Health Essentials from Cleveland Clinic

If you have an aging parent or grandparent, chances are they’ve had a urinary tract infection, or UTI, at some point in life.

But the risk of a UTI is greater when a person is frail, increasing their odds for delirium, hospitalization and death.

Here, geriatrician Amanda Lathia, MD, and urologist Howard Goldman, MD, explain six things you should know to help the older adults in your life:

1. Confusion alone does not signal a urinary tract infection

When an older adult becomes confused, many people — both medical and non-medical — assume that a UTI is responsible.

But aging increases the incidence of confusion and delirium, especially among those who are cognitively impaired, depressed, malnourished or completely dependent.

“Delirium can be caused by various factors, the most common one being dehydration,” notes Dr. Lathia.

2. Bacteria in the urine isn’t necessarily a problem

Elevated urinary bacteria (asymptomatic bacteriuria) doesn’t cause any symptoms and can often be corrected by increasing fluid intake.

The condition occurs in about 6 to 16 percent of women over age 65, 20 percent of women over age 80, and 25 to 50 percent of women living in nursing facilities.

“Doctors should not treat urinary bacteria with antibiotics unless there are multiple other signs or symptoms of a UTI. This can encourage antibiotic resistance and make future UTIs harder to treat,” says Dr. Lathia.

The presence of antibiotic-resistant bacteria in the urine also increases the risk of serious complications, including C. difficile infection and death.

3. Older adults should have other symptoms, too

When your loved one’s doctor suspects a UTI, be sure to mention whether these symptoms are also present:

• Fever over 100.5 °F
• Worsening urinary frequency or urgency
• Sudden pain with urination
• Tenderness in the lower abdomen, above the pubic bone

Having at least two of the symptoms above, along with a positive urine culture, will confirm a UTI.

4. Underlying problems can sometimes cause a UTI

Older adults may have other conditions that increase their risk for a UTI or that produce similar symptoms.

“For example, bladder obstruction is what usually causes UTIs in older men,” explains Dr. Goldman. “Focusing only on the UTI can mask this serious underlying problem.”

5. Older adults don’t need powerful antibiotics for UTIs

Treatment for UTIs should begin with narrow-spectrum antibiotics, say Dr. Lathia and Dr. Goldman.

These drugs are less likely to lead to antibiotic resistance and problematic side effects than broad-spectrum antibiotics.

Today, amoxicillin is commonly prescribed as first-line treatment for UTIs in older adults.

Other common narrow-spectrum must be used with caution when patients have chronic kidney disease or take blood pressure medication, as many older adults do; or because their side effects can be serious in older adults.

6. How to help your loved one avoid UTIs

Do you give the older adult in your life cranberry juice or probiotics to prevent a UTI? These products won’t hurt them, but whether they’ll help is unclear.

“We don’t have enough research to support their effectiveness in UTI prevention, although their medical benefits can’t be ruled out completely,” says Dr. Goldman.

Instead, he recommends these tried-and-true prevention strategies:

• Encourage sufficient fluid intake
• Promote genital and urinary hygiene
• Ask the doctor about low-dose vaginal cream for postmenopausal women (to rejuvenate the vaginal skin and support the presence of good bacteria)

Dr. Goldman says researchers are also studying D-Mannose for UTI prevention. The supplement, which has few side effects, sticks to bladder receptors that normally attract the E. coli bacteria usually responsible for UTIs.

Researchers also believe D-Mannose may keep bad bacteria from colonizing the digestive tract, which can harbor the bacteria responsible for UTIs in women.

Following these tips should help your aging relative stay healthy, productive and out of the hospital.