Recognizing, Preventing & Testing for Urinary Tract Infections (UTIs) in Persons with Dementia
Why UTIs are Common in Persons with Dementia
A urinary tract infection (UTI) is an infection in the bladder, kidneys, or urethra (where urine comes out). This is caused by germs entering the body through the urethra. UTIs are more common in women because they have shorter urethras than men, making the illness-causing bacteria have less distance to travel. The percentages amongst the sexes are disproportionate because dementia is more common in women than men. Other causes can be:
– People with dementia may have a harder time cleaning themselves, leading to being more prone to getting a UTI.
– A higher percentage of people with dementia use adult diapers that are not changed with enough frequency, which can also lead to increased UTIs.
– Someone who loses control of the bladder or bowels can also be prone to UTIs. An infection is more likely if it is dirty around the private area.
– None of the medications for treating dementia (such as cholinesterase inhibitors and memantine) are known to cause UTIs, they can cause urine retention thus making one more likely to get an infection.
Helping Caregivers Recognize UTI Symptoms
UTIs must be dealt with as quickly as possible. These infections are easily treatable, but the consequences of letting them go can be serious or fatal. If your loved one has difficulty communicating, it will be up to you to spot the signs because they can not tell when there is a problem. In the early stages of dementia, it can still be possible for someone to indicate that something feels wrong, this becomes impossible for people in the middle and late stages of the disease.
The most common symptoms of UTIs are:
– Burning during urination
– Frequent urge to pee
– Dark, bloody, or strange-smelling pee
– Fatigue
– Fever or chills
– Abdominal pain
For people with Alzheimer’s disease or another form of dementia, the symptoms can be atypical. Immune system changes in older people cause them to react to infections differently. Instead of responding normally to pain, an elderly person is prone to become confused, agitated, or withdrawn. These can be similar to dementia symptoms making it difficult for caregivers to diagnose UTIs. Additionally, look for:
– Delirium, or confusion that comes on suddenly
– Sudden loss of functional ability
– Unexpected falls
– Incontinence
– Changes in appetite
– Sleeping more than usual, or suddenly unable to sleep
A UTI can cause dramatic shifts in behavior. Watch for delirium, a sharp change in behavior instead of the gradual decline in thinking and mood that are normal for someone with dementia. Delirium is marked by a rapid change in the brain that provokes anxiety or aggression and makes focus, memory, and sleep difficult.
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Preventing UTIs
Caregivers need to keep their loved ones healthy and clean to reduce the risk of UTIs. Try these tips:
– Encourage your loved one to drink between six and eight glasses of water per day. Because urine in older people can carry bacteria, the tract between the bladder and urethra needs to be flushed thoroughly, with the bladder emptied often and as fully as possible.
– Prompt your loved one to use the bathroom regularly, about every two or three hours.
– Ensure good hygiene, including a daily shower and wiping correctly after using the bathroom. Be sure your loved one wipes from front to back, because wiping from back to front can carry bacteria from the anus into the vagina. Wet wipes by the toilet may be more effective than regular toilet paper.
– If your loved one wears diapers or incontinence pads, change them as soon as they’re soiled.
– Eating high-fiber foods, drinking enough fluids, and exercising daily will encourage regular, healthy bathroom use with less constipation, and decrease the chance of UTIs.
– Underwear that is too tight or not breathable can trap moisture around the crotch and make UTIs more likely.
– If your loved one uses a catheter (a tube running out of the bladder that empties urine into a bag), bacteria is a common issue and you’ll need to be conscious of the increased potential for UTIs.
– If your loved one is sexually active, this can also be a reason for getting a UTI. Sex makes infections much more likely. Immediately after sex, a woman should urinate to flush any lingering bacteria. Read more about helping your loved one with toileting and incontinence and bathing and hygiene.
UTIs can be treated fairly easily with antibiotics, often clearing up within a week and causing no further problems. If left untreated, however, the infection can spread to the kidneys and cause damage to that vital organ. An even worse consequence is blood poisoning, which can be fatal.
Testing Urine & How to Get a Sample
UTIs can be diagnosed with a simple urinalysis. You will need only collect a urine sample to deliver to a laboratory. Sterile specimen cups for collecting samples should be available at any pharmacy. To get urine from someone with dementia, try these tips:
– Morning is best because there will be more urine the first time it’s passed in the day.
– If your loved one is incontinent and wears diapers, urine can be collected from the pad with a urine collection pack, which includes a syringe and specimen container. Contact your doctor or a local laboratory to ask about getting one of these.
There are also home tests for UTIs, which are strips that you wet by holding in the urine stream for a few seconds. The strip will indicate bacteria that could be causing the infection. These tests are available at pharmacies without a prescription, but because they’re not considered reliable (and because the consequences of misdiagnosing an older person can be very high) a urinalysis with a reputable laboratory is the better option.