Risk factors for developing symptomatic UTI in the aging population are different to those in younger women. Age-associated changes in immune function, exposure to nosocomial pathogens and an increasing number of comorbidities put the elderly at an increased risk for developing infection .
This is because as you get older, your immune response changes – it’s part of normal aging. A UTI places stress on the body,” says Dr. Pearson, “and any type of stress, physical or emotional, can cause an older adult to become confused.
Classic symptoms such as fever may be either absent or reduced in intensity, and atypical symptoms such as new or increased confusion, functional decline, falls, and loss of urinary or fecal continence may be the presenting manifestation of infection.
More often, than in patients without UTIs, they reported symptoms such as delirium (28.9% vs. 18%), tachycardia (11.1% vs. 1.5%) or hypotension (20% vs. 12.1%).
Atypical UTI may be due to infection from a bacterium other than E. coli, e.g. Staphylococcus spp., or from an underlying condition, such as a congenital renal tract abnormality. Atypical UTI and recurrent UTI in children is associated with an increased risk of complications, such as septicaemia or renal scarring.
Seniors experiencing UTIs can show a sudden change in behavior and symptoms that may appear to be associated with cognitive issues, such as: Frequent falls. Confusion. Dizziness.
Many UTIs occur due to E. coli, a type of bacteria that is commonly present in stool and can enter the urinary system through the urethra. Other organisms that are capable of causing a UTI may be present in older adults who have a catheter or reside in a hospital or care facility.
Often, when people age, there is immunosenescence, which means that the immune system doesn’t function as well or as vigorously. The combination of increased comorbid conditions and the decrease in activity of the immune system can make people more prone to infections.
Atypical Presentation of Common Geriatric Emergencies
Classic symptoms other than pain and discomfort include shortness of breath, nausea, diaphoresis, and sometimes light-headedness. Identified atypical symptoms include fatigue, weakness, numbness or tingling in the upper extremities, palpitations, indigestion, loss of appetite, and confusion.
UTI is considered to be the most common infection among the elderly1–3 and the most common cause of bacteremia,4 but patients with bacteriuria who can clearly communicate the absence of urinary tract symptoms have asymptomatic bacteriuria (ASB) and do not require treatment.
For most people, asymptomatic bacteriuria does not cause any problems and treatment is not necessary. If you do develop a urinary tract infection, prompt treatment with antibiotics will almost always take care of it.
Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of nitrofurantoin in the elderly. However, elderly patients are more likely to have age-related heart, liver, lung, or kidney problems, which may require caution in patients receiving nitrofurantoin.
Uncomplicated UTI – infection in a healthy, non-pregnant, pre-menopausal female patient with anatomically and functionally normal urinary tract. Complicated UTI – infection associated with factors increasing colonization and decreasing efficacy of therapy.
E. coli is responsible for more than 50% of complicated UTI events and 80 to 90% of uncomplicated pyelonephritis cases. Klebsiella and Proteus may be more common among hospitalized or instrumented patients. Proteus is often a cause of UTI associated with stones.
Examples of a complicated UTI include: Infections occurring despite the presence of anatomical protective measures (UTI in males are by definition considered complicated UTI) Infections occurring due to anatomical abnormalities, for example, an obstruction, hydronephrosis, renal tract calculi, or colovesical fistula.