Why Urinary Tract Infections Are More Harmful If You’re Older
Recognition is tricky, but ignoring symptoms may be deadly
Urinary tract infections (UTI) are one of the most common ailments affecting young women, but they are also prevalent in women over 65 and men over 85. And the consequences of getting a UTI when you’re older are far more dire.
A recent article published by the Philadelphia Inquirer reported that because urinary tract infections have often progressed over time in older adults before they are caught, older people are at greater risk for serious illness. Because much older adults often experience other health problems, they are even more vulnerable. Millions of older adults need to be hospitalized every year because of UTIs, and the infection can be deadly if it spreads to the kidneys or bloodstream.
"Pneumonia and urinary tract infections are the biggest infectious reasons for admission to the hospital for older adults," Dr. John Bruza, a geriatrician at Penn Medicine, told the Inquirer.
More Difficult to Recognize in Older Adults
Part of the problem is that while UTI symptoms — including urgency and burning during urination — are pronounced and obvious signs in younger adults, they are less intense and recognizable for older adults. Doctors point out that older people tend to feel the need to urinate more frequently for other reasons and are less likely to notice urgency and burning.
Fever, which is also a sign of a progressed UTI, is not a clear indication of a UTI in the elderly because of often-weaker immune systems.
Additionally, although a UTI is often suspected when an older patient suddenly becomes disoriented or weak, doctors might mistake confusion for regular symptoms of aging or worse, misdiagnose a UTI as Alzheimer's or dementia.
Why UTIs Are Prevalent in Older Population
The nature of urine itself changes with age, making it a less hostile environment for bacteria, and women undergoing hormonal changes may be more prone to infection. Older men and women tend to have more trouble emptying their bladders as they age, said the Inquirer, and if urine sits longer in a bladder, it is more likely to be colonized by bacteria. UTIs are also more common in older people who are incontinent or have diabetes, constipation and enlarged prostates.
Another common source of infection in older adults: catheters, or tubes, placed in the urethra and bladder. According to the Infectious Diseases Society of America (IDSA), catheters sometimes interfere with the body’s ability to clear microbes from the urinary tract. Bacteria travel through or around the catheter and establish a place where they can thrive within the bladder.
Still, a person who cannot urinate in the normal way or who is unconscious or critically ill often needs a catheter for more than a few days. Hospitals are required to report urinary tract infections patients caught while being hospitalized, and this change is credited as an incentive for reducing the use of urinary catheters. The IDSA recommendation is to use catheters for the shortest time possible to reduce the risk of a UTI, which might mean replacing the catheter with adult diapers after an extended period of time. Medical teams now routinely discuss whether catheters should be removed, and nurses have authority to remove them.
Prevention and Diagnostic Concerns
Doctors recommend similar UTI preventive measures for older adults as for younger adults: Drink plenty of water, urinate before and after sexual activity, use the restroom regularly and always wipe from front to back. Sedentary elderly adults living in assisted living should be encouraged by caregivers to use the restroom frequently.
Treatment of a strong course of antibiotics is also similar to the treatment for younger people, but this assumes that the older patient is otherwise healthy.
Many doctors worry that older adults are over-diagnosed and over-treated for UTIs. That's because urine testing in elderly patients can be more complex; bacterial levels in their urine tends to be higher than normal anyway. Dr. Paul Mulhausen, a Des Moines geriatric physician, told the Inquirer he worries that UTI symptoms might be similar to those of more serious problems —medication issues, strokes, internal bleeding or other infections including pneumonia. Extra precautions should be taken to ensure a correct diagnosis, he said.
Moreover, Mulhausen believes over-prescription of antibiotics is also concerning. The Centers for Disease Control has warned the medical community against over-prescribing antibiotics because of the building of antibiotic resistance and potential adverse drug reactions. This is especially a concern in an older population that already may take a variety of medications for other ailments.
Mulhausen said doctors must consider how treatments like antibiotics and catheters may help and harm older patients.
"Older people are more vulnerable to the harm of our treatment," he said in the Inquirer. "They require more thoughtful deliberation about risks and the benefits."