Urinary Tract Infections in the elderly

Do you know what to look out for and how to prevent a Urinary Tract Infection (UTI)? A UTI is more common among people with incontinence and the elderly. Therefore, it is important that you know what to look out for and how to prevent UTIs.

A UTI is something that anyone can get, but some groups are more vulnerable than others. If you are taking care of a relative with incontinence or some other diagnose, there are a few things that can be good to look out for.

UTIs occur when harmful microbes make their way into the lower or upper urinary tract. This can lead to unpleasant and, sometimes, serious symptoms. In most cases, the bacteria which invade the lower urinary tract come from our own bodies.

E. Coli is the most common type of bacteria that causes UTI. It normally lives in the intestine and can infect the urinary tract when the urethra is exposed to faeces.

What are the most common symptom for a bladder infection?

• Painful urination or a burning sensation
• Frequent urination and constant urge to urinate
• Small amounts of urine
• Traces of blood in the urine
• Dark, cloudy or strong-smelling urine
• Feeling chilly, but usually not having fever
• Sudden urinary incontinence

Generally speaking, a UTI isn´t dangerous, although it is painful. It is most commonly treated with antibiotics by prescription from a doctor, but if left untreated, the infection can spread from the lower urinary tract to the upper urinary tract and the kidneys. Such an infection can potentially cause kidney damage or even kidney failure. If that happens, the symptoms will get considerably worse with e.g. back pain, nausea and fever. From the kidneys the infection can enter the blood stream (urosepsis) and spread to other parts of the body, which is a serious medical condition that requires intensive care.

The symptoms of an infection can be very vague and unclear among people with low immune response and diabetes, as well as in elderly people, especially those with dementia. Symptoms can include general weakness of their condition, confusion, nausea, dizziness, sudden incontinence or increased severity of incontinence, for example. Often these symptoms seem connected to other conditions that are unrelated to a UTI, which makes it difficult to recognize an infection.

Knowing what is normal for the one you care about is important, so that the infection can be identified early and be treated as soon as possible.

Smelly and dark urine without any other symptoms should not be confused with a urinary tract infection. Actually, some people have “friendly” bacteria in the bladder, these bacteria may show no symptoms except for smelly urine. This is a harmless condition that should not be treated with antibiotics.

Not drinking sufficiently can also cause dark, cloudy and smelly urine. So, make sure that your loved one gets enough to drink.

Although anyone can be infected, people who are vulnerable due to other health conditions are at higher risk of getting a UTI. Examples of such groups are the elderly, and those with diabetes mellitus, or with an indwelling catheter, residents and patients.

The main reason women are more susceptible to UTIs has to do with the female anatomy. The urethra, is shorter than in a man, and it is also close to the anus from where bacteria can invade the urinary tract. In women, oestrogen hormone levels also decline with age. This can cause the walls of the urinary tract to become thinner and dryer. The protective mucous membrane, or mucosa, also becomes less acidic which reduces its ability to fight off infection. This is why oestrogen hormone treatment is recommended to prevent UTIs.

Not being able to empty the bladder properly is another example of what can increase the risk of UTI, since bacteria can grow in the remaining urine. Residual urine can be caused by many things, such as constipation, outflow obstruction from an enlarged prostate or a prolapse, spinal cord injury or nerve damage, which interferes with the normal function of the urinary tract.

Prevention through proper hygiene, skin care and toileting routines, is naturally of great importance for all of them.

The most important method of prevention is to keep the genital area clean and healthy, and able to protect itself against infection. Remember to hydrate as well, because dehydration can cause similar symptoms as UTI, and additionally urination can also flush out unwanted bacteria from the urinary tract. Finally, try to make sure your loved one gets help to empty their bladder entirely, since urine remaining in the bladder is a risk that bacteria thrive and multiply in the present urine.

Easy steps to avoid a UTI

• Wipe from front to back, to avoid transferring bacteria to the urinary tract
• Remove used incontinence products from front to back
• Don´t over-wash or use harsh soap in the sensitive genital area
• Use TENA wash cream to clean if the skin is fragile, and TENA barrier cream for protection.
• Dry the skin when changing hygiene products since bacteria grows better in moist areas
• Use high quality, breathable TENA incontinence products with a dry surface.
• Vaginal Oestrogen treatment is often recommended to prevent UTIs

Toilets can be difficult to use for those who have a mobility problem, or another disability, and many people with medical health conditions have trouble completely emptying their bladder. This can cause problems since the remaining urine can act as a medium for bacteria. By helping your relative with good toilet habits, you can avoid an unnecessary risk of infection.

Here are a few tips:

• Make sure your relative gets to the toilet in time
• Avoid constipation and ensure regular bowel movements
• Ensure your loved one has a comfortable correct toilet posture that facilitates complete bladder and bowel emptying. This means slightly leaning forward with bent knees and feet resting on the ground or on a footstool. A raised toilet chair, a foot rest or a soft cushion on the toilet seat can be helpful.
• Assist with double or even triple voiding. This means encouraging your loved one when they have finished voiding, to stand up and sit down again a few times. This may facilitate urine to be voided that was left behind the first time.

It’s important to recognize the earliest signs of a UTI for rapid diagnosis and treatment, particularly for frail elderly people who may show fewer symptoms and suffer more severely. So, keep a look out and communicate about changes with your loved one in your day-to-day routines.

A full diagnosis will be made by a physician. They will base this on urine test results and on symptoms of the infection. If an Upper or Lower UTI has been diagnosed and treatment is needed, the doctor will decide on which antibiotic to prescribe and at what dosage.

Relieving the symptoms of a UTI

• Make sure the person you care for drink enough to help flush out bacteria
• Non-Steroidal Anti-Inflammatory Drugs (NSAID*) can ease symptoms of a UTI like pain, fever and inflammation.
• Use a heating pad on the lower back or stomach to relieve pain or discomfort