For a large portion of the Australian population, urinary tract infections are not an issue that is generally seen as a cause for major concern.

It is believed that as many as 50% of women will develop a UTI in their lifetime, while only 5% of the male population will fall victim to the infection.

One of the reasons for this infection’s gender bias simply comes down to a difference in anatomy, and the fact that women have a shorter urethra than men do, which shortens the distance that bacteria have to travel in order to reach the bladder.

And when your immune system fails to fight off bacteria and it reaches the bladder or kidneys, the end result is a urinary tract infection.

There are a number of different types of UTI’s, with each specific type indicating infection in a different part of the urinary tract.

Urethritis is an infection of the urethra, cystitis is an infection of the bladder, pyelonephritis is an infection of the kidneys, and vaginitis is an infection affecting the vagina.  

While detecting and treating UTIs is relatively simple for those in the middle- age brackets, elderly Australians cannot afford to take these types of infections so lightly.

The symptoms can be harder to detect, and the consequences of not treating these types of infections can be far more devastating.

Without treatment, UTIs can spread to the kidneys and through the bloodstream, which may lead to blood infections and very serious illness.

Classic symptoms of urinary tract infections include burning sensations while urinating, frequent urination, fever, chills, and abnormal odours while urinating.

But elderly people do not always display these types of classic symptoms, and those dealing with issues of cognitive impairment can have trouble detecting or communicating these symptoms even if they are occurring.

And that’s why those caring for elderly people who are living with dementia need to be extremely attentive and aware of the subtle nuances that can help them identify a potential UTI.

UTI’s & Dementia

One of the main issues in identifying urinary tract infections in elderly people who are living with dementia is that many of the non-classic UTI symptoms can mimic the changes in mood and symptoms of dementia itself.

For instance, UTIs can cause sudden confusion (delirium) in elderly people, but delirium can also be a common issue for people living with dementia.

But detecting out-of-the-ordinary signs of delirium is not exclusively a sign of urinary tract infection, in fact, most delirium in the elderly is actually the result of dehydration.

However, dehydration itself can also be the result of the infection, which further exacerbates things.

Other symptoms of living with dementia can also be mood-related symptoms like lethargy or agitation, which can also be symptoms of a UTI.

Unfortunately, being unable to effectively communicate your feelings is extremely frustrating, and the so-called ‘behaviours’ that people often refer to when speaking about someone living with dementia, are actually emotions coming through in a distorted manner.

This can make identifying mood changes and associating them with UTIs extremely difficult.

Identifying any of these symptoms as a sign of a potential UTI in a person living with dementia requires carers with a thorough knowledge of the person in question.

Understanding the regular moods and behaviour patterns of someone living with dementia makes it easier to identify actions that are out of the ordinary, which makes communication between carers in an aged care environment vital.

And keeping a log of unusual or out-of-character actions and mood-changes ensures that anyone who is giving care is aware that there may be a problem and can add further insight when applicable.

More severe symptoms can occur when a UTI spreads to the kidneys of an elderly person, which can result in things like fever, flushed skin, back pain, nausea, and vomiting.

Any signs of these severe symptoms combined with any of the other symptoms listed above, are a great indication of a UTI and requires medical attention immediately.

And any prolonged or immediate change in mood is always worth looking into.

It is also worth noting that bowel and bladder incontinence, catheter use, being postmenopausal, and having an established history of UTIs are all factors that increase the likelihood of an elderly person developing urinary tract infections.

Treatment

The treatment of choice for urinary tract infections in elderly people is the use of antibiotics.  

And it is extremely important to start antibiotic treatment as soon as possible because an untreated infection can spread to the kidneys and bloodstream.

The choice of treatment that is available to a person with an acute UTI should take into account many things based on individual patient factors such as medication history, safety and tolerability of the drug, but also consider community issues such as local resistance to a particular antibiotic drug by a bacteria such as the most common bug in UTIs, E.coli.

One of the common antibiotics used to treat acute UTIs in Australia has resistance rates of up to 30%, which means that for close to one-third of those that are prescribed this medication, it may not work. It is important you speak to your health care professional about all antibiotic options available.

Severe UTI infections may require hospitalisation and the use of intravenous antibiotics, so it is important to treat UTIs in the community as conveniently and effectively as possible to avoid this.

This is extremely beneficial to the wellbeing and health of our most vulnerable citizens.

 

This article was sponsored by Mayne Pharma.  Mayne Pharma International Pty Ltd ABN 88 007 870 984.  1538 Main North Road, Salisbury South, South Australia. Date of preparation March 2019.

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