February Caregiver Connection: UTIs, Risks and Detection

If you asked a random sample of people to list the possible dangers that threaten the health of a person with dementia, chances are that few would name urinary tract infections.  But senior citizens, and particularly people with dementia, are especially vulnerable to this common infection, and may suffer greater health consequences if the infection goes undetected.  Learn more about the connections between dementia and UTIs, and how to detect one before it gets serious.

Special Susceptibility

Seniors in general are at a greater risk for developing UTIs, especially elderly women.  Elderly people often have suppressed immune systems due to age or age-related conditions, leaving them more vulnerable to infections such as a UTI.  Diabetics are more prone to developing UTIs, as are those who require a catheter in the urethra or bladder. Women who have gone through menopause produce less estrogen, which helps to reduce the risk of UTIs, and are therefore more prone to developing this type of infection.  Furthermore, weakened bladder muscles in the elderly make it more difficult to fully empty the bladder, which increases the likelihood that bacteria will accumulate there.  Kidney stones and enlarged prostates can also contribute to a greater risk of infection.  To complicate matters, the elderly often don’t exhibit any of the common symptoms of a UTI due to weakened immune response.  This includes fever, and the burning during urination that many family caregivers would recognize as a sign of a UTI.

UTIs in People with Dementia

People with dementia have an even greater risk of developing a UTI.  Incontinence, inability to perform toileting functions relating to urinating, and prolonged use of incontinence garments increase the likelihood that bacteria will accumulate in their urinary tract. UTIs can be hard to detect in elderly people, and are especially likely to be overlooked in people with dementia.  People with dementia don’t have the language skills to report changes in their condition, and many of the symptoms of a UTI in an elderly person look a lot like symptoms typical of a person with dementia.  These include:

  • Confusion, or delirium-like state
  • Agitation
  • Hallucinations
  • Behavioral changes
  • Withdrawal
  • Poor motor skills or dizziness
  • Falling

Sometimes, cognitively healthy seniors who are simply suffering from a UTI have their symptoms mistaken for dementia.  For those with dementia, a UTI can worsen their condition, and poses the danger of developing into a very serious infection.  An untreated infection can spread to the upper urinary tract (the kidneys and ureters), which could cause permanent damage to the kidneys and even lead to kidney failure.  An upper urinary tract infection can also lead to bacteria in the blood, sepsis, and even death.

Detection and Prevention

Though dementia symptoms and the symptoms of a UTI are similar, UTIs will cause sudden changes, while the normal progression of dementia will be more gradual.  If your loved one exhibits sudden dramatic behavior changes, increasing falls, hallucinations, significant disorientation, or other abrupt and concerning changes, contact your doctor immediately.

Some tips to reduce the risk of UTIs include:

  • Change the person’s incontinence products frequently
  • Encourage front-to-back cleansing (in women) and be sure that genital area is clean
  • If the person is still toileting independently, support them with prompts or reminders to use the bathroom approximately every 3 hours
  • Monitor fluid intake, aim for six to eight glasses of water a day
  • Avoid caffeine and alcohol, these irritate the bladder

Though incontinence care and toileting support isn’t the most pleasant part of caregiving, being aware of potential related complications can go a long way toward keeping your loved one in good health!

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