An elderly woman is found at home with a dazed expression on her face, unaware of her surroundings and speaking nonsensically. Despite her advanced age, she’d always been mentally sharp, up to date on the latest news, and remained a vital part of the community.
At the hospital a doctor orders a series of tests to determine whether or not the woman has had a stroke or a brain aneurysm. When the results come back negative, the physician suggests her symptoms could indicate the early onset of dementia or perhaps Alzheimer’s Disease.
Meanwhile, the woman’s family members are beside themselves trying to understand how someone’s cognitive abilities could change so drastically and seemingly overnight. The medical team is perplexed as well until the source of the problem is discovered when a blood test reveals that the woman is suffering from a urinary tract infection (UTI).
“That would be my first guess,” said JoAnn Franklin, advance practice nurse with NHC Healthcare in Desloge. “There are six illnesses which are the high transfer rates for the elderly and a UTI is one of the six. Those six things are the most common reason for people to go to the hospital but are things that can be managed if you capture them early so people don’t get to the point of having confusion because they have infection.”
According to the Urology Care Foundation, a UTI occurs when bacteria finds its way into the urine and travels up to the bladder. They cause more than 8.1 million visits to health care providers each year. About 10 in 25 women and 3 in 25 men will have symptoms of at least one UTI during their lifetime.
Typical symptoms of UTIs include urine that appears cloudy or dark, bloody urine; strong or foul-smelling urine; a frequent or urgent need to urinate; pain or burning during urination; feelings of pressure in the lower pelvis; low-grade fever; night sweats; shaking or chills.
Older people may not exhibit any of the telltale signs of having an UTI because their immune system is unable to mount a significant enough response to the infection. On top of the lack of noticeable symptoms, many senior adults either do not, or can not express discomfort to their caregivers.
Because older bodies respond differently to infection, they may exhibit different signs and symptoms. A frequent symptom of UTIs in the elderly is often mistaken for the early stages of dementia or Alzheimer's disease, that according to National Institutes of Health. Indicators of infection in senior adults include confusion or delirium; agitation; hallucinations; other unusual behavioral changes; poor motor skills or loss of coordination; dizziness; and falling.
“UTIs and pneumonia often do present with mental status changes,” Franklin said. “As a matter of fact, we input data every single month for the centers of Medicare and Medicaid. One of the main things that presents is mental status changes — altered mental status. That’s one of the top changes that you see because the infection has progressed to a place where people can’t think correctly.
“Oftentimes when we have people with mental status changes we do a urine. We do a complete metabolic panel test which looks at electrolytes, it looks at kidney function and it looks at liver function. And then we do a complete blood count that looks at whether they’re anemic — which can cause changes in thinking — or whether or not they have an elevated white blood cell count which shows they have an infection.”
So, why do the elderly tend to develop UTIs?
It can be due to conditions such as diabetes; urine retention; medications; use of a urinary catheter; bowel and urinary incontinence; an enlarged prostate; immobility; surgery of any area around the bladder; or kidney stones.
Franklin delicately brought up one of the biggest causes of UTIs.
“People who are elderly — particularly women that have changes in joints and things — might not do their toiletry care from the front to the back,” she said. “Instead they go from the back to the front and then you can get stool, which is E. coli — the most common bacteria found in UTIs. That’s because women’s plumbing is all short and so they can move stool into that area and then get an E. coli infection.”
The good news is that treatment of a UTI is relatively straight-forward as long as a doctor visit takes place before the case becomes advanced and leads to complications. Otherwise, it involves a simple course of antibiotics that typically clears the infection quickly with a return of the patient’s mental faculties.