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Recognizing, Preventing & Testing for Urinary Tract Infections (UTIs) in Persons with Dementia

Last Updated: January 22, 2020

 

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), usually caused by germs entering the body through the urethra. UTIs are much more common in women, who have shorter urethras than men, so illness-causing bacteria has less distance to travel. As dementia is more common in women than men, there is a disproportionate number of UTIs. Additionally, persons with dementia may have a harder time cleaning themselves and therefore more prone to getting a UTI. A higher percentage of persons with dementia use adult diapers and diapers which are not changed with enough frequency can lead to increased UTIs. Someone who loses control of the bladder or bowels can also be prone to UTIs. If it is dirty around the private area, an infection is more likely. While none of the medications for treating dementia (such as cholinesterase inhibitors and memantine) are known to cause UTIs, they may cause one to retain urine and be more likely to get an infection.

 Did You Know? The most common type of infection among residents in memory care communities (assisted living for people with dementia) is urinary tract infections. Source

 

Helping Caregivers Recognize UTI Symptoms

UTIs must be dealt with as quickly as possible. These infections are easily treated, but the consequences of letting them go can be serious or even fatal. If your loved one has difficulty communicating, and most people with dementia have difficulty communicating, it will be up to you to spot the signs because your loved one can’t tell when there’s a problem. While in the early stages of dementia, it may be possible for someone to indicate that something’s wrong , this becomes harder (or impossible) for people in middle-to-late stages. Again: Seeing the signs is up to the caregiver.

For most people, symptoms of UTIs include:
– 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 related dementia the symptoms can be different and surprising. 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. As these symptoms are similar to normal symptoms shown by people with dementia, UTIs can be difficult for caregivers to catch and diagnose in their loved ones. Behavior changes that could indicate a UTI include:

– Delirium, or confusion that comes on suddenly
– Loses functional ability quickly
– Unexpected falls
– Incontinence
– Changes in appetite
– Sleeps longer than usual, or is suddenly unable to sleep

Further, 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 an abrupt change in the brain that causes anxiety or aggression and makes focus, memory, and even sleep much more difficult.

 

Preventing UTIs

To reduce the risk of UTIs, caregivers need to keep their loved ones healthy and clean. 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, it’s important for the tract between bladder and urethra 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 just normal 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 the infections much more likely. Immediately after sex, a woman should urinate to flush any lingering bacteria.

Read more about help with toileting and incontinence and bathing and hygiene.

 

  Consequences of Not Treating a UTI
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’ll 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.