UTI in Elderly: Nursing Interventions

• Working as a nurse in long term care for much of my nursing career, I can attest to the fact that UTIs are by far the most common infection I have witnessed in the elderly population. 
• The elderly are most at risk for UTIs due to a variety of urological issues, mobility concerns, and weakened immune systems. 
• The most important part of caring for the elderly patient with the UTI is providing testing and treatment as soon as you have a concern, they are experiencing a UTI. 

UTI in Elderly

Urinary tract infections (UTIs) are one of the most common infections experienced by elderly patients. Infections are more serious in the elderly due to a variety of reasons. Working as a nurse in long term care for much of my nursing career, I can attest to the fact that UTIs are by far the most common infection I have witnessed in the elderly population. 

UTIs can present quickly and escalate to more serious conditions if left untreated. It is important to be vigilant with the elderly patients you are providing nursing care and be familiar with their usual health and behaviors as their condition can change fast. This will assist you in quick diagnosis and treatment of a UTI in elderly. 

Why Are the Elderly More at Risk for UTIs?

Decreased Urine Flow

An enlarged prostate in a male patient or kidney stones may block the flow of urine making it easier for bacteria to grow in the urinary tract. 

Decreased Mobility

Having a difficult time traveling to and from the bathroom may cause older adults to hold their urine, increasing the risk of bacterial growth. In addition, a lack of flexibility may make it harder for seniors to wipe from front to back after going to the bathroom, making it more likely that bacteria will travel to the urethra. 

Weakened Bladder Muscles

Bladder muscles become weaker as people age, and this can make it difficult to completely empty the bladder. This leaves residual urine in the bladder and makes it possible for bacteria to grow in the residual urine.  

Fecal Incontinence

Bacteria found in the stool can cause urinary tract infections. 

Catheters

Older adults who use catheters are more likely to develop infections, especially if nursing staff are not using sterile techniques and catheters are not changed often. 

Weakened Immune Systems

As you age, your immune system becomes less effective at fighting the bacteria that cause UTIs. 

Hormonal Changes

The drop in estrogen that occur in women after menopause can make infections more likely to occur. 

Low Water Intake

Elderly patients are often prone to dehydration due to not drinking enough water. This can make the urine more concentrated and encourage bacteria growth. 

What Are the Symptoms of a UTI in Elderly?

• Frequent urination 
• Urinary urgency 
• Low urine output 
• Low grade fever 
• Abdominal pain and pressure 
• Blood in urine 
• Urine that has a cloudy appearance 
• Foul smelling urine 
• Pain or burning with urination 
• Confusion or hallucinations 
• Irritability 
• Fatigue 

Some of these symptoms may be absent which may make diagnosis more difficult. UTI related confusion may mimic dementia which can also make diagnosis difficult. If an elderly patient is suffering from a UTI, they may be disoriented, have trouble remembering, and withdraw from other people and activities. UTI related confusion can also cause a patient to fall, increasing the risk of serious injury.  

How is a UTI in Elderly Treated?

The most common treatment for a UTI in the elderly is antibiotics, broad spectrum antibiotics are typically used because they act on the two major bacterial groups. These groups are gram-negative and gram-positive bacteria.  

UTIs are usually caused by gram negative bacteria. If the UTI is caused by a urinary catheter, minimize the use of the catheter, or be sure it is replaced more often. Make sure the schedule for the catheter change is followed by nursing staff and that sterile technique is used to minimize the introduction of bacteria into the urethra.

How Can a UTI in Elderly Be Prevented?

UTIs can be prevented by ensuring the elderly patient is getting adequate water, wiping from front to back, keeping genital areas clean, offering toileting as often as possible, frequent catheter changes, and estrogen hormone therapy for women.  

What Happens if a UTI is Left Untreated?

Untreated UTIs can lead to kidney infections and also put the elderly patient at risk for organ damage and sepsis. Sepsis is a life-threatening infection in the bloodstream that can cause organ systems to fail leading to death if untreated.  

The Bottom Line

In conclusion, elderly patients typically recover well from urinary tract infections and treatment is short. The most important part of caring for the elderly patient with the UTI is providing testing and treatment as soon as you have a concern, they are experiencing a UTI. If the UTI is caught early, treatment can usually be completed at the long-term care facility.  

In cases where the UTI has spread to the kidneys causing a kidney infection, hospitalization is usually required. As a nurse, we want to try our best to keep the patient healthy and out of the hospital as much as possible to achieve positive health outcomes and patient comfort.  

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