriatric primary care doctor with Vanderbilt Health Geriatric Care. She explains how urinary tract infections may affect older patients.

Older adults are somewhat less likely than younger ones to run a fever with UTI infections. But they’re more likely to have cognitive symptoms or differences in their mental state, Gifford said.

A sudden change in mental status or awareness, such as not recognizing people or their surroundings, or even just an increase in agitation, irritability or restlessness — these are all possible red flags, Gifford said. 

“An additional sign,” Gifford said, “is a change in continence in an older adult who is previously continent and then has unexpected incontinence” or leaking urine, especially if the inability to control the bladder happened suddenly. The older the person, the more likely that a urinary tract infection will cause these changes in cognitive ability (the ability to think clearly) or continence, Gifford said.

However, many other medical conditions can cause similar problems with clear-headedness, energy level and mood, Gifford said. The list includes dehydration, dementia, the flu or other type of infection, or even a head cold, which can cause clogged ear tubes and make it difficult for an older person to hear well. Certain medications or a combination of medicines may also make someone feel foggy or “off.”

“That can present in the exact same vague way,” Gifford said. “Everybody has a story … ‘My (grandmother, or mother, or aunt, etc.) was acting funny. She got antibiotics, and now she feels better.’ And whether or not those are truly people who got better because they treated a urinary tract infection or they would have gotten better anyway, we really don’t know.” 

Primary care providers have known for many years that these cognitive problems are possible symptoms of urinary tract infections, Gifford said.

A longstanding (since 1991) definition of a urinary tract infection is known as McGeer’s criteria. It includes a mention of altered mental status plus at least one physical symptom. (However, many professional societies have offered different definitions that do not include altered mental status.) There’s also evidence that older adults are overtreated for urinary tract infections, Gifford said – given antibiotics when there’s really another cause for their symptoms. 

“For people who are totally cognitively intact, though, and don’t have any dementias, it’s less common to have a completely sudden change with confusion,” Gifford said. “When somebody at a baseline is pretty normal and then all of a sudden is confused, that points toward an infection.”

Who is likely to get a urinary tract infection?

In general, women are more prone to these. But later in life, a man’s chance of having them increases, partly because as a man ages, the prostate gland gets larger. An enlarged prostate can interfere with the flow of urine. If urine sits in the bladder longer, there’s a greater chance for an infection to develop in the bladder.

How to prevent a urinary tract infection in an older adult

Good hygiene is the best defense, Gifford said, no matter how old the patient is.

The elderly may have trouble properly cleaning themselves after urinating or defecating, which can increase their chances of developing an infection. Anyone involved in caring for an older adult, especially with helping in the bathroom, should be sure the patient is wiped clean after each visit to the toilet. Thoroughly washing hands – the older adult’s, and the caregiver’s — after using the toilet is very important.

Staying well hydrated may also help prevent urinary tract infections, Gifford said, because a steady intake of water during the day helps flush the bladder, so bacteria are less likely to accumulate and “stick” there.

What to do if an older adult shows signs of a urinary tract infection

A visit with the primary care provider can lead to a quick diagnosis. Geriatricians (doctors specializing in caring for older adults) are also helpful in diagnosing these infections and getting antibiotics started.

These infections are diagnosed from a urine sample. The lab will identify whether there is an infection, and which type of bacteria is causing it. That informs a doctor or nurse practitioner’s decision about which antibiotic to prescribe. UTIs are typically cleared up with a five- to seven-day course of antibiotics.

If possible, an in-person appointment between the older adult and the health care provider is best, Gifford added, or at least a virtual telehealth visit with video, so the provider can get a better assessment of the patient’s mental state than a phone call might provide. It’s also helpful to have a friend or relative accompany the older adult to the appointment, because they can explain what behaviors they’ve observed, in addition to information the patient reports.

“Sometimes those stories are different,” Gifford said. “That can be really helpful” when the doctor or nurse practitioner is figuring out what’s causing symptoms.

Head-and-shoulders portrait of a middle aged white woman standing outdoors.

Need help with a UTI?

If you are older than 65 and think you may have a urinary tract infection — or if you are caring for an older relative who might — a primary care physician or a geriatric specialist can help with diagnosis and treatment. Vanderbilt Health urologists can also help.

Vanderbilt Primary Care