UTI May be Cause of Sudden Confusion in Elderly
A Urinary Tract Infection May Cause an Older Person to be Confused
Jul 3, 2009
If an older person becomes suddenly confused, some people may think that the elder must be developing Alzheimer’s Disease. Others may mistakenly assume that confusion is normal for all older people. If seeking advice from a healthcare provider regarding a quick onset of confusion, you might be surprised if the doctor orders a urine specimen. Actually, a urine specimen is not a bad idea since urinary tract infections (UTIs) are a common cause of delirium in the elderly.
Prevalence of UTI in the Elderly
Urinary tract infections, with or without symptoms, are quite common in the elderly.
- According to a 2005 article in Drugs Aging by Florian M.E. Wagenlehner et. al. entitled Asymptomatic Bacteriuria in Elderly Patients, 20-25% of women and 10% of men over the age of 65 experience asymptomatic bacturiuria.
- People over 80 years are even more likely to develop asymptomatic bacteriuria: over half of women and over a third of men.
- According to The Merck Manual of Geriatrics, as many as 10% of all elders have symptomatic UTIs.
Asymptomatic (without symptom) UTIs in the elderly are usually not treated unless the benefits outweigh the risks, but recognizing and properly treating a symptomatic UTI in an elderly person may help prevent more serious infections and complications.
Common Symptoms of UTI in Elders
- Painful urination
- Frequency or more frequent urination
- Incontinence or incontinence that is unusual for that person
- Flank pain
- Fever
- Confusion or delirium
Common Risk Factors for UTI in the Elderly
- Use of urinary catheters
- Living in a long-term care facility or nursing home
- Hormonal factors such as estrogen deficiency in women
- Anatomical factors such as an enlarged prostrate in men or a cystocele in women
- Functional factors such as Parkinson’s disease or dementia
- Metabolic factors such as diabetes
- Factors related to immunity such as increased cytokines and acute phase proteins
Measures to Prevent UTI
Prevention is the best and safest approach.
- Limit the use of chronic indwelling catheters
- If a catheter is necessary, perform appropriate catheter care and consistently use appropriate infection control guidelines while maintaining a closed drainage system.
- Recognize and replace an obstructed catheter.
- Prevent catheter trauma, such as pulling on tubing with a transfer from bed to chair.
- Employ generally accepted hygienic measures, such as keeping the perineal area clean and dry and wiping from front to back.
- Oral lactulose showed promising results in a study published in the 1989 Journal of Hospital Infections entitled Lowered prevalence of infection with lactulose therapy in patients in long-term hospital care.
- Intravaginal estriol is often recommended for postmenopausal women with recurrent UTIs due to studies showing significantly lower rates of UTI with the use of estriol.
- Certain vaccinations may be recommended for special populations.
- Future studies are focusing on developing materials in urinary catheters that resist biofilm formation, according to a 2005 article in Drugs and Aging entitled Catheter-related urinary tract infections by Lindsay Nicolle.
Confusion May be Reversed
Is sudden confusion permanent? The answer to that may depend on whether or not and how quickly a cause is determined. Caregivers of the elderly should be particularly watchful for changes in an elder’s mental status and should contact a healthcare provider of any acute confusion or sudden worsening of existing confusion. Ruling out a UTI would be an appropriate early step if an elder suddenly became confused or had worsening confusion. Early treatment of a symptomatic UTI may prevent more serious symptoms and complications and can quite possibly result in a return to the elder’s normal mental status.
Consult your healthcare provider for any specific concerns related to an elder's health. This article is for informational purposes only.
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